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- Site Selection and Technique
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Site Selection and Technique
Site Selection for Intramuscular (IM) Injection:
<18 months old: anterior thigh (vastus lateralis), with a 5/8 to 1-inch needle for children >2 months of age. The ventrogluteal site may be an alternative.
18-36 months: anterior thigh (vastus lateralis) or upper arm (deltoid). There is controversy about which is most appropriate. The ventrogluteal site is an alternative.
>36 months of age: the upper arm (deltoid) should be used instead of the thigh, but the ventrogluteal site may still be an alternative.
Standard Administration Technique
For all intramuscular (IM) injection:
- Skin should be held taut around the injection site
- The needle darted into the skin at a 90° angle
- Aspiration of the needle has been shown by recent research to be unnecessary (the plunger is slightly withdrawn to certify that the needle did not enter a vein)
- Inject vaccine with steady pressure
- Withdraw the needle at the same angle at which it was inserted
For all subcutaneous (SQ) injections:
(i.e. inactivated polio, MMR, or varicella vaccine)
- Skin around the site is pinched or bunched
- Needle inserted into fatty tissue at a 45° angle
- See intramuscular injection for additional suggestions
- Usual site is tissue of thigh or outer tricep
Z-track technique*:
In one study, less pain with injections was reported with use of the Z-track technique compared with standard-technique injections.
*Description of Z-track technique: The injector's hand is placed on edge across the injection site. The skin is then pulled to displace it from the underlying subcutaneous tissue, and the injection is administered. When the injection is completed, the skin is released to return to its normal position, thereby trapping the vaccine in the muscle.
To learn more about pain reduction techniques, click here.
Reference: Schechter, N. L., Zempsky, W. T., Cohen, L. L., McGrath, P. J., McMurtry, C. M., Bright, N. S., Pain reduction during pediatric immunizations: evidence-based review and recommendations. Pediatrics 2007 May; 119(5):e1184-e1198.