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.
I am an RN, but also a prior DVT patient that administered Lovenox to myself. Never heard of applying pressure. Very important tho to NOT purge the air from the pre-filled syringe.
I have to admit...I absolutely slaughtered my own stomach with these injections. I gave once a day for 7 days & ended up with 3 minor bruises and one huge ugly purple bruise. Trust me - it was MY gut & I was trying my best to be careful. I didn't itch with the injection but it stung really bad for about 5 minutes.
I frequently am giving Lovenox several times on each shift, never held the injection site and am not aware of anyone else that does (coworker). As for bruising, it happens, especially if the patient is on additional thinners; I try to administer the Lovenox into the 'love handle' portion of the abdomen, more lateral than medial, this area has more fatty tissue.
I think you might have misconstrued the "holding" part as something I've heard before. But it is not holding the site. It might be to inject, then pause a second or so, then withdraw needle straight out carefully. This probably was thought to avoid pulling out too fast and pulling anticoag up "streaking" upper layers as you go and increasing the bruise site. I really don't think there would be much of a difference. As you get going with Lovenox, it'll cause bruising, though the lat abd site I hear is best if you can do it there.
I have never heard of holding the site either. I notice you stated the resident has bruising on the tummy: I was taught that Lovenox does NOT go in the tummy per se, but only the Love-handles.
MicromedX says specifically do not rub site. It references the product information from Aventis to make this point. Proper administration technique is deep SubQ with the airlock that is already in the syringe. In fact I give heparin this way too.
Specializes in med/surg/tele/neuro/rehab/corrections.
I learned to administer slowly as the injection will hurt if administered too fast. It's pretty thick and I've heard a resident yell when a student administered it the way you do insulin injections.
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.
I think it was the preceptor who misconstrued it....
Yes, she used to time me lol. Now I'm a RN on my own and won't be holding the site any longer lol (unless necessary of course)
I do give it slowish, with the airlock, deep s/c, 2+ inches from umbilicus, etc. It was just the holding thing that I noticed wasn't mentioned in the monograph from the box so I was curious and didn't want to give my coworkers direction without checking first. Thanks again :)
I give Lovenox most shifts and I just clean some flesh between the umbilicus and the hip with an alcohol wipe, grab the flesh, inject the needle, let go of the flesh and gently inject the medication, count to 15 and remove the needle. I have never seen pts get bruises from Lovenox . Now heparin is another story. I was taught that the longer you keep the needle in the flesh, the less likely the pt will end up with bruising.
Thanks all!
. Now heparin is another story. I was taught that the longer you keep the needle in the flesh, the less likely the pt will end up with bruising.
Nascar nurse, ASN, RN
2,218 Posts
I am an RN, but also a prior DVT patient that administered Lovenox to myself. Never heard of applying pressure. Very important tho to NOT purge the air from the pre-filled syringe.
I have to admit...I absolutely slaughtered my own stomach with these injections. I gave once a day for 7 days & ended up with 3 minor bruises and one huge ugly purple bruise. Trust me - it was MY gut & I was trying my best to be careful. I didn't itch with the injection but it stung really bad for about 5 minutes.