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!

[gfoak3]

Ugh. I am patient (who is considering going into nursing). I was *never* instructed to use my abdomen, just told it was subQ. I am currently using my thighs and running out of 'room' due to bruising. I am malnourished and on TPN and thus have very little subq fat on my abdomen. I 'save' my lovehandles for glucose sensors, and also use my thighs for infusion sets. Arms are thin, but saved for picc's and iv's.

In patients like me (oh, also have a 10" ab surgical scar that is only six weeks old), I can't fathom using the abdomen. It's skin, no fat...

[hopefulnurse84]

The abdomen has been chosen because medications administered there are absorbed the most.

[BostonNurse2876]

I have had some doctors order an odd dose of Lovenox where you have to expel some of the medication. like an order for 70mg SC. It doesn't come in that strength. Hmmm wonder if the doctors know you should not be expelling the "bubble" in the syringe???

[MYOHOPRINCESS]

Lovenox can ABSOLUTELY be given in pregnancy and is given very often for patients with history of dvts, genetic disorders that predispose them to clots and to patients with history of multiple miscarriages (depending on the reason for the miscarriage).

I myself am 17 weeks pregnant and give myself Lovenox injections on a daily basis.

So, I just wanted to clear up any confusion about this.

Thanks.

[cahikerchick]

I have been self injecting for the past 2 months, 100mg once daily. I'm fairly thin with a small pad of fat on my abdomen. I was instructed to inject on my abdomen. I was actually supplied with a patient instruction guide while in the hospital, this is supplied by the manufacturer of Lovenox and includes a booklet, DVD and handy sharps container. Per the instrutions I was injecting alternate sides up and down the abdomen, about 2-3 inches out and I was bruising quite abit, especially on the right side, I still have a couple of "knots" on the right side from over a week ago. The area with the fat would bruise about 2 inches across and always hurt. I began injecting in the relatively "fatless" skin of my abdomen a week ago. I pull up the skin, and inject. So far, my bruising is only little tiny dots about the size of an eraser. Also, make sure the alcohol is dry...otherwise it will sting.

[LoveANurse09]

BostonNurse2876 said:

I have had some doctors order an odd dose of Lovenox where you have to expel some of the medication. like an order for 70mg SC. It doesn't come in that strength. Hmmm wonder if the doctors know you should not be expelling the "bubble" in the syringe???

On my unit Lovenox is wt based, so sometimes get an odd dose. But I always leave room for an air lock.

[KSU-SN]

One of our most respected and trusted surgeons recently instructed us to inject Lovenox into the patient's thigh if they have had abdominal surgery. So it can be injected into the thigh

[whitebunny]

I had a work injury 39-year-old young patient who is on lovenox 30mg BID. I did research, I tired abd and I tried love handles. I tried 45 degree and I tried 90 degrees. The pt complained that the love handles hurts sooooooooooo much and 45 degree hurts a lot but less than love handles. A 90 degree injection like insulin is what he wanted! the only places I havent tried is his thigh, look like he doesnt want me to go that far, but I definately understand that I would not give it in the arms =D

[panurse123]

According to the Lovenox website.. the anterior or posterior lateral abdominal wall. aka..love handles

[TinyHineyRN]

I occasionally give Lovenox to my Peds patients and, if possible, will give it in the anterolateral abdomen like I think we all learned in school. I remember a specific case of a 17 month old little girl who had extensive cardiac surgical repairs. She had a thrombus in one of her atria and was on long-term Lovenox therapy. This little one was very tiny, as many kids with congenital heart defects are and was still hospitalized while trying to refeed. As a result, the girl had just about no adipose tissue! Pinching the skin on the tummy was just that...pinching just skin! For younger kids, the pharmacy draws Lovenox into 1mL syringes with a TB syringe. I gave it in her lateral thigh b/c I really think I would've been more at risk of a needle stick injury if I tried to give it in her "love handle" like we are conventionally taught!