Patient with DVT is advised low molecular heparin. At which site nurse will administer this?

AIIMS Delhi NO- 2019

Pharmacology

Easy

Appeared in: AIIMS Delhi NO- 2019

Explanation

Low Molecular Weight Heparin (LMWH), such as enoxaparin, is specifically formulated for subcutaneous (SC) administration.
The SC route allows for slow and predictable absorption from the fatty tissue, leading to a stable anticoagulant effect with a longer duration of action.
This method enables outpatient management of DVT and reduces the need for frequent laboratory monitoring that is required with intravenous unfractionated heparin.
The abdomen is the most common site for administration because of its consistent absorption rate. The injection should be given in the anterolateral or posterolateral abdominal wall, avoiding the area around the umbilicus.

Option B: Intramuscular (IM) injection of heparin is contraindicated. Because the patient is being anticoagulated, an IM injection can easily cause bleeding into the muscle, leading to a large, painful hematoma and tissue damage.
Option C: Heparin is a large protein molecule that cannot be absorbed through the gastrointestinal tract. If taken orally, it would be broken down by stomach acids and digestive enzymes, rendering it ineffective.
Option D: While intravenous (IV) administration is used for anticoagulation, it is the standard route for unfractionated heparin (UFH), not LMWH. LMWH is specifically designed for subcutaneous use.

Clinical Relevance

Nursing practice connection: Use the key finding related to Route of Administration for Low Molecular Weight Heparin (LMWH) to guide bedside assessment, documentation, and the next nursing action.
Correct site selection and injection technique are critical for patient safety and medication efficacy. Injecting into a muscle (IM) can cause a severe hematoma, while improper SC technique can lead to poor absorption or skin irritation.
Patient education is a key nursing responsibility. Nurses must teach patients or their caregivers how to self-administer LMWH at home, including site rotation, proper disposal of sharps, and signs of bleeding to report.
What if the order was for 'heparin infusion' instead of 'low molecular heparin'? In that case, the nurse would prepare for a continuous intravenous (IV) infusion, likely with a loading dose, and would need to monitor the patient's aPTT levels closely, as this indicates unfractionated heparin therapy.

How to Approach the Question

First, identify the key medication in the question: 'low molecular heparin' (LMWH).
Recall the specific pharmacokinetic properties and standard administration route for this class of drug.
Analyze the options provided: SC, IM, Oral, IV. These are all possible routes for medications.
Evaluate each route in the context of LMWH. Rule out Oral because heparin is not absorbed in the gut. Rule out IM due to the high risk of hematoma. Differentiate between SC for LMWH and IV for unfractionated heparin.
Select the route that is standard, safe, and effective for LMWH, which is Subcutaneous (SC).

Concept Tested & Keywords

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