Injection considerations for needle length and gauge selection Intradermal injections INTRAMUSCULAR SUBCUTANEOUS pages 1 - 2 Subcutaneous injections INTRADERMAL pages 3 - 4 Epidermis Dermis Subcutaneous tissue Intramuscular injections Muscle pages 5 - 6 1 Intradermal injection considerations For needle length and gauge selection* INTRAMUSCULAR SUBCUTANEOUS INTRADERMAL Epidermis Dermis Subcutaneous tissue Muscle Intradermal (ID) Location of injection** Needle length** Needle gauge** Needle angle < 12 months (infants) Anterolateral aspect Paediatric of forearm, upper chest, 12 months to 18 years 10mm – 19mm 26 – 28 G º º to adult upper back, back of upper 10 – 15 arm > 18 years * Adapted from Fundamentals of Nursing Human Health and Function, Craven R, Hirnle C, Henshaw CM, 8th ed. Wolters Kluwer, 2017 ** Location, needle length & gauge dependent on patient age, physical condition and medication requirements. 2 Intradermal (ID) injection considerations: .8 .7 .6 .5 .4 .3 .2 10-15° Anterior aspect of the Upper chest Injection procedure forearm • Spread the skin taut, and insert the needle tip at a 10º – 15º angle. • Inject medication slowly. If a wheal does not appear, it was administered in the subcutaneous tissue. Upper back / back of arm This information is being provided for convenience only and is not intended to replace clinical decision making. Each clinician is soley responsible for determining the correct needle for each patient. 3 Subcutaneous injection considerations For needle length and gauge selection* INTRAMUSCULAR SUBCUTANEOUS INTRADERMAL Epidermis Dermis Subcutaneous tissue Muscle Subcutaneous (SubQ) Location of injection** Needle length** Needle gauge** Needle angle < 12 months (infants) Anterolateral thigh, upper Insulin delivery: Insulin delivery: outer tricep area, Paediatric 4mm – 13mm 29 – 32 G 12 months to 18 years upper buttocks, abdomen º º to adult 45 – 90 (avoid 50mm radius Other injections: Other injections: around umbilicus) 13mm – 16mm 26 – 31 G > 18 years * Adapted from Fundamentals of Nursing Human Health and Function, Craven R, Hirnle C, Henshaw CM, 8th ed. Wolters Kluwer, 2017 ** Location, needle length & gauge dependent on patient age, physical condition and medication requirements. 50 45 40 35 4 30 Subcutaneous (SubQ) injection25 considerations: 20 15 10 4545° 9090° Outer aspect of the Outer aspect of the Injection procedure upper thigh upper arm • Raise a fold of skin between the thumb (not prefered site) and forefinger, and insert the needle at a 45º – 90º angle. Abdomen—avoid Upper buttocks injecting within 50mm around the umbilicus This information is being provided for convenience only and is not intended to replace clinical decision making. Each clinician is soley responsible for determining the correct needle for each patient. 5 Intramuscular injection considerations For needle length and gauge selection* INTRAMUSCULAR SUBCUTANEOUS INTRADERMAL Epidermis Dermis Subcutaneous tissue Muscle Intramuscular (IM)** Location of injection*** Needle length*** Needle gauge*** Needle angle < 12 months (infants) Vastus lateralis muscle (≤0.5ml vol.) 22mm – 25mm 25 – 27 G 90º Paediatric Deltoid muscle, ventrogluteal site, 12 months to 18 years dorsogluteal site (not recommended 22mm – 30mm 22 – 25 G 90º for <3 years), vastus lateralis muscle Deltoid muscle, ventrogluteal site 25mm – 40mm (may be best site for cachetic adults), Adult > 18 years 19 – 25 G º dorsogluteal site (avoid in obese adults), (up to 76mm for 90 vastus lateralis muscle large adults) * Adapted from Fundamentals of Nursing Human Health and Function, Craven R, Hirnle C, Henshaw CM, 8th ed. Wolters Kluwer, 2017 **Prior to administering an IM injection, refer to your procedure manual to determine the injection site utilising body landmarks. *** Location, needle length & gauge dependent on patient age, physical condition and medication requirements. 6 Intramuscular (IM) injection considerations: Greater Iliac crest trochanter of femur Injection site Arterior superior iliac spine 9090° The vastus lateralis site is in the lateral middle third of the Greater Middle trochanter third of thigh between the Injection vastus site lateralis greater trochanter muscle and the knee. When The ventrogluteal site: Place the palm over injecting, lift the the greater trochanter, form a ’V’, with the vastus lateralis middle finger toward the iliac crest and the Lateral muscle away from index finger toward the anterior superior iliac Injection procedure femoral spine. Inject within the center of the ‘V’, below condyle the bone. • Spread the skin taut (except the the anterior superior iliac crest. vastus lateralis which requires lifting the muscle) and insert the needle at a 90º angle. Clavicle Acromion Prosterior Injection site • Pull back plunger slightly. If blood process superior Injection Imaginary line iliac spine site appears, remove needle, dispose of Injection site Scapula properly and prepare a new injection. Auxillary Greater • If no blood is present, inject trochanter medication slowly. Humerus The thickest part of the deltoid muscle The dorsogluteal site is above an imaginary is 2.5–4 cm (1–3 finger breadths) below line between the greater trochanter and the the lower edge of acromion process of posterior superior the scapula over the midaxillary line. iliac crest. The injection is administered laterally and superior to this imaginary line. This information is being provided for convenience only and is not intended to replace clinical decision making. Each clinician is soley responsible for determining the correct needle for each patient. 30G 29G 28G 27G 26G 25G 24G 23G 22G 21G 20G 19G 18G ISO hub color standards for safety-engineered needles: ISO 6009:2016 BD Switzerland Sàrl, Terre Bonne Park - A4, Route de Crassier 17, 1262 Eysins, Switzerland bd.com BD and the BD Logo are trademarks of Becton, Dickinson and Company. © 2020 BD. All rights reserved. BD-17180 adapted from BD-0469 (10/16)..