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Technically Speaking
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July 2020
Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
IAC Executive Director Dr. Deborah Wexler writes Technically Speaking, a column featured in each issue of Vaccine Update for Healthcare Professionals, the monthly e-newsletter from the Vaccine Education Center (VEC) at the Children's Hospital of Philadelphia. Technically Speaking columns cover practical topics in immunization delivery such as vaccine administration techniques, storage and handling, contraindications and precautions, and scheduling.
Subscribe to VEC's Vaccine Update for Healthcare Professionals to stay up to date on vaccine-related issues, including reviews of recently published journal articles, media recaps, and announcements about new resources and webinars. To subscribe, visit the Vaccine Update Newsletter Sign-up Form
The archive of past Technically Speaking columns is also available through links on the right side of this web page.
TECHNICALLY SPEAKING
Choosing Proper Needle Length for Vaccination of Children and Adults: What Should You Consider?
Published July 2020
Selecting the proper needle length when vaccinating your patients is critical – vaccine must reach the desired tissue site for optimal immune response to occur. To determine the proper needle length to use in each situation, you must consider the following factors:
  • People of all ages:
  • the route of injection — whether it is intramuscular or subcutaneous
  • the anatomic site of the injection
  • Infants and children:
  • age must also be considered
  • Adults:
  • weight will also need to be taken into account

Below is a summary of the guidance for choosing the proper needle length for intramuscular and subcutaneous injections based on CDC’s General Best Practice Guidelines for Immunization (Vaccine Administration).

FOR INFANTS, CHILDREN, AND TEENS

Intramuscular (IM) injections: Injection site and needle size

  • For newborns (0–28 days): Use anterolateral thigh muscle, " needle, 22–25 gauge
    Note: For neonates (first 28 days of life) and preterm infants, a ⅝" needle is recommended if the skin is stretched flat between the thumb and forefinger and the needle is inserted at a 90° angle to the skin.
     
  • For infants (1–12 months): Use anterolateral thigh muscle, 1" needle, 22–25 gauge
     
  • For toddlers (1–2 years): There are two options for injection site and needle length:
    • Anterolateral thigh muscle – use 1"–1¼" needle, 22–25 gauge
    • Deltoid muscle – if muscle mass adequate, use "–1" needle, 22–25 gauge
       
  • For children (3–10 years): There are two options for injection site and needle length:
    • Deltoid muscle – use ⅝"–1" needle, 22–25 gauge
    • Anterolateral thigh muscle – use 1"–1¼" needle, 22–25 gauge
       
  • For preteens and teens (11–18 years): There are two options for injection site and needle length:
    • Deltoid muscle – use ⅝"–1" needle, 22–25 gauge
    • Anterolateral thigh muscle – use 1"–1½" needle, 22–25 gauge

Subcutaneous (Subcut) injections: Injection site and needle size

  • For infants (11–12 months): Inject at a 45° angle into fatty tissue overlying the anterolateral thigh muscle – use ⅝" needle, 23–25 gauge
     
  • For children and teens (1–18 years): Inject at a 45° angle into fatty tissue overlying the triceps or anterolateral thigh muscle – use ⅝" needle, 23–25 gauge

FOR ADULTS

Intramuscular (IM) 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.

Note: An alternate site for IM injection in adults is the anterolateral thigh muscle. The needle length and gauge are the same as when the deltoid muscle is used, i.e., 1"–1½" length, 22–25 gauge.

You should choose needle length based on the weight of your adult patients, as follows:

  • Adults weighing less than 130 lbs (60 kg): Use of a 1" needle is recommended. However, a " needle may be used for IM injection in the deltoid muscle if the fatty tissue overlying the deltoid muscle is flattened (i.e., not bunched between thumb and fingers during the injection) and the needle is inserted at a 90° angle to the skin.
     
  • Adults weighing 130–152 lbs (60–70 kg): Use of a 1" needle is recommended.
     
  • Women weighing 152–200 lbs (70–90 kg) and men weighing 152–260 lbs (70–118 kg): Use of a 1"–1½" needle is recommended.
     
  • Women weighing more than 200 lbs (90 kg) or men weighing more than 260 lbs (118 kg): Use of a 1½" needle is recommended.

