How to Administer IM and SC Injections to Adults

How to Administer IM and SC Injections to Adults
Intramuscular (IM) Injections
Administer these vaccines via IM route:
Tetanus, diphtheria (Td), or with pertussis (Tdap);
hepatitis A; hepatitis B; human papillomavirus
(HPV); trivalent inactivated influenza (TIV); and
meningococcal conjugate (MCV4). Administer
polio (IPV) and pneumococcal polysaccharide
vaccine (PPV) either IM or SC.
acromion
level of armpit
IM injection site
(shaded area)
Injection site:
elbow
Give in the central and thickest portion of the
deltoid—above the level of the armpit and below
the acromion (see the diagram).
Needle size:
90° angle
22–25 gauge, 1–1½” needle
skin
Needle insertion:
subcutaneous tissue
• Use a needle long enough to reach deep into
the muscle.
• Insert the needle at a 90° angle to the skin
with a quick thrust.
• Separate two injections given in the same
deltoid muscle by a minimum of 1”.
muscle
Subcutaneous (SC) Injections
Administer these vaccines via SC route:
MMR, varicella, meningococcal polysaccharide
(MPSV4), and zoster (shingles). Administer polio
(IPV) and pneumococcal polysaccharide vaccine
(PPV) either SC or IM.
Injection site:
Give in fatty tissue over the triceps (see the diagram).
45° angle
skin
subcutaneous tissue
muscle
Needle size:
23–25 gauge, 5/8” needle
Needle insertion:
•
•
Pinch up on the tissue to prevent injection into the muscle. Insert the needle at a 45° angle to the skin.
Separate two injections given in the same area of fatty tissue by a minimum of 1”.
acromion
SC injection site
(shaded area)
elbow
Adapted by the Immunization Action Coalition, courtesy of the Minnesota Department of Health
Technical content reviewed by the Centers for Disease Control and Prevention, May 2007.
www.immunize.org/catg.d/p2020A.pdf • Item #P2020A (5/07)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Administering Vaccines: Dose, Route, Site, and Needle Size
Injection Site and Needle Size
Vaccines
Dose
Route
Diphtheria, Tetanus,
Pertussis (DTaP, DT, Tdap, Td)
0.5 mL
IM
Haemophilus influenzae type b
(Hib)
0.5 mL
IM
Hepatitis A (HepA)
<18 yrs: 0.5 mL
>19 yrs: 1.0 mL
IM
Infants (1–12 mos)
Hepatitis B (HepB)
<19 yrs: 0.5 mL*
>20 yrs: 1.0 mL
IM
Children (>12 mos),
adolescents, and adults
®
*Persons 11–15 yrs may be given Recombivax HB (Merck)
1.0 mL adult formulation on a 2-dose schedule.
Subcutaneous (SC) injection
Use a 23–25 gauge needle. Choose the injection site that is appropriate to the person’s age and body mass.
Needle
Length
e"
Age
Injection Site
Fatty tissue over anterolateral thigh muscle
Fatty tissue over anterolateral thigh muscle or fatty
tissue over triceps
e"
Intramuscular (IM) injection
Human papillomavirus (HPV)
0.5 mL
IM
Influenza, live attenuated
(LAIV)
0.2 mL
Intranasal
spray
6-35 mos: 0.25 mL
>3 yrs: 0.5 mL
IM
Newborns (1st 28 days)
e"*
Anterolateral thigh muscle
Measles, mumps,
rubella (MMR)
0.5 mL
SC
Infants (1–12 mos)
1"
Anterolateral thigh muscle
Meningococcal, conjugated
(MCV4)
Toddlers (1–2 yrs)
0.5 mL
IM
1"–1¼"
e"*–1"
Anterolateral thigh muscle
or deltoid muscle of arm
Meningococcal, polysaccharide
(MPSV4)
0.5 mL
SC
Children & teens 3–18 yrs
e"*–1"
1"–1¼"
Deltoid muscle of arm or
anterolateral thigh muscle
Pneumococcal conjugate (PCV)
0.5 mL
IM
Pneumococcal polysaccharide
(PPV)
0.5 mL
IM or SC
Male or female
less than 130 lbs
e"*–1"
Deltoid muscle of arm
Polio, inactivated (IPV)
0.5 mL
IM or SC
Female 130–200 lbs
Male 130–260 lbs
1"–1½"
Deltoid muscle of arm
Rotavirus (Rv)
2.0 mL
Oral
1½"
Deltoid muscle of arm
Varicella (Var)
0.5 mL
SC
Zoster (Zos)
0.65 mL
SC
Influenza, trivalent
inactivated (TIV)
Use a 22–25 gauge needle. Choose the injection site and needle
length appropriate to the person’s age and body mass.
Age
Needle
Length
Injection Site
Adults > age19 yrs
Female 200+ lbs
Male 260+ lbs
*If skin is stretched tight and subcutaneous tissue is not bunched.
Subcutaneous (SC) injection
Intramuscular (IM) injection
Combination Vaccines
DTaP+HepB+IPV (Pediarix™)
DTaP+Hib (Trihibit™)
Hib+HepB (Comvax™)
MMR+Var (ProQuad®)
0.5 mL
IM
90° angle
45° angle
<12 yrs: 0.5 mL
SC
skin
skin
subcutaneous tissue
HepA+HepB (Twinrix®)
>18 yrs: 1.0 mL
IM
muscle
subcutaneous tissue
muscle
Please note: Always refer to the package insert included with each biologic for complete vaccine administration information. CDC’s Advisory Committee
on Immunization Practices (ACIP) recommendations for the particular vaccine should be reviewed as well.
Technical content reviewed by the Centers for Disease Control and Prevention, August 2007.
www.immunize.org/catg.d/p3085.pdf • Item #P3085 (8/07)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org