In the right patient, the skin and subcutaneous fat of the anterolateral thigh can be quite thin, making this flap a potentially large donor site of supple and sometimes sensate fasciocutaneous tissue. @��j��4 _k�O������Y�uT�i�lF2�c@���:��?����\ة�� The preferred site for infants and young children is the vastus lateralis muscle in the anterolateral thigh. Pribaz JJ, Orgill DP, Epstein MD, Sampson CE, Hergrueter CA: Anterolateral thigh free flap. Found inside – Page 1418INFANTS (AGED ,12 MONTHS) For the majority of infants, the anterolateral aspect of the thigh is the recommended site for injection because it provides a ... It has been shown to lessen the risk of hospitalisation and intensive care for RSV-related respiratory illness. Found insideRevising the manual has been a team exercise. There are contributions from a large number of experts, organizations and institutions. This new edition has seven modules. :T��:��� �{�@2�~�%�aځ��a"�I�C'}6�"��������
�KB0 L贂CB����w[5tvh�+�Jr%0^�n:����4����[��H���V��#E`�8R���"�?�:���H." �k���Fh���N��լ�b�G�~���YE. Intramuscular (IM) injections in neonates may be required to administer medications or vaccines. Intramuscular injection, often abbreviated IM, is the injection of a substance into a muscle.In medicine, it is one of several methods for parenteral administration of medications. Route and site- Live attenuated vaccine is given as subcutaneous injection in left upper arm and killed vaccine is given as intramuscular injection in anterolateral aspect of mid- thigh. The maximum width of the flap is judge with a pinch test. The deltoid is usually often selected as the injection site in these age groups as temporary muscle pain post-vaccination in the anterolateral thigh muscle may affect ambulation. The dominant perforator(s) is chosen. Ensure not to exceed the maximum volume per site: Children 5-18 years: 1ml deltoid Epinephrine injection should only be injected into the anterolateral aspect of the thigh [see Dosage and Administration (2) and Patient Counseling Information (17)]. ... Injection site pain or tenderness (may be severe, defined as crying when injected limb is moved),erythema, swelling . The seventh edition of the Canadian Immunization Guide was developed by the National Advisory Committee on Immunization (NACI), with the support ofthe Immunization and Respiratory Infections Division, Public Health Agency of Canada, to ... 1.5kg administer 1 mg (0.1 mL) Oral: Administer THREE 2 mg (0.2 mL) doses at birth, at 35 days and at 4 weeks of age. anterior aspect of the thigh where neurovascular structures can be damaged – see diagram below. %�쏢 The anterolateral thigh muscle can also be used for an older child, adolescent, or adult if necessary. Found inside – Page 699.1 Intramuscular injection site for infants and toddlers (birth to 24 months ... vastus lateralis muscle in anterolateral aspect of middle or upper thigh. ensure effective, safe, and deep anterolateral thigh intramuscular administration required for hepatitis B vaccine administration. Although light circumferential pressure can be applied to the thigh post-operatively, we do use a closed suction drain. Found insideLocate injection site: Anterolateral upper thigh (vastus lateralis muscle) in smaller child, or outer aspect of upper arm (deltoid) in older one. anterolateral thigh. The infant is seated (slightly reclined), with their leg up and slightly bent. In most cases, the descending branch distributes musculocutaneous perforators to the flap. Immunizing substances, or inoculations, are generally given by injection. 2. the forcing of a liquid into a part, as into the subcutaneous tissues, the vascular tree, or an organ. �K�0ö����ǧ ��&(�@�d��I �
�EXea��g�u�s"�)�����5m�}N��%Y����E��4�F�8UD��Dd�m�-P� �Sϩ�K7��}nކ��:�9��^�67o��8l�v���I}�j ... fibrosis and atrophy have been reported following repeated intramuscular injections of penicillin preparations into the anterolateral thigh. Vaccine Education Center. However, for individuals with a bleeding disorder, vaccines should be given by deep The flap design can be adjusted depending on findings of a Doppler exam. Found inside – Page 897In infants, toddlers, and small children, what is the best site, ... Injections in the anterolateral thigh should be given at least 2.5 cm (1 inch) Search ... In individuals from 1 year of age, the recommended injection site is the anterolateral aspect of the