What Is The Recommended Site And Needle Length For Giving Influenza Vaccine To Adults By Intramuscular Injection
- Use a – to 1-inch needle for men and women who weigh less than 130 pounds . Insert the needle at a 90-degree angle and stretch the skin flat between thumb and forefinger.
- Use a 1-inch needle for men and women who weigh 130152 pounds .
- Use a 1- to 1½-inch needle for women who weigh 152200 pounds and men who weigh 152260 pounds .
- Use a 1½-inch needle for women who weigh more than 200 pounds and men who weigh more than 260 pounds .
CDC has vaccine administration resources for clinicians administering influenza vaccine, including a needle length and gauge chart and demonstration videos for intramuscular injection and intranasal administration.
Additional information on vaccine administration and safe injection practices can be found in the following resources:
Can Live Attenuated Influenza Vaccine Be Given At The Same Time As Other Vaccines
Live, attenuated influenza vaccine may be administered simultaneously with other live or inactivated vaccines. However, if two live, attenuated vaccines are not given during the same clinical visit, they should be separated by at least 4 weeks to minimize the potential risk for interference. For example, if live, attenuated influenza vaccine was given, at least 4 weeks should pass before MMR is administered.
Short Needle Vs Traditional Needle
The FDAâs approval was based on clinical trial data of 4,276 adults who were randomly assigned to receive Fluzone via intradermal or intramuscular routes. People in the intradermal group had a similar immunologic response as people who received intramuscular injections, Sanofi Pasteur says.
People in the intradermal group experienced more frequent injection site reactions, except pain, which was similar in both groups. Adverse reactions included redness, swelling, pain, itching, headache, muscle ache, and malaise.
The vaccine, the company says, may trigger anaphylaxis in patients who are hypersensitive to any of its components.
The new formulation is to be used in adults aged 18 to 64.
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V1 Public Health Program Decision
1. NACI recommends that, in the event of a significant population-level shortage of influenza vaccine, a full dose influenza vaccine should continue to be used, and existing vaccine supply should be prioritized for those considered to be at high risk or capable of transmitting to those at high riskFootnote b of influenza-related complications or hospitalizations .
- NACI concludes that there is fair evidence to recommend the use of a full dose influenza vaccine compared to a fractional dose for individuals at high risk or those capable of transmitting to those at high risk of influenza-related complications or hospitalizations .
Summary of evidence and rationale
2. NACI recommends against the use of fractional doses of influenza vaccine in any population
- NACI concludes that there is insufficient overall evidence at this time to recommend the use of fractional IM influenza vaccine doses
- NACI concludes that there is fair evidence that fractional ID influenza vaccine doses provide a sufficient immune response, but this route of administration is not feasible at this time
Summary of Evidence and Rationale
Description Of The Intervention
Hypodermic needles are available in a wide range of sizes for delivering drugs, vaccines, and other substances into the body or for extracting fluids and tissue samples . The term ‘needle size’ is used to refer to two aspects of hypodermic needle geometry, namely gauge and length. The gauge refers to the nominal outside diameter of the needle tube, and the length refers to the nominal length of the needle tube . Both dimensions are typically expressed in millimetres , although in some countries needle length is also expressed in inches. The most commonly used system for describing the gauge of needles is the Stubs Iron Wire Gauge system, developed in England in the early 19th century . The gauge of a needle is often abbreviated as ‘G’ or ‘ga’ the higher the needle gauge number, the smaller the diameter of the needle lumen . The International Organization for Standardization has established ISO standards for the inner and outer diameters of hypodermic medical needles of a specified gauge number . International standards have also been developed for colour coding of needles to enable rapid visual identification of the outside diameter of singleuse hypodermic needles . The standards for the most commonly recommended needle gauges for administering vaccines to children and adolescents are presented below.
Factors influencing needle size selection for vaccination procedures
Route of administration and injection site
Angle of insertion
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Data Collection And Analysis
Selection of studies
The PRISMA flow diagram in Figure 1 summarises the screening and selection process for the updated review. Two review authors independently screened the titles and abstracts of the search results.
Study flow diagram.
For the original review , three review authors independently screened the titles and abstracts of the search results to identify trials that met the selection criteria. We retrieved the full texts of any potentially relevant papers and corresponded with trial authors where necessary to clarify study eligibility. The PRISMA flow diagram for the original review is available in Beirne 2015.
Data extraction and management
Three review authors independently extracted data from the included trials using a predesigned data collection form developed by one of the review authors . The three review authors independently piloted the data extraction form on one of the included trials, Diggle 2006, before proceeding with data extraction for the remaining included trials. Following completion of the data extraction process, the three review authors compared the details recorded in the three independently completed data collection forms for each trial. In instances where details were missing from included trials , we contacted the trial authors to obtain the required information. Any disagreements regarding the details recorded on the data extraction forms were resolved by discussion and consensus.
