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- Intramuscular injection sites in children
- Vastus Lateralis
- Location
- Palpate to find greater trochanter and knee joints; divide vertical distance between these two landmarks into thirds; inject into middle third
- Needle insertion and size
- Insert needle perpendicular to knee in infants and young children or perpendicular to thigh or slightly angled toward anterior thigh 22 to 25 gauge (
to 1 inch)
- Insert needle perpendicular to knee in infants and young children or perpendicular to thigh or slightly angled toward anterior thigh 22 to 25 gauge (
- Advantages
- Large, well developed muscle that can tolerate larger quantities of fluid (0.5 mL [infant] to 2 mL [child])
- Easily accessible if child is supine, side lying, or sitting
- Disadvantages
- Thrombosis of femoral artery from injection in midthigh area
- Sciatic nerve damage from long needle injected posteriorly and medially into small extremity
- More painful than deltoid or gluteal sites
- Location
- Ventrogluteal
- Location
- Palpate to locate greater trochanter, anterior superior iliac tubercle (found by flexing thigh at hip and measuring up to 1 to 2 cm [0.4 to 0.8 inch] above crease formed in groin), and posterior iliac crest; place palm of hand over greater trochanter, index finger over anterior superior iliac tubercle, and middle finger along crest of ileum posteriorly as far as possible; inject into center of V formed by fingers
- Needle insertion and size
- Insert needle perpendicular to site but angled slightly toward iliac crest 22 to 25 gauge (
to 1 inch)
- Insert needle perpendicular to site but angled slightly toward iliac crest 22 to 25 gauge (
- Advantages
- Free of important nerves and vascular structures
- Easily identified by prominent bony landmarks
- Thinner layer of subcutaneous tissue than in dorsogluteal site, thus less chance of depositing drug subcutaneously rather than intramuscularly
- Can accommodate larger quantities of fluid (0.5 mL [infant] to 2 mL [child])
- Easily accessible if child is supine, prone, or side lying
- Less painful than vastus lateralis
- Disadvantages
- Health professionals’ unfamiliarity with site
- Location
- Deltoid
- Location*
- Locate acromion process; inject only into upper third of muscle that begins about two finger breadths below acromion
- Needle Insertion and Size
- Insert needle perpendicular to site but angled slightly toward shoulder 22 to 25 gauge (
to 1 inch)
- Insert needle perpendicular to site but angled slightly toward shoulder 22 to 25 gauge (
- Advantages
- Faster absorption rates than gluteal sites
- Easily accessible with minimal removal of clothing
- Less pain and fewer local side effects from vaccines compared with vastus lateralis
- Disadvantages
- Small muscle mass: only limited amounts of drug can be injected (0.5 to 1 mL) Small margins of safety with possible damage to radial nerve and axillary nerve (not shown; lies under deltoid at head of humerus)
- Location*
- Vastus Lateralis
- Intramuscular injection sites in children
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