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View Full Version : Blood Clot and Giving Shots


Smokin Joe
02-23-2005, 19:29
My wife just developed a spontanious blood clot in her superfical femoral. The Mother F**king E.R. missed it too. :mad:

I have to give her 5 shots of Lovenox (enoxaparin sodium injection) as well as she is now on cumiden (sp?).

Tonight I gave her the shot in her left abdomen. She complained of some pain during and after the shot. She can be a whimp when it comes to pain. But to make sure I'm not screwing up I figured I would ask you all.

Here is a pic of the syringe I used. I disinfected the area and placed the needle about half way in at a 45 degree angle.

What tips do you have for giving shots?

NousDefionsDoc
02-23-2005, 20:50
1. The Doc told you to give it to her in the abdomen?
2. Are you using alcohol to disinfect?
3. You are doing fine. You want to insert with the bevel of the needle up where you can see it and aspirate (pull back on the syringe a bit like when you put the drug in the syringe) to make sure you aren't in a vessel. You don't need to pull it hard. If you don't get any blood in the syringe, you're good to go. If you do, pull it out a bit and change the direction and try again. Don't worry about the blood, you can inject it back in.

There's not much you can do about the pain.

Sacamuelas
02-23-2005, 21:32
Luvenox is brandname form of heparin. It is given subcutanous... you dont' have to give it "deep" as you are going for the fat layer just under the skin but not all the way into the muscle and vasculature. For best results, give her the shot at the same time(s) each day, as prescribed by your doctor. She is on both heparin and coumadin for the same reasons, yet the coumadin takes a while to take effect therefore the heparin is used for immediate results. See MAB32 cardioversion thread as this is being discussed in that thread as well.

My HH6 was put on heparin when on strict bedrest for several weeks during her pregnancy.

AS NDD stated, aspiration is always a good idea, but it looks like you have a fairly short needle on your little kit so you shouldn't be into the vascular layer under the fat. Also, depending on the gauge of the needle, it may be so small a lumen that a red blood cell can't actually be pulled up into the carpule portion so aspirating may be unnecessary and a waste. Here is what I would do and had to do with my wife:

Squeeze an inch of skin between your thumb and two fingers, pulling the skin and fat away from the underlying muscle. (If you use a 5 millimeter needle to inject, you don't have to pinch up the skin when injecting at a 90 angle; with this shorter needle, you don't have to worry about injecting into muscle.)
insert the needle
Hold the pinch so the needle doesn't go into the muscle.
Push the plunger in to inject in the heparin.
Release the grip on the skin fold.
Remove the needle from the skin.

Good luck and my sympathy to your wife for having to have Mr. Heavy hands aka Torguewrench Joe perform medicine on her after your display with the aimpoint mounts. ;) LOL

Smokin Joe
02-23-2005, 23:24
Squeeze an inch of skin between your thumb and two fingers, pulling the skin and fat away from the underlying muscle. (If you use a 5 millimeter needle to inject, you don't have to pinch up the skin when injecting at a 90 angle; with this shorter needle, you don't have to worry about injecting into muscle.)
insert the needle
Hold the pinch so the needle doesn't go into the muscle.
Push the plunger in to inject in the heparin.
Release the grip on the skin fold.
Remove the needle from the skin.

Good luck and my sympathy to your wife for having to have Mr. Heavy hands aka Torguewrench Joe perform medicine on her after your display with the aimpoint mounts. ;) LOL

I disinfected with an alcohol wipe, let it dry, then preformed the above by the numbers tonight but forgot to place it in the original post. However I did not aspirate

I would guess that the needle is approximately 10mm long so rough estimate is I placed 5mm into the abdomen, and the Doc directed me to give them to her in her abdomen, even though I sort of pushed for the arm or butt. But he wouldn't hear of it and said they could only be given in the abdomen.

Thanks for the sympathy Saca I feel for her too. The Doc originally wanted her to give the shots to herself (Ya, right) so I had to step up. I'm an all the way type of guy (you know do or do not there is no try) so its difficult for me to preform finess tasks such as giving shots....I need one of those air gun thingys to give shots.

In the future I might try and aspirate just to make sure that I'm good to go but I feel bad using her as a pin cushin. Hell it would be easier to do it to myself then to my wife.

Thank you for the help and feed back guys. It makes me feel more confident in what I have to do.

ccrn
02-24-2005, 09:41
The shots can be administered into the abdomen as previously advised. Make sure you rotate sites on the abdomen never administering any closer than one inch to the umbilicus.

