Open Forum

Dear Colleagues working with infants and immunizations,

I have a situation in which the question of what is the maximum volume can be given in 6 - 8-month-old in the vastus lateralis? (references would be great)

In researching the topic, ACIP and CDC guidelines were reviewed as well as Dynamic Health. 

• Dorsalgluteal and rectus femoris are to be avoided for pediatric patients.
• Guidelines listed below are based on the size of the child and muscle- larger muscle can have larger volumes
• Making sure injections are at least 2.5 cm (1 inch) apart
• Sequencing order injections from least to most painful, understanding MMR, PCV13, and HPV are known to be more painful than many others
• Using different anatomical sites when possible and using thigh for multiple injections when all anatomical sites are exhausted per Dynamic Health

Newborns 

• Vastus lateralis muscles only. Do not exceed 0.5 ml per site

For 1 year-3 years old:

• Many different organizations have a recommendation of 5ml max volume total. ACIP and the CDC do not have a specific amount, instead refer to individual vaccine volume and the requirement that there is separation of multiple vaccines by 1 inch or 2.5 cm.

1 year to 11 years old:

• Ventrogluteal can be used: Maximum injection volume of 1–2ml per site with multiple injections separated by at least 2.5 cm (1 inch)

• Deltoid sites recommended for patients older than 3 years old – maximum injection volume of 1-2ml per site, with multiple injections separated by at least 2.5 cm (1 inch).
• Vastus Lateralis: maximum injection volume of 1-2ml per site

11 years old and older (70 kg+)

• Ventrogluteal can be used: Maximum injection volume of 2ml per site.
• Deltoid sites can be used for patients older than 3 years old – maximum injection volume of 4-5ml broken down into multiple injections, each separated by at least 2.5 cm (1 inch).
• Vastus Lateralis: maximum injection volume of 4-5 ml broken down into multiple injections, each separated by at least 2.5 cm (1 inch)

Whaley and Wong's textbook published May of 2023 states maximum volume to be administered in a single site is 1 ml for older infants and small children and 2 ml for older children and adolescents.  

Case in point: 

Providers would like to administer Beyfortus (1.0ml), Flu (0.5ml), and Prevnar (0.5ml) to infant between 6 and 8 months old at the same visit. I have one nurse who believes 1 ml is the max volume that can be delivered in the vastus lateralis. Reportedly the infant was not premature or larger than expected for their age. 

What is your best recommendation? References appreciated if available. 

Dear Colleagues working with infants and immunizations,

I have a situation in which the question of what is the maximum volume can be given in 6 - 8-month-old in the vastus lateralis? (references would be great)

In researching the topic, ACIP and CDC guidelines were reviewed as well as Dynamic Health. 

• Dorsalgluteal and rectus femoris are to be avoided for pediatric patients.
• Guidelines listed below are based on the size of the child and muscle- larger muscle can have larger volumes
• Making sure injections are at least 2.5 cm (1 inch) apart
• Sequencing order injections from least to most painful, understanding MMR, PCV13, and HPV are known to be more painful than many others
• Using different anatomical sites when possible and using thigh for multiple injections when all anatomical sites are exhausted per Dynamic Health

Newborns 

• Vastus lateralis muscles only. Do not exceed 0.5 ml per site

For 1 year-3 years old:

• Many different organizations have a recommendation of 5ml max volume total. ACIP and the CDC do not have a specific amount, instead refer to individual vaccine volume and the requirement that there is separation of multiple vaccines by 1 inch or 2.5 cm.

1 year to 11 years old:

• Ventrogluteal can be used: Maximum injection volume of 1–2ml per site with multiple injections separated by at least 2.5 cm (1 inch)

• Deltoid sites recommended for patients older than 3 years old – maximum injection volume of 1-2ml per site, with multiple injections separated by at least 2.5 cm (1 inch).
• Vastus Lateralis: maximum injection volume of 1-2ml per site

11 years old and older (70 kg+)

• Ventrogluteal can be used: Maximum injection volume of 2ml per site.
• Deltoid sites can be used for patients older than 3 years old – maximum injection volume of 4-5ml broken down into multiple injections, each separated by at least 2.5 cm (1 inch).
• Vastus Lateralis: maximum injection volume of 4-5 ml broken down into multiple injections, each separated by at least 2.5 cm (1 inch)

Whaley and Wong's textbook published May of 2023 states maximum volume to be administered in a single site is 1 ml for older infants and small children and 2 ml for older children and adolescents.  

