Background Epinephrine auto-injectors are expected to deliver the drug intramuscularly. Objective To study whether injection through clothing influences the frequency of subcutaneous and intraosseous/periosteal deposition of epinephrine. Methods Skin to muscle and skin to bone distances were measured for 303 children and adolescents and 99 adults. Distance was determined by ultrasound, with high or low pressure on the ultrasound probe. The risk/percentage of subcutaneous and intraosseous/periosteal injections was calculated using the lower and upper limits for the authority-approved length of EAI needles as provided by two high pressure EAI manufacturers and one low pressure EAI manufacturer. The addition winter clothing on the delivery of epinephrine was illustrated by comparing drug delivery fissue depth with no clothes. Furthermore, the riof non-intramuscular delivery for the shortest and longest approved needle length was calculated. Results When using EpipenJr® in children < 15 kg the risk of intraosseous/periostal injection was reduced from 1% and 59% for the shortest and longest approved needle length to 0 and 15% with winter clothes. The Auvi-Q® 0.1 mg had no risk of intraosseous/periosteal injection. However, the subcutaneous deposition risk increased from 94% and 28% to 100% and 99% with winter clothes. The risk of subcutaneous injection using EpipenJr® in the youngest children increased from 13% and 0% to 81% and 1% with winter clothes, and with Epipen® in adults from 45% and 17% to 60% and 38%. Emerade®, had a risk of subcutaneous injection in adults increasing from 14% and 10% to 28% and 21% adding winter clothes. Conclusion The risk of intraosseous/periosteal injections decreases and the risk of subcutaneous injection increases when injecting through winter clothes for all EAIs.

中文翻译：

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肾上腺素自动注射器针头长度：冬季服装的影响。


背景 肾上腺素自动注射器有望通过肌肉注射药物。目的研究穿衣注射是否影响肾上腺素皮下和骨内/骨膜沉积的频率。方法测量了 303 名儿童和青少年以及 99 名成人的皮肤到肌肉和皮肤到骨骼的距离。距离是通过超声波确定的，对超声波探头施加高压或低压。皮下和骨内/骨膜注射的风险/百分比是使用两家高压 EAI 制造商和一家低压 EAI 制造商提供的权威批准的 EAI 针长度的下限和上限计算的。通过比较药物输送组织深度与不穿衣服的情况来说明添加冬季服装对肾上腺素输送的影响。此外，还计算了最短和最长批准针长度的非肌肉内输送的RIF。结果 当体重 < 15 kg 的儿童使用 EpipenJr® 时，骨内/骨膜注射的风险从批准的最短和最长针头长度的 1% 和 59% 降低到穿冬衣的 0 和 15%。 Auvi-Q® 0.1 mg 没有骨内/骨膜注射的风险。然而，穿冬衣时皮下沉积风险从 94% 和 28% 增加到 100% 和 99%。最小儿童使用 EpipenJr® 进行皮下注射的风险从穿冬衣的 13% 和 0% 增加到 81% 和 1%，成人使用 Epipen® 皮下注射的风险从 45% 和 17% 增加到 60% 和 38%。 Emerade®添加冬衣后，成人皮下注射的风险从 14% 和 10% 增加到 28% 和 21%。 结论 所有 EAI 穿过冬衣注射时，骨内/骨膜注射风险降低，皮下注射风险增加。