Lacerations and Embedded Needles Caused by Epinephrine Autoinjector Use in Children

Brown, Julie C.; Tuuri, Rachel E.; Akhter, Sabreen; Guerra, Lilia D.; Goodman, Ian; Myers, Sage; Nozicka, Charles A.; Manzi, Shannon; Long, Katharine; Turner, Troy; Conners, Gregory P.; Thompson, Rachel; Park, Esther

doi:10.1016/j.annemergmed.2015.07.011

Cited by 65 publications

(45 citation statements)

References 15 publications

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“…46,47 Unintentional injections into digits and other body parts, with or without injuries, 48 and lacerations incurred when an inadequately restrained child moves during the injection are reported from pen-type EAs. 49 Teenagers are at increased risk of death in anaphylaxis 16 -18 because of high-risk behaviors, including ethanol and/or recreational drug use, failure to recognize triggers, denial of symptoms, and failure to carry their EAs and inject epinephrine promptly when anaphylaxis occurs. [16][17][18] Additional efforts to provide anaphylaxis education for adolescents, their peers, and their communities are needed.…”

Section: Using Easmentioning

confidence: 99%

Epinephrine for First-aid Management of Anaphylaxis

2017

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Anaphylaxis is a severe, generalized allergic or hypersensitivity reaction that is rapid in onset and may cause death. Epinephrine (adrenaline) can be life-saving when administered as rapidly as possible once anaphylaxis is recognized. This clinical report from the American Academy of Pediatrics is an update of the 2007 clinical report on this topic. It provides information to help clinicians identify patients at risk of anaphylaxis and new information about epinephrine and epinephrine autoinjectors (EAs). The report also highlights the importance of patient and family education about the recognition and management of anaphylaxis in the community. Key points emphasized include the following: (1) validated clinical criteria are available to facilitate prompt diagnosis of anaphylaxis; (2) prompt intramuscular epinephrine injection in the mid-outer thigh reduces hospitalizations, morbidity, and mortality; (3) prescribing EAs facilitates timely epinephrine injection in community settings for patients with a history of anaphylaxis and, if specifi c circumstances warrant, for some high-risk patients who have not previously experienced anaphylaxis; (4) prescribing epinephrine for infants and young children weighing <15 kg, especially those who weigh 7.5 kg and under, currently presents a dilemma, because the lowest dose available in EAs, 0.15 mg, is a high dose for many infants and some young children; (5) effective management of anaphylaxis in the community requires a comprehensive approach involving children, families, preschools, schools, camps, and sports organizations; and (6) prevention of anaphylaxis recurrences involves confi rmation of the trigger, discussion of specifi c allergen avoidance, allergen immunotherapy (eg, with stinging insect venom, if relevant), and a written, personalized anaphylaxis emergency action plan; and (7) the management of anaphylaxis also involves education of children and supervising adults about anaphylaxis recognition and fi rst-aid treatment.

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Section: Using Easmentioning

confidence: 99%

Epinephrine for First-aid Management of Anaphylaxis

2017

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“…However, the steps identified as being most likely to be performed incorrectly (eg, holding the device for the recommended time and applying enough pressure to activate), are common to all AAIs and emphasising the importance of this to patients, parents/caregivers and HCPs during training is essential. Some may argue that the interval between triggering the device and removal of the needle need not be 10 s, as research has found that for the EpiPen, delivery time is 0.3 s 33. However, there are no disadvantages to holding the device in place for a longer period as this discourages rapid removal and is consistent with the majority of manufacturer guidelines (EpiPen, Jext, Anapen), although the more recently introduced Auvi-Q recommends 5 s. Related to training, we observed a 2.5-fold increase in correct administration technique for patients and parents/caregivers and threefold increase in HCPs emphasising the beneficial effect training can have on technique.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of patients', parents' and healthcare professionals' adrenaline auto-injector administration techniques

et al. 2016

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IntroductionIn order to enable fast treatment response to anaphylactic reactions, adrenaline auto-injectors (AAI) have been developed and manufactured. It has been reported in several studies that administration technique is suboptimal. The primary purpose of this study was to review the nature and extent of the deficiencies in administration technique among patients, parents/caregivers and healthcare professionals.MethodsRelevant publications were identified between 1998 and 2015 using two search methods: a keyword search in Embase, PubMed, British Nursing Index and Cumulative Index to Nursing and Allied Health Literature and a search of reference lists of relevant articles.ResultsTwenty-three studies met the inclusion criteria. Overall, 37% of patients, 32% of parents/caregivers and 21% of healthcare professionals demonstrated correct administration technique. For studies which employed a before-and-after training study design, correct technique was achieved in 77% of patients, 79% of caregivers and 65% of healthcare professionals. The most consistently observed error was the failure to hold the device in place for the recommended time. For patients, factors associated with good technique were being aged over 18 years, trained in AAI administration by an allergist, prescribed an AAI for more than 30 months, having a history of severe anaphylaxis and membership of a support group. For parents/caregivers in addition to those mentioned, being given a training device with which to practice, improved technique.DiscussionThere was wide variation in administration techniques reported. However, studies designed using before-and-after training show that even a brief demonstration and educational intervention can improve technique. Further studies are required to design and pilot acceptable and cost-effective educational materials.

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“…Furthermore, patient injury12 and injury due to inadvertent autoinjector administration of epinephrine into the finger of the person delivering the medication have been reported in both lay people and healthcare providers 13,14…”

Section: Introductionmentioning

confidence: 99%

Autoinjectors Preferred for Intramuscular Epinephrine in Anaphylaxis and Allergic Reactions

Campbell

Bellolio

Motosue

et al. 2016

WestJEM

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IntroductionEpinephrine is the treatment of choice for anaphylaxis. We surveyed emergency department (ED) healthcare providers regarding two methods of intramuscular (IM) epinephrine administration (autoinjector and manual injection) for the management of anaphylaxis and allergic reactions and identified provider perceptions and preferred method of medication delivery.MethodsThis observational study adhered to survey reporting guidelines. It was performed through a Web-based survey completed by healthcare providers at an academic ED. The primary outcomes were assessment of provider perceptions and identification of the preferred IM epinephrine administration method by ED healthcare providers.ResultsOf 217 ED healthcare providers invited to participate, 172 (79%) completed the survey. Overall, 82% of respondents preferred the autoinjector method of epinephrine administration. Providers rated the autoinjector method more favorably for time required for training, ease of use, convenience, satisfaction with weight-based dosing, risk of dosing errors, and speed of administration (p<0.001 for all comparisons). However, manual injection use was rated more favorably for risk of provider self-injury and patient cost (p<0.001 for both comparisons). Three participants (2%) reported a finger stick injury from an epinephrine autoinjector.ConclusionED healthcare providers preferred the autoinjector method of IM epinephrine administration for the management of anaphylaxis or allergic reactions. Epinephrine autoinjector use may reduce barriers to epinephrine administration for the management of anaphylaxis in the ED.

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Lacerations and Embedded Needles Caused by Epinephrine Autoinjector Use in Children

Cited by 65 publications

References 15 publications

Epinephrine for First-aid Management of Anaphylaxis

Epinephrine for First-aid Management of Anaphylaxis

A systematic review of patients', parents' and healthcare professionals' adrenaline auto-injector administration techniques

Autoinjectors Preferred for Intramuscular Epinephrine in Anaphylaxis and Allergic Reactions

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