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Implications of variation of epinephrine auto-injector needle length
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.ORCID iD: 0000-0002-3544-1557
Western Univ, Dept Med, London, ON, Canada.
Western Univ, Dept Med, London, ON, Canada;McMaster Univ, Dept Med, Hamilton, ON, Canada.
2019 (English)In: Annals of Allergy, Asthma & Immunology, ISSN 1081-1206, E-ISSN 1534-4436, Vol. 123, no 1, p. 89-94Article in journal (Refereed) Published
Abstract [en]

Background: The variation of needle lengths of epinephrine auto-injectors (EAIs) has not been investigated. Objective: To investigate the impact of the variation of the needle length of EAIs. Methods: Skin-to-muscle (STMD) and skin-to-bone distances (STBD) were measured for 303 children and adolescents and 99 adults. Distance was determined by ultrasound, applying high or low pressure on the probe. The risk of subcutaneous and periosteal/intraosseous injection was calculated using the lower and upper acceptance limits for length of EAI needles as provided for 3 high-pressure EAIs (HPEAI) and 1 low-pressure EAI (LPEAI). Results: The variation in needle length of the HPEAIs are for Epipen Jr/Epipen 5 mm, for Jext 2 mm, for Auvi-Q 2.5 mm, and for the LPEAI, Emerade, 1.5 mm. When using the longest acceptable needles for Epipen Jr, the risk of intraosseous/periosteal penetration was highest in children weighing less than 15 kg at 60% and for Jext at 43%. The risk was low for Auvi-Q and Emerade. The risk of subcutaneous injection was greatest with the shortest needles of the Auvi-Q 0.1 mg at 94% in children weighing less than 15 kg. In adults, the risk of subcutaneous injection using the shortest needles was for Epi-Pen at 41%, Jext at 36%, Auvi-Q at 38%, and Emerade at 12%. Conclusion: The variation in needle length of EAIs influences the risk of subcutaneous and intraosseous/periosteal injections. Compared with Epipen Jr, the Auvi-Q 0.1 mg for children weighing less than 15 kg had a low risk of intraosseous/periosteal injection but a very high risk of subcutaneous injection. For adults, there is a significant risk of subcutaneous injection. (C) 2019 Published by Elsevier Inc. on behalf of American College of Allergy, Asthma & Immunology.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC , 2019. Vol. 123, no 1, p. 89-94
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Public Health, Global Health, Social Medicine and Epidemiology
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URN: urn:nbn:se:uu:diva-390802DOI: 10.1016/j.anai.2019.04.027ISI: 000472823700014PubMedID: 31071440OAI: oai:DiVA.org:uu-390802DiVA, id: diva2:1343774
Available from: 2019-08-19 Created: 2019-08-19 Last updated: 2019-08-19Bibliographically approved

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