Query on Lovenox Administration

[ginger58, ASN, RN]

Anywhere you can give insulin, give lovenox...

NOT TRUE! You must stay away from the umbilicus as there are vessels in that area. It needs to be given in the lateral abdomen about at waist level.

Well, except for the squabbling, this has been a good thread. I have not been as lateral as I should be for Lovenox, but I promise to change!

Another thing I just found out about Lovenox is how to activate the needle protector after giving the injection. (Can you believe I didn't know this until recently??) It's not obvious like other needle protectors.

"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."

Duh. But ya learn something new every day.

Oldiebutgoodie

[cardiacRN2006, ADN, RN]

Another thing I just found out about Lovenox is how to activate the needle protector after giving the injection. (Can you believe I didn't know this until recently??) It's not obvious like other needle protectors.

"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."

I didn't know this!

However, we don't use lovenox at our hospital, just heparin 5000units SQ. Next time I see lovenox, I'll try the needle protector!

I didn't know this!

However, we don't use lovenox at our hospital, just heparin 5000units SQ. Next time I see lovenox, I'll try the needle protector!

My friend also didn't know this, and was complaining to the Lovenox pharm rep, who explained it to her. Maybe Lovenox needs to make it more obvious, or something. It works like a charm, but is not at all apparent how it works.

Oldiebutgoodie

question: at my hospital, we do a lot of TRAM surgeries who have very large transverse abd incisions going from one love handle to the other. also, with the TRAM, we are usually not allowed to give any injections or venipunctures in either arm if the tram involved both breasts. our clinician instructed us in this case to give the lovenox in the thigh. i am now questioning if this would be correct...what do you think?

Hi. I am trying to find out where my sister-in-law should be putting her Lovenox. She was advised not to put it into the abdomen by her plastic surgeon. She is hoping to get breast reconstruction some time shortly after she finishes the Lovenox. So thanks for all the info. I wonder if we can get the makers of Lovenox to give some advice in these cases. I will try. PS I am not a nurse, but a lowly md. Thanks for having this info on line. It will help.

Okay, seriously, I did not know about the "no burping."

When I went to the lovenox administration site, it stated that you should only not expel the air in the 30 and 40 dose prefilled syringes.

Are you saying that you should NEVER burp it, or that you should at least leave a little air? Can anyone point me to some documentation saying that you should always leave a little air--do all of you do this this for any other subQ, or just for lovenox?

I just gave Lovenox for the first time in my clinicals last week to my pt - and when I lifted her shirt, I was HORRIFIED at the huge bruises in her abdomen from previous injections... she had about three of them, the biggest being underneath her navel area. Omg. My instructor told me to inject her in the abdomen, but didn't say lateral abdomen. This is good to know. Although she didn't bruise from my injections... I was taught to hold the needle in for 10 secs after injecting the med, and not to rub afterwards. My patient told my instructor to give me an A+ :-)

As for the air, I was told to leave that bubble in the pre-filled Lovenox syringe. I don't think that's true for any sub-q, though... but hey, I'm just a student :-)

And as for this:

Haven't you read the rest of the postings, dear?

Could you possibly be any more condescending?? Sheesh.

Update: Today in clinicals, I overheard one of the RNs stating that she was about to give a Lovenox injection. I had forgotten about this thread until that moment, so I asked her, "Where do give that injection?" Her response: "In the belly, like a heparin shot." Ok, she's the RN, her call... but I wanted to look it up. So I did, in my Saunders drug book, and it specifically states "Instruct pt to lie down before administering by deep SQ injection. Inject between lt and rt anterolateral and lt and rt posteroalateral abd wall."

So I brought it up in post-conference, and my instructor said, "Wow, I didn't know that... learn something new every day." She wasn't being snotty about it, she was genuinely interested that I had found this info and passed it on.

So, thanks everyone...

And yes, I'll be sure to read my drug book more carefully in addition to what my instructor teaches. :-)

~Laurie

Did the Lovenox rep mention what the air bubble in the syringe preload is. I've been told it is nitric oxide to help accelerate the absorption by dilating the blood vessels.

as long as it is in injected in SQ

http://www.youtube.com/watch?v=ThWUwxHcuYQ ...This is a link to a youtube video by Lovenox; it's 9:33 long with about 3 minutes of useful information, but worth looking at if you have any questions.

[bunsterj]

For whoever wanted the package insert...The last place I worked at, The pharmacy removed everything that came in a package so that they could label the actual syringe, vial, etc. I would call them and ask for a package insert and they would send one up in the pneumatic tubes. Also, isn't the information in the PDR (I'm assuming all have easy access to one on your floor) the same as a package insert?

Has anyone ever given it in the posteriorlateral area?

Also, when I first got out of nursing school, I was taught to use an air bubble on all of my IM and SQ injections...somewhere along the way they told us to stop that. Does anyone know the reason why?

i give it in any area of the body that i can grip some subq fat tissue. important not to rub after nor aspirate before. what does the manufacturer say?

Lovenox drug rep said, "Give it on lateral lower abdomen. Just think about the name and say Lovenox goes in the love handles." "Just keep repeating that to yourself." These were his exact words and I've never strayed from it since. As it was explained to us, after the umpteen thousand trials they've done. This is the site that the drug is absorbed at the rate they wanted for optimal effect.:)

[LifeGoesOn]

Lovenox = grab a good amount of fatty tissue in the abdominal area, two inches away from the umbilicus. Keep the syringe vertical and inject the air bubble all they way.

[SillyInScrubs]

when I first got out of nursing school, I was taught to use an air bubble on all of my IM and SQ injections...somewhere along the way they told us to stop that. Does anyone know the reason why?

I was told that the reason for keeping the air bubble was because when you push out the air, some of the medication gets on the tip of the needle and gets into contact with all tissues on the way in. So if you're giving an IM the med makes contact with the dermal and epidermal layers and it can sting or be damaging to the area. I also seem to remember something about it making the bruising worse, but I'm not positive on that one. I was never told to "stop that". Interesting.

[RussA, BSN, RN]

Previous response(s)/thread indicate site as "lateral" versus packaging direction as: "anterolateral" and/or "posterolateral" of abdomen. Also for the question of not expelling the air from (30 and 40 mg) syringes, is written on insert. Following site from manufacturer from FAQ. When in doubt, I side with written direction versus word-of-mouth practice.

LOVENOX- Questions About Treatment & DVT Blood Clots

[babyhawk73]

We have one doc that writes " in legs only" so we have to give it in the thighs