Beware the Code-Cart Epinephrine Syringes When Treating Kids

From MedPage Today:

Trying to treat children in cardiac arrest with epinephrine from commercially-available, pre-filled syringes on the code cart likely overdoses them in most cases, researchers found.

Matt Hansen, MD, MCR, of Oregon Health & Science University in Portland, and colleagues evaluated 56 pre-filled epinephrine syringes used to resuscitate patients experiencing cardiac arrest, simulating direct injection from the syringe into an IV port and then a flush.

Pushing the stopper to the 0.5-mL mark for a child’s dose actually expelled 0.90 mL on average (95% CI 0.85-0.96 mL) with a range of 0.50-1.30 mL, they reported online in JAMA Pediatrics. Only three out of the 56 syringes delivered volumes within 20% of 0.5 mL; 17 delivered volumes more than twice that.

“Administering a small volume of epinephrine directly from pre-filled syringes risks delivering more than the intended dose,” the authors concluded. “Owing to limited accuracy, clinicians should transfer epinephrine to a smaller syringe for infant dosing. Manufacturers could also make devices to better meet the needs of pediatric patients.”