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July 2003 • Volume 37 • Number 7

News

7/8 inch is recommended for infants
Pediatricians Using Wrong Needle Sizes for Vaccinations

Doug Brunk
San Diego Bureau

SAN DIEGO — Many pediatricians were not following the established guidelines of needle length requirements for routine immunization of infants, children, and adolescents, results from a small survey found.

“The 5/8-inch needle seems to be the most popular choice,” Dr. Clifford Nerwen said at the annual meeting of the American Association of Clinical Endocrinologists.

While it remains unclear what this means in terms of the effectiveness of vaccine titers, it underscores the importance of following current needle length recommendations “in the best interest of the kids,” he said. “Effective immunization practice is dependent upon the needle length and route of vaccine administration.”

A needle length of 7/8 inch is recommended for an average healthy infant receiving an intramuscular vaccine in the thigh and a needle length of 1-2 inches for an adolescent receiving a deltoid intramuscular vaccination.

These requirements are cited in the Report of the Committee on Infectious Diseases by the American Academy of Pediatrics in the “Red Book 2000” and Centers for Disease Control's “General Recommendations on Immunization” (MMWR 51[RR-02]:1-36, 2002).

For the study, he and his associates sent a survey to 356 community-based pediatricians affiliated with Schneider Children's Hospital, New Hyde Park, N.Y. Pediatric subspecialists and full-time academic pediatricians were excluded from the study.

The multiple-choice survey contained questions about needle length, as well as the site and route of administration for routine vaccination of children of various ages. All responses were anonymous. A total of 145 surveys were returned, for a response rate of 41%.

Only 10% of respondents used an appropriately sized needle to administer DTaP vaccine in 6-month-old infants, while the rest used needles that were 3/4 inch or smaller. The majority (75%) used a 5/8-inch needle. This pattern also held true of respondents who administered the Haemophilus influenzae type b vaccine to 6-month-old infants; only 9% used an appropriately sized needle. The majority (75%) used a 5/8-inch needle.

For 12-year-olds receiving the tetanus-diphtheria toxoid and hepatitis B vaccines, only 20% and 19% of respondents, respectively, used the appropriately sized needle for these two immunizations. Again, the majority used the 5/8-inch needle (63% and 62%, respectively).

One limitation of the study is the relatively small number of pediatricians surveyed, said Dr. Nerwen, who is a pediatrician in the division of general pediatrics at Schneider Children's Hospital.