how to inject heparin during pregnancyis there sales tax on home improvements in pa

The effectiveness and safety of different methods administering subcutaneous heparin (UFH or LMWH) during pregnancy have not been systematically evaluated. your doctor. He is the director and founding partner of CCRM New York and was named a rising star by Super Doctors from 2017 to 2019. Before you handle the syringe or vial of heparin, you should wash your hands thoroughly. Overall though, it really does become second nature after a while. <> Diagnosing DVT is difficult during pregnancy. Women are especially at risk for blood clots during pregnancy, childbirth, and the three-month period after delivery. American College of Obstetricians and Gynecologists. Heparin injections "thin" the blood, decreasing the tendency to form clots. Thrombosis. Women may use opioids as prescribed, may misuse prescription opioids, may use illicit opioids such as heroin, or may use opioids as part of medication-assisted treatment for opioid use disorder. This for me meant I was included early so they could manage it. Good luck! Hello! Some of the most common heparin side effects during pregnancy include: Heparin injection during pregnancy is usually administered to control blood clotting. There may be an increased tendency to bleeding. Repeated miscarriages. *Knock on wood* I havent had any bruising or knots so far. Steps to Follow for Injecting Heparin Subcutaneously. I got to the point that I was in so much pain that I had to have my husband start injectioning me. Recent findings: Low-molecular-weight heparins do not increase the risk of maternal bleeding during pregnancy. Most commonly, venous thrombosis occurs in the deep veins in the legs, thighs or pelvis and this is called a deep vein thrombosis or a DVT. Safe Sleeping & Caring for your Baby at Night, Southwest Neonatal Network Donor Milk Bank. Treat the intended injection with a cotton pad moistened with alcohol. Also Read:Blood Clot in the Uterus During Pregnancy: Causes, Complications & Treatment. Here is the link to the other tip thread. 2010-2023 Parenting.FirstCry.com. <>/PageLabels 375 0 R>> Remove the cap from needle and gently pick up a well-defined fold of skin. DOI: 10.1002/14651858.CD009136.pub2, Copyright 2023 The Cochrane Collaboration. Are the heparin injections more painful than the progesterone? Let your provider know if you or anyone else in your family has ever had a blood clot. LMWH is given as an injection. Remove the cap from the needle. When all the heparin has been injected, slowly withdraw the needle at the same angle at which it entered, releasing the skin roll as you withdraw. Do not administer Heparin Sodium Injection by intramuscular injection because of the risk of hematoma at the injection site [see Adverse Reactions (6)]. Although its effect is not restricted to anticoagulation and also can modulate apposition , adhesion , and penetration of embryo . I shared a video way back in 2012 showing how to inject Clexane, and it is still one of my. This condition is not that serious and is reversible through treatment. Unfortunately, a 2010 study found that neither heparin nor low-dose aspirin improved birth rates in patients without antiphospholipid antibodies. Heparin is given by injection or drip into a vein (intravenously) or by injection under the skin (subcutaneously) to treat and prevent these types of blood clots. It has been found that complications with regard to CNS (Central Nervous System) are caused in the foetus. However, all these adverse effects are caused due to Unfractionated Heparin and other blood thinners. The use of heparin during pregnancy has been prevalent for quite some time. Bruising happens, you get used to it. PE occurs more commonly during the postpartum period than during pregnancy (relative risk = 15.0; 95% CI, 5.1 to 43.9),4 and 64 percent of postpartum VTEs occur after cesarean delivery. http://community.babycenter.com/post/a891375/tips_tricks_for_injections_-_list_em_here. Sometimes it stings more than othersand sometimes I don't feel a thing! jZNc?ypTc3*OZ3L?!.Y'Q@%t40O&MG@#&Ag"~% %~X;NE7QF ^'|_qB.Bs`n|-{ j#$>]82U%SXUX%I "UKx/]LD4m|m7+)@@ 9JSL;;{aw This content is owned by the AAFP. Select the site for the injection. Pulmonary embolism typically presents postpartum with dyspnea and tachypnea. I just switched to heparin (2x/day) and I do one side at night, the other in the morning. I hardly bruise at all. Dont Let a Blood Clot Spoil Your Joy. One nightI had a friend over who is a nurse and she watched me do my shot. That is wonderful information and answers a lot of questions!! Your doctor can discuss the costs and benefits of taking heparin to help you understand what side effects to look out for and decide whether it's right for you. Myeloproliferative neoplasms (MPN) such as essential thrombocythemia (ET) and polycythemia vera (PV) are rare during pregnancy. There is no evidence that the heparin, including the one that we use (Enoxaparin), passes into breast milk due to the nature of the drug. Suitable injection sites include the sides of your tummy (avoiding the area near It is also deemed safe for women to breastfeed when theyre on LMWH injections. