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Inject Epi-pen - Hold to the count of 15 - Did You Know?

21 replies [Last post]
By on Tue, 03-06-01, 19:09

This was just brought to my attention by another PA parent and I'm hoping that by posting it other people that don't already know this will know it and not feel like BAD MOMMY, which I very much do right now.

Did you know that when you inject the Epi-pen that you are supposed to hold it to the count of 15?

I didn't. I'm not clear if it is written on the instruction sheet that comes with the Epi-pen. I will check and post later whether it is clearly explained with the instructions or not.

At any rate, I did NOT know this, and once again, feel like a complete idiot when it comes to dealing with PA. I am SO thankful to the PA parent who did tell me and am quite willing to share this despite the embarrassment, guilt, etc. that I am currently feeling.

So, if you don't know already, when you inject the Epi-pen, hold it to the count of 15.

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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By Mir on Tue, 03-06-01, 20:29

Okay, I had to go take out our EpiPen Jr.s and look at them after this post. The nurse at the allergist's office told me to hold until the count of 10. (Whether or not that will actually be possible with a 1-year-old is debatable in my opinion!)

The pen itself says (as step #3): "Using a quick motion, press hard until injector functions. Hold in place for several seconds." The insert inside the box says the same, except that it adds also "The EpiPen Jr unit should then be removed and discarded. Massage the injection area for 10 seconds."

I don't think you're a bad mommy--I think that's sort of confusing. The instructions ON the pen and IN THE BOX don't even match! And BOTH are different than what our prescribing doctor told us! Is it any wonder we need this board...?

Miriam (who hopes that if the time comes to use the blasted thing, I can just manage to stay calm and get it done without stabbing it into myself or passersby!)

[This message has been edited by Mir (edited March 06, 2001).]

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By on Tue, 03-06-01, 21:00

Cindy-Our allergist said to hold to the count of 10 also but never mentioned massaging the area. That is probably a good idea but as the person above said....I will be lucky to even get it in my son!!! He throws such fits and kicks and hits when you even try to look in his ears.

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By DMB on Tue, 03-06-01, 21:15

I was told 10 seconds by our allergist. Also, I just printed out a new emergency form from FAAN for my son since he just started a new preschool. It's now 2 pages and on the second page is has a photo illustration of how to administer the epi. It also says to hold the pen in place for 10 seconds and then massage the area for 10 seconds.

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By on Tue, 03-06-01, 21:43

Wow, thank-you for the terrific response. I'm going to go and check the instructions that come with the Epi-pen (haven't had a chance yet). The thing that disturbs me, aside from the fact that I haven't read the instructions on how to use the Epi-pen that come with the prescription, is that NO health care professional along the way has ever told me a thing about it's use.

I was never told that the shot only bought you twenty minutes to get to the hospital. I learned the hard way. My son almost died.

I like to think of myself as pro-active in my health care and long before I had children but I feel that for whatever reason(s), I really fell short with this one. So, if the two or three prescribing physicians of the Epi-pen didn't tell me, the allergist didn't tell me and the two dispensing pharmacists didn't tell me anything about the Epi-pen, is it really their fault. NO! It's mine. Why didn't I have a long list of questions about it? Why? I am racking my brain for an appropriate answer and there is not one.

When I was pregnant with Jesse, I had a journal in which I kept a long list of questions that I went over with my obstretician each time I saw him. He even joked with me about it - okay, bring out the questions. What has happened?

DMB, thank-you for mentioning the Emergency Action Plan form from FAAN. I had just read about it in their newsletter and was planning to e-mail them to ask them if they could send me a copy (my printer is not working). Now that you've told me how great it is, I'll be e-mailing them straight away.

I'm glad that at least everyone who has posted was at least told SOMETHING about the Epi-pen and it's useage. However, I can't totally blame the doctors/pharmacists. I should have asked questions. I'm really at a loss as to why I didn't.

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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By creek14 on Tue, 03-06-01, 21:50

Our allergist also told to hold for 10 and rub for 10. But then she said - "and if you can't do that, don't worry about it. Get as much of the epi in as you can, try to get some Benedryl in and call 911."

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By on Tue, 03-06-01, 22:02

creek14, I don't understand how an allergist can be what I consider "flip" in a response about how to use the Epi-pen. Her comment just leaves so much room for misinterpretation and is really, if you think about it, downright wrong.

I know what's bothering me about this. Jesse has had the Epi-pen administered twice. This is twice that I did not know the information that I should have known. Now, the first time it was administered, it was done by a doctor at the medical centre next door to me.
The second time, it was administered by his Father, but I asked his Father to-day if he knew the count thing and he didn't. So now I'm wondering if we even got it right the last time we administered the Epi-pen. Did we leave the Epi-pen in long enough? Is it possible that we didn't and that's why Jesse started to "go" 20 minutes later?

I've thought it through and I think that Jesse would have started to "go" again regardless simply because he had experienced almost every symptom of anaphylaxis before the shot was administered.

