Fluid and Medication
Low Molecular Weight Heparin (LMWH) Subcutaneous Injection
Administration Procedure
Low Molecular Weight Heparin (LMWH) Subcutaneous Injection
Administration Procedure
Purpose
To ensure that LMWH is administered safely.
Scope/Audience
Nursing, Midwifery, Medical Staff and Approved Persons with an
administration or double independent check scope.
Associated documents
Enoxaparin (Clexane®) Patient Information pamphlet Ref 6972
Subcutaneous Fluid and Medication Administration Volume 12
Infection Prevention and Controls Principles related to Fluid and
Medication Therapy Volume 12
Roles and Responsibilities Policy Volume 12
MIMS New Ethicals
CDHB Management Guidelines for Common Medical Conditions
(the Blue Book)
Equipment and forms
Patient's drug treatment sheet (QMR0004)
Injection tray/kidney dish
Medication (prefilled syringe or graduated syringe)
1 Procedure
1. Ensure the patient's current weight is recorded on the patient's
drug chart if the medication is for therapeutic (treatment)
requirements
2. Check the medication to be administered against the patient's
drug treatment chart with two approved personnel - refer to the
Roles and Responsibility Policy Vol 12. Follow the administration
procedure as per the Sub Cut Policy Vol 12
3. Ensure the patient has been given education on the purpose for
the therapy and explanation of what will occur during the
procedure
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: Chief Medical Officer
Ref: 3448
Page 1 of 3
Issue Date: 19/02/2014
Be reviewed by: 19/02/2017
Fluid and Medication
Low Molecular Weight Heparin (LMWH) Subcutaneous Injection
Administration Procedure
4. Ensure patient is lying comfortably
5. Select appropriate injection site
6. Ensure if administering into abdomen that you avoid the
umbilicus by 5cm diameter
7. Prefilled disposable syringes are ready for immediate use
8. If lesser dose is required, calculate the amount required, and
depress the plunger of the syringe to discard medication not
required. Do not expel air bubble.
Please Note: For 60mg doses or greater invert the syringe allowing
for the air bubble to float to plunger end before discarding the
medication not required.
9. Do not expel the air bubble from syringe before the injection.
10. Tap the syringe so that the air bubble rises to plunger end.
Please Note: Administration should be alternated between left and
right anterior abdominal wall avoiding the umbilicus by at least 5cm.
11. Remove the needle sheath and hold syringe between thumb and
forefinger of dominant hand.
12. Gently grasp the skin between your thumb and forefinger to lift
the skin away from the underlying muscle
13. Insert whole length of needle vertically (at a 90 degree angle)
into skin fold. Be sure to hold the skin fold throughout the
injection.
14. Inject the solution slowly over at 30 seconds and wait 10
seconds before withdrawing the needle (significantly reduces
bruising)
15. Remove the needle by pulling it straight out then release the skin
fold
16. Do not rub injection site after administration
17. Do not recap needle. Discard into point of use sharps container.
18. Both approved personnel to record the administration of the
medication on the prescription chart as per Roles and
Responsibilities Policy Vol 12
19. Report any abnormalities or complications immediately.
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: CDHB Fluid and Medication Committee
Ref: 3448
Page 2 of 3
Issue Date: 19/02/2014
Be reviewed by: 19/02/2017
Fluid and Medication
Low Molecular Weight Heparin (LMWH) Subcutaneous Injection
Administration Procedure
References
Ministry of Justice Coronial Services Unit , March 2010 Coroners
Report
Crisp, J., & Taylor, C. (2008). Professional standards in nursing
practice. In Potter and Perry’s Fundamentals of Nursing.(3rd ed.).
Chatswood,Nsw: Elsevier.
Hunter, J (2008). Subcutaneous injection technique.Nursing
Standard. 22,(21) 41-44.
Medsafe data sheet on Clexane (Enoxaparin) April 2010
http://medsafe.govt.nz/profs/Datasheet/c/Clexaneinj.pdf
CDHB Patient Information Leaflet Enoxaparin April 2009
Sanofi Aventis (2010). Clexane injection ten steps
CHAN, H. (2001) Effects of injection duration on site-pain
intensity and bruising associated with subcutaneous heparin.
Journal of Advanced Nursing 35(6), 882 – 892.
Winslow, E.H., Jacobson, A.F. & Peragallo-Dittko, V.M.A. (1997)
Rethinking subcutaneous injection technique. American Journal
of Nursing 97(5), 71-72.
CDHB Chief Medical Officers February 2014 review of the
subcutaneous injection recommendations from a 2010 Coroners
Report
Procedure Owner
Procedure Authoriser
CDHB Fluid and Medication Management Committee
Chief Medical Officer
Date of Authorisation
19 February 2014
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: Chief Medical Officer
Ref: 3448
Page 3 of 3
Issue Date: 19/02/2014
Be reviewed by: 19/02/2017