Subcutaneous (Subcut) injections

  • Inject at a 45° angle into fatty tissue overlying the triceps muscle – a " needle, 23–25 gauge is recommended.

MORE RESOURCES

Administering Vaccines: Dose, Route, Site, and Needle Size

Administering Vaccines to Adults: Dose, Route, Site, and Needle Size

How to Administer Intramuscular and Subcutaneous Vaccine Injections

How to Administer Intramuscular and Subcutaneous Vaccine Injections to Adults

IAC’s Handouts: Administering Vaccines gateway page

IAC’s Clinic Tools: Administering Vaccines gateway page

CDC Vaccine Administration gateway page

CDC Vaccine Administration Resource Library with instructive videos on vaccine administration

CDC Epidemiology and Prevention of Vaccine-Preventable Diseases (“The Pink Book"), Chapter 6, Vaccine Administration: Route and Site

The archive of past Technically Speaking columns is also available through links on the right side of this web page.
 
This page was updated on July 21, 2020.
This page was reviewed on July 21, 2020
2020 ISSUES >> view all issues
NOVEMBER 2020
Prevent Shoulder Injuries Caused by Missing the Deltoid Muscle When Injecting Vaccines!
OCTOBER 2020
ACIP Updates Recommendations on the Use of MenACWY and MenB Vaccines
SEPTEMBER 2020
Is It 0.25 mL or 0.5 mL? What Is the Correct Dose of Injectable Flu Vaccine for Children Younger Than 3?
JULY 2020
Choosing Proper Needle Length for Vaccination of Children and Adults: What Should You Consider?
JUNE 2020
Preventing Preventable Vaccine Administration Errors in Your Medical Setting
MAY 2020
IAC Launches New MenB Vaccination Honor Roll Recognizing Colleges and Universities That Require or Recommend the Vaccine to Protect Their Students
APRIL 2020
Our Society Deserves Vaccination: Two New Educational Pieces from IAC Explain the Science Supporting Vaccines and the Value of the Vaccine Injury Compensation Program
MARCH 2020
Now Available to Order! IAC's Laminated Versions of CDC's 2020 Immunization Schedules
FEBRUARY 2020
Sign up for IAC Express—the Best Way to Stay Current with Weekly U.S. Immunization News, Information, and Resources
JANUARY 2020
CDC Releases 2020 Version of Its Vaccine Storage and Handling Toolkit
    >> view all issues
2019 ISSUES >> view all issues
DECEMBER 2019
ACIP Updates Its Pneumococcal Vaccine Recommendations for Adults Age 65 Years and Older
NOVEMBER 2019
ACIP Votes to Approve That Tdap and Td Vaccines May Now Be Used Interchangeably
OCTOBER 2019
CDC Updates Recommendations on the Use of HPV Vaccine
SEPTEMBER 2019
"Dear Colleague" Call-to-Action Letter from AAFP, AAP, ACHA, ACOG, APhA, SAHM, and IAC Stresses Importance of Implementing Immunization Visit at 16 Years of Age
AUGUST 2019
Newly Designed and Easy to Navigate—Visit Give2MenACWY.org to Enhance Your Efforts to Increase Rates for MenACWY Booster Doses and Other Adolescent Vaccinations
JULY 2019
ACIP Updates Its Guidance on the Use of HPV, PCV13, HepA, HPV, and MenB Vaccines at June 26–27 Meeting
JUNE 2019
Looking for New Tools and Resources to Help Increase Your Clinic's HPV Vaccination Rates? Here Are Some Great Ones!
MAY 2019
How to Protect Children, Adults, and Healthcare Personnel from Measles
APRIL 2019
Refresher! Use of Pneumococcal Vaccines in Infants and Children, as well as in Children with Health Conditions
MARCH 2019
With Measles "Breaking Out" All over the United States, Here Are Some Good Educational Resources
FEBRUARY 2019
Questions about Proper Vaccine Storage and Handling? CDC's Redesigned Toolkit Has Answers!
JANUARY 2019
Want to Avoid Vaccination Errors? These Print Materials and Slide Sets Will Help You!
    >> view all issues
 
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