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Although, the low molecular weight heparin is considered safe to use with regards to pregnancy, the Unfractionated Heparin version used before had several health risks associated with it. Some women may not self-administer heparin and must rely on others to give them their injections otherwise they stop using the heparin, thus exposing themselves to an increased risk of VTE. How can I tell that my baby is getting enough milk? How Effective Is Heparin During Pregnancy? This means that is slows down blood clotting or "thins" the blood. There is no evidence from randomised controlled trials to evaluate the best method of administering subcutaneous heparin to pregnant women. Good luck! There have been studies which conclude that usage of heparin, in general, is harmful to both the child and the mother. This is called a pulmonary embolism (PE), and can be life threatening. Blood Clot Prevention Checklist for Pregnant Women, Blood Clot Risk Checklist for Pregnant Women, This Is Serious (Duke Haemostasis Center), Join the Public Health Webinar Series on Blood Disorders. Doctors administer Heparin injections before . Wipe the area with alcohol. An increased risk of a clot forming during pregnancy or after birth, e.g. KING, MD, MPH. Heparin is a form of anticoagulant used to prevent blood from clotting. During pregnancy, progesterone plays an important role, especially early in the first trimester. Heparin Sodium Market - Covid-19 Impact and Recovery Analysis: We have been tracking the direct impact of COVID-19 on this market, as well as the indirect impact from other industries. : CD009136. There were no problems throughout the pregnancy. This was extremely painful and it made it difficult to walk. A PE may cause breathing problems, chest pain and coughing up blood but a large PE can cause collapse and may be life threatening. Cookies used to make website functionality more relevant to you. Learn about Blood Clots. Pregnancy Complications Caused by Heparin. I took heparin during my pregnancies (after having a DVT). It is used to treat several medical conditions, including blood vessels, heart, and lung conditions, and to prevent blood clotting in patients who need to take bed rest for a long time. V/Q scanning may be used if spiral computed tomography is unavailable. See permissionsforcopyrightquestions and/or permission requests. Tell your doctor if you have or have ever had heart disease, a stroke, deep venous thrombosis (DVT; blood clot in your leg), a pulmonary embolus (PE; blood clot in your lungs), or if you are going to have surgery. I inject on both sides. Warfarin is contraindicated during pregnancy, but is safe to use postpartum and is compatible with breastfeeding. Signs and symptoms of a PE include, Chest pain that worsens with a deep breath or cough, Faster than normal or irregular heartbeat. It is partially broken down and metabolized both by the liver and the reticuloendothelial system. Recently had a baby? There are different types of heparin. I tend to insert the needle and inject the heparin slow too. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Healthcare Professionals: Training and Education, Signs and Symptoms of Blood Clots with Cancer, Blood Clot Risk Checklist for Cancer Patients, Healthcare-Associated Venous Thromboembolism, U.S. Department of Health & Human Services. However, the risk of developing a pulmonary embolus, once a DVT has been diagnosed and treated, is extremely small. UFH is considered an acceptable alternative.32 Table 1 recommends dosages and monitoring.10,12,32,41 For postpartum DVT or PE, warfarin may be started concomitantly with heparin.42 LMWH or UFH should be continued until an international normalized ratio of 2.0 to 3.0 is achieved for two consecutive days.42 Post-thrombotic syndrome can be prevented if compression stockings are worn for at least one year starting in the first month after a DVT.1, Intrapartum management may vary depending on the indication for anticoagulation and whether therapeutic or prophylactic doses have been used.10 Expert guidelines suggest that women receiving adjusted-dose LMWH or UFH be instructed to discontinue heparin