Medication Administration Guidelines (MAGs) Via Christi Hospitals Wichita, Inc.

Generic Name Brand Name Patient Population Route of Administration SQ Enoxaparin Lovenox Adult Area for Drug Use (see below) 4 Standard Concentration and Solution Prefilled syringes: 30 mg in 0.3 ml syringe 40 mg in 0.4 ml syringe 60 mg in 0.6 ml syringe 80 mg in 0.8 ml syringe 100 mg in 1 ml syringe 120 mg in 0.8 ml syringe 150 mg in 1 ml syringe Dosing and/or Rate of Administration Administration is by subcutaneous injection in the abdomen at least 2 inches away from the naval. It is important to rotate injection sites with each administration. Prophylaxis: 30 mg SQ BID or 40 mg SQ daily Treatment: 1 mg/kg SQ BID or 1.5 mg/kg SQ daily (DVT/PE only) STEMI: May give 30 mg IV bolus with first dose of SQ for more rapid onset of action PCI: If therapeutic SQ enoxaparin given 8-12 prior to PCI then IV bolus dose of 0.3 mg/kg may be given Administration Considerations IV Line Requirements Special Flushing and Tubing Requirements Personnel Administration Requirements Extravasation Risk Onset of Action and Duration Dose Adjustment Recommendations N/A N/A N/A

IV Push

N/A Clinical Considerations Onset: 3-5 hours Duration: 12 hours For CrCl < 30 ml/min prophylaxis dosing is reduced to 30 mg SQ daily and treatment is reduced to 1 mg/kg SQ daily. Enoxaparin dose may be adjusted per anti-Xa level according to the Via Christi enoxaparin nomogram (PH-MED-62 Exhibit A) A baseline hemogram and Scr (or within the last 24 hours) should be obtained at enoxaparin initiation. Ongoing laboratory parametersinclude a hemogram and Scr twice weekly.

Monitoring Requirements

Laboratory Considerations Reversal Recommendations

Anti-Xa levels may be drawn in select patient populations where efficacy or toxicity is a concern. Consider an anti-Xa level in pregnant patients, patients with severe renal insufficiency, pediatrics or obese patients. Therapeutic anti-Xa levels are 0.5-1.0 for treatment doses of 1 mg/kg SQ BID or 1-1.5 for treatment doses of 1.5 mg/kg/daily. Therapeutic prophylactic anti-Xa levels are 0.2-0.5 for both 30 mg BID and 40 mg daily dosing. N/A Protamine sulfate and packed red blood cells can be given in the event of an enoxaparin overdose or major bleed. Protamine reversal is not complete (approximately 60%). If it is less than eight (8) hours since an enoxaparin dose, 1 mg of protamine should be given for every 1 mg of enoxaparin. If it has been 8 to 12 hours, then 0.5 mg of protamine per 1 mg of enoxaparin should be given. If it has been greater than 12 hours since the enoxaparin dose, protamine is not effective and should NOT be given. Only Via Christi approved protocols may be utilized for treatment with therapeutic enoxaparin. Do NOT expel air bubble at tip of syringe. Insertion or removal of an epidural catheter is not recommended while a patient is receiving enoxaparin. Avoid IM injection administration.

Other

Area for Drug Use: 1 = Intensive Care Units, Emergency Rooms, Code Blue, Cardiac Cath Labs, VC-SF: SPS. 2 = Cardiac Units, VCH-SF: 4SW, 4SE, 6CAD, 8SW VCH-H: 5W, 6E VCH-ST: 3E, 3N 3 = Operating Room Areas (Includes OR, Recovery, Pre-Anesthesia Care Unit), VCH-H: MOPS 4 = Hospital wide, cardiac monitor NOT required 5 = Hospital wide, cardiac monitor required 6 = Sedation. Use must be in accordance with the Via Christi Regional Medical Center Sedation Policy 7 = Rapid Response Team presence required All drugs should be administered by an infusion pump unless otherwise specified or ordered. Please see Clinical Pharmacology for full drug information. Abbreviations: MSTU: Medical/Surgical Transplant Unit (VCH-SF) ODCU: One Day Care Unit (VCH-SF) PALS: Pediatric Advanced Life Support Updated Name Stephanie Schroeder Tari Malmgren Taylor Gill Taylor Gill Taylor Gill

Date 12/17/2002 11/11/2005 10/14/2010 04/14/2011 04/11/2013