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Adrenaline self-injection: beware of accidental injection

Thorough and repeated training of healthcare professionals, patients and their carers in the use of an autoinjector is the main preventive measure against handling errors.

In some cases of severe allergy, only the prompt administration of adrenaline makes it possible to avoid death. Autoinjectors are disposable, prefilled devices enabling the patient or their carers to administer adrenaline as quickly as possible, before medical help arrives.

The frequency of accidental injections with these devices is rising. The effects are variable: no adverse reactions in 10% of patients, minor effects in 77%, more marked effects in 13% of patients. Nearly 75% of unintentional injections are made into a finger. The effects are often worrying and painful. Sometimes they distract attention in an emergency situation, and compromise the treatment of the person in anaphylactic shock. The symptoms often disappear without treatment, or simply by applying heat. Sometimes they worsen, and can result in the amputation of a finger or become life-threatening.

Adrenaline autoinjectors are not subjected to clinical assessment before being marketed. Handling errors can be due to malfunctions or to design defects: labelling errors; counter-intuitive devices that do not allow for an appropriate, fast reflex use in an emergency situation. However, the main cause of error is users’ lack of understanding of how autoinjectors work.

Prevention of these unintentional injections requires informing patients, carers and healthcare professionals, demonstrating how to handle the devices and training all concerned, as well as improving their design.

©Prescrire 1 October 2012

"Accidental injection with adrenaline autoinjectors" Prescrire Int 2012; 21 (131): 236-239. (Pdf, subscribers only).
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