injections at the onset of labor to prevent anticoagulant complications during delivery.12,32 When delivery is predictable, as for elective induction or planned cesarean birth, LMWH or UFH should be discontinued 24 hours before delivery.12,32 For high-risk patients, such as those with mechanical heart valves or recent VTE, the American College of Obstetricians and Gynecologists (ACOG) recommends switching to intravenous heparin at the onset of labor.10 The short half-life of intravenous UFH allows discontinuation four to six hours before the anticipated time of delivery.10,32 To minimize spinal and epidural hematoma risk, the ACOG and the American Society of Regional Anesthesia advise avoiding regional anesthesia for 24 hours after the last LMWH dose for women on twice daily therapeutic doses of enoxaparin (Lovenox), and for 12 hours after the last dose of LMWH for women receiving daily prophylactic dosing.10, Evidence is insufficient to recommend for or against an inferior vena cava filter if anticoagulation is contraindicated or repeat PE occurs despite adequate anticoagulation.1, Systematic reviews of observational studies have found VTE prophylaxis with LMWH to be safe and effective in pregnancy, but there are no randomized controlled trials confirming this.35,42 Table 2 lists representative prophylactic doses of LMWH and subcutaneous UFH.6,43 Table 3 summarizes recommendations for the type and duration of prophylaxis based on specific clinical risk factors.5,10,15,32,39,40 Consultation should be considered for high-risk thrombophilias such as antithrombin deficiency.6, Low-dose aspirin (75 to 81 mg) is sometimes used for women with an increased risk of thrombosis that does not meet the threshold for prophylactic heparin (e.g., a woman with a mild thrombophilia and no history of VTE).6 Due to the lack of studies of aspirin for this indication, such treatment is of unknown benefit; however, low-dose aspirin is safe to use during pregnancy.32, Postpartum thromboprophylaxis is not routinely indicated following vaginal delivery,42 but may become necessary because of labor-related risk factors, such as prolonged labor, mid-forceps delivery, and immobility after delivery.6, Unless other VTE risk factors are also present, women who undergo a scheduled cesarean delivery are not routinely placed on pharmacologic VTE prophylaxis.44 However, mechanical prophylaxis with pneumatic compression stockings has been shown to provide effective post-cesarean thromboprophylaxis.45 Graduated compression stockings provide effective prophylaxis in nonpregnant postoperative patients.46 A decision analysis comparing pneumatic compression stockings with no intervention for post-cesarean VTE prophylaxis found the former to be cost-effective.47. Based on data from nonpregnant patients, PE can be excluded with a normal or low probability V/Q scan if clinical suspicion is low to moderate.25 Likewise, PE can be diagnosed with a high probability scan if clinical suspicion is moderate to high.25 In a study of V/Q scanning in 120 pregnant women with suspected PE, 73.5 percent were normal and 1.8 percent were high probability, compared with 27 to 36 percent normal and 8 to 14 percent high probability scans in nonpregnant patients.31 When V/Q scanning is nondiagnostic, additional options include repeat leg compression ultra-sonography, repeat V/Q scanning, spiral computed tomography, magnetic resonance imaging, and pulmonary angiography. collection of VTE educational resources published by The Joint Commission. There are various types of heparin the type we usually use is a Low Molecular Weight Heparin (LMWH) such as Enoxaparin (also known as Clexane) or Dalteparin. %PDF-1.5 Some people prefer to inject the heparin fast, but I prefer to go slowly. Pregnancy is a risk factor for deep venous thrombosis, and risk is further increased with a personal or family history of thrombosis or thrombophilia. Heparin injection during pregnancy is usually administered to control blood clotting. Unfortunately, not knowing the cause of miscarriage makes it difficult to know what to expect if you choose to become pregnant again. During pregnancy, heparin is prescribed to avoid potential blood clots, and also to deal with the critical complications arising due to blood clottings, such as preeclampsia, low birth weight, disruption of the placenta, and loss of the foetus. Thrombophilia disorders are also thought to cause other issues with the placenta., Bloodwork helps identify certain markers to diagnose antiphospholipid syndrome. I mostly stick to my sides/love handles. Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. BabyCenter may earn a commission from shopping links. