A guide on how to give your child enoxaparin injections.
Key points
Enoxaparin is an anticoagulant (blood thinner).
Enoxaparin helps prevent unwanted blood clots or existing clots from getting bigger.
It is given for as long as your child needs it.
Enoxaparin can be injected into the thigh or upper arm (for infants older than four to six months).
It comes in two forms: a multi-dose bottle and pre-filled syringes.
You will be given a prescription for the right size of syringes if using the multi-dose bottle. They are called insulin syringes and come in sizes of 30 units (3/10 mL), 50 units (1/2 mL) and 100 units (1 mL). The size of the syringe depends on the prescribed dosage.
Enoxaparin does not require refrigeration and can be kept at room temperature.
Once opened, the multi-dose bottle can be used for up to 28 days.
1 unit on the insulin syringe = 1 mg of enoxaparin.
Introduction
What is enoxaparin?
Enoxaparin is a blood thinner (anticoagulant). It works by changing the normal way cells in the blood clump together. It helps prevent unwanted blood clots or existing blood clots from getting bigger.
About the treatment
What to expect before going home
You will be given information that explains why your child is taking enoxaparin.
The nurse or pharmacist will teach you how to give your child the enoxaparin injections. They will help you learn to give your child enoxaparin by yourself before you go home. Please note that the syringes used at the hospital may look slightly different from the ones you will pick up from a pharmacy.
You will be given a prescription for enoxaparin.
You will be given a prescription for either the multi-dose bottle and insulin syringes or pre-filled syringes. The insulin syringes come in sizes of 30 units (3/10 mL), 50 units (1/2 mL) and 100 units (1 mL). The size of syringe you will need depends on your child’s dosage.
Your child's health-care team will arrange follow-up clinic appointments. The dates and the times should be on your discharge instructions or you will receive notification of the appointments by phone or through the mail.
How long will your child need to take enoxaparin?
Your child’s thrombosis team will decide how long your child needs to take enoxaparin, depending on the reason for your child’s treatment.
To decide when to stop your child’s treatment, the thrombosis team may do follow-up imaging tests, such as an ultrasound, MRI, echocardiogram or a CT scan.
Keeping track of blood work results
You will discuss where and when the blood work will be done with your child's health-care team and with the thrombosis team.
Treatment
Storing enoxaparin
Enoxaparin does not require refrigeration and can be kept at room temperature (less than 25°C). Once you open the multi-dose bottle, it can be used for up to 28 days. After 28 days, the bottle must be thrown away, even if there is still medicine in it.
Pre-filled syringes are single use only.
How much to give
Doses can be administered no sooner than 10 hours apart, and no later than 14 hours between doses.
Enoxaparin is available in several different strengths. The dosing information below applies to the 100 mg/mL (3 mL) multidose bottles.
Enoxaparin is usually injected using insulin syringes that are specially designed for injections into the skin. It is important to note that the volume is measured in "units" on an insulin syringe, and that one unit on the insulin syringe is equal to 1 mg of enoxaparin.
Your child has been prescribed _______ mg of enoxaparin for each dose. This dose is equivalent to _______units on an insulin syringe.
Drawing up enoxaparin from a multi-dose bottle
Before giving your child enoxaparin, you first need to draw up the medicine from the bottle. Make sure to check the date on the medication bottle to make sure it has not expired.
You will need:
Enoxaparin bottle (100 mg/mL)
Insulin 30 unit (3/10 mL), 50 unit (1/2 mL) or 100 unit (1 mL) syringe, depending on the dose. Use only insulin syringes. You must use a new needle and syringe each time.
Alcohol swab
Cotton ball
Sharps container
Precaution
Make sure that the concentration of the enoxaparin is 100 mg/mL and that you check that you are using the correct size of syringe for your child’s dosage. Take a look at the pictures below. If you are unsure if the size of the syringe is correct, contact your pharmacy or your child's thrombosis team.
Out-patient insulin syringes: Enoxaparin dosingThe syringe your child is prescribed will depend on their dosage of enoxaparin. Because the syringes look very similar, it is important for you to double check the type of syringe you have before giving enoxaparin to your child.
To draw up enoxaparin:
Wash your hands.
Clean the rubber stopper on the medicine bottle with an alcohol swab. Wait 30 seconds for the alcohol to dry.
Remove the cap from the needle and syringe. Put the needle through the rubber stopper on the medicine bottle at 90 degrees.
Turn the bottle upside down with the syringe in it. Ensure the tip of the needle is in the solution.