Infection Prevention And Control
Vaccine providers should incorporate routine infection control practices into all immunization procedures as follows:
- Hand hygiene should be performed before vaccine preparation, between vaccine recipients, and whenever the hands are soiled. Alcohol-based hand sanitizers are an alternative to hand washing with soap and water when hands are not visibly soiled. Hand hygiene should be performed after removing gloves.
- Glove use during immunization is not routinely recommended unless the skin on the vaccine provider’s hands is not intact or when administering Bacille Calmette-Guérin or smallpox vaccine. If gloves are worn, they should be changed between vaccine recipients.
- Prior to withdrawal of vaccine into the syringe, the vaccine vial should be uncapped, the stopper wiped with a suitable disinfectant and the stopper allowed to dry.
- Before injection, the skin should be cleansed with a suitable antiseptic such as an alcohol swab and allowed to dry.
- A separate sterile needle and syringe should be used for each injection.
- Policies and procedures should be developed and implemented regarding accidental exposure to blood or body fluids, including needle stick injuries, and vaccine providers should be educated about these policies and procedures. Refer to Immunization of Workers in Part 3 for more information about vaccines recommended for health care workers.
In addition to the recommendations above, the following practices should be observed:
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Criteria For Considering Studies For This Review
Types of studies
We only included RCTs in this review. We excluded quasirandomised trials due to the increased risk of systematic differences between comparison groups if allocation is performed on the basis of a pseudorandom sequence .
Types of participants
We included trials involving children and adolescents, from birth to 24 years of age, undergoing vaccination with any type of vaccine administered via intramuscular, subcutaneous, or intradermal routes using hypodermic needles in any setting . For the purposes of this review, we defined a child as a person aged less than 10 years and an adolescent as a person aged 10 to 24 years. We chose the upper limit of 24 years because “many researchers and developmental specialists in the U.S. use the age span 10 24 years as a working definition of adolescence” .
Types of interventions
We included trials evaluating the effects of hypodermic needles of any size used to administer any type of injectable vaccine to children and adolescents.
We included trials making any of the following needle size comparisons:
We excluded trials where the comparison arms of the trial intentionally differed as part of the trial design with regard to factors other than needle size that could influence immunogenicity and reactogenicity outcomes. These factors included:
Why It Is Important To Do This Review
There are inconsistencies in the recommendations made by NITAGs in different countries regarding the sizes of needles that should be used when administering vaccines to children and adolescents of specific ages or body masses at preferred injection sites via intramuscular, subcutaneous, and intradermal routes. There is also some evidence of variation in clinician adherence to these recommendations. For example, surveys conducted in Australia, Cook 2001, Scotland, McKinstry 2004, and the US, Schechter 2010, have documented that, contrary to guideline recommendations, some clinicians prefer to use a shorter rather than a longer needle when administering intramuscular vaccinations to children. This reluctance to use longer needles may be due to concerns about the possibility of damaging deep tissue and bone and causing more discomfort to the child .
Finally, this review complements existing reviews published in the Cochrane Library that have evaluated the effects of other interventions for needlerelated procedural pain in children and adolescents, including sweettasting solutions, Harrison 2015 Kassab 2012, and psychological interventions .
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Logistics For Fractional Dosing Strategies
Both fractional dosing strategies assessed in this Statement would require using influenza vaccine that has been packaged in the format and of an antigen concentration authorized for use in Canada. Therefore, administering a fractional dose would require administering a lower volume of vaccine to achieve the desired lower dose, which is only possible when influenza immunizations have been packaged as multi-dose vials , and not as pre-filled syringes. A significant proportion of the influenza vaccine supply purchased for public programs is in MDV format however, the distribution of MDV of influenza vaccine may not be equal across jurisdictions, and varies between provinces, based on provincial vaccine orders. When vaccine has already been ordered in a given season, there is not typically the opportunity to change the supply to MDV mid-season.
Using standard doses, MDVs contain 5 mL of vaccine solution, sufficient to vaccinate 10 individuals. The volume of vaccine for some fractional doses , would not split evenly from 5 mL vials. Therefore, using fractional doses that do not divide evenly into 5 mL could result in unnecessary vaccine wastage, which would not allow for the full advantage of implementing fractional dosing as a dose sparing strategy. A half dose of influenza vaccine is likely the most feasible fractional dose for influenza vaccine programs, regardless of route of administration, as this dose could allow the full use of the vial without wastage.
