Intramuscular injection sites in children

        • 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 ( equation.pdf to 1 inch)
            • 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
          • 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 ( equation_1.pdf to 1 inch)
            • 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
          • 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 ( equation_2.pdf to 1 inch)
            • 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)

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