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Epinephrine for the out-of-hospital (first-aid) treatment of anaphylaxis in infants: Is the ampule/syringe/needle method practical?,☆☆

https://doi.org/10.1067/mai.2001.119916Get rights and content

Abstract

Background: Little information is available about administration of an accurate epinephrine dose to infants experiencing anaphylaxis outside the hospital setting. Objective: Our purpose was to perform a prospective, controlled study of (1) the time needed by parents to draw up an infant epinephrine dose from an ampule and (2) the dose accuracy. Methods: We gave 18 parents written instructions and asked them to draw up epinephrine 0.09 mL. We timed them by means of a stopwatch and measured the epinephrine content (in micrograms) in each dose by using HPLC-UV. Eighteen resident physicians, 18 general duty nurses, and 18 emergency department nurses served as controls. Results: The parents took significantly longer (P < .05) than the controls to draw up the dose; the mean (± SEM) times were 142 ± 13 seconds (range, 83-248) for the parents, 52 ± 3 seconds (range, 30-83) for the physicians, 40 ± 2 seconds (range, 26-71) for the general duty nurses, and 29 ± 0.09 seconds (range, 27-33) for the emergency department nurses. The control groups did not differ significantly from each other in speed (P > .05). The epinephrine content of the doses drawn up by the parents ranged 40-fold in contrast to the physicians' doses (7- to 8-fold), general duty nurses' doses (3-fold), and emergency department nurses' doses (2-fold). The mean epinephrine content did not differ significantly (P > .05) among the 4 groups. Conclusions: Most parents were unable to draw up an infant epinephrine dose rapidly or accurately. Most health care professionals drew up the dose rapidly; however, their accuracy was compromised by inherent variations of epinephrine concentrations in the ampules (United States Pharmacopeia compendial limits, 90% to 115%) and the inherent difficulty of measuring low volumes (<0.1 mL) of epinephrine. User-friendly premeasured epinephrine doses suitable for infants should be developed. (J Allergy Clin Immunol 2001;108:1040-4.)

Section snippets

Methods

This project was reviewed by the Research Ethics Board of the University of Manitoba. The study was performed at the Children's Hospital/Health Sciences Center and the John Buhler Research Center, Winnipeg, Manitoba, Canada.

Results

Eighteen parents of children at risk for anaphylaxis agreed to take part in the project, as did 18 pediatric resident controls, 18 general duty nurse controls, and 18 emergency department nurse controls. All 72 participants completed the study.

In contrast to the health care professionals, all of whom demonstrated the correct technique for opening the glass ampule, drawing up the epinephrine into the syringe, and removing the air from the syringe, 3 of 18 parents struggled to open the ampule and

Discussion

The available options for administration of an accurate epinephrine dose to infants experiencing anaphylaxis outside the hospital setting vary considerably in ease of use and in cost, and each has advantages and disadvantages.

The EpiPen Jr and EpiPen auto-injectors currently represent the most user-friendly method of giving an epinephrine injection, but they are also associated with the greatest expense ($50.00 US or more for a single dose) and are not available in many countries. They have the

Acknowledgements

We acknowledge the support of Wade T. A. Watson, MD, FRCPC, and the Allergy nurses, Lana M. Johnston, RN, Cathy A. Gillespie, RN, BA, Fay Ernst, RN, and Carolyn Kosowan, RN.

References (21)

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Supported by the Children's Hospital Foundation of Manitoba, Inc. No financial or in-kind support was provided by any corporate sponsor.

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Reprint requests: F.E.R. Simons, MD, FRCPC, 820 Sherbrook Street, Winnipeg, Manitoba, Canada R3A 1R9.

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