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Healthcare professionals who are using syringes and drawing down medications rather than auto injectors need to ensure that they deliver the injection with the correct needle and in the correct way. The advice from the UK Recucitaton Council is to use a standard blue needle,(25 mm and 23 gauge) to inject the intramuscular adrenaline. If you are treating an obese patient, then you should use a longer 39mm needle to ensure that the adrenaline is delivered into the muscle. The longer 25 mm needles are not as widely available as the standard orange needle. This is the most commonly available needle in the UK but is only 16 mm in length. The shorter length orange needle can result in injecting the adrenaline subcutaneously rather than intramuscularly.

The best site for an intramuscular injection of adrenaline in treating an anaphylactic reaction is the anterolateral area of the middle third of the thigh. The current Resuscitation Council UK guidance states that a 25 mm length needle is best and suitable for all ages. In pre-term or very small infants, a 16mm needle is suitable for an IM injection. In some adults, it may be necessary to use a longer needle.

The intramuscular injection needs to be given with the needle at 90 degrees to the skin and the skin should be stretched, not bunched. The UK resusication Council state in their anaphylaxis guidlelines that there is no specific evidence for any particular technique of intramuscular injection when treating an anaphylactic reaction. This guidance is based on the recommendations for intramuscular injections for vaccination (Immunisation against infectious disease. Department of Health UK, 2006).