I have run into surgeons who insist on low weight molecular heparin being given into the leg as shown. I would consult your Doc to see if this is ok. Rotate legs if you are to do this.

Aspiration is typical of intramuscular injections (IM route) and is not necessary with SubQ (subcutaneous) but cant hurt-

Roguish Lawyer
02-24-2005, 13:30
I gave myself allergy shots for an extended time period. Administered in the thigh. Found that it was easier if I just popped the needle in fast, but without slamming my leg. Prepped area with alcohol swab.

Smokin Joe
02-24-2005, 13:58
One of our nurses suggested using ice on the area before the injection to cut down on the pain. Any opinions?

Sacamuelas
02-24-2005, 14:11
Joe-
As I am sure you know, to do any good the ice has to be on the area for a pretty fair amount of time to give you anesthesia... THAT would hurt as much or more than a little stick from the micro needle, IMO.

Use some distraction techniques on her, rub an alchohol swab on a completely different area on her abdomen... let her mind "sense" the tingling from the alchohol as it evaporates and then give your injection while her mind is distracted to the other area. Talk to her, calm her down, get her less tense before the injection... 99% of what she is feeling is due to her anxiety not the shot. Find something that gets her mind off what you are doing...

alphamale
02-24-2005, 14:47
Joe,

What were the symptoms of the blood clot?

Hopes she's lots better soon.

FrontSight

ccrn
02-24-2005, 17:44
Found that it was easier if I just popped the needle in fast, but without slamming my leg.

Very good point and sorry I missed it.

The faster the needle goes in the less painful. This goes goes IM injections especially.

The preferred method is to "dart" the shot in ,with not letting go of course-

Roguish Lawyer
02-24-2005, 18:36
Very good point and sorry I missed it.

:lifter LMAO

Eagle5US
02-24-2005, 18:47
I'm 3 months past my double Pulmonary Emboli-
had to do the Lovenox for the first 2 months, twice a day in the tummy.
The longer I did it, the more "poke sensitive" my belly got. It seemed to just get worse over time.
Not to mention all the nickle sized bruises that were coming up after about 3 weeks every time I injected myself.
Once her coumadin levels stabilize, she will be able to stop the injections. Keep close track on the "eats" and "do not eats"-it makes HUGE variances in the coumadin measurments.

Best of luck to her...it won't be forever.

Eagle

Smokin Joe
02-24-2005, 20:40
Joe-
As I am sure you know, to do any good the ice has to be on the area for a pretty fair amount of time to give you anesthesia... THAT would hurt as much or more than a little stick from the micro needle, IMO.

Use some distraction techniques on her, rub an alchohol swab on a completely different area on her abdomen... let her mind "sense" the tingling from the alchohol as it evaporates and then give your injection while her mind is distracted to the other area. Talk to her, calm her down, get her less tense before the injection... 99% of what she is feeling is due to her anxiety not the shot. Find something that gets her mind off what you are doing...


Good call.....I'll just hold a Taser on her Junglar that should take her mind off of the shot. :lifter

Acutally tonight we used the ice and she said it helped a lot. I also think she was more "prepared" mentally.


Joe,

What were the symptoms of the blood clot?

Hopes she's lots better soon.

FrontSight

Moderate Rant to follow:

Feb 14th she started experiencing a cramping type pain in her left calf. Feb 15th she had moderate swelling.

Feb 16th She asked me WTF I thought and for some off the wall reason (God must have been looking out) I said its probably a blood clot. The extent of my med training is a wilderness first responder class about 4 years ago. So there is absolutely ZERO logical reason for me to guess that.

Next day she went to a walk-in clinic because the pain was getting worse and she couldn't get into see our Doc for a few days. The clinic Doc took one look at her leg, asked her to flex it, then sent her packing to the E.R. The E.R. did a sona-gram (sp?) and screwed the Pooch by telling us that it was a minor clot in a superfical vein and there wasn't really anything they could due to treat it.

Feb 18th we saw our Doc (who is an internist (sp?)). We go over what the E.R. did. He doesn't agree with how they treated her but conceded that being superfical there wasn't much they could do but they could have done something. He leaves the room for about 20 mins (Hmmm thats weird is ususally back faster than that) He had review the results of the sona-gram. Come to find out....its in the SUPERFICAL FEMORAL!!! which is a Deep vein hell I failed college A&P (twice) even I know the superfical femoral is a major deep vein. But a dumb ass himpy E.R. Doc missed it???

