Where should the BUBBLE Be

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.

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. :)

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?

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*

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

to help the absorption?? subcutaneously

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

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

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??????

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

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

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)