Venous Thromboembolism, Catheter-Related, CICU/CCU — Discharge Planning, for Enoxaparin, Refer to Case Management — Clinical Pathway: ICU and Inpatient

Venous Thromboembolism (VTE) Catheter-Related, Clinical Pathway — CICU and CCU

Discharge Planning for Enoxaparin, Refer to Case Management

Contact Cardiac Thrombosis Team at least 72 hrs before discharge to review follow-up plan.

Case Management
  • Contact as soon as it is identified that the child will be discharged on enoxaparin to avoid delays in discharge
  • Prescription insurance plans may require prior authorization which take up to 3 days to complete
Ordering Enoxaparin
  • Always round dose up to the nearest whole milligram
  • Order multidose vial with insulin syringes
Ordering Syringes
  • Include drug and administration recommendations with syringes
  • Drug available in multidose vial or pre-filled syringes; some pharmacies prepare syringes
  • If using multidose vial (300 mg/3 mL), order syringes (insulin or other) Include needle gauge, length
Using Insulin Syringes
  • Most common to use an insulin syringe
    • 31 gauge, 5/16 inch (8 mm) needle
    • 31 gauge, 15/64 inch (6 mm) needle
  • Insulin syringes are marked in units
  • Enoxaparin is given in mg, not units
    • 1 mg of enoxaparin is the same volume as 1 unit of insulin, therefore:
      1 unit measurement in an insulin syringe is = 1 mg of enoxaparin
  • Syringe volume sizes
    • 0.3 mL for doses < 25 mg
    • 0.5 mL for doses > 30 but < 45 mg
    • 1 mL for doses > 45 mg up to 100 mg
Manufacturers Pre-filled Syringes
  • Concentration 1 mg/mL for most pre-filled syringes
  • All brands have an attached 27 g, 1/2 inch needle
  • 30 mg, 40 mg syringes
    • No graduation marks on the barrel
    • Used for a dose that is fixed/not changing
  • 60 mg, 80 mg, 100 mg syringes
    • All syringes have graduation marks
    • Excess expelled to achieve ordered dose
      • e.g., 60 mg syringe, 12 mg discarded to administer 48 mg
  • 150 mg syringe
    • Rarely used in pediatrics
    • May be required for children with elevated BMI who require dose > 100 mg
Education
Follow-up
  • Include date, time and location for outpatient follow-up with written discharge instructions
  • Anti-Xa Level
    • 20 kg within 1-2 wks of discharge, then every 4-6 wks
    • < 20 kg within 1 wk, then every 4-6 wks
  • Obtain levels more frequently if bleeding, significant changes in weight or renal function occurs
  • Document the name and contact information of the Attending Physician responsible for outpatient enoxaparin management