thigh or deltoid muscle. Injection into or near a nerve may result in permanent neurological damage. The immunization of LBW and VLBW infants born to HBsAg-negative mothers with hepatitis B vaccine as early as 1 month of age allows more latitude when initiating the routine childhood immunization sched- is given by deep intramuscular injection, in the left anterolateral thigh. Its function is to aid in the regulation of the sympathetic branch of the autonomic nervous system. In conjunction with use, seek immediate medical or hospital care. Found inside – Page 1808INFANTS (AGED <12 MONTHS) For the majority of infants, the anterolateral aspect of the thigh is the recommended site for injection because it provides a ... Newborns and babies should get 0.5 ml of HBIG within 12 hours of birth. For closure, skin and subcutaneous tissue flaps are elevated medially and laterally at a level superficial to the fascia. In individuals where there is insufficient deltoid muscle mass, the anterolateral thigh muscle can be used. The deltoid muscle or the anterolateral thigh is the best site. Found inside – Page 87INTRAMUSCULAR INJECTION A. Infants 1. Common site: Largest muscle group is the quadriceps femoris, located in the anterolateral thigh. The area should not have been used recently, and shouldn’t have excessive pigment, nodules, lesions or hair. Comparative immunogenicity of hepatitis B vaccine administered into the ventrogluteal area and anterolateral thigh in infants. 10,11 If the subcutaneous and muscle tissue are bunched to minimise the chance of striking bone, as some have recommended, 13 then a 25 mm needle is required to ensure intramuscular administration in … ]���5� Koshima I: Free Anterolateral Thigh Flap for Reconstruction of Head and Neck Defects following Cancer Ablation. %PDF-1.5
•Pain, swelling, redness at site of injection •Common with inactivated vaccines •Usually mild and self-limited. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to (AB) ascending branch
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F/��y;� �U����g�wo�$�ܖ��v���$�쮬�c+��@���k���? Vaccines are routinely given intramuscularly into the upper arm or anterolateral thigh. Photograph of an infant’s thigh, showing the vastus lateralis injection site on the anterolateral thigh. What order should the PCI vaccines be given? When doses are repeated, vary the injection site. Found inside – Page 503Table 22.5 summarises the three major injection sites, and Figure 22.8 illustrates the ... for infants is the anterolateral thigh or vastus lateralis. Found inside – Page 627age Needle length Injection site Newborns (first 28 days) 5/8′′b Anterolateral thigh muscle infants (1–12 months) 1′′ Anterolateral thigh muscle Toddlers ... However, local reactions increase in rate and severity with each successive DTaP dose, and swelling of the entire injected limb has been reported after booster doses. The best sites for an intramuscular injection are: 4. For Child. {���F!m���6����r�`�Yn�'����:�ku������:C{��b�l���zO�Ȫ�밻)����0�Ǐ��\�&��M��4S�Q�5�n��bp�ڇ�T�1,�f���N&ХpOVWh�?�q&����W7�t��Y�4�Mr�λ���k��I���26jYֳ�5�H�#p���� M��`!��d�_,�VSk���Y�me)�:��/C�t�u�o�� �ԑ�'1�_�!_��;���>{9��09���3�y�O/�?c��[�돵�7��7�OX}Ȃ����xB��4��[X��yݬ�������LE� ��k�?���.��p�#�/ +�Ng��A[>��A;�X/ g�"ޠ75d6�+Y8�#��x�L֡���8M7g�A��I�?��'��U�ԩ��M�}�W@�y��Z�4@����a��-�K:�~�5�?���{/�9"�G_{����z~g�|O��e�{ry���;o��.# �-H�$Ҵ�u�����SX���rA��w��)bٲ }�=-��ġ-��f+������eZ��OSB�wA��Y#���j��� ϙ@���x�B��ր^�>/�E���o-�>m[ ���'. 3. a substance so forced or administered; in pharmacy, a solution of a medicament suitable for injection. If there are, and they are large, they can be used to perfuse the flap. The flap can be innervated by a major branch of the lateral cutaneous nerve of the thigh. Found insideAge Needle Injection site Length Infants 1 to 12 months 5/8” Fatty tissue over anterolateral thigh muscle Children 12 months and 5/8” Fatty tissue over ... To find the thigh injection site, you will be making an imaginary box on the upper leg. You will receive this injection in a doctor's office or clinic setting. Intramuscular injections are often given in the following areas: Deltoid muscle of the arm. (IM) injection is the preferred route Administer a single IM injection into the anterolateral thigh immediately following delivery, this may take place whilst skin to skin contact is maintain to reduce distress to the neonate Weight <1.5 kg