I'm 3 months past my double Pulmonary Emboli-
had to do the Lovenox for the first 2 months, twice a day in the tummy.
The longer I did it, the more "poke sensitive" my belly got. It seemed to just get worse over time.
Not to mention all the nickle sized bruises that were coming up after about 3 weeks every time I injected myself.
Once her coumadin levels stabilize, she will be able to stop the injections. Keep close track on the "eats" and "do not eats"-it makes HUGE variances in the coumadin measurments.

Best of luck to her...it won't be forever.

Eagle


Hopefully we only need to do this series of shots (which is only 5). After that the Doc said the coumadin should be in full swing.

Please excuse the knuckledragger in me but what do you mean by coumadin measurements? Like the bloods ability to clot or not? Also besides Vitamin K and green leffy veggies are there any or "Do Not Eats?"

Thanks again everyone for the help and Info it has defiently helped.

Eagle5US
02-24-2005, 21:20
Hopefully we only need to do this series of shots (which is only 5). After that the Doc said the coumadin should be in full swing.

Please excuse the knuckledragger in me but what do you mean by coumadin measurements? Like the bloods ability to clot or not? Also besides Vitamin K and green leffy veggies are there any or "Do Not Eats?"

Thanks again everyone for the help and Info it has defiently helped.
Your Coumadin clinic should be able to provide you a pamphlet with all the side effects of certain foods. The blasted thing is a small book.
Online searches seem very generalized, but my hemotology bubbas are adamant about my diet. Seems to be doing OK-levels have been stable for awhile now.
If you can't get ahold of anything, let me know and I will send you mine.

She should be going in for INR testing to determine her Protime (PT). This level is the effect the coumadin is having on her ability to clot. For example, I cut my fetchin finger the other day (small cut) and it bled for about 4 hours. Effect of coumadin :D

The protien cascade that is required to activate my clotting factors is measured by the coumadin clinic and expressed as my INR. She should be doing the same thing either now or in the very near future. Once she stabilizes, they may lengthen the time between coumadin clinic checks.

My absolute best to her...be sure to keep her safe, I bruise like a blasted grape.

Eagle

Smokin Joe
02-25-2005, 10:29
Great I can't wait for this :rolleyes:

Thanks for the info Eagle I will be a real pain in our Doc's ass for the next couple of months. :D

Penn
01-11-2017, 16:31
Fun with DNA, allergic to Haparin.....Having had a L/Femoral artery bypass, I realized the swelling and pain in my R/Calf was familiar and possibly a blood clot, called a local Dr/client who order a Sonogram.
Proof positive sent to the ER. Examined and prescribed meds: Xarelto $536.00 for 42 15mg tablets also with the same prescription Warafan 5mg

Question? Is it usual to order two types of meds to treat the same condition?

doctom54
01-11-2017, 18:43
You can use Xarelto (rivaroxaban) as solo therapy to treat acute DVT. It is dosed 15 mg twice daily for 21 days (then it changes).
There is NO reason to take Coumadin (warfarin) with it. Warfarin is not therapuetic for several days at best and if used to treat DVT something quick like low molecular weight heparin used until the warfarin is therapeutic. I'd just use the Xarelto and follow up with your PCP.

Penn
01-11-2017, 19:42
doctom54
Thank you for the insight, my question really was if Warfarin is therapeutic @$20, why the Xarelto @ $536.

Being clot prone, I was on a PM program of Warfarin for 7 years, and my PCP ended it about a year ago. But, I think it was the long non-stop drive from Bragg to NJ that is the culprit this time.

doctom54
01-11-2017, 20:18
IF you are going to be on it for more than 6 months then warfarin (Coumadin) is cheaper per pill, but when you figure in the frequent testing warfarin requires then there isn't as big a difference overall (however if your insurance pays for testing but not Xarelto then warfarin is a much better deal for you).

Feel free to message me if needed/wanted.

ender18d
01-20-2017, 12:27
They have actually renamed the vein the "common femoral vein" because this is not the first time this has happened that someone read an ultrasound report and misunderstood "superficial." Just talked about it in conference the other day actually.

Sorry that this happened and best wishes for a speedy recovery!

Red Flag 1
01-21-2017, 09:45
I'm paying $20.00 for a 90 day supply of Xarelto thru Express scripts.

My only worry is if I develop a bleed somewhere, GI for example.

Penn
01-22-2017, 01:19
Red Flag1 Express scripts info please, my insurance will not cover Xrealito.

Red Flag 1
01-24-2017, 16:59
Red Flag1 Express scripts info please, my insurance will not cover Xrealito.

PM inbound.