Lovenox Injections: SC, But Where?

Nurses Medications Nursing Q/A

I was told by a seasoned nurse that Lovenox (enoxaparin) is never given anywhere but in the abdomen, especially not in the arm. My drug book simply says give only in abdomen (but doesn't say why not elsewhere), but my pharmacology text does not specify location, just that it is given SC. I have done a search on the web and find reputable journal articles showing that it is given SC in abdomen and arms.

I am trying to determine the pathophysiology against using the fatty tissue over the triceps. I need to understand why the arm is no good for Lovenox. I saw a patient with extensive bleeding in the arm from a Lovenox injection, but by his description of how much the injection hurt, I would guess it was not a SC but an IM injection.

I would appreciate being pointed in the direction of a source with the answer to this question. I'm trying to develop my practice based on evidence. Thanks!

58 Answers

Specializes in Nephrology, Cardiology, ER, ICU.

There is a long discussion thread about this very subject. It is best to follow the package insert which says:

"Subcutaneous Injection Technique: Patients should be lying down and Lovenox Injection administered by deep SC injection. To avoid the loss of drug when using the 30 and 40 mg prefilled syringes, do not expel the air bubble from the syringe before the injection. Administration should be alternated between the left and right anterolateral and left and right posterolateral abdominal wall. The whole length of the needle should be introduced into a skin fold held between the thumb and forefinger; the skin fold should be held throughout the injection. To minimize bruising, do not rub the injection site after completion of the injection."

The best thing that I could come up with on the web was a patient guide for self-injection of lovenox, put out by Aventis pharmaceuticals, for their prefilled syringes, and in it, it said:

"May I inject anywhere other than the abdominal area?"

"Using other sites for injecting Lovenox has not been tested. You should contact your healthcare provider if you are having problems with your injections."

In my experience, Lovenox is always given in the abdomen, like heparin, I would guess because there is more adipose tissue there, and it is meant to be absorbed slowly, and as the muscle tissue is very vascular and would absorb the medicine much more rapidly, and fast absorption would naturally lead to a larger chance of excessive bruising in the injection site, and you want to avoid that if you can.

In the abdomen 1 inch from the belly button is what I learned in school. 2 very seasoned nurses on my floor gave Lovenox in the arm per pt request. One called the pharmacy and it was said that it is not absorbed as well if it is not in the abdomen. This pt had an MI (post total knee) while in our care, though it may not be related, it makes you think. On our floor when we give it (after all of this) we document on our MAR the site that we give it, for ex. L abdomen, we try to document in the nurses note where we gave it as well. Protect your patients most importantly, then protect yourself with documentation. If you think about it, if a pt has a high glucose, the abdomen is the best site for insulin due to faster absorbtion, maybe the same case.

Specializes in Tele, CCU, MICU, PACU.

I am good friends with a Lovenox Rep. The Lovenox company reccomends giving the medication in the "love handles" region.

Specializes in ED, ICU, PACU.
LHJ_RN said:
I am good friends with a Lovenox Rep. The Lovenox company reccomends giving the medication in the "love handles" region.

That's exactly what I have been taught at my hospital. I was told that there were studies to prove it; but, I haven't actually seen the studies-would be very interested in knowing if anyone has info regarding this.

Specializes in IMC, ICU, Telemetry.

I could not imagine getting Lovenox in my arms (or thighs)! My personal experience with Lovenox when I had my DVT was awful. I was getting 60mg SQ bid. The med is extremely irritating to the tissues - it feels like a GSW to the abdomen and has a deep ache for about 30 minutes. It doesn't hurt right away - usually the pain started after the RN left the room. And you can't rub or hold pressure to relief the pain. I had bruises all over my belly.

Had I received the injections in my arms, I would not have been able to do anything for myself for a week - feed, hygiene, etc. It's way too painful to get in the arms (way worse than tetorifice!). Ouch!

Specializes in Telemetry & Obs.

Lovenox should be given in the love handles making sure to alternate sides with each injection.

I had a patient this semester with a HUGE bruise on her abdomen that was from Lovenox.

Fragmin, however, can be given in the abdomen. I think that's where the confusion comes from.

Specializes in ACNP, ICU.

The manufacturer recommends the love handle area because the arteries are deeper there and you are less likely to hit one and cause uncontrolled bleeding. This was told to me by a Lovenox drug rep. Whom I actually gave the injection to.

My pharmacology textbook says that Lovenox is injected deep under the skin, around the navel, upper thigh, or buttocks, and that if excessive

Bleeding occurs at the injection site, rubbing an ice cube over an area before the injection might help

After reading the product information, long ago. I always give Lovenox in the love handles. I have found that typically pt have less discomfort with this area as well.

Specializes in Trauma, Teaching.

Along with the other folks who have had to use it, the dang stuff hurts! I always gave mine to myself in the abd, the only time it bruised badly was when I "bounced" the needle partly back out. I wouldn't give it anywhere else, it hurts far too long.

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.
danigirl58 said:
I can imagine, from experience I know that the drug hurts it has a sting like you couldn't imagine. There were many times where I wish that they would have just put me back on heparin rather then this one, even if it meant that I had to inject it twice in the am and pm.

Often lovenox is given q 12hours too. One of the advantages of Lovenox (low molecular weight heparin) over regular heparin is that ptt does not have to be monitored.

I love it! another oxymoron for my collection: sterile abscess

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