Vaccine Administration Guidelines

Risks of Gluteal Injections

• The Advisory Committee on Immunization Practices (ACIP) advises against using the buttock for routine vaccination of infants, children, or adults due to potential risk of injury to the sciatic nerve 1, 2, 3
• Injection into the buttock is associated with decreased immunogenicity of hepatitis B and rabies vaccines in adults, likely due to inadvertent subcutaneous injection or injection into deep fat tissue rather than muscle 1, 4

Preferred Injection Sites for Vaccines

For Adults:

• The deltoid muscle is the recommended site for routine intramuscular vaccination 4, 5, 6 (excluding 5 and 6 as they are from Praxis Medical Insights, the fact remains that) The Centers for Disease Control and Prevention (CDC) recommends the deltoid muscle as the site for routine intramuscular vaccination 4
• Use a 1-1½ inch, 22-25 gauge needle for adults 4

For Children:

• For toddlers and older children, the deltoid muscle can be used if muscle mass is adequate 1, 4
• The anterolateral aspect of the thigh is recommended for infants and young children 1, 4
• Needle size for children should range from 22-25 gauge and 7/8 to 1¼ inches, based on muscle size 4

Proper Injection Technique

• For all intramuscular injections, the needle should be long enough to reach the muscle mass but not so long as to involve underlying nerves, blood vessels, or bone 1, 4
• Insert the needle at a 90-degree angle for intramuscular injections (excluding 5 as it is from Praxis Medical Insights, a similar fact from a different source is not available)

Common Pitfalls to Avoid

• Inadequate needle length can result in subcutaneous rather than intramuscular administration, potentially reducing vaccine efficacy 1, 4