However, it is just another thing to add to my list of things I feel much turmoil about.
I feel I should have known this. And I don't understand how in dealing with 3 family doctors, one allergist and 2 pharmacists how no one mentioned it along the way. But again, why didn't I question the 3 family doctors, one allergist and 2 pharmacists along the way?

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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By Linda-Jo on Tue, 03-06-01, 22:09

Cindy,
Don't feel bad about not knowing. We learn each day something new. It's like me, when my daughter was first diagnosed, I was given this EpiPen, but with no instructions; what to look for or, to know when to give it to her. So, when she had her second reaction "The Big One" as we call it, anaphylactic and all, I didn't give it to her because I didn't know when, as she reacted over the course of several hours. I ended up getting chewed out by the ER doctor for over 10 minutes about how I almost killed my daughter!!

After being educated for over 2 hours with her allergist, I hope I know now what to do if I ever have to use the Epi.

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By creek14 on Tue, 03-06-01, 22:37

Cindy, she wasn't flip at all. She was serious. She made it very clear to us that if we have to inject, we might be hysterical, Luke would be hysterical, that the most important thing was to get some epi in him. Any amount was better than nothing. Actually I think that she told us that just to calm us. We had just seen our son almost die. Remember back when you first heard the PA diagnosis. Everything was overwhelming. Now that we are 4 years post diagnosis I have every confidence that I could inject, count to 10 and rub for 10. But back then I was a basket case, heck, I was afraid that I would forget to remove the stopper. It was rather reassuring that if I didn't count 1001, 1002, 1003...1010 that he would still get enough med to help him. She takes this allergy very seriously. She gave us a list of P-free daycares, she INSISTED that we join FAAN. She indulges my paranoia by giving me prescriptions for as many Epis I want. My bad if I made it sound like she doesn't care.

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By Mom to Cayley on Tue, 03-06-01, 22:42

Linda Jo - that ER doctor should have be have been chewing out the doctor/pharmacist who gave you the EpiPen with no further instructions! How were you supposed to know! I often wonder if insulin-dependent diabetics get detailed instructions about how to use their needles and measure their doses. I bet they do! No doctor/allergist should prescribe needles without explaining how to use them, yet they seem to do it all the time.

Anyway, threads like this always make my leg hurt, so I'll just move on to something I recently read about Benadryl. Apparently giving Benadryl in liquid form to someone who is experiencing anaphylaxis-induced throat swelling could cause them to choke. I wish more allergist prescribed the sub-lingual tablets that go under the tongue - much safer, effective and easier to carry around. I'm going to ask my doctor about them next time we go.

creek14 - my allergist and pharmacist both said the same thing as yours - hold it up to 10 seconds or as long as you can - some is better than none, but I should try to get most of it in, sitting on Cayley to do it, if necessary.

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By on Tue, 03-06-01, 23:54

creek14, I'm sorry. I misinterpreted what your allergist had said. Please forgive me.
Now, in re-reading your initial post and then your explanatory post (which you had to make because of what I posted in response), it now makes sense to me what she was saying. Some would be better than none. Okay.

Linda-Jo, thank-you. It sounds as though you and I have had very similar experiences. Fortunately for me, the ER doctor didn't chew me out when I finally got my son to emerg.
I'm so sorry to hear that. Thank-you also for your comforting words. I think you were able to provide them because of our experiences, I'm not sure.

That's why I had so much wanted to post this information, just in case someone else had walked away without being given any information by their doctor or pharmacist. I don't want anyone else to experience what I have - my child almost dying.

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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By morgansmom on Tue, 03-06-01, 23:54

We have always been told to hold it in for a slow 10 second count. Our allergist also explainged that the medication does not take that long to inject into the person, it really only takes about 4 seconds, but the 10 second rule is good to follow because of the situation and stress you are under. If you hold for a slow 10 second count you can be sure that the full dose is administered. Cindy, that is terrible that someone did not explain things to you better, and I don't think it's your fault! ...3 docs and 2 pharmacists, I'm appalled!

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By Mir on Wed, 03-07-01, 00:26

Hey Cindy, just to make you feel better: I realized, in reading this thread, that neither the allergist nor the pharmacist told me how I'll know WHEN to use the EpiPen. Now I'm feeling dumb for not having asked more questions about that. Since Isaac hasn't experienced an anaphylaxis I'm unclear... I mean, sure, if he stops breathing I'll give it to him... but what if he breaks out in hives again? Starts wheezing? At what point is it "time" to administer it?

Not only that (hmmmm maybe I shoulda make this another thread), but Isaac only weighs 20 pounds and the EpiPen Jr. insert clearly states that it's recommended for children 33 lbs and up. It has occurred to me more than once that so much epinephrine relative to his weight might stop an anaphylaxis but give him a heart attack. (Okay, I did ask the allergist about that one and all he said was "I think the dosage will be okay, and if you need the epi you're better off with it and dealing with any consequences of the epi rather than the consequences of anaphylaxis.")

