A new series of case studies has been published, highlighting the dangers of epinephrine autoinjectors. Many injuries are attributed to the use of EpiPens and other injectors, some of them potentially life-threatening.

Although the use of epinephrine autoinjectors has been credited with countless lives saved, they have their dangers. Autoinjectors are used to treat both cardiac and allergy-related incidents, but many cases involving the injury of the patients being saved because of the design of these injectors has caused some concern.

Surprised by the severity of injury.

“We were surprised by the severity of some of these injuries, including thigh lacerations and embedded needles,” said lead study author Julie Brown, MDCM, MPH, of Seattle Children’s Hospital and University of Washington in Seattle, Wash.

The study is a case series published online in Annals of Emergency Medicine and identifies some design features of the popular EpiPen, the most commonly-used autoinjector, that are causing injuries in children.

“We can’t think of anywhere else in pediatric medicine where we would hold a needle in an awake child’s leg for 10 seconds. That’s a set-up for injury, particularly in the uncontrolled, stressful setting of anaphylaxis. In addition, the instructions for use do not mention patient restraint, so parents are not appropriately prepared,” Brown continues.

Injuries are not due to mis-use.

The injuries are not necessarily due to mis-use of the pens, though one case mentioned in the study did involve a child who used an EpiPen that was not his. Instead, injuries are due to the requirement that the needle be held in the patient for such a long period. Injuries include laceration, needles being broken off inside the patient, etc.

The conclusions of the study give five recommendations for reducing risk of injury when using an EpiPen.

  1. The child’s leg should be immobilized.
  2. The action of administering epinephrine and site of delivery should be as well controlled as possible.
  3. The needle should remain inserted in the thigh for as short a time as possible.
  4. The needle should be strong enough that it does not bend during use.
  5. The needle should never be reinserted.

“We want to emphasize that these injuries are uncommon and should not deter parents and patients from using their epinephrine auto-injectors when needed,” said Dr. Brown. “Epinephrine is a life-saving medication that must be given early in the course of anaphylaxis. Our goal in reporting these injuries is not to create fear of the EpiPen device but simply to identify limitations with the device, and hopefully motivate improvements in product design and instructions for use.”

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