Effect of Needle Length When Immunizing Obese Adolescents With Hepatitis B Vaccine

Middleman, Amy B.; Anding, Roberta; Tung, Celestine S.

doi:10.1542/peds.2009-1592

Cited by 58 publications

(47 citation statements)

References 24 publications

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“…Current evidence guides practice to consider gender when administering an IM injection. [2,3,[11][12][13] Recent evidence recommends ventrogluteal site be the preferred site for IM injections. [14,15] Evidence shows the ventrogluteal site is far from major vascular and nerve structures and has a relatively low subcutaneous thickness in comparison with the traditionally used dorsogluteal site.…”

Section: Practice Variationmentioning

confidence: 99%

See 1 more Smart Citation

Evidence calls for practice change in intramuscular injection techniques

Strohfus

Paugh²,

Tindell³

et al. 2017

JNEP

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Background and Objective: Intramuscular (IM) injections are administered to patients in all health care settings. Even though this procedure is invasive and the evidence supporting the process of administration is extensive, techniques and procedures vary throughout the literature and in practice. The purpose of this descriptive correlational study was to 1) investigate the literature on current evidence-based IM injection procedures pertaining to gender, patient weight, injection site, needle length, and technique, 2) compare surveyed healthcare personnel self-reported IM injection practices, and 3) query respondents on informational resources they access, continuing education they receive, and their years of healthcare experience and higher education. Methods: The Intramuscular Injection Questionnaire (IIQ) was sent via email to various professional healthcare facilities and their respective social media sites. Two hundred and six (206) healthcare personnel of various healthcare backgrounds and educational levels accessed the IIQ via a link to Qualtrics software. SPSS Version 24 was used for data analysis. Results: Most respondents were registered nurses with 4 -15+ years of experience. Seventy-eight percent of respondents considered their IM injection knowledge at above average or expert levels. Gender was not considered an important factor when selecting an injection needle among 75% of participants. Of all respondents, 61% use z-track technique, 59% use the ventrogluteal site and 34% always bunch or stretch the skin during injection. IM injection education was not provided in 75% of healthcare facilities. Conclusions: IM injection practices vary among respondents and in the literature; some reported practices are contrary to current evidence-based practice. While the evidence provides some sound recommendations, some procedures are not well-documented or supported including in nursing texts. Nurses and other healthcare personnel must critically analyze the site, depth, needle, volume, medication, vaccine, and whether to bunch or stretch, according to evidence-based practice. Healthcare facilities should provide IM injection education routinely to ensure safe practices. Future studies (Level 1 and 2) are needed to further demonstrate the best evidence leading to safe and effective IM injections.

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Section: Practice Variationmentioning

confidence: 99%

“…[2,11,13,43] Continuous education based on current evidence is vital to providing safe quality care.…”

Section: Practice Variationmentioning

confidence: 99%

Evidence calls for practice change in intramuscular injection techniques

Strohfus

Paugh²,

Tindell³

et al. 2017

JNEP

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“…15,16 Final group assignment was made using an eligibility checklist completed after review of the patient information. Fiveto 10-mL aliquots of blood were obtained for baseline quantitative anti-HBs and qualitative anti-HB core antigen (anti-HBc) determination before HB vaccine challenge dose administration.…”

Section: Visitmentioning

confidence: 99%

Duration of Protection After Infant Hepatitis B Vaccination Series

et al. 2014

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BACKGROUND: Little is known about duration of protection after the infant primary series of hepatitis B (HB) vaccine in settings of low HB endemicity. This study sought to determine the proportion of adolescents immunized as infants who had protective titers of antibody to hepatitis B surface antigen (anti-HBs) before and after a challenge dose of vaccine. METHODS: US-born 16- through 19-year-olds who received a recombinant HB vaccine 3-dose series initiated within 7 days of birth (group 1) or at ≥4 weeks of age (group 2) and completed by 12 months of age were enrolled. Participants had serologic testing before and 2 weeks after randomization to receive a challenge dose of 10 µg or 20 µg of Engerix-B. Baseline and postchallenge levels of anti-HBs were compared by group, challenge dosage, and demographic and behavioral characteristics. RESULTS: At baseline, 24% had protective anti-HBs levels of ≥10 IU/mL; 92% achieved protective levels after challenge dose. Although group 1 had a lower proportion of seroprotection at baseline, group and challenge dosage were not associated with postchallenge proportion of seroprotection. Being in group 2, higher test dosage, higher baseline geometric mean titer, and nonwhite race were associated with significantly higher geometric mean titer after challenge dose. CONCLUSIONS: More than 90% of study participants immunized against HB as infants exhibited a seroprotective response to a challenge dose of vaccine. Duration of protection from the primary infant HB vaccine series extended through the adolescent years in the setting of low HB endemicity.