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. dontletitbeabouttom 2 yr. ago. Begin unfractionated heparin at 333 u/kg subcutaneous and then 250 u/kg subcutaneous q 12 hours. Againsure wish I had gotten some guidance from my dr. And, I thank you in advance for any guidance you ladies can give me! We take your privacy seriously. Anticoagulation options include low-molecular-weight heparins (LMWHs), unfractionated heparin (UFH), and warfarin (Coumadin; postpartum only). Pregnant women may also experience less blood flow to the legs later in pregnancy because the blood vessels around the pelvis are pressed upon by the growing baby. I have to do enoxaparin injections once a day and started at 8 weeks (30 weeks now). l= x FwdjEM!uULSQx44DVT Venous compression (Doppler) ultrasonography is the diagnostic test of choice. Mumsnet carries some affiliate marketing links, so if you buy something through our posts, we may get a small share of the sale (more details here). "DOC'$), $V@,0 =M-`>[ EPM`JL ,VJO !Js2=@oy. LEE T. DRESANG, MD, PAT FONTAINE, MD, MS, LARRY LEEMAN, MD, MPH, AND VALERIE J. Thromboprophylaxis during pregnancy By subcutaneous injection Adult 5000-10 000 units every 12 hours, to be administered with monitoring, Important: prevention of prosthetic heart-valve thrombosis in pregnancy calls for specialist management. `$hnvxZ}X=+zCTCT #=GES$CcCdL./&gSuE4WMVdU-GI$jaa7Qa[yN"o l>]h ta~]^H~}~mIc6a>L6;v{d>l"^KK As of 2020, the campaign has realized more than 300 million media impressions. It is important that the heparin is given at the same time of day (within two hours) and it is recommended that it be given in the morning if the blood tests to monitor it are needed. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. To comment on this thread you need to create a Mumsnet account. A clot arising during this or a previous pregnancy. The flu shot is made of dead . To compare the effectiveness and safety of different methods of administering subcutaneous heparin (UFH or LMWH) to pregnant women. It is used to treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE) including during pregnancy and following certain types of surgery. tb5:7BhO '!^hF NK See references Heparin flush Breastfeeding Warnings A DVT can limit blood flow through the vein, causing swelling and pain, but there is a risk that it can break off and travel through the blood stream. Airway, breathing, and circulation should be addressed immediately and may require management in the intensive care unit. You will be shown how to give the injections. The LMWH comes in preloaded syringes. Pregnant women with a history of venous thromboembolism (VTE), antithrombin deficiency, or other risk factors for VTE, need heparin (unfractionated heparin (UFH) or low-molecular weight heparin (LMWH)) prophylaxis, mainly through administering subcutaneously. Monitoring for these is part of your clinic visit, but the more serious side effects are almost never seen with LMWH use in pregnancy. This lowers your risk of life-threatening conditions like pulmonary embolism or heart attack. Heparin is an anticoagulant, which prevents blood clotting. Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage. Heres why: Several other factors may also increase a pregnant womans risk for a blood clot: Too many women die from pregnancy-related complications and many more experience severe-pregnancy-related complications. The dosage and how often you use it are based on. When I first started it I would get really hard bumps and I bruised really bad. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Staying hydrated during pregnancy helps prevent clots by keeping the blood from getting too thick, Roshan said. I don't really know why I don't get them anymore but it just stopped. It is not necessary to follow the activated partial thromboplastin time.10 Anti-Xa levels need only be obtained in patients who are at extremes of weight (< 121 lb [55 kg] or > 198 lb [90 kg]) or have abnormal renal function.12 Monitoring of platelets while on LMWH is no longer recommended.12 UFH may be used instead of LMWH for the treatment of VTE in pregnancy, because of cost or availability. Since LMWH does not cross the placenta, experts recommend it as it causes no side effects to the foetus. Use heparin sodium during pregnancy only if the potential benefit justifies the potential risk to the fetus. Due to the risks and uncertain benefits, heparin treatment is recommended only for those with a confirmed diagnosis of antiphospholipid syndrome or an inherited thrombophilia disorder. Symptoms of dyspnea are nonspecific in pregnancy. In addition to the treatments described, calcium and vitamin D supplements can be prescribed to reduce