Lovenox Injections: SC, But Where?

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!

[jetscreamer101]

TracyB,RN said:

Ya' know, I was just thinking... it's late, I'm tired & rambly, BUT, we use alcohol to cleanse the injection site. I'm willing to bet most people don't allow a dry time & I wonder if the needle passing through the wet alcohol causes more of a stinging sensation. I'm sure I probably heard that somewhere & it's just popping into my head... but food for thought.

I have received Lovenox injections while in the hospital and at home. I had an abdominal surgery, so I wouldn't let them give it in my abdomen, so they used my arms. When I got home, I did end up giving in the "love handle" area. And it hurts. I am a diabetic, and have needed insulin also. The insulin injections didn't hurt near as bad as the lovenox.

[TexasCowgirl24]

lmz said:

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!

We had a drug rep on the floor and he said that lovenox is supposed to be given in the "love handles". in fact, that is how the drug got its name

[suzanne4, RN]

The literature that is with the actual injection from the company states the abdomen and SC. It never once mentions the arms as being an approved site for the injections.

If it is not listed by the actual company, then it would not be considered an approved site to use.

[PMR1027]

Lovenox is a Low Molecular Weight Heparin. It should only be given in the abdomen, and only subcutaneously. I take care of alot of postop patients in my subacute rehab unit, and administer this drug daily.You cannot give it IV, but I do not know why.

[mapperson]

Recommended to inject AT LEAST 2 inches from umbilicus rotating between L & R anterolateral and posterolater sites. Aventis considers this the "love handles". It would appear to be a problem of semantics with regard to using "love handles" vs. "abdomen". SC injections of a LMWH in this area makes more sense with regard to absorption and a reduction of bruising. Remember, this is an extremely exacting anticoagulant. Giving it anywhere else where more frequent movement increases blood flow; i.e. arms or legs may increase incidence of bruising. Also the "air" bubble is actually a nitrogen bubble which prevents oxidation of the drug. It is also used to ensure that when injected, THE ENTIRE AMOUNT OF LOVENOX is administered into the SC tissue. It should never be expelled. Again, this is a very exacting drug and all of it must be administered. I apologize for the excessive use of caps, but I don't have the italics icon present. It seems so much more gentle to use italics then the caps! I think it has been interesting to read the postings from nurses on this subject. I think it really helps to see how information and misinformation is passed along. My information came from a very thorough inservice years ago by a very knowledgeable and wickedly bright nurse who was our drug rep for Aventis. Really, the inservicing is only as good as the person giving it. Always look for the rationale behind the instruction.

[a-patient]

Love handles, abdomen, anywhere there's some fatty tissue. Alas, I'm gravely ill and have virtually no fatty tissue anywhere. My caregiver complains about slim pickings.

a-patient

[CrazyGoonRN]

A nurse in the hospital told me that it always goes in the love handles. My instructor said that it can go anywhere that a subcutaneous shot can go, but she was known to teach the wrong things. She even taught the wrong way to mix and draw up insulin

[danigirl58]

When I was pregnant I had to use this med, but as I was prego I couldn't obviously inject it into my abdomen. I was told to inject it into my thigh's and let me tell you that it stung like the dickens.... and that being an understatement sometimes I would try to do it 3-5 times before I actually injected it. The other thing I found was that at times there would be knotted tissue areas (under the skin) which also hurt to touch and that being said I'm not sure that I could have handled a waste band of either pants or underwear touching it.

Now my personal experience being said and done, I generally only give it injected into the abdomen ..... as taught in school

[RNin2007]

the lovehandle area? really??

~J

[traumaRUs, MSN, APRN]

YEs, the love handle region is what is recommended.

[TennRN2004]

traumaRUs said:

YEs, the love handle region is what is recommended.

That's our policy for administration of lovenox as well.

[ItalianRN, BSN, RN]

I was taught to give it in the Love Handles too.