Children’s services : How to give emergency hydrocortisone injections to children with adrenal insufficiency or congenital adrenal hyperplasia (Instructions for liquid Efcortisol vials)

Who is this leaflet for?

This leaflet gives advice for parents or guardians of children with adrenal insufficiency or congenital adrenal hyperplasia and includes instructions for the use of liquid Efcortisol vials.

Introduction

It may be necessary in certain situations to give your child an emergency injection of hydrocortisone. These situations include if your child or young person:

• Is unable to take tablets or fluids by mouth (e.g. due to continued vomiting).
• Has severe diarrhoea
• Feels sleepy, drowsy and is difficult to wake up
• Does not feel better after increased tablets for two doses
• Has been involved in a major accident

Dosage

The dose of the injection depends on the age of your child:

• Under 1 year give 25mg (0.25ml of Efcortisol)
• Age 1-5 years give 50mg (0.5ml of Efcortisol)
• Age 6 years and above give 100mg (1ml of Efcortisol)

Equipment Needed

Clinell wipe

2ml syringe

Blue (or orange) needle

Red filter needle

Hydrocortisone ampule

1. Preparing the syringe and needle

1.1 Remove the syringe from the sterile packet without touching the nozzle of the syringe.

1.2 Carefully remove the red filter needle from the sterile packet and attach it to the nozzle end of the syringe.

2. Opening the hydrocortisone ampoule

2.1 Holding the ampoule upright, gently tap the top of the bottle to empty any of the hydrocortisone into the barrel of the ampoule.

2.2 Using the empty syringe packet, carefully snap the top off the ampoule. (There should be a coloured dot on the neck of the ampoule, which is the best place to try and break it open). Place the open ampoule on a firm surface.

3. Loading the syringe Part 1

3.1 Remove the needle cover and insert the needle into the open ampoule.

3.2 Carefully suck up the contents of the ampoule into the syringe.

3.3 Remove the needle from the ampoule.

4. Loading the syringe Part 2

4.1 Remove the red filter needle from the syringe and attach the blue (or orange) giving needle. Remember which needle to use, never give an injection with the red filter needle.

4.2 Turn the syringe so that the needle is pointing upwards.

4.3 Tap the syringe to ensure any air bubbles rise to the top.

4.4 Gently push up the plunger so that any air is expelled from the syringe.

4.5 Gently push up the plunger to expel any excess hydrocortisone so that you have the correct dose for the child.

5. Giving the injection

5.1 Your child should be lying down in a safe position.

5.2 The injection should be given into the upper outer thigh or the upper outer aspect of the bottom depending on where you have been shown to give it.

5.3 Clean the skin with the Clinell wipe.

5.4 Place one hand on the surrounding skin.

5.5 Smoothly insert the needle through the skin to a depth of about half the length of the needle.

5.6 Smoothly push down the plunger until the syringe is empty.

5.7 Remove the needle and syringe from the skin and dispose of the needle in a sharps bin if you have one. (If a sharps bin is not available, put the needle in an empty sandwich box or other suitable container and take it with you to hospital where it can be disposed of safely).

5.8 Take the child to your nearest hospital with an emergency department immediately.

Contacts

Please contact the specialist endocrine nurses on 01223 217496 if you need any further advice.