背景:肾上腺素自动注射器有望肌内递送药物。
目的:研究通过衣服注射是否会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。用超声波测定距离,超声波探头上的高压或低压。皮下和骨内/骨膜注射的风险/百分比使用由两个高压EAI制造商和一个低压EAI制造商提供的授权批准的EAI针头长度的下限和上限计算。通过比较无衣服的药物输送深度,说明了在肾上腺素输送时增加冬季服装。此外,计算了批准的最短和最长针头长度的非肌内给药rif.
结果:当在<15kg的儿童中使用EpipenJr®时,骨内/骨膜注射的风险从最短和最长批准的针头长度的1%和59%降低到冬季服装的0%和15%。0.1mg的Auvi-Q®没有骨内/骨膜注射的风险。然而,冬季服装的皮下沉积风险从94%和28%增加到100%和99%。在最小的儿童中使用EpipenJr®皮下注射的风险从13%和0%增加到冬季服装的81%和1%,成人中的Epipen®从45%和17%增加到60%和38%。Emerade®,成人皮下注射的风险从14%和10%增加到28%和21%,增加了冬装。
结论:所有EAI通过冬衣注射时,骨内/骨膜注射的风险降低,皮下注射的风险增加。
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.
CONCLUSIONS: The risk of intraosseous/
periosteal injections decreases and the risk of subcutaneous injection increases when injecting through winter clothes for all EAIs.