Epi-Pen Auto Injector

[mwboswell]

Would like to know who is starting to use the epi-pen autoinjector for your allergic reactions in the ED.

Apparently some places have considered doing this as there is less chance for medication error as you don't have to draw it up out of that small little epi ampule any more. Of course this means they are going IM instead of SQ.

Any comments appreciated.

-MB

[blondy2061h, MSN, RN]

Not an ER setting here, but we have patients anaphylact during their stem cell reinfusions sometimes, and they get epi drawn up subq. Granted, IM injections are contraindicated in the BMT population due to thrombocytopenia.

[merlee]

What makes you think Epi-pen is IM? They have very short needles, much like all the insulin pens.

[Jolie, BSN]

The Epi-pen is an IM injector. See the following:

http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=7150

DESCRIPTION

The EpiPen® and Epipen® Jr auto-injectors contain 2 mL epinephrine injection for emergency intramuscular use. Each EpiPen auto-injector delivers a single dose of 0.3 mg epinephrine from epinephrine injection, USP, 1:1000 (0.3 mL) in a sterile solution.

Each EpiPen Jr auto-injector delivers a single dose of 0.15 mg epinephrine from epinephrine injection, USP, 1:2000 (0.3 mL) in a sterile solution.

[BuckyBadgerRN, ASN, RN]

What makes you think Epi-pen is IM? They have very short needles, much like all the insulin pens.

Because of the site of injection--right into a big muscle (well, not so big on MY bird-like legs!). That needle is big--gauge-wise and longer than any insulin pens I've worked with.

[sethmctenn]

Here's an interesting discussion of this issue: http://pediatrics.aappublications.org/content/124/1/65.full

Evidently, IM is now preferred due to faster rise to peak plasma level. The needle is 1" long so it's IM for some people but not for those with an elevated BMI

[mwboswell]

Yes, IM is becoming the preferred method. One reason is that given SQ, the epinepherine causes the SQ capillary bed to vasoconstrict, thereby causing some of the drug to remain "trapped" in the local SQ injection site and thus unavailable to circulate and get the benefits intended.

[rjflyn, ASN, RN]

Not starting, have been here for some time. Generally idiot prove save for the one or two that think the orange end is a button to push and have injected their thumbs. Only down side is that for infants one still has to draw up a dose from an ampule, I guess there is a second down side is cost EPI pens are expensive- I know I have to pay the highest copay on my insurance plan for mine.

[gamegirlkimmy]

Several Nurses have accidentally injected themselves in the thumb with our epi pen. Be careful!

[mmutk, BSN, RN, EMT-I]

Boswell,

Why the question? Is this a developing trend? I can't think of many good reasons why we would need this in the ER.

[mwboswell]

Boswell,

Why the question? Is this a developing trend? I can't think of many good reasons why we would need this in the ER.

@mmutk: Yes it is. There are proponents of this device to minimize dosing errors, injury during drawing it up and speed of access. After all -why not? It only makes it simpler!

[Jolie, BSN]

@mmutk: Yes it is. There are proponents of this device to minimize dosing errors, injury during drawing it up and speed of access. After all -why not? It only makes it simpler!

It also makes it way more expensive. The auto-injector is intended for emergency use by non-medical people. It seems overkill to use it in an inpatient setting where staff should be capable of safely drawing up and administering medication from a vial.