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Tytuł:
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When should a longer needle be used for intramuscular injection in obese patients? A combined analysis of New Zealand data.
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Autorzy:
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Doppen M; Medical Research Institute of New Zealand, Private Bag 7902, Wellington 6242, New Zealand. Electronic address: .
Kearns C; Medical Research Institute of New Zealand, Private Bag 7902, Wellington 6242, New Zealand. Electronic address: .
Weatherall M; University of Otago Wellington, 23A Mein Street, Newtown, Wellington 6242, New Zealand. Electronic address: .
Kearns N; Medical Research Institute of New Zealand, Private Bag 7902, Wellington 6242, New Zealand.
McIntyre P; Women's and Children's Health, University of Otago Dunedin, Dunedin 9054, New Zealand. Electronic address: .
Hills T; Medical Research Institute of New Zealand, Private Bag 7902, Wellington 6242, New Zealand; Auckland District Health Board, Level 7/214 Green Lane West, Greenlane, Auckland 1051, New Zealand. Electronic address: .
Beasley R; Medical Research Institute of New Zealand, Private Bag 7902, Wellington 6242, New Zealand; Capital and Coast District Health Board, 49 Riddiford Street, Newtown, Wellington 6021, New Zealand. Electronic address: .
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Źródło:
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Vaccine [Vaccine] 2023 Apr 17; Vol. 41 (16), pp. 2690-2695. Date of Electronic Publication: 2023 Mar 17.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: Amsterdam, The Netherlands : Elsevier Science
Original Publication: [Guildford, Surrey, UK] : Butterworths, [c1983-
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MeSH Terms:
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Obesity*
Skin*
Adult ; Humans ; Male ; Female ; Injections, Intramuscular ; New Zealand ; Body Mass Index
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Contributed Indexing:
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Keywords: COVID-19; Guidelines; Needle length; Obesity; Vaccination
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Entry Date(s):
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Date Created: 20230319 Date Completed: 20230411 Latest Revision: 20230424
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Update Code:
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20240105
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DOI:
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10.1016/j.vaccine.2023.03.018
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PMID:
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36935287
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Aim: To estimate thresholds for Body Mass Index (BMI) and arm circumference above which a longer needle is needed to ensure intramuscular (IM) delivery of a vaccine in the deltoid muscle at the site recommended by New Zealand (NZ) immunization guidelines.
Methods: A combined analysis of two studies, including 442 adults, with measurements of arm circumference, BMI and skin to deltoid muscle distance (SDMD) at the NZ immunization guideline-recommended IM injection site. Receiver Operator Characteristic curves identified arm circumference and BMI cut-points that gave 100% sensitivity for SDMD thresholds. These thresholds were: SDMD of 20 mm, accounting for a minimal penetration of 5 mm into muscle with the standard needle; and 25 mm, which is the length of a standard needle for IM injection, representing the depth this can reach.
Results: Cut-point values for arm circumference, at which a longer needle would be required, were higher for males than females: 35 cm versus 30 cm for the 20 mm cut-point, and 40 cm versus 36.7 cm for the 25 mm cut-point respectively. The BMI cut-points were also higher for male than females: 24.6 kg/m 2 versus 23.7 kg/m 2 for the 20 mm cut-point, and 38.2 kg/m 2 vs 31.6 kg/m 2 for the 25 mm cut-point respectively.
Conclusion: Arm circumference and BMI cut-points provide practical measures from which to choose a needle length that increases the chance of successful IM vaccination. Based on our data, an arm circumference of 35 cm for men and 30 cm for women should prompt selection of a longer needle to ensure intramuscular injection at the deltoid site. Thresholds for the different skin to deltoid sites proposed internationally should be determined to enable successful IM vaccination in clinical practice beyond NZ.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
