How do I administer an EpiPen (epinephrine) in case of anaphylaxis?

How to Administer an EpiPen for Anaphylaxis

To administer an EpiPen, remove the safety cap, place the orange tip against the outer thigh, push firmly until it clicks, and hold for 3 seconds, then seek immediate emergency medical care. 1

Proper Administration Technique

1. Prepare the EpiPen:

   • Remove the EpiPen from its carrier tube
   • Grasp with your dominant hand, with your thumb closest to the blue safety cap
   • Remove the blue safety cap by pulling straight up (don't bend or twist)

2. Position correctly:

   • Hold the EpiPen with the orange tip pointing downward
   • Place the orange tip against the middle of the outer thigh
   • Position at a 90-degree angle to the thigh
   • Can be administered through clothing if necessary 2, 1

3. Administer the injection:

   • Push firmly against the thigh until you hear a click
   • Hold in place for 3 seconds (count "1-2-3")
   • The orange needle cover will extend automatically after injection 1

4. After injection:

   • Massage the injection site for 10 seconds
   • Call emergency services (911) immediately
   • Prepare for possible need of a second dose 2

Critical Considerations

Injection Location

• Correct location: Middle of outer thigh (vastus lateralis muscle) 2, 3
• Avoid these locations:
  • Do NOT inject into buttocks (risk of Clostridial infections)
  • Do NOT inject into hands, feet, or digits (risk of tissue necrosis)
  • Do NOT inject into deltoid (arm) muscle (slower absorption) 3

Dosing Information

• Adults and children ≥30kg: 0.3mg dose auto-injector
• Children 7.5-25kg: 0.15mg dose auto-injector
• Children 25-30kg: Either 0.15mg or 0.3mg (typically transition to 0.3mg at approximately 25kg) 1

Timing and Second Doses

• Epinephrine should be administered immediately when anaphylaxis is suspected 2, 4
• A second dose may be needed if symptoms persist or worsen after 5-15 minutes 1
• 6-19% of patients require a second dose of epinephrine 1

Common Mistakes to Avoid

1. Delaying administration - Fatal outcomes are associated with delayed epinephrine use 2, 5
2. Incorrect injection site - Using deltoid or buttocks instead of thigh 3
3. Not holding in place long enough - Must hold for full 3 seconds 1
4. Placing thumb over either end - Can result in accidental injection into thumb/hand
5. Not seeking emergency care - Always seek medical attention after using an EpiPen 1

After Using an EpiPen

• Monitor for side effects: pallor, tremor, anxiety, palpitations, headache, nausea 1
• All patients who receive epinephrine should be transported to an emergency department 1
• Typical observation period is 4-6 hours 1
• Bring the used EpiPen to the hospital for proper disposal

Special Considerations

• There is no absolute contraindication to epinephrine in anaphylaxis, even in patients with heart disease, elderly patients, or pregnant women 2, 1
• In obese individuals, standard needle length may not reach muscle tissue 1
• Always check expiration dates and replace expired auto-injectors 6

Remember that epinephrine is the first-line treatment for anaphylaxis and should never be substituted with antihistamines or other medications as the initial treatment 1, 4.