A guide on giving your child tinzaparin injections at home. Also learn when to call your thrombosis team.
Key points
Tinzaparin is a blood thinner (anticoagulant).
Tinzaparin helps prevent unwanted blood clots or existing blood clots from getting bigger.
It is given for as long as your child needs it.
It can be injected into the thigh, upper arm and abdomen.
You will be given prescriptions for the right size of syringes. They are called insulin syringes and come in sizes of 30 units (3/10 mL), 50 units (1/2 mL) and 100 units (1 mL). The size of the syringe depends on the prescribed dosage.
Tinzaparin does not require refrigeration and can be kept at room temperature.
Once opened, the bottle can be used for 30 days only.
1 unit on the insulin syringe = 200 units of tinzaparin.
Introduction
What is tinzaparin?
Tinzaparin is a blood thinner (anticoagulant). It works by changing the way blood normally clots together. It helps to prevent unwanted blood clots or existing blood clots from getting bigger.
Tinzaparin comes as a clear liquid for injection.
About the treatment
What to expect before going home
You will be given information that helps to explain why your child is taking tinzaparin.
The nurse or pharmacist will teach you how to give your child the tinzaparin needles. We will help you be able to give your child’s tinzaparin needles by yourself before you go home. Please note that the syringes used at the hospital may look slightly different from the ones you will purchase from a pharmacy.
You will be given a prescription for tinzaparin.
You will be given a prescription for the right size of syringes. They are called insulin syringes and come in sizes of 30 units (3/10 mL), 50 units (1/2 mL) and 100 units (1 mL). The size of the syringe you will need depends on your child’s dosage.
The medical team will arrange follow-up clinic appointments. The dates and the times should be on your discharge paperwork or you will receive notification of the appointments by phone or through the mail.
How long will your child need to take tinzaparin?
Your child’s thrombosis team will decide how long your child needs to take tinzaparin depending on the reason for your child’s treatment.
To decide when to stop your child’s treatment, the doctor may do follow-up imaging tests, such as an ultrasound, MRI, echocardiogram, or a CT scan.
Keeping track of blood work results
You will discuss where and when the blood work will be done with the medical team.
Treatment
Storing tinzaparin
You do not need to store tinzaparin in the fridge. You can keep it at room temperature (less than 25°C). Once opened, the bottle can be used for 30 days only. After 30 days, throw the bottle away, even if there is still medicine in it.
How much to give
Tinzaparin is available in several different strengths. The dosing information below applies to the 20,000 units/mL (2 mL) multidose vials only.
Tinzaparin injections are given using an insulin syringe. It is important to remember that the volume is measured in “units” on an insulin syringe; one unit of insulin is not equal to one unit of tinzaparin.
One unit on the insulin syringe = 200 units of tinzaparin.
Your child has been prescribed _______ units of tinzaparin each dose. This dose is equal to _______units on an insulin syringe.
Drawing up tinzaparin
Before giving your child tinzaparin, you first need to draw up the medicine from the bottle. Check the date on the medicine bottle to make sure it has not expired. You will need:
Tinzaparin bottle (20,000 units/mL)
Insulin 30 unit (3/10 mL), 50 unit (1/2 mL) or 100 unit (1 mL) syringe, depending on the dose. Use only insulin syringes. You must use a new needle and syringe each time.
Alcohol swab
Cotton ball
Sharps container
Precaution
Make sure that the concentration of the tinzaparin is 20,000 units/mL and that you check that you are using the correct size of syringe for your child’s dosage. Take a look at the pictures below. If you are unsure if the size of the syringe is correct, contact your pharmacy or your child's thrombosis team.
Out-patient insulin syringes: Tinzaparin dosingThe syringe your child is prescribed will depend on their dosage of tinzaparin. Because the syringes look very similar, it is important for you to double check the type of syringe you have before giving tinzaparin to your child.
To draw up tinzaparin:
Wash your hands.
Clean the rubber stopper on the medication bottle with an alcohol swab. Wait 30 seconds for the alcohol to dry.
Remove the cap from the needle and syringe. Put the needle through the rubber stopper on the medication bottle at 90 degrees.
Turn the bottle upside down with the syringe in it. Ensure the tip of the needle is in the solution.
