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....

[Simba&NalasMom, LPN]

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.

This happened in a nursing home. Of course, IVs can be started in these facilities, but often starting IVs in LTC is challenging b/c nurses don't do them on a regular basis (use it or lose it). I once had a woman who looked like she was literally mummifying before my eyes, she was so dehydrated...she refused to let me send her to the ER so I got a verbal order to start fluids; of course, what we had available in our emergency kit were 125 bags and the MD had ordered 100!!! So I was faced with a choice of waiting for the MD to return another page, or pleading with the pt to go to the ER. I chose the latter and she consented. When the medics arrived, even THEY could not get a vein and they do sticks all the time; I don't do IVs myself but I think the IV certified LPN working with me would have had a hard time getting a vein.

I'm assuming the MD knew the pt's weight and ordered the dose according, but who knows for sure...

[wooh, BSN, RN]

of course, what we had available in our emergency kit were 125 bags and the MD had ordered 100!!!

I'm assuming the MD knew the pt's weight and ordered the dose according, but who knows for sure...

25 extra cc's? I'd have given it and called it "flush." (Or if you want to be particular, just pull 25 from the bag, give the rest.) Besides, 100 cc is the standard bolus for a 5-10kg baby. That wasn't going to help an adult all that much.

[Simba&NalasMom, LPN]

25 extra cc's? I'd have given it and called it "flush." (Or if you want to be particular, just pull 25 from the bag, give the rest.) Besides, 100 cc is the standard bolus for a 5-10kg baby. That wasn't going to help an adult all that much.

Thanks for the insight; like I said, I'm not IV certified so don't know much about it. FWIW the nursing supervisors also felt the best thing was to send her out.