TITLE:
Appropriate Needle Lengths Determined Using Ultrasonic Echograms for Intramuscular Injections in Japanese Infants
AUTHORS:
Tetsuo Nakayama, Urara Kohdera, Motoko Fujino, Toshihiro Tanaka, Keitaro Yatabe, Tomoyuki Hashiguchi, Tomohide Sato, Minoru Kino
KEYWORDS:
Intramuscular Injection, Subcutaneous Injection, Vaccines, Needle Length
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.6 No.2,
June
6,
2016
ABSTRACT: Adjuvanted vaccines are recommended for administration through an
intramuscular route. The Centers for Disease Control and Prevention (CDC) has
recommended the anterolateral thigh using a 22 - 25-G 25-mm (1 inch) needle for
infants, injected at a 90°into the skin surface, and using a 16 mm (5/8 inch)
for newborns. Appropriate needle lengths may differ depending on racial backgrounds.
In the present study, the thickness of the epidermis and lengths from the skin
surface to the muscle fascia and bone were measured using ultrasonic echograms
in order to determine suitable needle lengths for Japanese infants aged 2, 3,
4, 5, 6, and 12 - 15 months old. The thickness of the epidermis was 1.44 - 1.54
mm (95% CI), and the lengths from the skin surface to the muscle fascia and
bone were 11.52 - 12.28 mm (95% CI), and 25.66 - 26.93 mm (95% CI),
respectively, at the anterolateral thigh. At the center of the deltoid muscle,
skin thickness was similar to that at the thigh, furthermore the lengths from
the skin surface to the muscle fascia and bone were 8.49 - 9.10 mm (95% CI),
and 17.38 - 18.31 mm (95% CI), respectively. The lengths from the skin surface
to the muscle fascia and bone were 1 - 2 mm shorter in 2-month-old infants than
those in older generations. Therefore, the appropriate needle length for
intramuscular injections in Japanese infants was 16 mm (5/8 inch) at any age
and sites, and with 25 mm (1 inch) needles at a 90°angle being associated with
the risk of over-penetration.