the risk of heparin-induced osteoporosis (reduced bone strength). Here's how the blood thinner heparin can have a striking impact on pregnancy outcomes for certain patients. The optimal treatment of VTE during pregnancy has not been studied via randomized controlled trials, and clinical recommendations are based on expert opinion.10,12,24,32, Stabilization is the first priority. Venography still serves as the definitive test for diagnosing DVT19 and may be used in clinical situations where noninvasive tests are equivocal, empiric anticoagulation is relatively contraindicated, and clinical suspicion is high.24, Figure 2 outlines a diagnostic approach for suspected PE based on expert opinion derived from studies mostly involving nonpregnant patients.2427, With low or moderate clinical suspicion, a negative highly sensitive d-dimer test rules out PE.25,28 If d-dimer testing is positive, or if clinical suspicion is high, additional testing is needed. Experts have theorized that heparin may prevent recurrent miscarriages even in patients who test negative for antiphospholipid antibodies. You can review and change the way we collect information below. If the embolus lodges in the lung this is known as a pulmonary embolus (PE). For individuals with antiphospholipid syndrome, the benefits of heparin usually outweigh the risks. Approximately 1% of women experience recurrent miscarriages, according to the American College of Obstetricians and Gynecologists. While everyone is at risk for developing a blood clot (also called venous thromboembolism or VTE), pregnancy increases that risk fivefold. It is known as Low Molecular Weight Heparin (LMWH). The incidence of refractory angina (22.9% in the placebo group) was significantly reduced to 8.5% ( P =0.002) in the heparin group and 10.7% in the heparin-plus-aspirin group ( P =0.11) but was 16.5% in the aspirin group. Multidetector-row (spiral) CT is the imaging modality of choice to evaluate for PE in pregnancy because, in nonpregnant patients, the diagnostic accuracy is equivalent to pulmonary angiography, and radiation exposure to the fetus is less than with a V/Q scan. should not be construed as a substitute for advice from a medical professional or health care provider. The three most common reasons for women starting heparin during pregnancy or after the birth are: For pregnant women and women who have given birth, heparin is the anticoagulant of choice and is recommended by the Royal College of Obstetricians and Gynaecologists. A couple minor inconveniences to your day! Breech baby at the end of Pregnancy and ECV, Pregnancy Related Pelvic Girdle Pain (PGP), Mendip Birth Centre - Southmead Hospital Bristol, Central Delivery Suite - Southmead Hospital Bristol, Spontaneous Rupture of the Membranes (SRM), Discharge Advice After an Epidural or Spinal Anaesthetic, Getting Breastfeeding off to a Good Start. Make sure you're rotating spots so to not make one area more sore than other spots. recurrent thrombosis. After deep subcutaneous (intrafat) injections, tests for adequacy of dosage are best performed on samples drawn 4 to 6 hours after the injection. I'm a fan of medical intervention of necessary but I am really worried about getting pushed about and rushed. Heparin is an anticoagulant commonly used after surgery. 5 For individuals with antiphospholipid syndrome, the benefits of heparin usually outweigh the risks. These documents share important information about blood clot signs and symptoms, and risks for blood clots in pregnant women or women who just delivered a baby. Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage. Hold the syringe in a dart fashion and insert the needle directly into the skin at a 45-90 degree angle just into the . Closed management is needed during the peripartum period, and discontinuing Low-molecular-weight heparins at least 12 h before delivery seems sufficient to prevent post-partum haemorrhage. So today I noticed that I have a HUGE bruise to the left of my belly button. The upper outer side of the thigh. Copyright 2023 American Academy of Family Physicians. By Krissi Danielsson The syringe is completely ready for use. In addition, Stop the Clot, Spread the Word was one of many CDC resources recognized in 2017 as an important asset in a collection of VTE educational resources published by The Joint Commission. zo90q |%()J 69#YVWpC(H#Vg g U.S. National Library of Medicine, ToxNet. DVT is a clot in the deep veins of the leg blocking blood flow; parts of the clot may break away and be carried in the blood to the lungs, to form a PE. The welcome thread at the top of page one has lots of tips in it. Another thingsince I didn't know it was necessary to change sites, I've