Goldman Ran D, Long Katharine C, Brown Julie C
1The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, 4480 Oak St, Vancouver, BC Canada.
2Mary Bridge Children's Hospital, Tacoma, WA USA.
Allergy Asthma Clin Immunol. 2020 Mar 14;16:19. doi: 10.1186/s13223-020-00418-0. eCollection 2020.
The prevalence of epinephrine auto-injectors (EAI) use is on the rise. Our objective was to describes children with hooked EAI needles that were embedded in soft tissues.
Results: Two children self-injected in their shins. The embedded EAIs required removal in the Emergency Department. Both needles were hooked and splayed at the tip. A boy in anaphylaxis kicked his leg during EAI injection and the hooked needle embedded under his skin and was difficult to dislodge. The exposed needle was curved. A girl had an EAI administered for anaphylaxis, which was also difficult to dislodge. On removal, the distal needle tip was hooked approximately 160 degrees. Images of the device revealed that the needle fired off-center from the device and the device components were cracked. We propose three different explanations for these hooked EAI needles. The first is that the needle could hit bone during injection and curve rather than penetrates further. Secondly, the needle could bend when the patient moves during injection. Thirdly, if a needle fires sufficiently off-center to hit the cartridge carrier, this could hook the needle prior to injection.
Awareness of the reasons for needle hooking, damage observed, and challenges and successful approaches to their removal, can better prepare the provider for these uncommon events. Teaching parents, children and educators about safe EAI storage and appropriate restraint during use may prevent some of these accidental injuries. Reporting device failures may lead to improvements in device performance and design.
肾上腺素自动注射器（EAI）的使用普及率正在上升。我们的目的是描述软组织中嵌入有带钩EAI针头的儿童情况。
结果：两名儿童自行注射到小腿。嵌入的EAI需要在急诊科取出。两根针头均呈钩状且尖端张开。一名过敏反应男孩在EAI注射时踢腿，带钩针头嵌入其皮肤下且难以拔出。露出的针头是弯曲的。一名女孩因过敏反应接受了EAI注射，同样难以拔出。取出时，远端针尖呈约160度的钩状。该装置的图像显示，针头从装置偏心射出，且装置部件有裂缝。我们对这些带钩的EAI针头提出三种不同的解释。第一种是针头在注射时可能撞到骨头并弯曲而不是进一步穿透。第二种是针头在注射时患者移动时可能会弯曲。第三种是如果针头射出的偏心度足够大以至于撞到药筒支架，这可能会在注射前使针头钩住。
了解针头钩住的原因、观察到的损坏情况以及取出时的挑战和成功方法，可以让医护人员更好地应对这些罕见事件。教导家长、儿童和教育工作者关于EAI的安全储存和使用时的适当约束措施，可能会预防一些此类意外伤害。报告设备故障可能会促使设备性能和设计得到改进。
