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

This issue is discussed in ACIP’s “Best Practices Guidelines for Immunization” (www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html). Intramuscular (IM) injections should be scheduled shortly after antihemophilia therapy or prior to a dose of anticoagulant. For both IM and subcutaneous (SC) 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. 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 SC route).