Lovenox Questions

mkfunk · Apr 2, 2004

the 'do not aspirate' has been bugging me because i couldn't find where i had read this. however, i found it today in my drug book (davis drug guide for nurses, 8th edition). it states:

sc: administer deep into sc tissue. alternate injection sites daily between the left and right anterolateral and left and right posterolateral abdominal wall, the upper thigh, or buttocks. inject entire length of needle at a 45° or 90° angle into a skin fold held between thumb and forefinger; hold skin fold throughout injection. do not aspirate or massage. rotate sites frequently. do not administer im because of danger of hematoma formation. solution should be clear; do not inject solution containing particulate matter.

to avoid the loss of drug, do not expel the air bubble from the syringe before the injection.

melissa

ps. my injection site is still tender and now a beautiful shade of purple.

nialloh, RN · Apr 2, 2004

I had the same question about the air when I met a Lovenox rep. She told me that it is not air, but nitrogen, and is there to form an airlock.

Also, never inject Lovenox anywhere other then the abd. I have seen the results more then once - hematoma,eccomosis and edema. Not nice as well as painful.

Brownms46 · Apr 2, 2004

http://www.aventis-us.com/PIs/lovenox_TXT.html#precautions%20-%20drug%20interactions

Administration: Lovenox Injection is a clear, colorless to pale yellow sterile solution, and as with other parenteral drug products, should be inspected visually for particulate matter and discoloration prior to administration.
The use of a tuberculin syringe or equivalent is recommended when using Lovenox multiple-dose vials to assure withdrawal of the appropriate volume of drug.
Lovenox Injection is administered by SC injection. It must not be administered by intramuscular injection. Lovenox Injection is intended for use under the guidance of a physician. Patients may self-inject only if their physician determines that it is appropriate and with medical follow-up, as necessary. Proper training in subcutaneous injection technique (with or without the assistance of an injection device) should be provided.
Subcutaneous Injection Technique: Patients should be lying down and Lovenox Injection administered by deep SC injection. To avoid the loss of drug when using the 30 and 40 mg prefilled syringes, do not expel the air bubble from the syringe before the injection. Administration should be alternated between the left and right anterolateral and left and right posterolateral abdominal wall. The whole length of the needle should be introduced into a skin fold held between the thumb and forefinger; the skin fold should be held throughout the injection. To minimize bruising, do not rub the injection site after completion of the injection.
Lovenox Injection prefilled syringes and graduated prefilled syringes are available with a system that shields the needle after injection.
* Remove the needle shield by pulling it straight off the syringe. If adjusting the dose is required, the dose adjustment must be done prior to injecting the prescribed dose to the patient.

nialloh, RN · Apr 2, 2004

Thanks Brownie :)

Brownms46 · Apr 3, 2004

Thanks Brownie :)

You're welcome nialloh:)!

MikeLPN · Apr 3, 2004

The needles for lovenox seem dull. Is there a reason for this?

Brownms46 · Apr 3, 2004

The needles for lovenox seem dull. Is there a reason for this?

Excellent question, and one in which I have no clue!

Noney · Apr 4, 2004

Our rep insisted that the needles are not dull. I guess he's never been on the recieving end:)

Noney

JoMom4 · Apr 4, 2004

This may be a little off the subject, but the nurse giving the injection made the comment "you always expel the air when giving an injection".

When I went to school 20 yrs ago, we were taught to always leave approx. 0.25cc of air in the syringe when giving an IM. Theory was that it was to push the medication past the sub-q tissue into the muscle. When I tell this to nurses now, they freak and say they were never taught this. Anyone else leave air for an IM?

Brownms46 · Apr 4, 2004

Good question JoMom4! I am from the old school, and was taught to not leave air in the syringe. However there have been much heated debate, and even research done about this very subject. Here are two conclusions of such studies, and the rational for not leaving the air in:

http://www.aorn.org/journal/research/rc498.htm

When using glass syringes, an air bubble was recommended; however, with the advent of plastic syringes, the air bubble should have become a thing of the past. In fact, we learned that an air bubble can affect the accuracy of the dose of medication in the syringe.

http://www.indianpediatrics.net/sep2003/sep-835-845.htm

Air Bubble: Though it is a topic of heated debate, it has been proved to be outdated and non-scientifically recommended procedure and should be eliminated from IM injection procedure(15,18,25). There were two thoughts: (a) It ensures correct dose taking into consideration of dead space. But disposable syringes are calibrated taking into account of medication within syringe hub and needle. Some syringes are available with projection on the plunger, which enters the hub after finishing of pushing the medication. (b) Air bubble seals the medication in the muscle after injection and prevents backflow of medication through needle track. This later problem can be eliminated by using Z track technique. Skin is pulled downwards and laterally before injection. This displaces the skin and SC tissue leaving the muscle there only and uses the valve action to prevent leakage of medication into the SC tissue .

spitfire · Apr 4, 2004

The needles for lovenox seem dull. Is there a reason for this?

My experience is that the abd skin varies between patients, some pts have very tough skin and it seems you almost have to really push to get the needle in, I feel bad for the pt. but there is nothing that can be done about the density of the skin, usually younger pt are the harder stick and some of the very older folks. spitfire