Can Inactivated Influenza Vaccine Be Given At The Same Time As Other Vaccines Such As Pneumococcal Polysaccharide Or Zoster Vaccines
Yes if other vaccines are indicated, they can be administered during the same clinical encounter as inactivated influenza vaccine. When giving several injections at a single visit, administer each vaccine at a separate injection site. The injection sites should be separated by 1 inch or more, if possible, so that any local reactions can be differentiated.
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How To Administer A Flu Shot
This article was medically reviewed by Shari Forschen, NP, MA. Shari Forschen is a Registered Nurse at Sanford Health in North Dakota. She received her Family Nurse Practitioner Master’s from the University of North Dakota and has been a nurse since 2003.There are 17 references cited in this article, which can be found at the bottom of the page.wikiHow marks an article as reader-approved once it receives enough positive feedback. In this case, several readers have written to tell us that this article was helpful to them, earning it our reader-approved status. This article has been viewed 369,703 times.
Experts say that an annual flu shot is your best bet for preventing the flu, but it’s not 100% effective.XTrustworthy SourceMayo ClinicEducational website from one of the world’s leading hospitalsGo to source Typically, the annual flu shot will protect you against 3 or 4 strains of the virus that are expected to be prevalent that flu season. Research suggests that flu shots are usually given in the upper arm, and you may get a specific type recommended for your age group.XTrustworthy SourceCenters for Disease Control and PreventionMain public health institute for the US, run by the Dept. of Health and Human ServicesGo to source Fortunately, flu shots are fairly easy to administer.
Fda Oks Flu Shot With Smaller Needle
New Needle Is 90% Shorter Than Traditional Needle
May 12, 2011 — The FDA has approved the first flu shot to be injected with a tiny needle into a skin layer called the dermis rather than into muscle.
The new needle is expected to be available for adults for the 2011-2012 flu season.
The French drugmaker Sanofi Pasteur says the companyâs Fluzone Intradermal vaccine will be administered with a needle less than one-tenth of an inch long. Thatâs 90% shorter than those used now in the U.S., and therefore wonât need to be inserted as deeply.
In general, current influenza shots are injected deep into muscle tissue with a needle that can be 1 to 1.5 inches long.
Sanofi Pasteur says in a news release that its new product has a needle that is attached to a prefilled syringe that holds a smaller amount of flu vaccine.
The smaller amount of Fluzone is all that is needed because the skin layer under the surface, the dermis, has a high concentration of dendritic cells, which are key to generating an immune response.
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Technically Speaking: Choosing The Proper Needle Length For Vaccination
Editors note: This is an updated version of the article originally published in August 2014.
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
Below is a summary of the guidance for choosing the proper needle length for intramuscular and subcutaneous injections based on CDCs General Best Practice Guidelines for Immunization .
New Tool To Increase Vaccine Rates
According to Sanofi Pasteurâs U.S. affiliate, patients have indicated they prefer shorter, slimmer needles of the Fluzone Intradermal vaccine. The short needles already are used in Europe, Australia, and Canada.
Oliver Charmeil, CEO of Sanofi Pasteur, the vaccines division of Sanofi-Aventis Group, says the new product is likely to increase flu vaccination rates in the U.S.
Flu and its complications kill thousands of people in the U.S. every year, yet many adults donât get the flu vaccine. The CDC says on its web site that flu deaths vary from a low of about 3,000 to about 49,000 yearly.
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Syringe And Needle Selection
Depending on the vaccine dose, health professionals should use a 1 mL or 3 mL syringe. Depending on the site of administration, it is important to select the right needle size to optimize the immune response and reduce the risk of injection site reactions. For example, vaccines with adjuvants need to be injected into the muscle and not the subcutaneous tissue to prevent inflammation and formation of granulomas. Furthermore, vaccine absorption can be impaired if the vaccine is inadvertently injected into lymphatic circulation. When selecting a needle length for an intramuscular injection, consider a length that is long enough to reach deep tissue without involving underlying bone, nerves, or blood vessels. Longer needles often result in less redness and swelling when compared to shorter needles. The selection of the right needle should be determined by: 1) route of administration 2) the clients age and size of muscle mass 3) viscosity of the vaccine or passive immunizing agent. Table 3.3 offers needle selection guidelines to inform clinical judgement, which are then visualized in Images 3.2 and 3.3. It is important to note that the needle size recommendations are based on the practice of having the skin stretched flat between thumb and forefinger at the time of administration.
Table 3.3: Needle Selection Guidelines
| Route of Administration |
What Is The Correct Dosage Of Vaccine
The amount of inactivated vaccine that should be administered intramuscularly is based on the patients age and the vaccine product you are using.
- For children 635 months of age, the correct dosage is:
- 0.25 mL for Afluria Quadrivalent
- 0.5 mL for Fluarix Quadrivalent
- 0.25 mL or 0.5 mL for Fluzone Quadrivalent
- 0.5 mL for FluLaval Quadrivalent
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