Case in point: 

Providers would like to administer Beyfortus (1.0ml), Flu (0.5ml), and Prevnar (0.5ml) to infant between 6 and 8 months old at the same visit. I have one nurse who believes 1 ml is the max volume that can be delivered in the vastus lateralis. Reportedly the infant was not premature or larger than expected for their age. 

What is your best recommendation? References appreciated if available. 

Dear Colleagues working with infants and immunizations,

I have a situation in which the question of what is the maximum volume can be given in 6 - 8-month-old in the vastus lateralis? (references would be great)

In researching the topic, ACIP and CDC guidelines were reviewed as well as Dynamic Health. 

• Dorsalgluteal and rectus femoris are to be avoided for pediatric patients.
• Guidelines listed below are based on the size of the child and muscle- larger muscle can have larger volumes
• Making sure injections are at least 2.5 cm (1 inch) apart
• Sequencing order injections from least to most painful, understanding MMR, PCV13, and HPV are known to be more painful than many others
• Using different anatomical sites when possible and using thigh for multiple injections when all anatomical sites are exhausted per Dynamic Health

Newborns 

• Vastus lateralis muscles only. Do not exceed 0.5 ml per site

For 1 year-3 years old:

• Many different organizations have a recommendation of 5ml max volume total. ACIP and the CDC do not have a specific amount, instead refer to individual vaccine volume and the requirement that there is separation of multiple vaccines by 1 inch or 2.5 cm.

1 year to 11 years old:

• Ventrogluteal can be used: Maximum injection volume of 1–2ml per site with multiple injections separated by at least 2.5 cm (1 inch)

• Deltoid sites recommended for patients older than 3 years old – maximum injection volume of 1-2ml per site, with multiple injections separated by at least 2.5 cm (1 inch).
• Vastus Lateralis: maximum injection volume of 1-2ml per site

11 years old and older (70 kg+)

• Ventrogluteal can be used: Maximum injection volume of 2ml per site.
• Deltoid sites can be used for patients older than 3 years old – maximum injection volume of 4-5ml broken down into multiple injections, each separated by at least 2.5 cm (1 inch).
• Vastus Lateralis: maximum injection volume of 4-5 ml broken down into multiple injections, each separated by at least 2.5 cm (1 inch)

Whaley and Wong's textbook published May of 2023 states maximum volume to be administered in a single site is 1 ml for older infants and small children and 2 ml for older children and adolescents.  

Case in point: 

Providers would like to administer Beyfortus (1.0ml), Flu (0.5ml), and Prevnar (0.5ml) to infant between 6 and 8 months old at the same visit. I have one nurse who believes 1 ml is the max volume that can be delivered in the vastus lateralis. Reportedly the infant was not premature or larger than expected for their age. 

What is your best recommendation? References appreciated if available. 

Dear Colleagues working with infants and immunizations,

I have a situation in which the question of what is the maximum volume can be given in 6 - 8-month-old in the vastus lateralis? (references would be great)

In researching the topic, ACIP and CDC guidelines were reviewed as well as Dynamic Health. 

• Dorsalgluteal and rectus femoris are to be avoided for pediatric patients.
• Guidelines listed below are based on the size of the child and muscle- larger muscle can have larger volumes
• Making sure injections are at least 2.5 cm (1 inch) apart
• Sequencing order injections from least to most painful, understanding MMR, PCV13, and HPV are known to be more painful than many others
• Using different anatomical sites when possible and using thigh for multiple injections when all anatomical sites are exhausted per Dynamic Health

Newborns 

• Vastus lateralis muscles only. Do not exceed 0.5 ml per site

For 1 year-3 years old:

• Many different organizations have a recommendation of 5ml max volume total. ACIP and the CDC do not have a specific amount, instead refer to individual vaccine volume and the requirement that there is separation of multiple vaccines by 1 inch or 2.5 cm.