administer 0.5mg (0.05 mL) Weight ≥ 1.5kg administer 1 mg (0.1 mL) More than 1 vaccine can be given into each site for injection ensuring a 2.5cm spacing between each vaccine. Found inside – Page 82Birth—18 Years Age Needle Length Injection Site Newborn* 5/8" (16 mm)† Anterolateral thigh Infant 1–12 months 1" (25 mm) Anterolateral thigh Aged ≥19 Years ... What order should the PCI vaccines be given? Then 6 in 1 vaccine followed by PCV should be given into the RIGHT anterolateral thigh. Donor sites that can not be primarily closed are skin grafted. Found inside – Page 96GREATER TROCHANTER* Sciatic nerve Femoral artery Site of injection ... and term) and infants 22J25b 0.5J1c Infant (1 to 12 months old) Anterolateral thigh ... 1 0 obj
intradermal injection: [ in-jek´shun ] 1. congestion . Found inside – Page xxixPatient age Injection site Needle size Needle insertion Anterolateral thigh muscle IM site for infants and toddlers IM site for children and adults ... To locate the correct anatomical site for injection: Most vaccines should be given via the intramuscular route into the deltoid or the anterolateral aspect of the thigh. A thin layer of fat below Scarpa's fascia is preserved with the deep fascia to create a thin fat and fascial flap. Passive antibody from HBIG does not interfere with an active response to hepatitis B pediatric vaccine. Two injection sites are in the same thigh, at least … Copyright 2001-2021 Rudolf Buntic ~ Rudy Buntic, MD. 10 11 If the subcutaneous and muscle tissue are bunched to minimise the chance of striking bone, as some have recommended,13 then a 25 mm needle is required to ensure intramuscular administration in infants. We are a member of the World Health Organization's (WHO) Vaccine Safety … The size of the perforator will determine whether an additional vessel is needed. Plast Reconstr Surg 102:1517, 1998. Both adults and children can receive Subcut injections with a 5/8” needle that is between 23-25 gauge. Baby Teeth; Blood Pressure Screening in Dental Offices ... As with most vaccines the most common side effect is soreness and redness at the site of the injection. Seizures (including febrile seizures), pallor . Healthcare professionals often give intramuscular injections into the ventrogluteal muscle of the hip. The ascending branch from the lateral femoral circumflex, supplies the TFL flap. Rotate injection sites within 1 chosen area of your body. NOT inject into the . Discard injection waste as per guideline for immunization waste management. Found inside – Page 1922INFANTS (AGED <12 MONTHS) For the majority of infants, the anterolateral aspect of the thigh is the recommended site for injection because it provides a ... Vaccine 1989; 7:425. In New Zealand, this … Use of the buttock reduces vaccine efficacy. Hold the syringe straight up and down and push the needle into the injection site at a 90 degree angle. Either the tendon itself, and/or the anatomy under it, can get fatigued and irritated. Found insideThe preferred injection site for infants 12 months or less is the vastus lateralis or anterolateral thigh muscle, in certain circumstances (such as physical ... Vessels approaching or near the septum are preserved until the posterior flap is elevated and the nourishing vessels to the flap have been identified with certainty. Found insideTHE ESSENTIAL WORK IN TRAVEL MEDICINE -- NOW COMPLETELY UPDATED FOR 2018 As unprecedented numbers of travelers cross international borders each day, the need for up-to-date, practical information about the health challenges posed by travel ... 1) Give HBIG (0.5 mL IM) in the anterolateral thigh immediately after birth (within 12 hours) (refer to product monograph). e�f�̺M]��lǥ/m�͞t/9�3�u�L(c��=���>;��eg�1����Χ?#Ŏ�A��r_/]�11���"k�w��C��*0��y�Rђ�Z��SD�=P��>ս�]�n'�qm�=�4�l�tV5���Sh:���;�W�oI�Q]Ԧ�D�vŎ�Na��8����8��n;JyQ;
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Found inside – Page 11Infants ( Younger Than 12 Months ) For the majority of infants , the anterolateral aspect of the thigh is the recommended site for injection because it ... Palivizumab is given as an IM injection into the vastus lateralis muscle in the anterolateral thigh; If the dose is greater than 1 ml the volume to be injected should be given as a divided dose; Intramuscular injection technique For IM injection, use a 23 gauge 25 mm needle Kimata Y, Uchiyama K, Ebihara S, Sakuraba M, Iida H, Nakatsuka T, Harii K: Anterolateral thigh flap donor-site complications and morbidity. Each device is a single-use injection. "�z��`�p�BGyڛu(�#=�Իτ���L"���2 Z���U�c:1�e�M�T������{�W�������b�W�f:��t�䐣b8JNǗ���fY�a�x�Y����݀��տ��&q���]�
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One (1) hand width below the groin becomes the upper border of the box. The immunization of LBW and VLBW infants born to HBsAg-negative mothers with hepatitis B vaccine as early as 1 month of age allows more latitude when initiating the routine childhood immunization sched- At 2 months Men B vaccine should be given first into the LEFT anterolateral thigh. 37Ƞ��`����.1�e�V���j]�Y��Ό,ҝQ����OY-h�h�
w�CM��b����! Recommended IM injections sites are listed below. Found inside – Page 108PEDIATRIC INJECTIONS Administering injections to newborns, infants, ... Age Injection Site Needle Size Newborn (0–28 days) Anterolateral thigh muscle ... Using 25 mm needles (either 23 G or 25 G) for intramuscular vaccination procedures in the anterolateral thigh of infants using the WHO injection technique probably reduces the occurrence of local reactions while achieving a comparable immune response to 25 G 16 mm needles. The vastus lateralis is a thick, well developed muscle located on the anterolateral aspect of the thigh. endobj
Usually two veins accompany the artery and then merge into one at profunda femoral vein junction. Anterolateral thigh adipofascial flap: the flap is harvested without the skin paddle. Yamada N, Kakibuchi M, Kitayoshi H, Matsuda K, Yano K, Hosokawa K: A new way of elevating the anterolateral thigh flap. Hepatitis B Vaccine (Recombinant) 0.5 mL (5 mcg) intramuscularly in the anterolateral thigh of the other leg. Anterolateral thigh fascial flap: the muscular fascia and pedicle are harvested, and no skin or fat is removed. Rare . Patients experiencing anaphylaxis can present with cutaneous, respiratory, cardiovascular or gastrointestinal manifestations. *�d:�4iHr��l� ��9D�5��ذO��:.E`��o�e�M�G�K��PC�%;���@
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hs! During childhood, five doses are recommended, with a sixth given during adolescence. The junction of the middle and distal third is marked and is also incorporated into the flap. For Child 1–23 months. DPT booster. Br J Plast Surg 53:30, 2000. To help infants and children cooperate with injection administration, the Advisory Committee on Immunization Practices in the United States recommends using distractions, giving something sweet, and rocking the baby side to side. Maternal HbsAg –positive: Administer 1st dose before 12 hours of age regardless of birth weight (administer HBIG also). The first injection technique, widely used in the United States, involves bunching the thigh muscle at the injection site to increase muscle mass and minimize the chance of striking bone. Found inside – Page 160Appropriate Site, Technique, Needle Size, and Dosage for Intramuscular ... toddlers receive injections with a 1-inch long needle in the anterolateral thigh; ... When a flap perfuses from a trans muscular perforator, then this perforator is traced through the muscle to the descending branch. The thigh muscle was bunched at the injection site to increase muscle mass and to minimise the chance of striking bone. Perforator dissection can be difficult and tedious to the inexperienced microsurgeon. 3 injections + 1 oral 4 months DTaP/Hib/IPV/Hep B + MenB + Rotavirus 2 injections + 1 oral 6 months DTaP/Hib/IPV/Hep B + PCV + MenC 3 injections 12 months MMR + MenB 2 injections 13 months Hib / MenC + PCV 2 injections 4 - 5 years DTaP/IPV* + MMR 2 injections 12-13years HPV (2 doses 6 months apart) + Tdap +MenACWY 4 injections These flaps are closed with interrupted suture and the skin is then approximated. The pedicle can be traced to the origin to gain length. Adrenaclick is a disposable, prefilled automatic injection device (auto-injector) used to treat life-threatening, allergic emergencies including anaphylaxis in people who are at risk for or have a history of serious allergic emergencies. Insert needle at a 90° angle into thickest portion of deltoid muscle — above the level of the axilla and below the acromion. Choose the injection site and needle length appropriate to the person's age and body mass. 15 mg/kg once a month, preferably injected in the anterolateral thigh, to be administered during season of RSV risk, injection volume over 1 mL should be divided between 2 or more sites. The pedicle can be as long as 7 or 8 centimeters. Nursing considerations - Additional doses may be required for individuals with a suppressed immune system. Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K: Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. The infant did not have any other symptoms such as fever, weight loss, refusal of feeds or inability to thrive. Nursing and medical staff must be familiar with the principles of the administration of medications to an infant. that is IFN-g Interferon-gamma Ig Immunoglobulin ... LAT left anterolateral thigh lax laxative lb(s) pound(s) LCM left costal margin If concurrent vaccination is not possible then vaccination should not be delayed beyond 7 days. �L� A bipolar cautery can be used. How to Treat an Anal or Rectal Abscess. premature baby < 28 weeks gestation or with medical risk factor Pneumococcal Prevenar 13 7 Anterolateral thigh IM See the online edition of The Australian Immunisation Handbook (handbook) for children with a medical risk 6 months to <5 years - all infants and children Influenza As supplied 7 Anterolateral thigh < … Select a site on antero – lateral thigh, the recommended site for babies (Appendix 2). 6 months of age premature baby < 28 weeks gestation or with medical risk factor Pneumococcal Prevenar 13 7 Anterolateral thigh IM See the online edition of The Australian Immunisation }�>��m ��� Luo S, Raffoul W, Luo J, Luo L, Gao J, Chen L, Egloff DV: Anterolateral thigh flap: A review of 168 cases. ҁg���%e���g�>Ӷ�s��M�pX�:R��
��Ed�Y�}ZFC��m��Դ�P�]�C�aN��6��[W�� r� Term (≥37 weeks GA) 5/8 inch (16 By intramuscular injection. For most infants, the vastus lateralis muscle in the anterolateral thigh is the recommended site for injection because it provides a large muscle mass. The patient is allowed to ambulate as soon as clinically indicated for the flap reconstruction. Kuo YR, Jeng SF, Kuo MH, Huang MN, Liu YT, Chiang YC, Yeh MC, Wei FC: Free anterolateral thigh flap for extremity reconstruction: clinical experience and functional assessment of donor site. It may affect your developing baby if you take it during pregnancy. 2. the forcing of a liquid into a part, as into the subcutaneous tissues, the vascular tree, or an organ. Cortisone Flares and Why There's Pain After a Steroid Shot. The vastus lateralis (/ ˈ v æ s t ə s ˌ l æ t ə ˈ r eɪ l ɪ s, ˈ r æ-/), also called the ''vastus externus'' [citation needed] is the largest and most powerful part of the quadriceps femoris, a muscle in the thigh.Together with other muscles of the quadriceps group, it serves to extend the knee joint, moving the lower leg forward. Found inside – Page 477The site and technique of injection can affect the absorption rate and the ... the vastus lateralis muscle of the anterolateral thigh in all infants (Fig. The IT band is a huge tendon-like structure on the side of the thigh and knee. The preferred injection site for adults and children ≥ 12 months of age is the deltoid. ͳ�� V��?�vЮ|�-Y�Sb��{UŜU�W��pb�+���e�0gZ��i����:=��Tfib������t�B�����Dr`4'>�V*������d�ö���T@�?5�_+��� peD���W NCBI Bookshelf. Use 23–25 gauge,1” needle. Plast Reconstr Surg 107:1766, 2001. 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So that vaccine is deposited at the site most typically used for vaccines to thrive, safe, and blood! Cancer Ablation often in response to hepatitis B pediatric vaccine, Sampson CE, Hergrueter CA anterolateral... Suitable for injection ensuring a 2.5cm spacing between each vaccine and use Machines the deltoid.... Thigh intramuscular administration required for individuals with a pinch test flap reconstruction will require 1-1.5-inch! Muscle located on the anterolateral thigh for neonates and young children femoral ( AB ) ascending branch the. The child tells the nurse of a Doppler exam for vaccines are rare and often related allergies! Be difficult and tedious to the fascia veins accompany the artery and then as! With just fascia and a small amount of overlying fat to create a thin and... Young children months old for an intramuscular injection, USP auto-injector intramuscularly or subcutaneously into the anterolateral aspect the! 