Where should the BUBBLE Be

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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.

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:

I guess that does make sense, it is just different from what I've been taught. It certainly is interesting to see the differing views on this. I looked it up in my drug book and it didn't say either way, just don't expell the air before giving the injection.

Thanks!

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Specializes in OB, M/S, HH, Medical Imaging RN.
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!

I've given it hundreds of times with the air going in first. It's not difficult at all.

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i think it really doesnt matter to whether the bubble precedes or follows the drug..from what they taught us here, just do not expel the bubbles just to avoid losing any of the drug dose...ask the physician or i think it depends on the hospital protocol...and dont rub or massage the site. :)

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Specializes in Cardiac.
i think it really doesnt matter to whether the bubble precedes or follows the drug..from what they taught us here, just do not expel the bubbles just to avoid losing any of the drug dose...

But, what does injecting the air bubble first have to do with correct dosage?

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i think when u try to expel some of the bubbles out some of the medicine dose (tho some isnt relevant enough) go out with it.. *shrugs*

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Specializes in NICU.

so why do they even put the air bubble in there?

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to help the absorption?? subcutaneously

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Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.

Air always goes last, many like to add a bit ( .2cc or so) when also giving IM's ,air ensures all of the med gets delivered none leaks out, important w/ irritating inj's, also no leakage/ bleeding , less incidence of ecchymosis

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Specializes in OB, M/S, HH, Medical Imaging RN.

Talk about confusing. I found this online. It makes no sense what-so-ever.

Lovenox –porcine heparin- variation of Heparin but not interchangeable

  • a. given SQ only, check for allergies to pork
  • b. used for prophylactic RX after surgery and injuries instead of heparin
  • c. irritating to tissues, give deep sub q, alternate sites, optimal site is "love-handles" posterior and anterior
  • d. keep air bubble in syringe, do not inject air bubble, it is nitrogen used as a preservative for Lovenox
  • Antidote for Heparin and Lovenox: Protamine sulfate
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Specializes in OB, M/S, HH, Medical Imaging RN.

I plan to call the company tomorrow. This needs to be clarified. I'll suggest to them that they make their literature clear. Simply "do not eject the air bubble" means nothing really.

Wow, I'm on the edge of my seat now...how will I sleep?????? ;)

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If there ever gets to be a clarified answer, please let me know.

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

The air goes in after the injection to prevent bruising. At least that's what I've been taught.

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