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