Hold injection site with Lovenox?

[RescueNinja]

I have a Res on Lovenox injections right now and I have had to teach some of the older nurses how to give it as some of them had never even heard of Lovenox.

Anyway, during my preceptorship I was taught to ALWAYS hold with firm pressure for at the very least 2 full minutes, but try for 5 (my preceptor timed me every time) but to also make sure you never rub the site. She said this was to prevent bruising and I have never had a pt get a bruise where I gave a Lovenox so I always figured it was the holding that prevented them.

I was reading the monograph last night and couldn't find anything at all about holding the site afterward so I was just wondering how others have been taught to give Lovenox...my poor Res has a tummy full of bright purple bruises and I wanted to make sure the holding technique is correct before asking my coworkers to hold the site.

[anon456, BSN, RN]

I am not an expert, but I just finished my preceptorship and got my RN! :-) I gave lots of Lovenox under the guidance of my preceptor. I never was told to hold it. I just pinched the skin, gave the injection pretty quickly, removed it, and checked the site for bleeding. Never had any bleeding either, but was told if there was bleeding to *then* apply pressure for 5 minutes since the person was presumably on bleeding precautions.

Same with removal of an IV-- if person was on a blood thinner I held the IV site for 5 minutes instead of the usual 2 before lifting to check for any further bleeding.

[psu_213, BSN, RN]

Without looking this up in my nursing books, here are my thoughs...

First, as you were saying, never rub the injection site (and I have known some experienced nurses who did this).

Second, I have never heard of having to hold pressure on the site. I for one do not usually have two to five minutes to stand around holding pressure on a subQ injection site!

Finally, most people who are on lovenox develop some amout of bruising. I find it hard to believe that holding pressure would make that much of a difference. In most cases Lovenox is short term, so I would it is really not that big of a deal if they become bruised.

[Brandieelynne]

I am a student nurse but have given lovenox a million times with my preceptor...never heard of putting pressure on the site. Interesting!

[evolvingrn, BSN, RN]

Never heard of that either?

[SNIXRN]

http://www.lovenox.com/consumer/prescribed-lovenox/self-inject/inject-lovenox.aspx

I've never applied pressure after any injection. I looked up in my 2010 drug book and it doesn't say to apply pressure nor does their website say you should do so.

[RescueNinja]

Hmmm...thanks for all the replies. Maybe it is an old school thought?? My preceptor was an ICU nurse with 25+ years of experience...

[ANNIENURSEANGEL]

They have bruises most likely from itching the site. Lovenox can be itchy to some people, and so they itch it. As for holding the site, you are doing the right thing.

[ANNIENURSEANGEL]

If you have to put pressure on the site, their blood may be getting thin enough. So labs should be done to prevent the blood from being too thin.

[RescueNinja]

They have bruises most likely from itching the site. Lovenox can be itchy to some people, and so they itch it. As for holding the site, you are doing the right thing.

I never thought about pts scratching it...interesting point!

So we are supposed to hold it?

[Picklefreak]

There is no mention of what you describe on the manufacturer's website. (They even have a little video!)

http://www.lovenox.com/hcp/dosing/lovenox-administration.aspx

[canesdukegirl, BSN, RN]

According to the manufacturer, you should hold the injection site ONLY while administering the drug to ensure that only the fatty tissue is being injected. Furthermore, the manufacturer does NOT advise rubbing the area, as it will create bruising.

http://www.lovenox.com/consumer/prescribed-lovenox/self-inject/dos-donts.aspx

Hope this helps.