How to inject enoxaparin at home

When you have a deep vein thrombosis, you may notice any of the following signs in one or both legs:

• Pain or tenderness in the calf or thigh. 
• Swelling, redness, or skin colour changes. 
• Warmth in your calf or leg.

You are much more likely to notice something is wrong if you have a blood clot in your lungs (PE). You may notice one or more of these signs:

• Chest pain.
• Shortness of breath. 
• Coughing or coughing up blood.
• Racing heartbeat or fast pulse. 
• Rapid breathing.
• Tiredness.
• Feeling feverish (temperature above 38.3°C).

If you think you may have a DVT or PE, contact your doctor immediately for advice.

Note: There are different brands of enoxaparin, the below instructions are for the Inhixa® brand. If these instructions are different from those your nurse or doctor has given you, please follow their advice or the instructions included with your product.

1. Wash your hands with soap and water. Dry them thoroughly.
2. Sit or lie in a comfortable position so that you can see the part of your stomach where you are going to inject. It may help if you can prop yourself up with cushions or pillows, either on a bed or in an armchair. Make sure that your safety bin (sometimes known as a ‘sharps bin’) is within reach.
3. Choose an area on either the left or the right side of your stomach. This should be at least 5cm away from your belly button and out towards your sides.
   Remember: Do not inject yourself within 5cm of your belly button or around existing scars or bruises. Change the place where you inject each day between the left and right sides of your stomach, depending on the area you last injected.
4. Remove the plastic blister containing the pre-filled syringe from the box. Open the blister and remove the pre-filled syringe
5. Carefully remove the protective cap from the end of the syringe, taking care not to bend the needle. Throw the needle cap away in your safety bin; you will not need it again. The syringe is pre-filled and ready to use.
6. Do not press on the plunger before injecting yourself. Once you have removed the cap, do not allow the needle to touch anything. This is to make sure the needle stays clean (sterile).
   Make sure you hold the skin fold throughout the injection.
7. Hold the syringe in the hand you write with (like a pencil). With your other hand, gently pinch the area of your abdomen between your forefinger and thumb to make a fold in the skin.
8. . Press down on the plunger with your thumb. This will inject the medicine into the fatty tissue of the abdomen. Make sure you hold the skin fold throughout the injection.
9. Remove the needle by pulling it straight out. Do not release the pressure on the plunger.
   To avoid bruising, do not rub the injection site after you have injected yourself
10. Push hard on the plunger. The needle guard, which is in the form of a plastic cylinder, will be activated automatically and it will completely cover the needle.
11. Drop the used syringe into the sharps container. Close the container lid tightly and place the container out of reach of children. When the container is full, dispose of it as instructed. Do not put it in the household rubbish. If you require an additional bin, please contact your GP surgery

As with all medicines, enoxaparin can have side effects in some people. Please see the patient information leaflet supplied with your injections for more advice on possible side effects. 

The most common effect is that you may be more susceptible to bruising and bleeding than usual. You may also notice mild irritation or other reactions of the skin on your stomach where you have been injecting. These might include redness, pain, small hard bumps (known as nodules) or bleeding into the skin (sometimes called a haematoma).

These effects may be caused by your injection and may occur some time after an injection. There may also be a sign of infection; if you notice redness, puffiness, warmth, skin discolouration or oozing of the skin near a previous injection, you should contact your nurse or doctor straight away. 

If you notice any of the following effects, please contact your nurse or doctor at once:

• Bleeding from your surgical wound.
• Any other bleeding – for example, from the skin where you have injected, nosebleeds, blood in your urine (pink or dark brown), blood in your stools (bowel movement), black tarry stools, or if you cough up blood.
• Unusual bruising not caused by a blow or any other obvious reason.

You should also tell your nurse or doctor if: 

• You have a serious fall or head injury.
• You notice any other unusual symptoms.

Another issue to look out for is heparin-induced thrombocytopenia (HIT). Enoxaparin contains heparin, which in rare cases, can cause a fall in platelets. This typically occurs 5 to 10 days after starting treatment with enoxaparin.

