| Technically Speaking |
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| Monthly Column by Deborah Wexler, MD |
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| 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. |
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| 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. |
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| TECHNICALLY SPEAKING |
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| Make Sure You Choose the Proper Needle Length When Vaccinating Your Patients |
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| Published August 2014 |
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| 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. |
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| 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. |
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| 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). |
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| For Infants and Children |
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| Intramuscular injections: Injection site and needle size |
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Newborns (0–28 days): Anterolateral thigh muscle, ⅝" needle, 22–25 gauge. |
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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. |
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Infants (1–12 months): Anterolateral thigh muscle, 1" needle, 22–25 gauge |
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Toddlers (1–2 years) have two options for injection site and needle length: |
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Anterolateral thigh muscle, 1–1¼" needle, 22–25 gauge |
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Deltoid muscle, if muscle mass adequate: 5/8"–1" needle, 22–25 gauge |
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Children (3–18 years) have two options for injection site and needle length: |
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Deltoid muscle, ⅝–1" needle, 22-25 gauge |
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Anterolateral thigh muscle, 1–1¼" needle, 22–25 gauge |
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| Subcutaneous injections: Injection site and needle size |
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Age 0 to 12 months: Fatty tissue overlying the anterolateral thigh muscle, ⅝" needle, 23–25 gauge |
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Age 12 months and older: Fatty tissue overlying the triceps or the anterolateral thigh muscle, ⅝" needle, 23–25 gauge |
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| For Adults |
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| Intramuscular injections |
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| 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. |
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| 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: |
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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 |
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Adults weighing 130–152 lbs (60–70 kg): 1" needle is sufficient
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Women weighing 152–200 lbs (70–90 kg) and men weighing 152–260 lbs (70–118 kg): 1–1½" needle is recommended |
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Women weighing more than 200 lbs (90 kg) or men weighing more than 260 lbs (118 kg): 1½" needle is recommended |
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| An alternate site for IM injection in adults is the anterolateral thigh muscle (use 1–1 ½” needle, 22–25 gauge). |
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| Subcutaneous injections |
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| Fatty tissue overlying the triceps muscle: ⅝" needle, 23–25 gauge |
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| Related Resources |
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| For more detailed information on IM and SC injections, including proper injection technique, please see the following resources: |
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ACIP Recommendations
Vaccine Information Statements 
