Lovenox question.

[LuVnLpN08]

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....

[poopyhead]

There is no reason not to give 2 shots of 40 mg. I have given 80mg before ,TWO 40mg , after discussing with the pharmacist and the doc. I think giving 2shots might be painful for the patient but no giving the fractional heparin as early as possible might cost the patient the MI.

[meandragonbrett]

I asked the nurse who said it, and she said "well its a personal thing, i just wouldnt-its my license on the line"

Gotta love how some nurses throw this excuse around EVERY single time they need an excuse. :confused:

[Music in My Heart]

we had a pt with 150mg lovenox daily ordered. the nurse that was the regular nurse on that hall has only been a nurse for about a year. one night she decided that the dose was too much for the pt and she started giving him 40mg because "that was a better dosage".

needless to say...the pt is in the hospital right now with a DVT.

And that nurse, I hope, is facing a malpractice suit and has been reported to the BON, with her license soon to be yanked.

Gross negligence... simply inexcusable.

[Music in My Heart]

I was also thinking about the cost of the drug and looked it up. 40mg enoxaparin sodium injection costs $52.30 New Zealand dollars for 10. That's $10.46 NZ for that 80mg dose, probably $7 or $8 US. Compared to the cost of having to assess and treat the patient for DVT/PE...

Not to mention the morbidity and mortality associated with thromboses.

[Guitar_Heroine]

Sometimes there's no way around two injections and I really don't understand the reasoning of those other nurses. We send a lot of people home with Lovenox and it's great when they do need two shots at a time because then you can demonstrate one and then have them demonstrate the second! :)

[LuVnLpN08]

Thanks so much for all the replys! this site is great to me in situations like this. My mind is so curious so i love to hear others opinions. and FYI-yes, this was a nursing home, and no on site pharmacy. when we send for STAT orders, pharm is required to have it in minimum of 2 hours, hardly ever works like that! We have an emergency box and a stat box, but no lovenox. As well i know i could have spoke with pharmacy but with pt going downhill quickly i guess my mind was elsewhere. As for calling MD- i did, i called him back almost immediatley..The hard part is, i didnt take the order, another nurse did. I actually didnt speak with the doctor at all until after pt went to ER. I was comming in for the shift, and i guess you could say walked right into this situation-night nurse really didnt know what she was doing, sadly. Its where we get into the rock and hard spot so to speak-other nurses such as unit managers, DON's ect rec'ing orders from MD and the staff/floor nurses taking orders off... its crazy!!! But anyways thanks again for all the replies, I think I will be posting more on this site

[GilaRRT]

Oh my, I am somewhat shocked that a nurse told you this. You received a STAT order for Lovenox. In my mind this typically equates to badness, like acute coronary syndrome bad. Why, when the patient clearly has something much more important than a debate about two subcutaneous injections and your license, would a nurse even consider not administering the medication?

[wooh, BSN, RN]

Why, when the patient clearly has something much more important than a debate about two subcutaneous injections and your license, would a nurse even consider not administering the medication?

I don't think it's a debate so much about giving 2 subq injections, but about giving 2 doses. If you give a lot of lovenox, you know what the dosages tend to be. So 80mg of lovenox, even if you have to give 2 prefilled 40mg syringes, isn't a big deal, you just give it. But if you aren't super familiar, and aren't sure of the doses, then anytime you have to give 2 syringes of something, it SHOULD be a red flag to stop and think. Part of our job is to make sure that the dose we're adminstering is appropriate. Just because "the doctor says so" isn't enough. If all they kept on hand were 100mg syringes, and the doctor said, "Give 200 mg lovenox" would we be saying, "It's a stat order, the doc said give it, who cares that it's 2 syringes!" No, we'd be saying that getting out 2 syringes should have alerted her something was up even if she didn't regularly give the drug.

It was prudent to stop and think. It was prudent to ask someone with more experience, sometimes they know off the top of their head the answers to our questions. Best thing would have been to quickly look in a drug guide and see that 80 mg was an appropriate dose (or in my what-if-example that 200 mg more than likely would not be.)

[donsterRN, ASN, BSN]

I see your point. Excellently made, BTW!

[GilaRRT]

The OP did look in a drug guide and found no contraindications. The dose of the medication is not a question either. The OP was specifically told not to give Lovenox in two divided doses by the nurse in question. When confronted with additional evidence, the nurse in question stated "it's a personal thing," then stated some mumbo jumbo about a license. So, people fail to give the proper doses of medications based on "personal feelings." In this case, it was a STAT order for a patient being shipped to the ER.

[vernonleon]

of course there is all kinds of great information posted in response to the ops question, but i've got to throw in my little bit that's a bit of a tangent but still on the topic of lovenox. make sure you warn your patient that he or she may begin to bleed from the injection site, even some time well after the injection was given. some folks get really, really scared when they see unexplained blood on the fronts of their gowns.

[LTACRN]

What was the problem with the patient? Why were they sent to the ER? Lovenox is weight based, so the dosing should have been established based off of weight of the patient and not just some personal preference. Lovenox can also be given in a bolus for acute coronary syndrome, but it appears that the pre-filled syringes were sent to the floor. It is safe to give a patient two injections, we do it all the time with lovenox, insulin injections and even immunizations. The alternative would be that the patient would receive a sub therapeutic dose of LMWH and subsequently develop a DVT. Just because the nurse has more years in the hospital, doesn't always mean they stay up to date on important issues. Know where to go in your hospital system to find out the appropriate information and whenever in doubt call the pharmacist. Hope this helps.