Do you work in a hospital, pharmacy, doctor’s office, or outpatient clinic?
Are you a dentist, paramedic, home health care nurse, or infusion specialist?
Then your workplace—whether it’s an acute, subacute, or community setting—should have a supply of epinephrine on hand to treat anaphylactic emergencies related to the medications or vaccinations you administer.
Epinephrine, among the most basic of medications, can quickly turn a life-threatening emergency around.
For years, clinicians have relied on epinephrine autoinjectors for first-line treatment of anaphylaxis. But as the cost of the autoinjectors continues to rise, clinicians are looking for more cost-effective alternatives.
There aren’t many options for administering the drug. Since epinephrine is generally injected intramuscularly or subcutaneously in anaphylaxis, you can either administer it using a needle and syringe or an autoinjector.
Although neither delivery method is foolproof, recent recalls of autoinjectors have highlighted some of the recognized and lesser-known problems associated with epinephrine delivery methods.
In this post, we’ll compare the potential clinical issues associated with both methods of epinephrine administration.
Epinephrine Autoinjector Challenges
The challenges below focus on the autoinjector and its potential administration issues.
The autoinjector’s labeled dose may not be delivered.
There have been at least two recalls for this reason, including the most recent one of Auvi-Q.1,2
The autoinjector’s dosage is insufficient for some adults.
Some adults need more than the 0.3 mg dosage that is preloaded into an autoinjector. The World Allergy Organization Guidelines recommend a maximum dose of 0.5 mg for adults. A second dose can be administered if needed.
The needle is too short.
A 2014 study3 found that one autoinjector’s needle length was too short to deliver epinephrine intramuscularly, particularly in women. Women in the study whose skin-to-muscle depth exceeded the length of the autoinjector’s needle received the dose subcutaneously. (Intramuscular administration is preferred because it is absorbed faster than with subcutaneous administration—an important consideration with life-threatening anaphylactic emergencies.)
The needle breaks or bends.
Children, particularly those who may not stay still for the duration of an injection, are particularly at risk for an autoinjector’s needle to break or bend during administration.4
The autoinjector may cause a needlestick injury.
Autoinjector sharps injuries have been reported in professionals and nonprofessionals alike.5,6
Individuals may not be trained to use the device.
Ideally, all who need to use an autoinjector are trained to use one. In fact, all autoinjector manufacturers provide training kits. Sometimes, though, a formulary may replace one autoinjector brand with another, and clinicians may not realize that the new autoinjector functions differently than the one they were trained to use.
Epinephrine Ampule Challenges
Some clinicians have concerns about delivering epinephrine using an ampule, needle, and syringe. EPIsnap®, which was created by an RN, addresses these concerns directly.
It takes too long to draw a dose.
EPIsnap can be administered in 30 seconds or less. Our training video demonstrates the EPIsnap kit, including how long it takes to draw a dose.
The process seems too complicated.
EPIsnap uses standard filter needles, safety needles, and syringes, tools that you, as a clinician, probably use daily, unlike an autoinjector, which you may rarely, if ever, use. With EPIsnap, the skills you need to use it get reinforced on every shift.
Glass from breaking the ampule may contaminate the epinephrine.
The ampule is prescored to make the ampule easier to break open. And the EPIsnap emergency medical kit contains both safety needles and filter needles. Using a filter needle to draw the dose will reduce the risk of glass particle contamination.
I may accidentally administer too much epinephrine at one time.
The EPIsnap kit contains a 1 mg/mL ampule of epinephrine USP 1:1000. It is designed to deliver up to three doses of 0.3 mg of epinephrine or two doses of 0.5 mg. (It is not intended for pediatric use.) Use your clinical training to draw the correct dose, and remember to never administer the entire ampule at one time.
So, Ampule or Autoinjector?
It’s really your decision. The important thing to know is, you have options.
The EPIsnap® emergency medical kit gives you control over an anaphylactic emergency. It:
- Allows for more dosing options than an autoinjector
- Ensures that the needle length is 1 inch, sufficient for most patients
- Is administered like every other intramuscular medication you give
- Costs considerably less than autoinjectors
See how easy it is to administer EPIsnap.
Sources
1https://www.fda.gov/Safety/Recalls/ucm469980.htm
2https://www.wsj.com/articles/SB894664589151993500
3https://www.aacijournal.com/content/10/1/39
4https://www.annemergmed.com/article/S0196-0644%2815%2900588-0/fulltext
5https://www.ncbi.nlm.nih.gov/pubmed/19441598
6https://www.annemergmed.com/article/S0196-0644%2810%2900225-8/fulltext