Subq injection/4 yr old..question!

[maisyLPN]

Today I had a 4 yr old come in for her shots. She was getting a Varicella and MMR. These always make me nervous because the doc prefers we do them in the thigh at this age and there usually isn't very much of a fatty area. So for the little girl I had today, I gave the shot in the mid-side of the thigh, in the outer aspect where the fat is, if that makes any sense. It wasn't on the front of the thigh. When she stood up, she'd have to turn to the side for you to see it. I felt fine about it until I walked out of the office and wondered "was that too far to the side?" I pinched up the skin and felt like it was good and fatty, and injected it at a 45 degree angle as always. I'm just worried that maybe that area wasn't a good idea. I'd appreciate some feedback, TIA.

[Flo., BSN, RN]

From mid front to mid side on the outside of the thigh is OK.

[kiszi, RN]

they do vaccines sub Q now?

[maisyLPN]

MMR, Varicella, and Polio are given subq. Polio can also be given IM.

[lrobinson5]

For my daughters 15 month old shots she got MMR IM, or at least it appeared that way? I didn't think any vaccinations were given subQ.

[jadelpn, LPN, EMT-B]

I thought all of the numerous immunizations the kids need for kindergarten, at least a couple of them are IM.....(the MMR???). If it were IM, the front of the thigh is the more muscular area in this age. Subq more on the fatty outer area. With a child that age ready to run out the door after injection #1, KUDOS to you for getting in injection #2!!

[RNChristy]

Any vaccinations that I have ever given or my kids received were always IM also. Has that changed?

[ksm84]

I work in a pediatric office, and most of the vaccines are IM; but the MMR and Varicella are given sub-q. For kids around age 4 or under we usually do the thigh (vastus lateralis area.) It is easier to hold them still when they are laying down on an exam bed and we can hold their legs still with our thighs.

I wouldn't worry about the placement of your injection, it sounds ok.

[nurseprnRN, BSN, RN]

*i* would worry about placement if the op thinks all injections should be given in "fatty tissue," not im (this means, "intramuscularly." when did mmr go to subq? and fwiw, i am not sure "subq" means "into fatty tissue." i am willing to be enlightened, though.

[maisyLPN]

Thanks everyone.

MMR and Varicella are given subq. There is no other way to give it. It may have seemed like it was IM because a lot of nurses give those injections in the thigh along with the IM injections, such as DTAP, HIB, and Hep A. I'm well aware of what an intramuscular and subcutaneous injection is. I tend to explain things in layman's terms more often now because I've been working with children and parents who have no idea what subcutaneous means. So I've gotten used to calling it the "fatty tissue right under the skin" when explaining the difference between an injection in the muscle and an injection into the subcutaneous tissue. This was copied from the CDC's website: "Subcutaneous

injections are administered into the fatty tissue found below the dermis and above muscle tissue." That's pretty much what I tell the parents. And they say to inject into the fatty area of the thigh as well in order to avoid injecting MMR or Varicella into a muscle, which is what I felt like I did but being a new nurse, I worry. But thanks.