Author(s)

Tetsuo Nakayama^1*, Urara Kohdera², Motoko Fujino³, Toshihiro Tanaka⁴, Keitaro Yatabe⁵, Tomoyuki Hashiguchi⁵, Tomohide Sato⁵, Minoru Kino²

¹Kitasato Institute for Life Sciences, Laboratory of Viral Infection I, Tokyo, Japan.
²Department of Pediatrics, Nakano Children’s Hospital, Osaka, Japan.
³Department of Pediatrics, Saiseikai Central Hospital, Tokyo, Japan.
⁴Department of Pediatrics, Shizuoka Kosei Hospital, Shizuoka, Japan.
⁵Department of Clinical Development & Medical Affairs, Japan Vaccine Co., Ltd., Tokyo, Japan.

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.

Intramuscular Injection, Subcutaneous Injection, Vaccines, Needle Length

Nakayama, T. , Kohdera, U. , Fujino, M. , Tanaka, T. , Yatabe, K. , Hashiguchi, T. , Sato, T. and Kino, M. (2016) Appropriate Needle Lengths Determined Using Ultrasonic Echograms for Intramuscular Injections in Japanese Infants. Open Journal of Pediatrics, 6, 163-170. doi: 10.4236/ojped.2016.62024.