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Anaphylaxis: How to Use Epinephrine (Epi-Pen)
Health Issue Category
Date of Issue
Revision Date
February, 2006
Related Policies, Administrative Procedures and Forms:

Information about the use of Epinephrine

Epinephrine may be supplied as an

a) EpiPen®
b) EpiPen Jr.®
c) TwinJect
d) TwinJect Jr.

Expiration dates need to be checked regularly. Auto-injectors should be stored at 25*C (77*F).  (On a field trips the permitted range is  15* to 30*C ( 59*F to 86*F))

A Junior EpiPen® with .15 mg of epinephrine, should be provided if the student weighs 15 - 30 kg (33 - 66 lbs), to ensure the proper dosage is administered. The student’s weight is be recorded on the Emergency Medical Alert Form. (AP-314-F-D3)  An adult EpiPen with .3 mg of epinephrine should be provided if the student weighs 30 kg (66 lbs) or more.

The following is a synopsis of the training that would be provided to staff in First Aid Certification. This section is not meant to replace the training sessions.

When injecting an auto-injector, ensure the proper end is placed on the thigh. Many incidents were reported where thumbs were accidentally injected rather than the anaphylactic individual. Arrows pointing toward the tip of the auto-injector have been added right next to the instructions that read, “Place tip against outer thigh. This will assist new users in properly administering the auto-injector.

When injecting, remember to hold the auto-injector against the body for a full ten seconds, to allow complete dissemination of the medication. The anaphylactic student's leg may have to be held firmly to avoid disengaging him/her from the auto-injector. It is normal to see some liquid left in the used auto-injector. The statement “1.7 ml. of liquid will remain after activation” was added to avoid confusion. The complete dose of epinephrine will have been injected if it was held in place for ten seconds. Massage the area for 10 seconds after injection.

It is not uncommon for individuals to be fearful of using the auto-injector the first time, if up until then they have only practised with the trainer. There is confusion from first time auto-injector users about not hearing the “click” on the real auto-injector, as one hears when using the trainer.

The actual auto-injector does not have a “click” but one can feel the device activate.  On Epi-Pens an orange sheath surrounds an exposed needle. On TwinJects, the exposed needle will need to be bent backwards on a hard surface if the second dose is needed.

It is recommended that the used auto-injector be disposed of at your local Health Unit, at your own pharmacy, or at the Hazardous Waste Depot, rather than a trash container at home or school. It may be helpful to take it to the Hospital Emergency Room to show what was given.

ALL individuals receiving emergency epinephrine must be transported to hospital immediately. Further treatments may be required and therefore observation in a hospital setting is necessary.

Additional epinephrine must be available during transport and may be administered after 10 to 15 minutes, should symptoms not subside or in fact, reoccur.

About  Auto-Injectors

An auto-injector administers epinephrine (also known as synthetic adrenaline)—the medication recognized by healthcare professionals as the only treatment of choice for severe allergic reactions.

Auto-injectors are simple and ready to use.
The labels on EpiPen and TwinJect Auto-Injectors provide quick, simple directions. The carrying case provides built-in protection to promote safety. Epinephrine has been used to treat severe allergic emergencies for over 30 years.

People can reduce the risks associated with a severe allergic emergency by:

  •  Carrying an auto-injector at all times
  •  Use auto-injector at the earliest sign of a reaction
Make sure you are prepared wherever you go by having an auto-injector in all key locations, including:

  •  Home (on every floor)
  •  Work (office and briefcase)
  •  School and/or day care (backpack, classroom and school office)
  •  Gym class
  •  In transit (purse, briefcase, and luggage)
Are there different doses of EpiPen?
Yes. There are 2 dosage strengths: EpiPen (0.3 mg) and EpiPen Jr. (0.15 mg). EpiPen should be used for adults and children weighing 30 kg or more. EpiPen Jr. should be used for children weighing 15 kg to 30 kg.
How do I use EpiPen and EpiPen Jr. Auto-Injectors?
EpiPen can be administered in 2 simple steps:
Step 1
Step 1

Remove the yellow or green cap from the storage tube

Grasp the Auto-Injector with the black tip pointing down

Pull off the grey safety cap
Step 2
Step 2

Place black tip against mid-outer thigh and press firmly until the Auto-Injector activates.

Hold while counting for several seconds, then remove.

Massage the injected area for 10 seconds

Seek medical attention immediately.
Either call 911 or have someone take you to the emergency room.

What should I do after I use EpiPen?
Carefully place any used Auto-Injectors, needle first, back into the storage tubes. Screw the caps back on the storage tubes tightly.
It is important that you call 911 or have someone take you to the emergency room because the effects of epinephrine can wear off and there is a chance of a second reaction. You should also stay within close proximity to a hospital or where you can easily call 911 for the next 48 hours.
Give any used Auto-Injectors in their storage tubes to emergency responders or emergency room personnel.
You should also try to stay warm and avoid unnecessary movement.

Twinject Auto-Injector

Look at TwinjectTM 0.3 mg or TwinjectTM 0.15 mg regularly. It may not work if medicine looks cloudy (has particles), pinkish, or more than slightly yellow, or if the expiration date has passed.

In the event of a life-threatening allergic reaction, you should use an out of date product, if that is all you have.

Do NOT remove the GREEN or the RED cap until you are ready to use.

PULL of Green end Cap to see a GREY cap
Never put thumb, finger, or hand over the GREY cap.
Removing Grey Cap
PULL off RED end cap.
Place GREY cap against mid-thigh (can go through clothes).
Press down fromly until auto-injector activates - hold while slowly counting to ten.
Remove auto-injector and check the GREY cap; it needle is exposed, you received the dose. If not, repeat #3 and #4 under step 2. Prepare for second dose.

Get emergency medical help right away

Unscrew and remove GREY cap. Beware of exposed needle.
Yellow Cap
Holding BLUE hub at needle base, remove syringe from barrel.
Slide YELLOW (Twinject 0.3 mg) or ORANGE (Twinject 0.15 mg) collar off plunger.
PAUSE HERE. If symptoms have not improved in approximately 10 minutes since first injection, proceed with Step 4.
Insert needle into mid-thigh.
Insert Needle
Push plunger down completely.
Get emergency medical help right away.
Re-insert syringe, needle first, into blue case. Return it to your physician or pharmacist for proper disposal. Do not throw away in trash.

Source: Twinject, autoinjector, epinephrine inhection (USP1:1000),

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