1 year to 11 years old:

• Ventrogluteal can be used: Maximum injection volume of 1–2ml per site with multiple injections separated by at least 2.5 cm (1 inch)

• Deltoid sites recommended for patients older than 3 years old – maximum injection volume of 1-2ml per site, with multiple injections separated by at least 2.5 cm (1 inch).
• Vastus Lateralis: maximum injection volume of 1-2ml per site

11 years old and older (70 kg+)

• Ventrogluteal can be used: Maximum injection volume of 2ml per site.
• Deltoid sites can be used for patients older than 3 years old – maximum injection volume of 4-5ml broken down into multiple injections, each separated by at least 2.5 cm (1 inch).
• Vastus Lateralis: maximum injection volume of 4-5 ml broken down into multiple injections, each separated by at least 2.5 cm (1 inch)

Whaley and Wong's textbook published May of 2023 states maximum volume to be administered in a single site is 1 ml for older infants and small children and 2 ml for older children and adolescents.  

Case in point: 

Providers would like to administer Beyfortus (1.0ml), Flu (0.5ml), and Prevnar (0.5ml) to infant between 6 and 8 months old at the same visit. I have one nurse who believes 1 ml is the max volume that can be delivered in the vastus lateralis. Reportedly the infant was not premature or larger than expected for their age. 

What is your best recommendation? References appreciated if available. 

Dear Colleagues working with infants and immunizations,

I have a situation in which the question of what is the maximum volume can be given in 6 - 8-month-old in the vastus lateralis? (references would be great)

In researching the topic, ACIP and CDC guidelines were reviewed as well as Dynamic Health. 

• Dorsalgluteal and rectus femoris are to be avoided for pediatric patients.
• Guidelines listed below are based on the size of the child and muscle- larger muscle can have larger volumes
• Making sure injections are at least 2.5 cm (1 inch) apart
• Sequencing order injections from least to most painful, understanding MMR, PCV13, and HPV are known to be more painful than many others
• Using different anatomical sites when possible and using thigh for multiple injections when all anatomical sites are exhausted per Dynamic Health

Newborns 

• Vastus lateralis muscles only. Do not exceed 0.5 ml per site

For 1 year-3 years old:

• Many different organizations have a recommendation of 5ml max volume total. ACIP and the CDC do not have a specific amount, instead refer to individual vaccine volume and the requirement that there is separation of multiple vaccines by 1 inch or 2.5 cm.

1 year to 11 years old:

• Ventrogluteal can be used: Maximum injection volume of 1–2ml per site with multiple injections separated by at least 2.5 cm (1 inch)

• Deltoid sites recommended for patients older than 3 years old – maximum injection volume of 1-2ml per site, with multiple injections separated by at least 2.5 cm (1 inch).
• Vastus Lateralis: maximum injection volume of 1-2ml per site

11 years old and older (70 kg+)

• Ventrogluteal can be used: Maximum injection volume of 2ml per site.
• Deltoid sites can be used for patients older than 3 years old – maximum injection volume of 4-5ml broken down into multiple injections, each separated by at least 2.5 cm (1 inch).
• Vastus Lateralis: maximum injection volume of 4-5 ml broken down into multiple injections, each separated by at least 2.5 cm (1 inch)

Whaley and Wong's textbook published May of 2023 states maximum volume to be administered in a single site is 1 ml for older infants and small children and 2 ml for older children and adolescents.  

Case in point: 

Providers would like to administer Beyfortus (1.0ml), Flu (0.5ml), and Prevnar (0.5ml) to infant between 6 and 8 months old at the same visit. I have one nurse who believes 1 ml is the max volume that can be delivered in the vastus lateralis. Reportedly the infant was not premature or larger than expected for their age. 

What is your best recommendation? References appreciated if available.