Service Evaluation of Laceration Risk Using Trainer Adrenaline Auto-Injectors

Abstract

To assess the potential laceration risk epinephrine autoinjectors (AAIs) by using 2 methods, swing and jab (S&J) and the place and press (P&P), given the published concerns over laceration injuries.In this study in Cardiff, England, researchers examined the different methods of AAI use in 100 children (5–11 years old; mean: 8 years) without previous knowledge of autoinjector use.Face paint was placed in the center of the EpiPen trainer device, in which the needle would be in a real AAI, and all excess paint around the “needle” indentation was removed. Both methods (S&J and P&P) of administration were used on each child’s lateral outer bare thigh sequentially, with the first method alternating between each child. When the trainer pen clicked, the child was asked to pretend they felt a pinch or sting and move their leg accordingly. Whether the child moved for each method was recorded. The length of each painted mark was measured in millimeters to assess the risk of laceration.A total of 50% did not move when the EpiPen was administered; 32% moved for both methods, and 18% moved for 1 method (12 children for S&J and 6 children for P&P). Of the children that moved for the S&J method, the mean paint length was 8.3 mm (SD: 17.4; 95% CI: 3.4 to 13.3), and the P&P mean length was 3.5mm (SD: 11.0; 95% CI: 0.4 to 6.6). The mean difference between methods was 4.8 mm (SD: 10.1; 95% CI: 1.9 to 7.7; P = .001). For the children who did not move for either method, there was no significant difference between the paired measurements (P = .402; S&J mean: 1.0 mm [SD: 1.6]; P&P mean: 0.8 mm [SD: 1.5]).The S&J method produces more movement and longer paint marks than the P&P method for administering the EpiPen device. The risk of laceration and pain when administering an EpiPen to young children may be lower by using the more controlled P&P method.Previous cases have revealed a risk of laceration when administering an EpiPen device to children by using the recommended S&J method. Current instructions with the Mylan device caution to hold the leg firmly in place while administering an injection to a young child. It does not recommend the P&P method. Children are often worried about the injection and move their legs. When using this type of autoinjectable device, it may be advisable to change the teaching we give to families with young children <11 years of age to a P&P method, instead of an S&J technique. The need for epinephrine during anaphylaxis is essential regardless of the method used, and it is important to hold the child before administering any AAIs to avoid laceration.