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Giving Enoxaparin at home

Click here to download a printable version of the information from this page.

Your child needs enoxaparin at home. This medication must be given by injection (a needle) into the fatty layer of tissue, just below the skin and above the muscle. This is the subcutaneous layer or SC.

How do I prepare my child for an injection?

Children take their cues from their parents. Any fear or dislike you have of needles may make your child afraid too. Some parents find that reminding themselves that the injection allows their child to survive and stay healthy makes injection time easier. For example, if parents say, “I need to give your injection so you will have lots of energy to play and to grow,” the child begins to understand. Follow up each needle with a big hug and kiss, and get on with the day’s activities.

Who should give the injection?

In many families, one person takes on most of the responsibilities for injections. However, there may be problems when that person is not there. It is important for all regular caregivers to share the responsibility of giving the injection. Your child should feel safe and confident with any of them. Lone-parent families should get the help of a friend or relative. Some families work out a schedule. One caregiver might take care of the morning injections while another looks after evening injections.

Sharing the task of injections will make it easier to cope with the daily demands of your child’s condition and will help prevent caregiver burnout.

How do I give Enoxaparin?

Your child or teen will probably have the first dose of enoxaparin in the hospital or clinic. One of the nurses will teach you how to give the injections at home. You’ll learn how to give the injection into the layer of fatty tissue just under the skin (subcutaneous). Because there isn’t much blood flow to this tissue, medicine is absorbed more slowly. Enoxaparin may come in a pre-filled syringe, or you may have to draw it up from a vial.

Before giving enoxaparin injections, make sure you:

  • Understand how to prepare and inject enoxaparin. Please let us know if you have questions or are worried about anything.
  • Know how to dispose of the needle and syringe safely in a sharps container.

How much Enoxaparin should I give?

Most of the time, you’ll use insulin syringes to inject enoxaparin. These syringes are made for injections into the fatty tissue just under the skin (subcutaneous). 

Important!

The amount of medicine is measured in units on an insulin syringe. 1 unit on the insulin syringe is equal to 1 mg enoxaparin. (1unit = 1mg enoxaparin)

Example:

  • Give your child or teen _XX_ mg of enoxaparin each dose.
  • This dose is the same as _XX_ units on an insulin syringe.

Make sure you always have enough enoxaparin to last through weekends, holidays, and vacations. Call your pharmacy at least 2 days before you run out to order more. 

Injection Sites

Open pdf to see images:

Birth to 12 months: Middle of the thigh. Inject medicine into the middle of the thigh where there is a lot of fatty tissue . Use the front, outer top of the thigh. Do not use the inner thigh or back of the thigh. 

12 months and older For children older than 12 months, medicines can be injected into 3 sites:

  1. Middle of the thigh: Inject medicine into the middle of the thigh where there is a lot of fatty tissue. Use the front, outer top of the thigh. Do not use the inner thigh.
  2. Back of the arm: This is the fatty tissue over the back part of the upper arm.
  3. Abdomen: Inject enoxaparin into fatty tissue on the belly.

Remember!

  • Change sites with each injection.
  • Separate each injection by at least one inch.
  • Avoid areas that are bruised, scarred from injuries, swollen or tender.
  • Write down each injection on the chart on the last page.
  • Call your Nurse Case Manager or doctor before your child or teen has any dental work, surgery, medical procedures or immunizations (needles). You may need to hold 1 or 2 doses of enoxaparin before these treatments or tests.

What you need

  • Vial of enoxaparin (multi-dose vial) or
  • Pre-filled enoxaparin syringe
  • (1) Alcohol or alcohol-chlorhexidine wipe
  • (1) 2x2 sterile gauze

If you’re not using pre-filled syringes, you’ll also need:

  • Insulin syringe (30, 50 or 100 unit syringe).

Exemple:

Give your child or teen _XX__ mg of enoxaparin each dose.

This dose is the same as _XX_ units on an insulin syringe.

Steps

Key points

  1. Assemble equipment and wash hands.
 
  1. Multi-dose vial: Check the expiry date and mg/mL on the enoxaparin vial. Pre-filled syringe: Check the dose and the expiry date. Skip to step #8.

If a multi-dose enoxaparin vial is in use, check the expiry date (enoxaparin is good for 28 days from when opened). Write the date you open it on the vial.

  1. Clean the rubber stopper on the vial of enoxaparin with an alcohol or alcohol-chlorhexidine wipe for 30 seconds, and allow to air dry for 30 seconds.

This removes dust, which may contain germs.

