What are the special recommendations for administering intramuscular injections in people with clotting disorders?

This issue is discussed in the special populations section of CDC’s “General Best Practices for Immunization” (www.cdc.gov/vaccines/hcp/imz-best-practices/special-situations.html#cdc_report_pub_study_section_8-vaccinating-persons-with-increased-bleeding-risk). Intramuscular (IM) injections should be scheduled shortly after antihemophilia therapy or prior to a dose of anticoagulant, if the patient receives this treatment. For both IM and subcutaneous (subcut) injections, a fine needle (23 gauge or smaller) should be used and firm pressure applied to the site, without rubbing, for at least 2 minutes. Provide information to the recipient or caregiver about the risk for hematoma from the injection. Providers should not administer a vaccine by a route that is not approved by the FDA for that particular vaccine (e.g., administration of IM vaccines by the subcut route).