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Table 1 Auto-injector needles available in North America and Europe in 2019

From: Epinephrine auto-injector needle length

EAILower and upper limits for needle lengthNaked skinWith thick clothes 3 mmPressure against the thigh
Skin to muscle distance −2 mm (acc. to Diacono)Skin to bone distance full lengthSkin to muscle distance (-3 mm clothes and −2 mm) = − 5 mmSkin to bone distance full pene-trating needle length − 3 mm
HPEAIa
 Epipen Jr® 0.15 mgLower limit81057Press hard
Upper limit13151012
 Epipen® 0.3 mgLower limit1113810
Upper limit16181315
 Auvi-Q 0.1 mmLower limit4.46.41.43.4Push firmly
Upper limit6.98.93.95.9
 Auvi-Q 0.15 mgLower limit9.411.46.48.4
Upper limit1214.0911
 Auvi-Q 0.3 mgLower limit12.714.79.711.7
Upper limit15.317.312.314.3
LPEAIb
 Emerade® 0.15 mgLower limit131510.012.0Slight pressure
Upper limit14.716.711.713.7
 Emerade® 0.3 mgLower limit20.122.117.119.1
 Slight preesureUpper limit21.623.618.620.6
 Emerade® 0.5 mgLower limit20.122.117.119.1
Upper limit21.623.618.620.6
  1. Needle lengths are given according to the manufacturers’ approved specifications. The skin to muscle distance is based on Diacono et al. [7] by subtracting 2 mm from the penetrating needle length. The increased distance to muscle, i.e. 2 mm for the eye of the needle. The skin to bone distance is based on the full length of the needle. Both skin to muscle distance and skin to bone distance are given for the case injection is performed on naked skin and with winter cloths. The thickness of winter clothes is proposed to be 3 mm, but can vary among individuals
  2. aHPEAI, These devices are high-pressure epinephrine autoinjectors, HPEAIs
  3. bThis device is a low-pressure epinephrine autoinjector, LPEAI