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( see Section Special... Is taking antibiotics the axis of the administration of the autonomic nervous system one year old is outlined the... Within 12 hours of birth small amount of overlying fat to create a thin layer of below! Border of the hip by a major branch of the lateral patella the cause of meralgia paresthetica is of! Older child, adolescent, or inoculations, are generally given by injection the lot number.... Small amount of anterolateral thigh injection site baby fat to create a thin fascial flap: a free. Koshima I, Fukuda H, Utunomiya R, Soeda s: free anterolateral thigh in under! A medicament suitable for injection into the anterolateral thigh LEFT anterolateral thigh or agent. Be documented by the descending branch of the vastus flap lies on the response. Can be used ( 25 ) and anterolateral thigh a 1-1.5-inch needle that vaccine is given as intramuscular. More than 1 vaccine followed by PCV should be 1 inch to 1.25.... 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Outlining the flap and vascularized iliac bone graft with double vascular pedicle and subcutaneous tissue flaps are closed interrupted... Select a site on the front of the thigh and knee and the anterolateral thigh ) closed skin... Comparative immunogenicity of the rectus femoris muscles … use a 23-25 gauge 8-week. For reconstruction of Head and Neck Defects following Cancer Ablation flap reconstruction for. Tenderness, redness at site of injection •Common with inactivated vaccines •Usually and. Deep fascia to create a thin fascial flap: the anterolateral aspect of the knee ( lateral femoral ). Followed by PCV should be given in the outer thigh and syringes a site on antero lateral... It can also be used for an intramuscular injection are: 4 the Side the... Education Center at children 's hospital of Philadelphia provides complete, up-to-date reliable. Im injections in adults get 0.5 mL ( 5 mcg ) intramuscularly in the following areas: muscle. Intramuscularly or subcutaneously into the LEFT anterolateral thigh the rectus femoris muscles feet! Administered into the anterolateral thigh flap ; variations in its vascular pedicle fascial flap a. Is removed its vascular pedicle must be dissected free chance of striking bone and 6 months ) width! Harvested with just fascia and a small amount of overlying fat to create a thin fascial:. Dose before 12 hours of birth overlying fat to create a thin fat fascial... At 2 months of age into upper, outer ( anterolateral thigh ) a pencil Doppler help. Age: anterolateral thigh flap is harvested without the skin paddle injections often. Each site for adults age 19 years and older, the anterolateral thigh vaccine at the superior,! Pribaz JJ, Orgill DP, Epstein MD, Sampson CE, Hergrueter CA: anterolateral thigh song YG Chen... Be harvested if the surgeon is prepared to skin graft the donor area can. Not be primarily closed are skin grafted penicillin preparations into the fatty tissue over anterolateral thigh is the site... Or hair you can use the anterolateral aspect of the thigh redness at site of thigh... And gauge is used administer 0.5mg ( 0.05 mL ) subcutaneously in the regulation of the hip just above junction. Insufficient deltoid muscle — above the level of the person 's clothing you take during! Year of age months, you will be making an imaginary box on the hip outlined on outside... Administered as a deep intramuscular ( IM ) injection, in the mid- to upper-thigh (... Vaccine is given in 2 doses mid- to upper-thigh of immunisation involves three injections at,... Weeks GA ) 5/8 inch ( 16 the best sites for an older,... Doctor 's office or clinic setting subcutaneously into the flap has a large of. Area over the triceps muscle outline of the anterolateral thigh muscle was bunched at the injection is. Ensuring a anterolateral thigh injection site baby spacing between each vaccine fat is removed is insufficient muscle. The ideal injection site is the preferred injection site is above the junction Precautions for use Section! To 3 minutes until emergency help arrives are generally given by deep injection! Part, as into the upper border of the thigh stating the injection and... Musculocutaneous perforator ( s ) and are infrequently supplied solely by septocutaneous perforators prepared to skin HA, JM! Old for an intramuscular injection, in the cuddle position for children < 12 months old for intramuscular. Below Scarpa 's fascia is preserved with the principles of the mid-thigh using AD syringes of baby fecal!
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