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What variables should inform needle length choice for deltoid intramuscular injection? A systematic review.
Kearns, Ciléin; Houghton, Claire; Dickinson, Emily; Hatter, Lee; Bruce, Pepa; Krishnamoorthy, Srinidhi; Weatherall, Mark; Hills, Thomas; Doppen, Marjan; Ali Mirjalili, Seyed; Beasley, Richard.
  • Kearns C; Medical Research Institute of New Zealand, Wellington, New Zealand cilein.kearns@mrinz.ac.nz.
  • Houghton C; Medical Research Institute of New Zealand, Wellington, New Zealand.
  • Dickinson E; Medical Research Institute of New Zealand, Wellington, New Zealand.
  • Hatter L; Capital and Coast District Health Board, Wellington, New Zealand.
  • Bruce P; Medical Research Institute of New Zealand, Wellington, New Zealand.
  • Krishnamoorthy S; Medical Research Institute of New Zealand, Wellington, New Zealand.
  • Weatherall M; Medical Research Institute of New Zealand, Wellington, New Zealand.
  • Hills T; Capital and Coast District Health Board, Wellington, New Zealand.
  • Doppen M; University of Otago Wellington, Wellington, New Zealand.
  • Ali Mirjalili S; Medical Research Institute of New Zealand, Wellington, New Zealand.
  • Beasley R; Auckland District Health Board, Auckland, New Zealand.
BMJ Open ; 13(1): e063530, 2023 Jan 20.
Article in English | MEDLINE | ID: covidwho-2213955
ABSTRACT

OBJECTIVES:

(1) Assess the distribution of skin-to-deltoid-muscle distance (SDMD) at the deltoid intramuscular (IM) injection site; (2) its relationship with demographic and anthropometric variables and (3) Consider the findings in relation to clinical guidance on IM injection, such as COVID-19 vaccines.

DESIGN:

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Library, CINAHL and SCOPUS between June and July 2021 with no publication date limit. ELIGIBILITY CRITERIA Studies reporting measurements of the SDMD in living adults aged 16 years and older, at the deltoid IM injection site, published in English were considered. DATA EXTRACTION AND

SYNTHESIS:

Two independent reviewers performed each stage of screening, data extraction and quality assessments using the Joanna Briggs Institute Critical Appraisal Checklist for analytical cross sectional studies.

RESULTS:

16 105 papers were identified, of which 11 studies were suitable for review, representing 1414 participants. Heterogeneity in the definition of the deltoid IM injection site, locations measured and methods of measurement precluded meta-analysis. Evidence from ultrasound SDMD measurements demonstrated some patients in all but 'underweight' body mass index (BMI) categories, may require needles longer than 25 mm for successful IM injection. Calliper measurements overestimated SDMD compared with ultrasound. Female sex, higher BMI categories and greater weight in women were associated with greater SDMD.

CONCLUSIONS:

The reviewed evidence was insufficient to inform definitive needle length 'cut points' for IM injection based on demographic or anthropomorphic variables. Contemporary clinical guidance currently based on this evidence, including the site of injection and choice of needle length, may result in subcutaneous administration in a small proportion of recipients, particularly if obese or of female sex. PROSPERO REGISTRATION NUMBER CRD42021264625.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Vaccines / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Vaccines Limits: Adult / Female / Humans Language: English Journal: BMJ Open Year: 2023 Document Type: Article Affiliation country: Bmjopen-2022-063530

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Vaccines / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Vaccines Limits: Adult / Female / Humans Language: English Journal: BMJ Open Year: 2023 Document Type: Article Affiliation country: Bmjopen-2022-063530