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My correct technique for immunising young children

I was appalled to see what I hope is a 'library' picture (Letters, April 5) purporting to demonstrate immunisation technique of a young child. During the last 30 years I have personally administered many thousands of infant and childhood vaccines.

As a senior lecturer in paediatrics I was involved in teaching injection techniques to nurses and doctors in paediatric training.

The 'two-handed' technique is totally inappropriate in either a child or infant. Quite understandably many patients will move the limb rapidly away from the needle before or during the injection. This can result in skin scratches and, in the case of the picture (shown right), vaccine being squirted at the adjacent wall.

The correct technique is to use one hand to operate the syringe while the other keeps the skin taught and can be used if needed to lightly hold the leg still during the injection, which should be as rapid as possible.

I note that an orange (5/8in) needle is being used. This is inadequate for intramuscular immunisations where a blue (1in) needle is needed to ensure the vaccine is not merely given subcutaneously.

The orange needle is adequate for young infants.

The use of EMLA cream to anaesthetise the skin is of minimal benefit when giving MMR since the comparatively acidic nature of the vaccine solution causes pain in the muscle which is unaffected by the cream.

Dr John Oakley

Sutton Coldfield

West Midlands

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