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“…Bu bulgular aşı reaktojenitesini etkilediği için yeterli kas girişinin ve doğru iğne uzunluğunun belirlenmesinin önemli olduğunu göstermektedir. 16 Koster ve ark. çalışmasında, deltoid bölgeden yapılan aşı uygulamalarında 60 kg altında olan adolesanlar için 16 mm enjektör iğnesi, 60-70 kg arasında olanlar için ise 25 mm iğne kullanılması önerilmiştir (Şekil 1).…”

Section: Kullanilacak İğneni̇n Uzunluğuunclassified

“…10 Eğer deltoid kası kullanılamı-yorsa ya da daha yüksek miktarlarda ilaç enjekte edilecek ise vastus lateralis kası da güvenle kullanılabilmektedir. Bir-üç yaşındaki bebeklere deltoid kası içine enjeksiyon yapmak için; 16 …”

Section: üç-18 Yaşunclassified

What are the Trues in Applicating of Intramuscular Injection to Children?: Review

Yıldız¹,

Kızıler²,

Fidancı³

et al. 2017

Turkiye Klinikleri J Nurs Sci

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Ö ÖZ ZE ET T Hemşirelik uygulamalarında intramusküler enjeksiyon, kolay bir beceri olarak düşünülmesine karşın güvenli ve uygun şekilde yapılmadığında çok ciddi komplikasyonlara yol açabilmektedir. Rahatlatma teknikleri, pozisyonu, ilaç miktarı, bölgenin seçimi ve çocukların kas kütlesi miktarı her intramusküler enjeksiyondan önce değerlendirilmeli, çocuğun yaşı ve gelişimine göre belirlenmelidir. Enjeksiyon bölgesi olarak yenidoğan ve küçük çocuklarda (<3 yaş) vastus lateralis, üç yaş ve daha büyük çocuklarda deltoid ve ventrogluteal bölge tercih edilmelidir. İntramusküler uygulamalarda uygun enjeksiyon bölgesinin seçimi kadar doğru tekniği kullanmak da önemlidir. Aynı zamanda, intramuskü-ler enjeksiyon için enjeksiyon derinliği, iğne uzunluğu ve uygulama hızının doğru belirlenmesi gerekir. Ağrı yönetimi, çocuğun yaş ya da gelişimsel özelliklerine göre ağrıyı azaltmak veya gidermek için bilinmelidir. Ağrı yönetimi için büyük yaş grubunda çocuğun işleme katılımı ve kararının alınması etkili iken küçük çocuklarda kombine farmakolojik olmayan yöntemler kullanılmalıdır. Bu nedenle, çocuk hemşirelerinin kanıta dayalı güvenli enjeksiyon uygulamalarını bilmesi önemlidir. Çocuk hemşirelerinin, intramusküler enjeksiyonlarla ilgili hasta sonuçlarını geliştirmek için en iyi uygulamaları içeren güncel literatürü takip etmesi gerekmektedir. Bu çalışmada, çocuklara uygulanan intramuskü-ler enjeksiyonun güncel literatür ve mevcut kanıtlar doğrultusunda değerlendirilmesi amaçlanmıştır.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Çocuk; enjeksiyonlar, intramusküler; kanıta dayalı hemşirelik A AB BS S T TR RA AC CT T Although intramuscular injections has been thought as an easy skill in nursing practice, it may cause serious complications when it's applied in unsafe and unusual procedure. Comfort techniques, positioning, amount of drug, site selection and the amount of muscle mass of the children should be assessed prior to each intramuscular injections and determined by the child's age and development. As an injection site, vastus lateralis for newborns and small children (<3 years), the deltoid and ventrogluteal region should be preferred for children age three and older children. For intramuscular injections, it is important to use correct technique as well as to choose the correct injection site. Therewithal, injection depth, the length of the needle and the application rate should be determined correctly for intramuscular injections. Pain management should be known to eliminate or reduce pain according to the child's age term and developmental characteristics. For effective pain management, in older age groups taking child's participation and decisionmaking process are effective while combined non pharmalogical methods should be used in small children. Therefore, it is important for pediatric nurses to know safe injection practices of evidencebased practice. Nursing practice requires pediatric nurses to review current literature that includes the best practice to improve patient outcomes. The aim of this article...

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Effect of Needle Length When Immunizing Obese Adolescents With Hepatitis B Vaccine

Abstract: This finding supports the hypothesis that needle length accounts for a significant portion of the discrepancy in immune response to HBV vaccine that is seen among those with obesity.

Cited by 58 publications

References 24 publications

Evidence calls for practice change in intramuscular injection techniques

Evidence calls for practice change in intramuscular injection techniques

Duration of Protection After Infant Hepatitis B Vaccination Series

What are the Trues in Applicating of Intramuscular Injection to Children?: Review

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