Is it just me?
Article in the BMJ today re whether long or short needles are best for infant vaccinations, including at 2 months. Found that longer needles same for immunogenicity, and caused less local reactions at the 1, 2 and 3 day follow-up, but not at six hours. The needle calibre, previously thought to matter, didn't.
Now, I love evidence as much as the next GP, and am well aware that the recommendation is for longer needles, but admit to being slightly worried about these findings when confronted with some full-term 2 month old babies, you know the one's without much padding.
The technique referred to in the BMJ article is stretching the skin flat between thumb and forefinger, inserting needle at 90 degrees and pushing down into muscle.
Did the authors push down until they thought they had hit muscle? Or did they go all the way in until hub met skin? If the former, not very scientific, if the latter, in some full term but petite babies I see, I'd hit bone or end up in the biceps femoris.
The accompanying editorial notes that 'if the subcutaneous and muscle tissue are bunched to minimise the chance of striking bone, as some have recommended, then a 25 mm needle is required to ensure intramuscular administration in infants'.
Yet this is not the technique used in the study.
Furthermore, at six hours after vaccination, when the greatest number of local reactions were seen, there was no statistical difference between longer and shorter needles. This seems to be glossed over in the paper.
I havent had the pleasure of visiting Birmingham, maybe they make 'em bigger than in Sydney.
Or maybe it's just me?
Now, I love evidence as much as the next GP, and am well aware that the recommendation is for longer needles, but admit to being slightly worried about these findings when confronted with some full-term 2 month old babies, you know the one's without much padding.
The technique referred to in the BMJ article is stretching the skin flat between thumb and forefinger, inserting needle at 90 degrees and pushing down into muscle.
Did the authors push down until they thought they had hit muscle? Or did they go all the way in until hub met skin? If the former, not very scientific, if the latter, in some full term but petite babies I see, I'd hit bone or end up in the biceps femoris.
The accompanying editorial notes that 'if the subcutaneous and muscle tissue are bunched to minimise the chance of striking bone, as some have recommended, then a 25 mm needle is required to ensure intramuscular administration in infants'.
Yet this is not the technique used in the study.
Furthermore, at six hours after vaccination, when the greatest number of local reactions were seen, there was no statistical difference between longer and shorter needles. This seems to be glossed over in the paper.
I havent had the pleasure of visiting Birmingham, maybe they make 'em bigger than in Sydney.
Or maybe it's just me?
posted by ozdocblog at 7:04 PM
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