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!

[TracyB,RN, RN]

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.

[AnnieOaklyRN, BSN, RN, EMT-P]

Lovenox, when it was first trialed on humans was only given sub q in the abdomen so therefore it is only FDA approved for that route.

Swtooth

[mamason]

swtooth said:

Lovenox, when it was first trialed on humans was only given sub q in the abdomen so therefore it is only FDA approved for that route.

Swtooth

OK, now I'm confused. I work on a busy tele floor which also gets overflow from medsurg. See a lot of post op surgical. Never thought I would enjoy that, but do. Anyway, that's besides the point. I do administer Lovenox to approximatley half of my pts on my team. Now, I always give it in the abdomen, and make sure that I grab a good handfull of skin and hold it. It seems to help the patients. They state that they can't feel the injection. OK. This is a good thing. Now, I'm thinking, I finally got this thing down to a tee and now I find out that I may have been injecting at the wrong site. So, is it the "love handles" or the "abdomen?" Would it be "wrong" to give the medication in the love handle area? Because if the rep and the pamphlet for the drug recommend it,then, it should be given there?

[BSN_DEC_2006]

okay, so does the air bubble get injected into the pt, since it is not expelled?

[AnnieOaklyRN, BSN, RN, EMT-P]

sorry I should have been more specific it is technically in the love handles.

BSN: Yes, the air bubble is suppose to be injected into the patient as it acts as a seal to prevent the medication from leaking back out after you remove the needle.

Swtooth

[ninsttmk]

Actually it is recommended and now published on the insert that it be administered in the flank area (love handles)

[maximaxi]

Where I work we had a drug rep from the Lovenox company come in to do an inservice & posed the same question to her. She said the manufacturer suggests only to give it in the abdominal area. They say in the event that "something" where to happen if it where given somewhere else.. you could be asked why you gave it somewhere else other than where the manufacturer suggests.. hmmmmm... That was the answer I rcvd...:icon_roll

[SteveNNP, MSN, NP]

We use an insuflon sub Q catheter to deliver Lovenox/enoxaparin into the subcutanous tissue on our babies anterior thighs. I've also seen it ordered/given IV in some cases.

[lil' girl, LPN]

Couple of years ago they started the recommendation that lovenox be given in the love handles. We even had to sign a statement at work that we had been educated on where to give it, and had to keep a chart with MAR that showed a picture of the love handles with sites to use and label which one we used with our initials.

[EmyEmergRN]

I've had multiple very thin pts. refuse the injection if it could not be given in another location than abd. By the description of the events, it would seem that when they were given the injection it was IM not SQ....hence extremely painful and they refused it ever again. I have had some of the emergency physicians state that it can be given in the upper arm SQ (ie: as you would with allergy shots). My father happens to be one of those such pts and refuses to even let me give him an injection in his abd. He has had it in his arm without any complications. With a very thin pt you must must pinch up the skin to ensure you do not give the injection IM. I too questioned the manufacturer but got no reply. I have never given an injection that someone told me it was painful or bruised. I gave them to my mother after knee replacement for at least a month, none of which bruised. However, some of the ones given in rehab left enormous bruises. I always pinch up the skin.

[PMR1027]

EmergRN: TY for the info that it can be given in the arm, if necessary. The facility I work in forbids it through policy, though. Have you heard anything of this affecting the PT/PTT and INR? It may be the nurse giving the injections that caused the bruising- with this particular drug I have heard from several patients that certian nurses give it so you do not feel it and it does not bruise, and other nurses give it and it hurts bad and bruises. I have had one woman who would only let me give her lovenox after her knee replacements. I could see in very thin patients where you could inadvertently give it IM.

[NYnurseatheart]

Hello all,

Reading this made me smile. Back when Lovenox was first being trialed in the hospitals (back in 1994) during a double blind study comparing its efficacy with heparin and coumadin, we were instructed by the drug reps doing the study, to inject in the "love handles" , which was why they named it lovenox in the first place. Most literature states abdomen (anterolateral) - which when looking at the charts posted in my hospital - clearly are the "love handles". Personally I know it stings - as I was given it when I had an episode of SVT that wouldn't quit....

Anyhow, also thought I would share this story. As a traveler I was working on a tele unit that handled patients 1 day post CABG and post cath and post angioplasty/stenting. I had a patient who was in A. Fib with RVR, and was scheduled to have cardioversion in the morning. When I assessed her I noticed a very large "lump" in her abdomen. She was pale and "not feeling very well". The lump was a huge, football sized hematoma, which necessitated that the woman get three units of blood transfused (can't remember her H/H, but that evening was a 6 point drop in her Hgb from the am draw). She also could not be cardioverted because of the huge hematoma, and had to stay on IV amiodarone for a few more days, then on po amiodarone... All that from a Lovenox injection given approximately 3 inches from the umbilicus on a fairly large woman with lots of subcutaneous tissue.

Anyhow, thought I would share. I never give Lovenox anywhere but the love handles. I have never had a problem (other than burning at the site) with this site for injection. I have seen multiple hematomas in the abdomen from Lovenox over the years - just none as dramatic as the lady I just mentioned.

NY nurse at heart