A Patient's guide to injecting Tinzaparin® at home

TINZAPARIN® helps to reduce the risk of blood clots and is known as an anticoagulant (coagulation is the medical term for clotting of the blood).

In some cases, it can actually be used to treat people who have had a blood clot.

Why do I need TINZAPARIN®?

A blood clot can develop in the large veins of the body, usually in the legs. The medical name for this condition is deep vein thrombosis (sometimes referred to as DVT, for short). Although these clots may not present an urgent risk, they do need to be treated to prevent possible problems.

Sometimes, a blood clot can break free and travel through the bloodstream. If a clot lodges in the lungs, it can cause chest pain and difficulty in breathing, and if severe can even cause death. The medical name for this condition is pulmonary embolism (PE). Rarely, a clot may move to the brain and cause a stroke.

There are lots of reasons why you may be at higher risk of blood clots.

Here are some of the most common ones:

• Age – once you are over 40, the risk increases the older you are particularly if you have poor mobility.
• Women who take oestrogen or depos-medroxyprogesterone acetate have a small increase risk of DVT
• Some heart problems
• Severe breathing difficulties
• Obesity
• If you have had a DVT before
• Stroke
• Surgery such as knee replacement, hip replacement or abdominal surgery
• Varicose veins

Early signs of a DVT (deep vein thrombosis)

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 change
• Warmth in your calf or leg

Sometimes, there are no obvious signs and you may not be able to tell that you have a DVT.

Early signs of a PE (Pulmonary Embolism)

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

• Chest Pain
• Shortness of Breath
• Coughing (or coughing up blood)
• Racing heartbeat (or a fast pulse rate)
• Rapid breathing
• Tiredness
• Feeling Feverish, when your temperature is 38° or above

If you experience these symptoms call 999 or go to A&E.

Your nurse or doctor will already have shown you how to inject yourself using a TINZAPARIN® syringe. It is important that you know the correct technique before you try to inject yourself. If you are unsure, you should ask your nurse or doctor for advice.

Step-by-step instructions for injecting TINZAPARIN®

• First wash your hands with soap and water. Then, dry them thoroughly.
  

• 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 the bed or in an armchair. Make sure that your special safety bin (known as a sharps bin) is within reach.

Choose an area on either the left or right side of your abdomen at least 5cm away from your naval – out towards your side – as shown by the dotted lines.

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• Bend the coloured lid on the plastic container all the way back.
• ​​Remove the syringe from the container.

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• Bend the orange safety device down away from the grey cap on the needle.

• Remove the protective needle cap without bending the needle only when ready to inject.

• Hold the syringe in your writing hand like you would hold a pen. With your other hand, make a fold of your skin by gently pinching the area where you are going to inject yourself with your thumb and forefinger.
  
• Gently but firmly insert the needle at a 90° angle and continue to hold the skin. Press down on the plunger slowly to inject the TINZAPARIN® over 10/15 seconds. Remove the needle from your skin, keeping it at 90° and then release the skin fold. 
  DO NOT rub or massage the area as this can cause bruising.
• Using a hard surface, bend the orange safety device back to its original position so it is now underneath the needle. Place the safety device flat against a hard surface, push downwards until the needle clicks in to the device. Bend the safety device so that the needle/ device is now at a 45° angle to the syringe.
  
  NEVER use your finger to press the needle into the orange safety device.
  

Disposal Option 1

• Carefully place the syringe, needle first, directly into the sharps container. The empty plastic container can be recycled.

NEVER put syringes or needles in the household rubbish.

Sharps Bin Disposal

• Take your used sharps bin to your GP or local pharmacy for safe disposal. Alternatively please contact your local council for advice on disposal of clinical waste.

Disposal Option 2

• Carefully place the syringe back into the open plastic container (needle first), followed by the grey needle cap.​​​​​​​

• ​​​​​​​​​​Push down the lid until it clicks. All your used syringes can be stored in the plastic containers and must be disposed of by your GP Practice or local pharmacy.

NEVER put syringes or needles in the household rubbish.

Do’s

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 in to the fatty tissue and not the muscle where it could cause bruising.

Do alternate the side on which you inject – right one day, left the next.

Do make sure you put your used syringes in to the sharps bin each time you inject – never leave a used syringe lying around the house

Do follow the advice of your nurse or doctor when using your injections

Do administer your injections at the same time every day

Do take care when shaving or using knives or other sharp objects as you may bleed more easily than usual.

Do tell your nurse or doctor about any other medications that you are taking – including those from the chemist and any herbal supplements. Other medicines can sometimes affect the way in which TINZAPARIN® works.

Don’ts

Don’t put the syringe down anywhere or touch the needle with anything before you inject – this will help keep it sterile and reduce the risk of infection

Don’t twist off the needle cap, as this could bend the needle.

Don’t inject in to bruised or scarred skin or anywhere that might be rubbed by clothing.

Don’t rub the skin after you have injected, as this may cause bruising.

Don’t let anyone else use your syringes.

Don’t put TINZAPARIN® in the fridge or the freezer – keep it at room temperature.

Don’t take any of these medicines while you are using TINZAPARIN® unless your nurse or doctor tells you to:

• Aspirin or anything that contains aspirin
• Pain relievers known as non –steroidal anti inflammatory drugs (such as ibuprofen)

Bear in mind that cold and cough remedies may contain these drugs.
​​​​​​​All these medicines can make you more likely to bleed

As with all other medicines, TINZAPARIN® can have side effects in some people.

Possible side effects:

You may be getting an allergic reaction if:

• You have difficulty breathing
• Your face or throat swell
• Your skin develops a severe rash
• You experience blistering of the skin, mouth, eyes or genitals or your skin peels
• Blood spots near the injection site which could develop in to a purple blister surrounded by red inflamed skin You should tell your doctor straight away if you spot any of the following signs which mean you may be starting to bleed severely:
  • Red or brown urine
  • Black tarry stools
  • Unusual bruising
  • Bleeding from your nose, or mouth or any operation wound that will not stop.

You may also notice mild irritation or other reactions of the skin on your abdomen where you have been injecting. These might include redness, pain, small bumps (known as nodules) or bleeding in to the skin (sometimes called a haematoma).

These effects may be caused by your injection but if they occur sometime after an injection, they may 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 GP for advice or visit your local Minor Injuries Unit/A&E out of hours.

Patient guide authors: Pooja Mavadia, Clinical Nurse Educator & Preceptorship Lead and Anuja Bathia, Principal Pharmacist, Medicines Governance & Digital Medicines