Slowly pull down on the plunger of the syringe until you have a bit more than the required number of units. If you have trouble pulling out the medicine, inject a bit of air into the bottle, and then try again.
Check the syringe for any air bubbles. Tap the syringe to make any air bubbles float to the top.
Slowly push up on the plunger to the desired amount. If you have pushed out too much, pull back again on the syringe to the correct volume. Recheck for air bubbles.
Lift off the medication bottle from the syringe. Be sure not to touch the exposed needle to any surfaces. It is now ready to give.
Where to inject tinzaparin
Subcutaneous injection with insulin syringe (90-degree angle)Subcutaneous injection with insulin syringe (45-degree angle)
Tinzaparin is injected into the fatty layer just below the skin. This is called the subcutaneous (SC) layer. Safe areas for injections are: thighs, upper arms, and abdomen. Do not use the buttocks.
Thigh injection site
Thighs: Top front side and outer parts of thigh only. Do not use the inner thigh or back of the thigh. Divide the thigh into thirds; the injection site is in the middle third section.
Upper arms injection site
Upper Arms: Fatty area on the side and back of the arm. This site is only for infants older than four to six months. Divide the upper arm into thirds; the injection site is in the middle third section.
Abdominal injection site
Abdomen: Inject at least 2 inches to the right, left or bottom of the belly button. Avoid areas near the waistband.
More information about the treatment
When giving your child the injection
Choose the injection spot. Clean the skin with soap and water (you do not need to use alcohol swab). Try to change injection sites with each injection you give. For example, inject into the left thigh in the morning and right thigh at night.
Gently squeeze up a well-defined fold of skin and fat with the thumb and index finger.
Hold the shaft of the syringe in a dart fashion, insert needle directly through the skin at a right angle (90-degree angle) quickly just into the fatty layer. The needle can be inserted at a 45-degree angle in areas that have little subcutaneous fat.
Move hand into position to direct plunger. Do not move needle tip once it is inserted.
Give drug slowly to reduce stinging, firmly push plunger down as far as it will go.
Pull the needle out gently at the same angle you put it in. As you take out the needle, let go of the skin roll.
Apply firm pressure with a cotton ball to the injection site for three to five minutes following each injection to reduce the chance of bruising. Do not rub the area as it may irritate the skin.
Put the needle and syringe in a thick, plastic bottle or sharps container with a lid. This is for safety. When the container is full, bring it to your local pharmacy. They can safely dispose of it for you. Do not put it in your regular garbage.
Complications
While your child is taking tinzaparin
Your child may bleed and bruise more easily.
Please check with the medical team about what activities your child is allowed. Contact sports are not recommended.
Your child may need to wear a Medic Alert bracelet if on this medication for a long time. You can discuss this with the thrombosis nurse.
When to seek medical attention
When should you call your child’s medical or thrombosis team?
Call the medical or thrombosis team if your child:
hits their head or has a fall
has bruises that are large or cannot be explained
has a nose bleed that is hard to stop
has bowel movements that are black or red
has new bleeding from gums when brushing the teeth
will be having any medical or dental procedures or surgeries
At SickKids
At SickKids
The Thrombosis Team
The Thrombosis Team at The Hospital for Sick Children operates 24 hours a day, seven days of the week to respond to urgent calls from families of children and teens. If you need immediate attention, please call
416-813-7500 and ask the switchboard operator to page the Thrombosis team member on call.
The Thrombosis Nurse Coordinator will arrange Thrombosis clinic appointments and call you with the dates and times. Families may call
416-813-5859 (Thrombosis Clinic) if they have not heard from the coordinator within two to three weeks after leaving the hospital with an appointment time.
Keeping track of blood work results
Blood tests can be done at SickKids. You will discuss where and when the blood work will be done with the Thrombosis Nurse. Please call the Thrombosis Nurse in one week after discharge to arrange next blood work.
Notify the Thrombosis Team on the day your child has had blood work done by calling the Thrombosis Nurse at
416-813-8514 on Monday to Friday. The Thrombosis team will call you when they have received the results and will let you know if anything needs to be changed. You should receive a call from the Thrombosis Team whether or not changes are required.
Resources
Personal stories about the use of low molecular weight heparins
Two families share their experiences with using low molecular weight heparins. This video will help to answer any questions you may have if you or someone you know will be taking this medication.