Platelets are a component of blood which are involved in blood clotting to stop bleeding. When there are too few in the blood, this is termed thrombocytopenia and this results in an increased risk of bleeding.

Signs of heparin-induced thrombocytopenia include:

• Weakness or numbness in the arms or legs.
• Pain, tenderness, redness, or swelling of the arms or legs.
• Flushing, black, reddish, or bluish discoloration of the skin, or a rash or skin sores in the area where the enoxaparin injection was given.
• Chest pain or tightness, or fast or troubled breathing.
• Fever, chills or sweating.
• Slurred speech, increased sleepiness, or problems seeing, talking, thinking or remembering.

If you think you may be affected by HIT then contact your doctor immediately for advice. A blood test can then be performed to check if this is occurring.

• Do make sure you keep holding the fold of skin on your abdomen until you have completely finished your injection. This will help ensure that the medicine goes into the fatty tissue rather than muscle, which could bruise. 
• Do alternate the side on which you inject – right one day, left the next.
• Do make sure you put your used syringes into the safety bin each time you inject – never leave a used syringe lying around. 
• Do follow the advice of your nurse or doctor when using your enoxaparin injections.
• Do try and carry out your injection at the same time every day. Do look for unusual signs of bleeding, and get assistance if these occur.

• Don’t put the syringe down anywhere or touch the needle with anything before you inject – this will help reduce the risk of infection. 
• Don’t twist off the needle cap, as this could bend the needle. 
• Don’t inject into bruised or scarred skin or anywhere that might be rubbed by clothing. 
• Don’t rub the skin after you have injected, as this can cause bruising. 
• Don’t let anyone else use your enoxaparin syringes. 
• Don’t put enoxaparin in the fridge or freezer – keep it at room temperature. 
• Don’t take any of the following medicines while you are using enoxaparin without discussing it with your nurse or a doctor first. (Note that these medications can be used after surgery so check if this is okay with your doctor or nurse): 
  aspirin, or anything containing aspirin, pain relievers known as non-steroidal anti-inflammatory drugs (NSAIDS, such as ibuprofen).
• Don’t use enoxaparin if you are allergic to enoxaparin or heparin.

If you have any concerns or worries you should contact the ward you were discharged from and ask to speak to the nurse in charge. You should be given a contact number when you are discharged from hospital. Alternatively, contact the hospital switchboard on 0117 950 5050 who will be able to put you through to the ward.

If you have not already been advised by your nurse or doctor that this is okay, then you should contact your nurse or doctor for advice.

You should ask your nurse or doctor for advice.

Unused syringes should be kept in a safe place out of reach of children. Keep them at room temperature, in the box provided and away from light and moisture.

The syringe normally contains an air bubble. You do not need to do anything to remove the air bubble before you inject.

You should contact your nurse or doctor for advice.

You should contact your nurse or doctor for advice.

You can read the patient information leaflet in the enoxaparin box.

Put used syringes (with the needle point facing down) into the safety or sharps collection bin you have been given. Always keep this out of reach of children. Never throw a safety bin away with your other household waste.

Collection of your used safety bin can normally be arranged with your local council. This depends on your local council:

For Bristol City Council 

Email: waste.services@bristol.gov.uk 

Phone: 0117 922 2100

For South Gloucestershire

You can complete an online form to request a sharps collection: Dispose of clinical and medical waste | BETA - South Gloucestershire Council (southglos.gov.uk)

Phone: 01454 868 000

For Bath and North East Somerset Council 

You can complete an online form to request a sharps collection: Clinical or sharps waste | Bath and North East Somerset Council (bathnes.gov.uk)

Phone: 01225 394041

For North Somerset

You’ll need to contact your doctor to ask for a sharps collection.

Email: clinicalwaste@n-somerset.gov.uk 

If you live outside these council areas please contact your GP practice or local community pharmacy for advice on clinical waste collection.