Lovenox(enoxaparin) SQ

[sharann]

Where do you inject it? I was told ALWAYS SQ in the abdomen. If given other areas can cause bleeds and hematoma.

[sscathlab]

When I first started in nursing I was taught to give Lovenox 2-3 in around the umbilicus. However the drug rep came to my hospital in the last 2 years or so and said that actually lovenox should be given more in your "love" handles. further out from the umbilicus. You need to tell your patient that it will burn I know from personal experience. Most of the prefilled lovenox syringes come where you can withdraw the needle back into the syringe to prevent needle sticks. DONT do this with the needle in your patient. You will not only bruise them but they can get hematomas.

[NRSKarenRN, BSN, RN]

always follow manufacturer advice:

aventis: lovenox administration

http://products.sanofi-aventis.us/lovenox/lovenox.html#boxed%20warning

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.

*inject using standard technique, pushing the plunger to the bottom of the syringe.

*remove the syringe from the injection site keeping your finger on the plunger rod.

*orienting the needle away from you and others, activate the safety system by firmly pushing the plunger rod. the protective sleeve will automatically cover the needle and an audible "click" will be heard to confirm shield activation.

*immediately dispose of the syringe in the nearest sharps container.

note:

*the safety system can only be activated once the syringe has been emptied.

*activation of the safety system must be done only after removing the needle from the patient's skin.

*do not replace the needle shield after injection.

*the safety system should not be sterilized.

*activation of the safety system may cause minimal splatter of fluid. for optimal safety activate the system while orienting it downwards away from yourself and others.

complications and drug interactions at above link. karen

[kbear]

In some cases, you can't give it in the abdomen because of extensive wounds and/or dressings--what then?

[pedirn06]

I work in peds and have recently had a pt who had Lovenox ordered and because of being underwt, did not have adequate SQ tissue in the abdomen to adm the injection (14y/0 male 5' 3" and 84 lbs) therefore, we used the posterior upper arms. Once he gained enough wt to have some abd SQ to give it in, we started using that site. Also, the dose was 46mg so we had to draw from a multidose vial and give with an allergy syrine - In this case, i would need to be documented the reason for site selection and a doctor's order to give in sites other than the abdomen.

[SEOBowhntr]

Now this one gets a little heated on occasion, esp. with ER nurses, but.....

according to the Drug Rep, Lovenox should never be given in the arm. That question came up during a CEU presentation I was at this fall, and he said the manufacturer strongly advises against using sites other than the abdomen, and if needed, they'd reccommend the leg, rather than the arm. A couple of ER nurses at our facility continue to do Upper arm, as we don't have a policy that specifies one location vs. another, but I've seen a few bad hematomas from arm injections. I've also seen a few rectus abdominus hematomas that got so large that they had to be evacuated.

In all honesty, I'd rather have someone put me on a Heparin gtt, and draw PTT's every 6 hours than give me Lovenox as there just doesn't seem to be as good of regulation of the bleeding times with Lovenox that there is with Heparin from what I've seen in the last 10+ yrs.

[RN37]

www.nlm.nih.gov/medlineplus/druginfo/medmaster/a693016.html

hello! please check this site.

[kbear]

Thank you everyone who replied---it's great to have peer input at the touch of my fingers!!

[NRSKarenRN, BSN, RN]

No SQ fat, then use leg. Arms have much more movement increasing hematoma risk.

[TheCommuter, BSN, RN]

99 percent of the time I give Lovenox SQ injections in the abdomen. One of my patient's abdomen was so badly bruised that I decided to administer it in the thigh.

[Patti 2nd gen RN]

Is there any rationale/studies--not just "we only tested it one way " from manufacturer" stuff regarding giving above or below the umbilicus with heparin or Lovenox?? At the rehab, we have people who get it for months....

[fetch33]

I work on a large orthopedic unit. We give a lot of Lovenox. Recently we had a problem with it. A patient was given her dose of Lovenox. The site began bleeding. We tried everything we could think of as nurses to get it to stop... pressure dressings, ice, having the patient lie on it with a pressure dressing... nothing worked. The medical docs didn't seem to worry about it and did nothing after multiple calls. The lady bled for 2 days and dropped her hemoglobin 2 grams! I would have thought they would have cauterized the puncture wound or something.... it was insane.

[hispanicpanic]

I am an RN who was actually on Lovenox for a DVT. Though the preferred spot is the abdomen that is not always possible. We as nurses must sometimes think outside of the box. A pt with 3rd degree burns to the abdomen doesn't have SQ tissue there(actual pt of mine). So you give the shot in other SQ tissue. There cannot always be an absolute.