Giving an Anticoagulant Shot to Your Child Using a Multi-Dose Vial: Care Instructions

Anticoagulants are often called blood thinners. They don't actually thin the blood. But they help prevent new blood clots from forming and help keep existing clots from getting larger. Some anticoagulant medicines are given as a shot (injection). Your child's doctor may have prescribed a type of anticoagulant called low-molecular-weight heparin, such as enoxaparin (Lovenox).

Anticoagulants can also make your child more likely to bleed. So it's important to take them safely. Have your child take medicines exactly as prescribed. Be sure to get and follow instructions about how to give this medicine safely. With care, you can help prevent bleeding and keep your child safe while letting them play and be active.

You will inject the medicine once or twice a day. The doctor will tell you how long you need to give the shots. At first, you may be nervous about giving your child a shot. But soon you'll be more comfortable giving the shot.

Important: If you need an anticoagulant for a newborn who was born early (premature) or who had a low birth weight, make sure your baby does not get one that contains benzyl alcohol. Anticoagulants usually contain benzyl alcohol as a preservative. The U.S. Food and Drug Administration (FDA) warns that benzyl alcohol has caused serious and fatal reactions in premature newborns and newborns who had a low birth weight.

Follow the doctor's instructions for how often to inject the medicine. You may need to give your child a shot once or twice a day. It is very important to give the shots at the same time each day.

When using a multi-dose vial, follow these steps.

1. Check the medicine in the vial. Look for a change in color, cloudiness, or something floating in it. Also check the expiration date.
   • Do not use the medicine if you think it looks different.
   • Contact your doctor or pharmacist if you are not sure if the medicine is safe to use.
2. Gather the medicine vial, a small (tuberculin) syringe, and an alcohol wipe.
3. Remove the cap from the vial. Clean the rubber stopper on top of the vial with an alcohol wipe.
4. Remove the tuberculin syringe from its package. Do not use a syringe from an already opened package or a package with holes in it.
5. Take the cap off the needle. Pull back the plunger, drawing air into the syringe. The amount of air should be the same as the amount of medicine your doctor has prescribed for your child.
6. Push the needle into the rubber stopper of the vial. When the needle is through the stopper, push the plunger on the syringe so that the air goes into the vial.
7. Keep the needle in the stopper and turn the vial upside down.
8. Keep the tip of the needle in the liquid and pull back on the plunger. The medicine will flow into the syringe.
9. Fill the syringe to your child's prescribed dose amount.
   • If you get too much, push some medicine back into the vial with the plunger.
   • If you did not get enough, keep pulling on the plunger.
10. Check for air bubbles in the syringe.
    • If you see air bubbles in the syringe, gently tap the syringe while the needle is still in the stopper. The air bubbles will move to the top of the syringe. Then push the plunger slightly, and the air will go back into the vial.
11. Check to make sure the syringe contains the prescribed amount of medicine. Then pull the needle out of the vial.

1. Wash your hands with soap and running water for at least 20 seconds. Dry them well.
2. Choose a place on your child to give the shot. Use a place where there is enough fatty tissue under your child's skin to pinch a fold of skin. Typical places are the backs of the upper arms, the upper thighs, or the belly. For the belly, choose a spot that is at least 2 inches off to the side of the belly button.
3. Use alcohol to clean the skin before you give the shot. Let it dry.
4. Remove the cap from the needle. Hold the syringe like a pencil close to the site, keeping your fingers off the plunger.
5. With one hand, slightly pinch a fold of skin between your fingers and thumb.
6. With the other hand, place the syringe at a 45-degree angle to the shot site. This angle helps you insert the needle into the fatty tissue under the skin. You might also be taught to place the syringe at a 90-degree angle to the shot site, standing straight out from the skin.
7. Quickly push the needle all the way into the pinched-up fold of skin.
8. Push the plunger of the syringe all the way in so the medicine goes into the fatty tissue.
9. Be sure to hold the skin fold as you give the shot. This will help make sure you do not inject the medicine into muscle.
10. Take the needle out at the same angle that you inserted it. Let go of the skin fold.
11. If the site bleeds a little, apply pressure over the shot area with your finger, a cotton ball, or a piece of gauze. To help avoid bruising, do not rub the area.
12. Follow the manufacturer's instructions for safely disposing of the needle and syringe. Don't use the same needle more than one time.
13. Ask your child's doctor or nurse if and when you should give the shot in different places on your child's body (rotate injection sites).
14. Record the site, date, and time of each injection.

• Call your doctor if you think your child is having a problem with a medicine.
• Talk to the doctor before you start or stop giving your child any medicines, vitamins, or natural remedies. This includes prescription and over-the-counter medicines, including pain relievers such as ibuprofen (Advil, Motrin). Medicines may affect how blood thinners work.
• Have your child wear medical alert jewelry. This lets others know that your child takes a blood thinner. You can buy it at most drugstores.
• Tell your child's doctors, dentist, and pharmacist that your child is taking a blood thinner. Also tell the people who care for your child, such as relatives, babysitters, and the school nurse. Let them know what to do if your child has a cut or bruise and when to call for help.

• Contact the doctor if you miss a dose and are not sure what to do. Your doctor can tell you exactly what to do so your child does not take too much or too little blood thinner. Then your child will be as safe as possible.
• Here are some general rules for what to do if your child misses a dose.
  • If you remember it on the same day, give your child the missed dose. Then go back to your regular schedule.
  • If it is the next day or is almost time to take the next dose, do not give your child the missed dose. Do not double the dose to make up for the missed one. At the next regularly scheduled time, give the normal dose.
  • If your child misses a dose for 2 or more days, contact the doctor.
• To help you stay on schedule, use a calendar or your phone to remind yourself when to give your child a shot. Note when you give the medicine.

• Keep the medicine at room temperature.
• Throw the vial away 28 days after the first use, even if there is medicine left.