Needle length for epinephrine prefilled syringes in children and adolescents: Is one inch needle appropriate? (2018)

Title           : Needle length for epinephrine prefilled syringes in children and adolescents: Is one inch needle appropriate?

Researcher       : Clin.Prof.Suwat Benjaponpitak 

Department     : Faculty of Medicine, Siam University, Bangkok, Thailand

E-mail                : med@siam.edu

Abstract            :  Background: Intramuscular epinephrine is the first line drug in the treatment of anaphylaxis. This study was to identify the appropriateness of 1 inch needle length for epinephrine prefilled syringes in children.

Methods: Children aged 1 month to 18 years were enrolled. Skin to muscle depth (STMD) and skin to bone depth (STBD) were measured using an ultrasonography at the mid-anterolateral thigh. A 1 inch needle was considered as being appropriate if the STBD was more than 1 inch and the STMD was less than 1 inch.

Results: Seventy five infants, 75 pre-school aged children, 75 school aged children and 147 adolescent were enrolled: 196 (52.7%) children were male. A 1 inch needle length was appropriate for 61% of the infants, for 88% of the preschool children, for 99% of the school aged children and for 95% of the adolescents. Thigh circumference ≥23 cm, BMI ≥16 kg/m2 and BW ≥ 6 kg in infants provided the sensitivity of 74%-96% in predicting the appropriateness of 1 inch needle. In preschool group, thigh circumference ≥25 cm, BMI ≥13.5 kg/m2 and BW ≥ 10 kg provided the sensitivity of 98.5-100% in predicting the appropriateness of 1 inch needle. Thigh circumference ≥ 49 cm in adolescents provided the sensitivity of 75% in predicting that a 1 inch needle was too short.

Conclusion: One inch needle length may not be appropriated for intramuscular injection at thigh in all children. Thigh circumference, BMI and body weight are useful for predictor for using the 1 inch needle.

Key words: Anaphylaxis, children, epinephrine, needle length, intramuscular

Link to Academic article:  DOI: 10.12932/AP-020317-0039

Journal : Asian Pacific journal of allergy and immunology 

Bibliography     : Manuyakorn, W., Bamrungchaowkasem, B., Ruangwattanapaisarn, N., Kamchaisatian, W., & Benjaponpitak, S. (2018, June). Needle length for epinephrine prefilled syringes in children and adolescents: Is one inch needle appropriate?. Asian Pac J Allergy Immunol, 36(2), 113-119. doi: 10.12932/AP-020317-0039. PMID: 28938839.