Prefilled syringes for anticoagulants

[Ayala]

A classmate of mine just started her Geriatrics clinical rotation. Her instructor is new to the facility and very nervous. My classmate was supposed to inject an anticoagulant into the abdomen of a patient. We had never used pre-filled syringes in class, and my colleague was puzzeled when she was handed what she called "a short fat syringe." The teacher told her to push the plunger hard. Apparently this action caused some kind of safety device to engage and prevent injection.

Do you understand what I'm talling about? Can any of you educate me on this type of syringe and how to use it?

Thanks a lot!

[Esme12, ASN, BSN, RN]

The pressing of the plunger after injection and removal of the needle from the abdomen deploys the needle safety guard. This is particular to Lovenox.

Patients should be lying down and Lovenox 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 prefilled syringes and graduated prefilled syringes are for single, one-time use only and are available with a system that shields the needle after injection.

Remove the prefilled syringe from the blister packaging by peeling at the arrow as directed on the blister. Do not remove by pulling on the plunger as this may damage the syringe.

1. Remove the needle shield by pulling it straight off the syringe (see Figure A). If adjusting the dose is required, the dose adjustment must be done prior to injecting the prescribed dose to the patient.

Figure A

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2. Inject using standard technique, pushing the plunger to the bottom of the syringe (see Figure B).

Figure B

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3. Remove the syringe from the injection site keeping your finger on the plunger rod (see Figure C).

Figure C

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4. Orient the needle away from you and others, and 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 (see Figure D).

Figure D

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5. Immediately dispose of the syringe in the nearest sharps container (see Figure E).

Figure E

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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

Lovenox (Enoxaparin Sodium Injection) Drug Information: Indications, Dosage and How Supplied - Prescribing Information at RxList

[Ayala]

Thanks a lot!