Appropriate Needle Lengths Determined Using Ultrasonic Echograms for Intramuscular Injections in Japanese Infants

Tetsuo Nakayama,Minoru Kino,Tomohide Sato,Urara Kohdera,Keitaro Yatabe,Motoko Fujino,Toshihiro Tanaka,Tomoyuki Hashiguchi

doi:10.4236/ojped.2016.62024

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.

Highlights

All vaccines have been administered using Subcutaneous Injections (SC) since 1970 in Japan, and IntramuscularInjections (IM) being prohibited, due to muscle contracture of the quadriceps caused by the repeated administration of antibiotics and antipyretics through IM [1]
An ultrasonic image from a five-months of age male is shown in Figure 2, and the thickness of the epidermis, subcutaneous tissues, muscle fascia, and bone were identified through different ultrasonic intensities, for example, in the right panel of Figure 2
A randomized control study was previously performed to assess adverse local reactions and immunogenicity in young infants aged two - four months immunized with DPT/IPV, Hib, or meningococcal vaccines using a 16- or 25-mm needle

Summary

Introduction

All vaccines have been administered using Subcutaneous Injections (SC) since 1970 in Japan, and Intramuscular. Injections (IM) being prohibited, due to muscle contracture of the quadriceps caused by the repeated administration of antibiotics and antipyretics through IM [1]. A number of young infants and children with delayed development in sitting and walking or awkward walking postures were reported in Yamanashi prefecture 1973. This was diagnosed as contracture of the femur quadriceps muscle and resulted in low suits. The Japan Pediatric Society proposed that muscle contracture was caused by the repeated administration of antibiotics and antipyretics through IM. All vaccines were subsequently administered SC [1]

Methods

Results

Conclusion