Are you administering Inj Clexane safely?

 

On physical examination of a newly admitted case of bedridden elderly patient I noticed circular red patches around 3-4 cm radius over right and left lateral thighs. I  recognised it as the local damage due to the improper administration of Injection Clexane, a subcutaneously administered antithrombotic, which is a Low Molecular Weight Heparin. This led me to the thought,” How can we administer inj clexane properly?”. ” How safely we are administering it daily?”. In this post, I will share my knowledge about inj Clexane and the recommendations for its safe administration.

WHAT IS INJ CLEXANE?

It is an Antithrombotic.

The active ingredient of Inj Clexane is Enoxaparin Sodium. It is a low molecular weight heparin (LMWH).

LMWH is produced by chemically splitting heparin into one-third of its original size. Has fewer side effects than heparin and has more predictable anticoagulant action. 

THERAPEUTIC INDICATIONS

  • Prophylaxis of Venous thromboembolic diseases in Surgical patients(orthopaedic and general surgeries) and in Medical patients(rheumatic disease)
  • Treatment of DVT and Pulmonary Embolism (PE)
  • Acute STEMI
  • Unstable Angina and NSTEMI
  • In Haemodialysis – To prevent thrombus formation in Extracorporeal Circulation

CONTRAINDICATIONS

  • Active significant bleeding
  • Hypersensitivity
  • Thrombocytopenia
  • Vascular aneurysms
  • Oesophageal varices
  • Hyperkalemia

SIDE EFFECTS

  • Haemorrhage
  • Haematoma
  • Anaemia
  • Ecchymosis
  • Confusion
  • Diarrhoea
  • Haematuria

DRUG INTERACTIONS

  • Aspirin
  • NSAIDs
  • Dextran
  • Warfarin

Interaction with these drugs increase the risk of bleeding

NURSING CONSIDERATIONS

METHODS OF ADMINISTRATION

Should NOT BE  administered by IM route. IM CAUSES HAEMATOMA.

Preferred injection method is subcutaneous

In special cases, IV routes are used

Screenshot_20180715-095804_1.jpg

TECHNIQUE FOR SAFE S/C ADMINISTRATION

  • Patient must be preferably in a lying position.
  • DO NOT expel the air bubble from the syringe. {This is to avoid the loss of drug while using prefilled syringes}
  • PREFERRED SITE: The subcutaneous tissue of the anterolateral or posterolateral ABDOMINAL WALL
  • It is administered as a DEEP S/C INJECTION
  • The whole length of the needle should be introduced PERPENDICULARLY, not from sides, into the skinfold gently held between the thumb and the index finger. SKINFOLD SHOULD BE HELD THROUGHOUT THE INJECTIONInjection_subcutaneous_insulinsyringe_angle_EQUIP_ILL_EN

 

  • DO NOT rub the injection site after administration

IV BOLUS ADMINISTRATION (Only for Acute STEMI)

  • Initiate the treatment with single dose IV bolus injection, followed by  s/c injection
  • For IV, Multidose Vials or Prefilled syringes can be used

حقن-كليكسان-CLEXANE

 

clexane multidose vial

 

  • IV administration should not be mixed or coadministered  with any other medications
  • Safely administered with NS (normal saline .9%) solution or 5%D in water.

MONITORING AND SAFETY IMPLICATIONS

  • Lab monitorings include

Baseline coagulation studies: aPTT, PT, INR, clotting time

periodic CBC for blood counts

periodic urine and stool examination for occult blood

  • apply direct pressure for venipuncture site for long durations
  • Assess for any history of allergy for the patient
  • Monitor for any signs of side effects

PATIENT TEACHING

  • Educate regarding the increased risk of bleeding while taking inj clexane, monitoring for bleeding and management of bleeding
  • Instruct not to take any OTC medications without the consultation of the doctor
  • Patients who will self-administer it must be instructed on correct s/c administration technique
  • Instruct not to breastfeed while taking inj clexane

Let us join hands for safe administration of antithrombotics, to ensure the full benefit of the therapy with minimal potential harm.

 

 

 

 

your chest pain… is it simply a chest pain or a heart attack???

Image result for images angina pectoris

It’s a common topic of discussion these days,  about the chest pain and heart attack. Several videos and writings regarding the topic and how to manage it is flying through the social media daily. Yes, it is a serious thing. But, do you think every chest pain of yours is a heart attack?. I thought to share with you what is my knowledge on the topic.

 

A chest pain which is felt like pressing, squeezing, choking or bursting and radiating to the left hand, shoulders, and left side of neck and jaw could be a serious symptom of a heart attack. At the same time, it could be a minor attack of angina pectoris. So,

what is the difference between Angina Pectoris and Myocardial Infarction(MI)?

ANGINA PECTORIS

  • Angina Pectoris is a symptom
  • Anginal pain is expressed as squeezing, chocking type felt at the Sternum
  • Angina can be different types
  • Caused by a decrease in oxygen supply to the heart muscles or an increased demand of oxygen
  • Maybe precipitated by activity or can occur during rest
  • ECG change noticed – ST depression
  • Investigated with the help of Stress Test
  • Relieved by rest or administration of Nitroglycerine

MYOCARDIAL INFARCTION(MI)

  • MI is a medical emergency
  • The chest pain is expressed to be crushing and typically spreads from the heart to the left arm, shoulders, jaw, neck, and back
  • Caused by the damaged myocardial cells resulting from  myocardial infarction (lack of oxygen supply to myocardium)
  • ECG shows a T wave inversion and an ST segment depression or elevation
  • Investigated mainly by labs – cardiac enzyme levels
  • Not relieved by rest or any medicines. Needed supportive therapy with Oxygen, analgesics, and positioning

 

Do you get additional points to add? .Please comment in the comment box.

Have a happy, pain-free life …