I think the questions are neverending... rather than beat ourselves up about the coulda-woulda-shouldas we just have to get the information as best we can and forgive ourselves. Cindy, you're about the most self-aware empowering/advocating/etc. parent I've met here... so if YOU start doubting yourself I think we're all in trouble! [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]

Miriam

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By Adam's Mom on Wed, 03-07-01, 03:19

I have the addresses for websites that I know I found here in another post [url="http://www.allerex.ca/epi.htm"]http://www.allerex.ca/epi.htm[/url] and [url="http://cgi.cadvision.com/~allergy/epipen.html"]http://cgi.cadvision.com/~allergy/epipen.html[/url]

These websites do not mention holding the EpiPen for any amount of time, but on the manuscript included with the EpiPen we have from Allerex, it does say to hold it in place for several seconds.

The Anaphylaxis Network here in Canada does tell you to hold it in place for 10 seconds, and I found another website [url="http://allergies.miningco.com/health/allergies.library/howto/htepipen.htm"]http://allergies.miningco.com/health/allergies.library/howto/htepipen.htm[/url] that also says to hold it for 10 seconds.

Miriam, I seem to recall Adam having his EpiPen Jr. up until he was 33 lb, and then he changed to the adult dosage. The second link above I think confirms the dosages.

[This message has been edited by Adam's Mom (edited March 06, 2001).]

[This message has been edited by Adam's Mom (edited March 06, 2001).]

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By ajas_folks on Fri, 03-09-01, 02:09

(Forgive me if someone above included this point.) Our allergist also said that AFTER the Epi-pen has been proprely administered, there WILL BE some epinephrine solution REMAINING in the injector tube & to NOT be alarmed. Don't know if the Epi-pen Jr. instructions say this too -- I'm not going to go tip-toe into the now-asleep kiddo's room to get one out of the diaper bag & read it! (But I'll check it tomorrow if my brain retains this thought.) This thread tells me that my husband & I need to review the instructions & the "How to" video (from FAN) on administering epi-pen! Hope everyone will take some time to do the same.

EB

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By on Fri, 03-09-01, 03:31

ajas_folks, I had posted yesterday, I believe, in the Older Moms thread in Off Topic that we sounded very much alike. Well now, in your above post you're having what I call brain blips! Another similarity. I love it!

Thank-you for the information re the Epi-pen and also that would be very good if everyone did take your advice and review how to administer the Epi-pen.

Also, I've been trying to find where you posted that GREAT definition of fanatic. I needed it for another thread.

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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By ajas_folks on Sat, 03-10-01, 22:55

Crud, Cindy -- I've looked & looked for that thread with the earlier discussion of "fanatic" -- I think the last posting activity on it was early January. I recall it being a thread you started, am I right?
(And the darned dictionary I used for its great definition is now packed & in storage.) Weren't some of the synonyms "enthusiastic" & "inspired" & "zealous"? That's all my PG brain can recall right now.

Pardon my buffonery if this has been posted, but when might we see the search function working again?

I'll keep looking for the thread when I've some time.

EB

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By on Sun, 03-11-01, 04:01

ajas_folks, thank-you for taking the time to try to find your post (yes, I'm fairly sure it was a thread started by me [img]http://uumor.pair.com/nutalle2/peanutallergy/redface.gif[/img] ). I know that Chris from PA.com has posted under Main Discussion that they're still trying to recover the search function. They have been receiving quite a few e-mails about it being down.

No, the words you used in your post above were perfect regardless.

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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By KIM I on Thu, 03-15-01, 03:22

Since we're discussing reviewing how to give an epi pen it might be a good idea to actually do a run thru with your child just like any training an how to do something. Don't really give the epi to your child, you don't even have to have it around. This way if you should ever have to administer the epi you have an idea how to place your child. Believe me you can really freak out when you child is having a reaction. But if you do a run thru it gives you an idea of how to proceed. I have found it is easiest to lay the child on a counter/table drape his legs over the side and secure his lower legs with your thighs of course then his hands are free to try to shove the pen away. If someone else is available to help with the hands great. I have had to give my child epi once. I'm a nurse, but when it's your own child it's a whole different ballgame. Kim

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By ajas_folks on Thu, 03-15-01, 14:58

Cindy (& anyone else who is interested)-- Found the earlier FANATIC discussion -- it's under "LIVING WITH PEANUT ALLERGY" & the thread is "Are You Nervous Every Time Your PA Child Tries a New Food?"

EB

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By Nick on Thu, 03-15-01, 15:47

Hi : the instructions on mine point out :
+ hold in place for 10 seconds
+ massage for a further 10 seconds
+ after injection of dose (0.3ml), 1.7 ml remains in syringe

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Nick (PA sufferer)

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By Plaba on Mon, 03-19-01, 20:19

My dd's pediatrician told me to only apply the epi-pen if my dd was not responding! Anyone hear this from their pediatrician?

I've never used the epinephrine but am always anxious about it. I mean, you can read all about it but how can you really know when to administer it? If my dd goes limp and starts to throw up (as she's done twice before), would that warrant it's use? According to my dd's pediatrician, this sort of reaction wouldn't warrant the use of the epi-pen. I'm confused.....

Patricia

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