Slowly pull down on the plunger of the syringe until you have a bit more than the required number of units. If you have trouble pulling out the medicine, inject a bit of air into the bottle, and try again.
Check the syringe for any air bubbles. Tap the syringe to make any air bubbles float to the top.
Slowly push up on the plunger to the desired amount. If you have pushed out too much, pull back again on the syringe to the correct volume. Recheck for air bubbles.
Lift off the medicine bottle from the syringe. Be sure not to touch the exposed needle to any surfaces. It is now ready to be given to your child.
Pre-filled syringes
Pre-filled syringes come in many dosage strengths.
30 mg/0.3 mL
40 mg/0.4 mL
60 mg/0.6 mL
80 mg/0.8 mL
100 mg/mL
Your child may be prescribed a pre-filled syringe if they are receiving one of the doses above and/or for ease of administration.
Note: The needle size on the pre-filled syringes is larger than on the insulin syringes and may not be suitable for very small children.
Where to inject enoxaparin
Subcutaneous injection with insulin syringe (90-degree angle)Subcutaneous injection with insulin syringe (45-degree angle)
Enoxaparin is injected into the fatty layer just below the skin. This is called the subcutaneous (SC) layer. Safe areas of injection are: thighs and upper arms. Do not use the buttocks.
Thigh injection site
Thighs: Top front side and outer parts of thigh only. Do not use the inner thigh or back of the thigh. Divide the thigh into thirds; the injection site is in the middle third section.
Upper arms injection site
Upper Arms: Fatty area on the side and back of the arm. This site is only for children older than four to six months. Divide the upper arm into thirds; the injection site is in the middle third section.
Abdominal injection site
Abdomen: Inject at least 2 inches to the right, left or bottom of the belly button. Avoid areas near the waistband.
More information about the treatment
When giving your child the injection
Choose the injection spot. Clean the skin with soap and water (you do not need to use alcohol swab). 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.
Gently squeeze up a well-defined fold of skin and fat with the thumb and index finger.
Hold the shaft of the syringe in a dart fashion, insert needle directly through the skin at a right angle (90-degree angle) quickly just into the fatty layer. The needle can be inserted at a 45-degree angle in areas that have little subcutaneous fat.
Move hand into position to direct plunger. Do not move needle tip once it is inserted.
Give drug slowly to reduce stinging, firmly push plunger down as far as it will go.
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.
Apply firm pressure with a cotton ball to the injection site for three to five minutes following each injection to reduce the chance of bruising. Do not rub the area as it may irritate the skin.
Put the needle and syringe in a thick, plastic bottle or sharps container with a lid. This is for safety. When the 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.
Complications
While your child is taking enoxaparin
Your child may bleed and bruise more easily.
Please check with your child's health-care team about what activities your child is allowed. Contact sports are not recommended.
Your child may need to wear a medical alert bracelet if on this medication for a long time. You can discuss this with your child's health-care team.
When to seek medical attention
When should you call your child’s health-care team or thrombosis team?
Call your child's health-care team or thrombosis team if your child:
hits their head or has a fall
has bruises that are large or cannot be explained
has a nose bleed that is hard to stop
has bowel movements that are black or red
has new bleeding from gums when brushing the teeth
will be having any medical or dental procedures or surgeries
At SickKids
At SickKids
The Thrombosis Team
The Thrombosis Team at The Hospital for Sick Children operates 24 hours a day, seven days of the week to respond to urgent calls from families of children and teens. If you need immediate attention, please call (416) 813-7500 and ask the switchboard operator to page the Thrombosis team member on call.
The Thrombosis Nurse Coordinator will arrange Thrombosis clinic appointments and call you with the dates and times. Families may call (416) 813-5859 (Thrombosis Clinic) if they have not heard from the coordinator within two to three weeks after leaving the hospital with an appointment time.
Keeping track of blood work results
Blood tests can be done at SickKids. You will discuss where and when the blood work will be done with the Thrombosis Nurse. Please call the Thrombosis Nurse in one week after discharge to arrange next blood work.
Notify the Thrombosis Team on the day your child has had blood work done by calling the Thrombosis Nurse at (416) 813-8514 on Monday to Friday. The Thrombosis team will call you when they have received the results and will let you know if anything needs to be changed. You should receive a call from the Thrombosis Team whether or not changes are required.
Resources
Personal stories about the use of low molecular weight heparins
Two families share their experiences with using low molecular weight heparins. This video will help to answer any questions you may have if you or someone you know will be taking this medication.
