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. 2017 Apr;18(3):479-486.
doi: 10.5811/westjem.2016.12.32279. Epub 2017 Feb 7.

Skin to Intramuscular Compartment Thigh Measurement by Ultrasound in Pediatric Population

Myto Duong  1   2 , Albert Botchway  3 , Jonathan Dela Cruz  1   2 , Richard Austin  1   2 , Kevin McDaniel  1   2 , Cassie Jaeger  3
Affiliations

Skin to Intramuscular Compartment Thigh Measurement by Ultrasound in Pediatric Population

Myto Duong et al. West J Emerg Med. 2017 Apr.

Abstract

Introduction: Pediatric obesity threatens the efficacy of medications given intramuscularly. In anaphylactic patients, epinephrine auto-injector needle lengths are potentially too short to reach the muscle compartment in patients with elevated body habitus. The objective of the study was to determine needle-length requirements for intramuscular injections in pediatric patients.

Methods: We used ultrasound to measure the distance from skin to muscle compartment of the thigh in 200 pediatric patients of various weight and body mass index who presented to the emergency department.

Results: Patients with higher body mass index had an increased distance to muscle and bone. If current recommendations were followed, 5% of patients within the EpiPen adult weight category and 11% of patients within the Centers for Disease Control and Prevention weight category would have potentially used a needle inadequate in length for intramuscular injections.

Conclusion: With the increase in childhood obesity, needle lengths may be too short to effectively deliver medications to the intramuscular compartment. Needle length should be evaluated to accommodate pediatric patients with increased skin to muscle distance.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Figure 1
Figure 1
Body mass index predicts distance to muscle. Regression analysis was performed from ultrasound measurements from skin to muscle and analyzed by gender (A) and ethnicity (B). Best fit regression lines are represented for gender and ethnicity. The equation of the line for total patients was Y=0.046x–0.2142, R2=0.3515.
Figure 2
Figure 2
Body mass index predicts distance to bone. Regression analysis was performed from ultrasound measurements from skin to bone and analyzed by gender (A) and ethnicity (B). Best fit regression lines are represented for gender and ethnicity. The equation of the line for total patients was Y=0.2356x–0.664, R2=0.6429.
Figure 3
Figure 3
Distance to muscle and distance to bone of pediatric patients in the EpiPen Jr (A) and EpiPen adult (B) weight categories. Left end of horizontal bars represent the beginning of the vastus lateralis muscle. Right end of horizontal bars represent beginning of greater tuberosity of femur. Vertical bar represents 1.3cm (panel A) and 1.6cm (panel B) needle distance of EpiPen Jr and EpiPen adult auto-injectors, respectively. Horizontal red bars represent patients with distance from skin to muscle larger than the recommended needle length.
Figure 4
Figure 4
Distance to muscle and distance to bone of pediatric patients in the 2.54cm CDC needle-length range (A) and 3.81cm CDC needle-length range (B) weight categories. Left end of horizontal bars represent the beginning of the vastus lateralis muscle. Right end of horizontal bars represent beginning of greater tuberosity of femur. Vertical bar represents 2.54cm (panel A) and 3.81cm (panel B) CDC-recommended needle length. Horizontal red bars represent patients with distance from skin to muscle outside the recommended needle length. CDC, Centers for Disease Control and Prevention.
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