been giving the injections primarily on my left side (because it doesn't hurt as much on that side, for whatever reason). Do not pre-press on the piston protrusion to remove air bubbles, as this may disturb the dosage of the drug. When I first started the Heparin they just told me not to put it in the exact same spot but they never said I couldn't do it on one side. Heparin is also known as: Heparin Sodium Pregnancy Warnings Breastfeeding Warnings Heparin Pregnancy Warnings Animal studies have revealed increased resorptions at doses approximately 10 times higher than the maximum human daily dose based on body weight. No. The most commonly used in pregnancy is 'low-molecular-weight heparin' (LMWH). General Precautions: Heparin is considered safe for use during pregnancy, mostly because it does not cross the placenta and thus does not reach the baby. Could be that I am a bigger girl but I have found that the heparin shots are much easier than the lovenox shots. Therefore it is considered that heparin is safe for you to have whilst you are breastfeeding. Anticoagulation is sometimes needed during pregnancy and/or the postpartum period, including individuals at high risk of deep vein thrombosis, a history of venous thromboembolism, with prosthetic heart valves, atrial fibrillation, left ventricular dysfunction, or a history of fetal loss. All information these cookies collect is aggregated and therefore anonymous. Quasi-randomised studies and cross-over trials were not eligible for inclusion.. Methods of administering subcutaneous heparin include intermittent injections versus indwelling catheters or programmable (auto) external infusion pumps, or any other devices to facilitate the subcutaneous administration of heparin (UFH or LMWH) during pregnancy. Opioid use during pregnancy can affect women and their babies. It does not cross the placenta, and therefore is considered to be safe. They type of LMWH we use is generally given once a day but we may give heparin twice a day, particularly during pregnancy. Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. However, the risk of developing a pulmonary embolus, once a DVT has been diagnosed and treated, is extremely small. <>/XObject<>/Pattern<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> All rights reserved. Side effects of heparin treatment may include bleeding and decreased bone density. Depo-Provera typically suppresses ovulation, keeping your ovaries from releasing an egg. I lie down and then just squeeze an inch of skin/fat and inject at a 45 degree angle. They postulated that unexplained miscarriages might be due to an unrecognized blood-clotting disorder. Heparin and LMWH have been used in pregnancy by thousands of women with no birth defects or bleeding problems in their unborn babies. They help us to know which pages are the most and least popular and see how visitors move around the site. Low-molecular-weight heparin has largely replaced unfractionated heparin for prophylaxis and treatment in pregnancy. 3 0 obj Shelly- instead of emla or ametop which both take 45mins to an hour to work, you could use xzylocane Coldspray, which works instantly you just spray it on but its cold!!!! l17'*}nN_Pq,~R/K-H 3W )Xg!~,k@fay}=A ,RBQh? It is considered safe since it does not penetrate the placenta. A family or personal history of blood clots or a blood clotting disorder, Prolonged immobility (not moving a lot), such as during bed rest or recovery after delivery, Complications of pregnancy and childbirth, Certain long-term medical conditions, such as heart or lung conditions, or diabetes, Know the signs and symptoms of blood clots, A blood clot occurring in the legs or arms is called deep vein thrombosis (DVT). (I'm not sure if you are supposed to do so, but it seems to help me sometimes). In one study, women with recurrent pregnancy loss experienced a 71% subsequent live birth rate when treated with heparin and low-dose aspirin, compared to a 42% live birth rate for those given aspirin alone. Heparin Use During Pregnancy Information for pregnant women or women who have given birth who are receiving low molecular weight heparin Heparin is an anticoagulant drug. I have been on heparin shots for a bit now. As the risk of losing blood is high during and post-pregnancy stages, heparin is considered largely effective in stopping blood clots. I was told today that I was going to have to Inject Clexane from now till 6 weeks after birth. Don't inject in that spot again til the bruising is gone. Sometimes it may be diluted and given to you as a slow injection into one of your veins (this is called an intravenous infusion). 2Li{.2e|s;G ;`%A.

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