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August 2014
Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children's Hospital of Philadelphia Vaccine Education Center’s (VEC's) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events.
TECHNICALLY SPEAKING
Make Sure You Choose the Proper Needle Length When Vaccinating Your Patients
Published August 2014
Information presented in this article may have changed since the original publication date. For the most current immunization recommendations from the Advisory Committee on Immunization Practices, visit www.immunize.org/acip/acip_vax.asp.
To determine the proper needle length for your patients’ vaccinations, the first things you need to consider are the route of injection — whether it is intramuscular (IM) or subcutaneous (SC) — and the anatomic site of the injection. For infants and children, the patient's age must be considered, and for adults, the patient's weight may need to be taken into account.
Below is a summary of the guidance on choosing the proper needle length for IM and SC injections based on CDC’s General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (pages 13–16).
For Infants and Children
Intramuscular injections: Injection site and needle size
Newborns (0–28 days): Anterolateral thigh muscle, ⅝" needle, 22–25 gauge.
Note: For neonates (first 28 days of life) and preterm infants, a ⅝" needle usually is adequate if the skin is stretched flat between the thumb and forefinger and the needle is inserted at a 90-degree angle to the skin.
Infants (1–12 months): Anterolateral thigh muscle, 1" needle, 22–25 gauge
Toddlers (1–2 years) have two options for injection site and needle length:
Anterolateral thigh muscle, 1–1¼" needle, 22–25 gauge
Deltoid muscle, if muscle mass adequate: 5/8"–1" needle, 22–25 gauge
Children (3–18 years) have two options for injection site and needle length:
Deltoid muscle, ⅝–1" needle, 22-25 gauge
Anterolateral thigh muscle, 1–1¼" needle, 22–25 gauge
Subcutaneous injections: Injection site and needle size
Age 0 to 12 months: Fatty tissue overlying the anterolateral thigh muscle, ⅝" needle, 23–25 gauge
Age 12 months and older: Fatty tissue overlying the triceps or the anterolateral thigh muscle, ⅝" needle, 23–25 gauge
For Adults
Intramuscular injections
The deltoid muscle is most often used as the site for IM injections in adults: Needle length is usually 1–1½", 22–25 gauge, but a longer or shorter needle may be needed depending on the patient's weight.
According to CDC’s General Recommendations on Immunization (page 16), you should choose needle length based on the weight of your adult patients as follows:
Adults weighing less than 130 lbs (60 kg): ⅝" needle is sufficient for IM injection in the deltoid muscle only if the subcutaneous tissue is not bunched and the injection is made at a 90-degree angle
Adults weighing 130–152 lbs (60–70 kg): 1" needle is sufficient
Women weighing 152–200 lbs (70–90 kg) and men weighing 152–260 lbs (70–118 kg): 1–1½" needle is recommended
Women weighing more than 200 lbs (90 kg) or men weighing more than 260 lbs (118 kg): 1½" needle is recommended
An alternate site for IM injection in adults is the anterolateral thigh muscle (use 1–1 ½” needle, 22–25 gauge).
Subcutaneous injections
Fatty tissue overlying the triceps muscle: ⅝" needle, 23–25 gauge
Related Resources
For more detailed information on IM and SC injections, including proper injection technique, please see the following resources:
How to Administer IM and SC Vaccine Injections [children and adults]
How to Administer IM and SC Vaccine Injections to Adults
Administering Vaccines: Dose, Route, Site, and Needle Size
Administering Vaccines to Adults: Dose, Route, Site, and Needle Size
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This page was updated on September 30, 2014
This page was reviewed on September 30, 2014
 
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