How do I use an EpiPen (epinephrine auto-injector)?

How to Use an EpiPen (Epinephrine Auto-Injector)

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

Step-by-Step Instructions for EpiPen Administration

EpiPen Instructions:

• Remove the EpiPen from the plastic carrying case 1
• Pull off the blue safety release cap 1
• Hold the orange tip near the outer thigh (always apply to thigh, even through clothing if necessary) 1, 2
• Swing and firmly push the orange tip against the outer thigh 1
• Hold in place for approximately 10 seconds 1
• Remove the EpiPen and massage the injection area for 10 more seconds 1

For Auvi-Q Auto-Injector:

• Remove the outer case (this will automatically activate voice instructions) 1
• Pull off the RED safety guard 1
• Place the black end against the outer thigh, press firmly and hold for 5 seconds 1

For Adrenaclick Auto-Injector:

• Remove GREY caps labeled "1" and "2" 1
• Place RED rounded tip against outer thigh, press down hard until needle penetrates 1
• Hold for 10 seconds, then remove 1

Critical Actions After Using an EpiPen

• Call 911 immediately after administering epinephrine 1
• Monitor the patient closely for symptom progression or improvement 1
• A second dose may be administered after 5 minutes if symptoms persist or recur 1, 3
• Keep the patient lying on their back with legs raised 1
• Note the time when epinephrine was administered to inform emergency responders 1

Important Considerations

• Always inject into the anterolateral aspect of the thigh for fastest absorption 3, 2
• Intramuscular injection leads to faster absorption (peak concentration at 8±2 minutes) compared to subcutaneous injection (34±14 minutes) 3
• Never delay epinephrine administration, as delays are associated with increased mortality 3, 4
• Antihistamines and inhalers should not be relied upon as primary treatment for anaphylaxis 1, 3
• Avoid injecting into the same site repeatedly to prevent tissue necrosis 2

Common Mistakes to Avoid

• Not holding the device in place long enough (57% of users make this error) 5
• Failing to apply enough pressure to activate the device (21% of users) 5
• Accidental self-injection into the thumb (16% of users) 5
• Delaying epinephrine administration while giving antihistamines first 3
• Using subcutaneous instead of intramuscular route 3

Additional Recommendations

• Always carry two epinephrine auto-injectors in case a second dose is needed 4, 6
• Check expiration dates regularly; however, if only an outdated auto-injector is available during an emergency, it may still be used if no discoloration or precipitates are visible 7
• Store auto-injectors at room temperature and protect from light 2
• Ensure all caregivers know how to use the specific auto-injector prescribed 8
• Seek medical attention immediately after use, even if symptoms improve 1, 3