Where should the BUBBLE Be

DutchgirlRN, ASN, RN · Feb 14, 2008

I don't understand how injecting the air first would help prevent the loss of the med.

The way I understood it was that the air being injected first creates a small pocket in the SQ tissue which causes the lovenox to be absorbed more quickly, hence not losing it and is distrubuted more evenly. I may be wrong. That's how I remember reading it when I first started giving it. Perhaps it's changed over the years. You know it's hard to teach an old dog new tricks. :uhoh21:

Editorial Team / Admin · Feb 14, 2008

Subcutaneous Injection Technique: 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.

http://products.sanofi-aventis.us/lovenox/lovenox.html#Boxed%20Warning

The air bubble preceeds the actual drug injection for one does not want to risk losing any of the drug from the syringe. The air bubble acts as a "safety feature" to prevent accidentially losing any of the drug.

november17, ASN, RN · Feb 14, 2008

From my understanding the air went in last to "lock" the medication into the SQ tissue and help prevent bruising. This rationale makes the most sense to me, personally. It's just like Z-Tracking an IM injection except you're using air. The "delivering the whole dose" rationale makes sense too, but at the same time why aren't we taught to do this with insulin as well, since insulin units are so tiny in volume?

Pushing the air out or putting air in first doesn't really make a lot of sense to me but whatever (I've been wrong in the past!).

RN007 · Feb 14, 2008

From the manufacturer's website:

Subcutaneous Injection Technique: 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.

http://products.sanofi-aventis.us/lovenox/lovenox.html#Dosage%20and%20Administration

Hope this helps!

DutchgirlRN, ASN, RN · Feb 14, 2008

http://products.sanofi-aventis.us/lovenox/lovenox.html#Boxed%20Warning
The air bubble preceeds the actual drug injection for one does not want to risk losing any of the drug from the syringe. The air bubble acts as a "safety feature" to prevent accidentially losing any of the drug.

THANK YOU sirI, I see I have not lost my mind after all. We old dogs are still sharp as ever girl!

rnmi2004 · Feb 14, 2008

I was taught the air bubble follows the injection of the medication. Since my patients are lying down, I'm not sure how I'd get the air in them first...

TigerGalLE, BSN, RN · Feb 14, 2008

I've yet to see anything that proves the correct way to do it... Does anyone have any reliable sources that tell us the correct way??? The sources only say to not expel the air bubble before injection...

Tiger

Reno1978, BSN, RN · Feb 14, 2008

I sent the manufacturer an inquiry - I'll report back if they respond.

I understand the rationale between both methods...both explanations make sense.

cardiacRN2006, ADN, RN · Feb 14, 2008

I'm another who was taught that the air bubble goes in AFTER the med. I was taught this was to ensure the entire dose goes into the pt.

time4meRN · Feb 14, 2008

ok..regarding lovenox injections....where should the air bubble be...
I was told the TOP...but what exactly is that.....top meaning bottom of plunger?
OR
TOP meaning part where the needle is?
No, i am not a nurse yet.

You want the bubble to go in last so the med doesn't leak out so easily

rnmi2004 · Feb 14, 2008

If you look at the manufacturer website:

http://products.sanofi-aventis.us/lovenox/lovenox.html#2

and scroll down to the illustrations, Figure B shows the syringe angled up, so the bubble would have to go in last.

The Lovenox teaching kit comes with a video. I wonder if they have one lying around work I could watch to be sure. I'd hate to think I'd been injecting and teaching it wrong all this time!

TRINI_RN · Feb 14, 2008

we were taught that the air bubble goes in last to lock/seal the medication in the tissue.