What is the proper technique for using an EpiPen (epinephrine auto-injector)?

Proper Technique for Using an EpiPen (Epinephrine Auto-Injector)

To properly use an EpiPen, remove it from the carrying case, pull off the blue safety cap, hold the orange tip against the outer thigh, firmly push until it clicks, hold for 10 seconds, then remove and massage the area for 10 more seconds. 1

Step-by-Step EpiPen Administration Technique

1. Remove the EpiPen from the plastic carrying case
2. Pull off the blue safety release cap
3. Hold the orange tip near the outer thigh (always apply to the thigh)
   • Can be administered through clothing if necessary 2
   • The anterolateral aspect of the thigh is the recommended injection site 3
   • When administering to a child, hold the leg firmly in place to minimize injury 2
4. Swing and firmly push the orange tip against the outer thigh until it clicks
5. Hold on the thigh for approximately 10 seconds to ensure complete delivery of medication
6. Remove the EpiPen and massage the area for 10 more seconds 1

Important Safety Considerations

• Call 911 immediately after administering epinephrine - all patients who receive epinephrine for anaphylaxis should be transported to an emergency department 3
• Do not touch the needle - this is a common error in administration 4
• Do not administer repeated injections at the same site as vasoconstriction may cause tissue necrosis 2
• Monitor for side effects - transient pallor, tremor, anxiety, and palpitations are common and similar to the body's natural "fight or flight" response 3
• Be prepared for a second dose - if symptoms persist or recur, a second dose may be given 5-15 minutes after the first 1

Dosing Guidelines

• Adults and children ≥30 kg (66 lbs): 0.3 mg dose (standard adult EpiPen)
• Children 10-25 kg (22-55 lbs): 0.15 mg dose (EpiPen Jr.)
• Children <10 kg: 0.01 mg/kg (consult with healthcare provider) 3, 2

Common Mistakes to Avoid

1. Delayed administration - epinephrine should be the first-line treatment for anaphylaxis; delays may be fatal 5
2. Incorrect placement - the anterolateral thigh is the only appropriate injection site 3
3. Not holding the device in place long enough - maintain pressure for the full 10 seconds 1
4. Forgetting to remove the safety cap - 38% of users fail to remove the cap before attempting to use the device 6
5. Overreliance on antihistamines - antihistamines should not replace epinephrine as first-line treatment 3

Training and Education

• Practice regularly with a trainer device - studies show that repeated instruction significantly improves proper technique 6
• Verify technique at every medical visit - only 5.6% of patients demonstrate perfect technique without reinforcement 6
• Ensure all caregivers know how to use the device - healthcare workers, school staff, and family members should all be trained 7

Remember that epinephrine is the cornerstone of anaphylaxis management, and proper administration technique can be life-saving. Even if your EpiPen is slightly outdated, it can usually be administered safely in an emergency situation while seeking immediate medical attention 8.