Letter

Needle length and incidence of local reactions to immunisation

BMJ 2001; 322 doi: 10.1136/bmj.322.7284.492 (Published 24 February 2001)
Cite this as: BMJ 2001;322:492

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How quickly can research change practice?

  1. John Platt, senior lecturer (j.c.platt@sheffield.ac.uk)
  1. School of Nursing, Northern General Hospital, Sheffield S5 7AU
  2. Department of General Practice, Glasgow G12 0RR
  3. West Middlesex University Hospital, Isleworth, Middlesex TW7 6AF
  4. Oxford Vaccine Group, Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU
  5. ICRF/NHS Centre for Statistics in Medicine, Institute of Health Sciences, University of Oxford, Oxford OX3 7LF
  6. University Children's Hospital Basel, PO Box CH-4005 Basel, Switzerland

    EDITOR—The paper by Diggle and Deeks was fast tracked in the hope of avoiding the five year delay that often occurs between the emergence of new evidence and a change in practice.1

    I think that in this case there has already been major delay. A Medline search quickly produces several papers on this subject. Ipp et al noted that more redness and swelling occurred in children injected in the thigh with a 16 mm needle than with a 25 mm needle.2

    The nature of the evidence also needs to be considered. This study used a standardised injection technique, but other techniques are used in practice, and Groswasser et al reported that injection technique is the most important variable in ensuring efficient delivery of intramuscular vaccine.3 Consequently, the injection technique chosen determines the appropriate needle size.

    The question of which needle length is preferable has been around for a long time, and the answer is relatively easy to obtain. We might still have to wait several years, however, for any change in practice.

    References

    1. 1.↵
      1. Diggle L,
      2. Deeks J
      .Effect of needle length on incidence of local reactions to routine immunisation in infants aged 4 months: randomised controlled trial.BMJ2000; 321:931–933. (14 October.)
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    2. 2.↵
      1. Ipp MM,
      2. Gold R,
      3. Goldbach M,
      4. Maresky DC,
      5. Saunders N,
      6. Greenberg S,
      7. et al
      .Adverse reactions to diphtheria, tetanus, pertussis-polio vaccination at 18 months of age: effect of injection site and needle length.Pediatrics1989; 83:679–682.
      OpenUrlFREE Full Text
    3. 3.↵
      1. Groswasser J,
      2. Kahn A,
      3. Bouche B,
      4. Hanquinet S,
      5. Perlmuter N,
      6. Hessel L
      .Needle length and injection technique for efficient intramuscular vaccine delivery in infants and children evaluated through an ultrasonographic determination of subcutaneous and muscle layer thickness.Pediatrics1997; 100:400–403.
      OpenUrlFREE Full Text

    Further research is needed before practice is changed

    1. Barry Gibson-Smith, higher professional fellow (Barrygs@doctors.org.uk)
    1. School of Nursing, Northern General Hospital, Sheffield S5 7AU
    2. Department of General Practice, Glasgow G12 0RR
    3. West Middlesex University Hospital, Isleworth, Middlesex TW7 6AF
    4. Oxford Vaccine Group, Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU
    5. ICRF/NHS Centre for Statistics in Medicine, Institute of Health Sciences, University of Oxford, Oxford OX3 7LF
    6. University Children's Hospital Basel, PO Box CH-4005 Basel, Switzerland

      EDITOR—The study by Diggle and Deeks on needle length and local reactions could lead to an interesting change in practice, although I do have several criticisms of the study and think that further research is needed.1

      Firstly, I am surprised by the design of the study, as no …

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