Where should the BUBBLE Be

[pat8585]

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.

[ShaunES]

I just got off the phone to the Australian manufacturer of Clexane (enoxaparin) med-info line, and she stated that the bubble shouldn't be expelled (we all knew this) and that when injecting the bubble goes to the top, against the plunger, and then inject fully if using the single-dose prefilled kits.

I asked if it would make much difference if it was injected first, and she said not really, the liquid and bubble mix up pretty well when the needle is withdrawn.

Will be interesting to see if other people get different answers.

(I called Sanofi-Aventis Australia Medication Information Line)

[NurseCherlove]

The sources only say to not expel the air bubble before injection...

Tiger

Exactly - Thank you!

Ok guys, I haven't seen anyone mention this important point yet....Lovenox burns like fire from what I've seen/been told. This effect is minimized greatly by injecting the air BEHIND the medication, locking it in (like the Z track concept per the other poster), so as not to track the burning med back out into the tissue while withdrawing the needle.

Also, I'm sorry, but I have to shoot down the argument that the air should go first so not to waste the med. That makes no sense at all. Think about it...if you push the air in and then the med, what is the last thing in the actual needle once you've pushed as far as you can go? Medicine. So medicine gets left behind in the needle.

Also, think "lovenox love handles", as that is the ideal location for lovenox injections - better absorbed (not sure why) and more comfortable for the patient. This instead of just going the one inch outside of the umbilicus.

[anonymurse]

Instead of saying "don't expel the air bubble before the injection" they ought to say "when wasting some for a partial dosage, keep the needle pointed down to preserve the air bubble." Easier to remember with a picture in mind.

[DutchgirlRN, ASN, RN]

Okay, this is the answer.

I spoke with Joyce F.......PhD with Sanofi-Aventis, she said that the air bubble is totally insignificant, it does not matter if it goes in first, last, or at all.

The air bubble is composed of nitrogen and is added to the syringe because the Lovenox solution itself does not contain a preservative and it inbibits oxidation of the medication. The literature says "do not expell the air bubble" because the dosage is prescribed by the patients weight and it is a precise amount and by expelling the air bubble some of the medication may be lost.

In the early years it was suggested that the air bubble be injected first as a safety measure because it was felt the nitrogen would help distrubute the medication in the SQ tissue but this was found not to be the case and the literature was changed so that it does not matter when or if the air bubble is injected. The only action which reduces bruising is not rubbing the area after injecting. The injections should be given in the love handle areas only. Never near the umbilicus, never in the arms or legs.

So there you have it. Straight from the horses mouth. The air bubble is nitrogen and is totally insignificant except as a preservative for the lovenox itself. The only importance in administration is the proper dosage, proper location and proper technique (SQ).

I'm so glad we got to the bottom of that

[eccentricRN]

Um... i thought you wanted the bubble to follow the med.. so that the incidence of bruising is decreased... pushing the med further into the SQ tissue.... ??

At least that was the reasoning i was taught... whatever the reason.. you want the bubble to go in after the med...

I was taught the bubble goes in last to prevent brusing/bleeding... you can always tell where someone before you hasn't admin the bubble last...they have a blood spot where the injection was given.

Best tip I have: when in doubt look it up & use the pharmacist if all else fails.

[DutchgirlRN, ASN, RN]

I was taught the bubble goes in last to prevent brusing/bleeding.

Nope, that's not true. I got it straight from the pharmacist at Sanofi-Aventis who manufactures the Lovenox.

[moonchild20002000]

I have a question. I took my hubby to ER today,he has a thrombus in his

leg,had a scope of his knee 6 days ago.I'm not looking for medical advice.

I am going to give him his Lovenox at home. I have been a nurse for years and

have experience but have never given this med. I watched the nurse give it

in the ER,she did not pinch up a fold of skin.I know the instructions call for that.

I also read about the bubble and understand that. I don't know if she aspirated or

not.

I guess you could call me a wee bit stressed......so tell me your technique.

Flat skin,pinch skin? Aspirate or not?I really am not as dumb as I appear.

Hubby kept his symptoms pretty much to himself until this am. He is a man

of few words.....getting any history out of him is like pulling teeth!As soon

as he started talking i KNEW what was going on.You know ,

the Oh !#$% feeling.

Anyway the docs thought he was stable and will Rx at home with Lovenox and coumadin.I think I just needed to vent and am in need of some reassurance at

this point.Its been a long day and I hate it when this man(DH) scares me .

[DutchgirlRN, ASN, RN]

I watched the nurse give it

in the ER,she did not pinch up a fold of skin.I know the instructions call for that.

I also read about the bubble and understand that. I don't know if she aspirated or

not.

You do not aspirate with a SQ injection. Unless your DH has a really flat tight stomach it's not necessary to pinch up a fold of skin. Stay away from the umbilicus and inject in the anterior love handles. Just make sure you inject into subcutaneous tissue. Good Luck.

[moonchild20002000]

Dutch,

Thanks for the reply...I feel so much better after a nights sleep!

[rnstudentsandy]

I am a nursing student and according to our instructors and P&P of the facility I am and the Lovenox in service at my facility from the manufacturer: the air bubble needs to be at the plunger, meaning being injected after the medication. Rationale is that the air bubble works to seal of the tissue keeping the med in after medication administration.

[DutchgirlRN, ASN, RN]

nope, we got it straight from the manufacturer. it doesn't matter in the least if the bubble is injected first, last or at all. the bubble is not air, it is nitrogen used as a preservative.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

I thought the bubble went last to seal in the med and decrease bruising.