Download Section: 2-1

Medications – Antithrombotic Therapy: Fragmin Administration
Strength of Evidence Level: 3
PURPOSE:
To provide guidelines for the safe administration of
injectable fragmin.
CONSIDERATIONS:
1. Fragmin injection is indicated for the prophylaxis if
ischemic complications in unstable angina and nonQ-wave myocardial infarction, when concurrently
administered with aspirin therapy.
2. Fragmin is also indicated for the prophylaxis of deep
vein thrombosis (DVT), which may lead to
pulmonary embolism (PE) in patients undergoing
hip replacement surgery, in patients undergoing
abdominal surgery who are at risk for
thromboembolic complications, and in medical
patients who are at risk for thromboembolic
complications due to severely restricted mobility
during acute illness.
3. Fragmin cannot be used interchangeably (unit for
unit) with unfractionated heparin or other lowmolecular-weight heparins.
4. Fragmin injection is contraindicated in patients with
active major bleeding or with known hypersensitivity
to the drug, heparin, or pork products, and should
be used with extreme caution in patients with history
of heparin-induced thrombocytopenia.
5. Fragmin, like other anticoagulants, should be used
with extreme caution in patients who have an
increased risk of hemorrhage; bleeding can occur at
any site during therapy. An unexpected drop in
hematocrit or blood pressure should lead to a
search for a bleeding site.
EQUIPMENT:
Gloves
Sharp’s container
Single-dose prefilled syringe Fragmin
PROCEDURE:
1. Adhere to Standard Precautions.
2. Identify patient and explain procedure.
3. Patients should be sitting or lying down and Fragmin
should be administered by deep subcutaneous (SC)
injection.
4. Fragmin may be injected in a U-shaped area around
the navel, upper outer side of the thigh, or the upper
outer quadrangle of the buttock. The injection site
should be varied daily.
5. When the area around the navel or the thigh is
used, using the thumb and forefinger, the patient
must lift up a fold of skin while giving the injection.
6. To ensure delivery of the full dose, do not expel the
air bubble from the pre-filled syringe.
7. The entire length of the needle should be inserted at
a 45-90 degree angle.
8. Dispose of sharps following agency procedure.
SECTION: 16.03
__RN__LPN/LVN__HHA
AFTER CARE:
1. Document in patient’s medical record:
a. Procedure and observations.
b. Instructions given to patient.
c. Patient’s response to procedure.
d. Communication with physician and caregiver(s).