Lovenox question.

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To go with my other post "feeling bad because i didnt go with my gut"...just a question-MD gave order for lovenox 80mg subq STAT...what we had in the facililty was lovenox 40mg....when I went to get it from the nurse who had it she said "NO, you cant give two lovenox injections at the same time!!" and another nurse agreed with her, she said "No, you NEVER do that". I said ok well i will have pharm stat it out then...later on when things calmed down i inquired about why you cant give two injections. i checked drug book and didnt see any indication that you shouldnt. my DON/ADON said they didnt see any reason why you shouldnt. I asked the nurse who said it, and she said "well its a personal thing, i just wouldnt-its my license on the line" and i said why do u say that? and she says i just wouldnt because of the drug itself and what its for... i said i dont see why you can't give 2 40mg injections one in each side of abdomen...she kept saying "as a nurse, i just wouldnt". So my question to the experienced nurses (unlike myself!) is....would you give 2 injections, and why or why not??

PS-pt ended up going to ER before the lovenox arrived, and MD was paged so I could claify to give 2 doeses or not, and page had no been returned by the time pt went to ER so it ended up not mattering in this situation by my mind is still inquiring....:confused:

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Specializes in LTC.

Hmmm. Only thing I could think of is the patient would have twice as many bruises, but better than having a DVT! If I only had 40's on hand, I would not have hesitated to give two shots, one on each side of the belly button of course. I can't find anything in the literature that indicates that more than one shot should be given.

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Specializes in Cardiac, ER.

I see no reason not to give 2 injections, other than the obvious of the pt getting 2 sticks,...sometimes it just can't be helped. I've done it multiple times!

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Specializes in Pediatrics, ER.

Lovenox is weight-based, usually 1 mg/kg q12 for acute tx but can go as high as 1.5mg/kg. How many shots you give it in has nothing to do with it, but the accurate dosing has everything to do with it...and what their creatinine clearance/serum creatinine levels are.

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Specializes in Cardiac Telemetry, ED.

"As a nurse, I just wouldn't do it" is not a rationale for not giving the ordered dose of this medication. The patient needed 80mg. There is absolutely no reason not to give two 40mg injections.

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Thanks for the response-The only reason I hesitated really is because both of the other nurses immediatley said "NO!" That sent up a red flag for me. They are "experienced and older nurses" and I am a young new nurse! and so it just flagged my attention. After the day I had today, I am REALLY re-evaluating myself and my education and learning that I need to start trusting MYSELF, as I know much more than I think I do. I would think if it was "dangerous" to give 2 injections that it would state that in the drug book, or something....

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You can give two shots at the same time, the only problem is that the patient will get stuck twice. You must have to give other doses of Lovenox in your facility besides 40mg? What is done then? You can also combine the two doses into one syringe. Surprised your Pharmacy couldn't help you. :confused:

Lovenox comes in 30mg to 150mg prefilled syringes. There is no overfill, only a small nitrogen bubble. They can be combined accurately. But, I agree, give two shots, it's easier.

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We dont use lovenox too much in our facility-actually i think ive only used it one other time, and it too was 40mg. We typically use coumadin. However, this pt allergic to coumadin. I guess ordinarily I would have asked the pharmacy but I was so flustered with everything going on I didn't even think about it....just another opportunity for learning I guess and I will know for next time!!

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Combine 2 doses into 1 syringe? They come pre-filled and I'm sure I would loose some if I tried to mess around with that. 40 and 40 is 80. I would have given 2 shots and explained to the patient the importance.

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Specializes in ER.

yes you can give two shots. The dose was 80mg, right? If that's how it's carried, as 40 mg prefilled syringes, then you give two shots. They're prefilled, with air at the end, so you wouldn't draw them up together and give - just give two shots.

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Specializes in Cardiac Telemetry, ED.

I've given more doses of LMWH than I can count. Most of my patients never feel it. It's not generally a very painful or traumatic experience.

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Specializes in ER.
thanks for the response-the only reason i hesitated really is because both of the other nurses immediatley said "no!" that sent up a red flag for me. they are "experienced and older nurses" and i am a young new nurse! and so it just flagged my attention. after the day i had today, i am really re-evaluating myself and my education and learning that i need to start trusting myself, as i know much more than i think i do. i would think if it was "dangerous" to give 2 injections that it would state that in the drug book, or something....

keep a pocket guide (and drug guide) on you, for those questions, so you don't have to ask those old, experienced, and wrong nurses. :D

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