In this video I will describe how to select the equipment needed to prepare vaccine for an
intramuscular injection for children birth through 18 years of age. This route is
abbreviated IM. Steps include gathering necessary supplies and selecting an appropriate syringe
and needle. CDC recommends providers prepare vaccines just prior to administration.
Providers should prepare vaccines in a designated area that is not adjacent to any area
where potentially contaminated items are placed. Before preparing or administering any
vaccine always start with proper hand hygiene. CDC has hand hygiene guidelines and resources
for health care personnel available online.
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To begin preparation gather the appropriate supplies. This includes a syringe and needle,
pre-packaged sterile alcohol wipes and bandages. A marker or label will be needed to identify
the vaccine once it is in the syringe. A 1 or 3 milliliter syringe is used to administer an
IM injection. Typically vaccines are not a thick liquid so a 22 to 25 gauge needle is used.
The appropriate needle length can vary. A supply of needles in lengths appropriate for the
patient population should be available. For an optimal immune response to occur the vaccine
must reach the desired tissue site. For an intramuscular injection the tissue site is
muscle. To reach the muscle the correct needle length and gauge must be used.
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The vastus lateralis muscle on the anterolateral thigh is the preferred site for infants
younger than 1 year of age. For the majority of infants a 1 inch 22 to 25 gauge needle is
sufficient to penetrate the thigh muscle. For very young babies, those younger than 28
days old and preterm infants, a 5/8 inch needle is usually adequate if the skin is
stretched flat between the thumb and the forefinger and the needle is inserted at a 90 degree angle.
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The vastus lateralis muscle on the anterolateral thigh is the preferred site for toddlers 12
through 35 months of age. To penetrate the muscle use a 22 to 25 gauge needle at least 1 inch
long. The deltoid muscle in the upper arm can also be used if the muscle mass is adequate.
A 5/8 inch needle is adequate only for the deltoid muscle and only if the skin is stretched
flat between the thumb and forefinger and the needle is inserted at a 90 degree angle to
the skin.
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The deltoid muscle in the upper arm is the preferred site for children 3 through 18 years of
age. For most children in this age group a 22 to 25 gauge, 5/8 to 1 inch needle is sufficient
to penetrate the muscle. In general, older children and adolescents require a 1 inch
needle. The vastus lateralis muscle is an alternate site if the deltoid muscle cannot be
used. A 1 to 1 1/4 inch needle will be sufficient to reach muscle tissue in older children and
adolscents. When preparing and administering vaccines always follow safe injection
practices and aseptic technique. Aseptic technique refers to the handling, preparing, and storing
of medications and injection equipment and supplies to prevent microbial contamination.
Always use a new needle and syringe for each injection. It is not necessary to change
needle between preparing and drawing vaccine from a vial and injecting it into the patient
unless the needle has been damaged or contaminated. Never combine vaccines in the same
syringe unless specifically approved by the Food and Drug Administration, or FDA, and
packaged for that specific purpose. CDC has injection safety resources for health care
personnel available online at www.cdc.gov/injectionsafety
This video is part of a series designed to demonstrate vaccine administration skills and best
practices. The video series is available on the Vaccine Administration web page on the
CDC Vaccines and Immunizations website at www.cdc.gov/vaccines