  1. Open the package containing the syringe.
 
  1. Remove the cap from the needle and draw back a small amount of air into the syringe. Press the needle into the rubber stopper of the enoxaparin vial and inject the air into the vial. Turn the vial upside down, making sure the tip of the needle is in the solution.

Injecting air into the vial first relieves the ‘vacuum’ pressure in the vial. This allows you to withdraw the medication.

  1. Slowly pull down on the plunger until you have a bit more enoxaparin than you need. Pull the syringe out of the vial. If you have trouble pulling out the medicine, inject a bit of air and try again.
 
  1. Flick barrel of syringe or tap syringe to get all bubbles caught at the bottom of the syringe to the top. Once air bubbles are at the top, use the plunger to push air bubbles out. 

Give the injection right after you draw it up. 

  1. Choose the injection spot. Clean the skin with the alcohol wipe and allow to dry. Try to change injection sites with each injection you give. For example, inject into the left thigh in the morning and right thigh at night.

Cleaning the skin with alcohol kills bacteria on the skin and prevents infection.

  1. Remove cap from needle. Hold the syringe in the hand you write with. With other hand, pinch and lift up skin over the fatty tissue.

Pinching and lifting the skin over the fatty tissue helps you to avoid the muscle. 

  1. Insert needle at a 45º angle to the skin if the child or teen does not have much fatty tissue under the skin. Use a 90º angle for a child with a lot of fatty tissue under the skin. You do not need to pullback on the syringe plunger (aspirate) after inserting the needle. 

45 - to 90 degree angle

  1. Push the plunger quickly, firmly pushing it as far as it will go.

Giving the enoxaparin quickly reduces pain.

  1. Pull the needle out gently at the same angle you put it in. As you take out the needle, let go of the skin roll.
 
  1. Apply firm pressure to the injection site with gauze. Hold for 30 seconds after each injection to reduce the chance of bruising. Do not rub the area as it may irritate the skin.
 
  1. Write where you gave the injection on the injection rotation chart (next page).
 
  1. Put the needle and syringe in a sharps container with a lid. Do not try to put the cap back on the needle. When the sharps container is full, bring it to your local pharmacy. They can safely dispose of it for you. Do not put it in your regular garbage.

Needle stick injuries happen when people try to re-cap the needle.

What if we miss a dose?

Enoxaparin is usually given every 12 hours. If you miss a dose:

  1. Give the missed dose as soon as you remember.
  2. Give the next dose at least 10 hours after that. Try to get back on schedule.
  3. Call the Nurse Case Manager or the Hematologist on call for further instructions.

Do not give your child 2 doses to make up for 1 missed dose.

What does it mean if there is bruising at the injection site?

This can happen from time to time. It is not harmful. It usually means the needle has nicked a tiny blood vessel. To reduce the chance of bruising, apply gentle pressure to the site with a dry piece of cotton. Also, be careful not to pinch the skin too tightly or insert the needle too slowly. If your child has too much bruising, consult your health care team.

What would happen if I inject an air bubble into my child by mistake?

It is not harmful to inject an air bubble under the skin. But you want to make sure you’re injecting medicine, not air, so your child gets the full dose of medication. Do your best to remove air bubbles before injecting the medication. 

When to call us

Call your Nurse Case Manager or doctor before your child or teen has any dental work, surgery, medical procedures or immunizations (needles). You may need to hold 1 or 2 doses of enoxaparin before these treatments or tests.

Call your Case Manager right away, if your child or teen: 

  • Develops a rash.
  • Has a bad fall. This is even more important if there is a hit to the head.
  • Gets a deep, dark purple bruise, pain, or swelling at the injection site.
  • Has unusual bleeding (for example: a very long nosebleed, blood in the urine, coughing or throwing up blood, bleeding at the place of injection, bleeding or oozing from a surgical incision).
  • Passes black, sticky, tarry stools or stools with red streaks.

Medical Day Unit (MDU) is open weekdays from 8:00 am – 4:30 pm 613-737-7600 x 2470

For Urgent Needs during evenings, weekends or holidays, Call the Hematologist/Oncologist on call: 613-737-7600 then press `0` for operator. Ask the operator to page the Hematologist – Oncologist on call. Please don`t hang up. It can sometimes take 5 – 10 minutes for the Hematologist Oncologist to reach the operator.

Call 911 if your child or teen:

  • Has signs of a life-threatening allergic reaction (wheezing, shortness of breath, chest tightness or chest pain, fever, itching, bad cough, blue skin colour, swelling of face, lips, tongue, or throat).
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