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Epinephrine autoinjectors save lives but can cause lacerations and other injuries

Published Online: February 18, 2016

Epinephrine auto-injectors are life-saving, but lacerations and needles getting stuck in bone have been reported.  In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Brown and Tuuri present a case of leg laceration caused by an EpiPen Jr injection during an anaphylactic event.  This case adds to 25 cases of epinephrine autoinjector-associated injuries recently reported by Brown and colleagues in The Annals of Emergency Medicine. These 26 injuries were identified by querying emergency medicine e-mail discussion lists and members of 8 allergy-related social media groups.

Cases occurred between 2006 and 2015 (21 cases in 2011 or later).  All cases involved EpiPen devices, and included 21 children with thigh lacerations, a nurse with a digit laceration, and 4 children with stuck needles. The average age of injured children was 3 years. Operators included health care providers (6), parents (16, including 2 nurses), educators (3), and a child (1). Laceration wound lengths were estimated to be between 1.5 cm and 8 cm, and two children had two lacerations, after reinsertion of needles that dislodged early.   

The authors identified the EpiPen 10-second hold instruction as potentially conducive to injury, presenting evidence that EpiPens deliver epinephrine in under 3 seconds.  They noted that were no injuries due to Auvi-Q or Allerject devices, where the needle retracts in under 2 seconds. They made five recommendations for manufacturers of auto-injector devices: minimizing needle injection time, re-evaluating the ‘swing and push’ approach, improving needle strength to prevent bending, and providing improved patient information instructions, including instructions to immobilize a child’s leg and never reinsert the device needle.  

In the JACI report, the authors emphasize the importance of teaching families how to restrain their children appropriately, and include an illustration with 7 examples of single-parent methods for child restraint during auto-injector device administration. All families carrying epinephrine auto-injectors for use in children should consider and practice not only how to use the auto-injector device, but also how they will hold their child while administering the device.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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