Free tool
Pick intradermal, subcutaneous or intramuscular and get the insertion angle, the typical gauge and needle length, the common sites and their landmarks. For IM, choose the patient's age or weight group for the CDC needle length. An interactive reference, with no doses anywhere.
Built for NHA CCMA exam prepGauge is the needle's diameter: the higher the number, the thinner the needle. Length is chosen by route, age, sex, weight and site.
Pick a route.
Angles, gauges, lengths and landmarks are a dense cluster of facts on the CCMA exam. The free NHA CCMA course drills them with spaced repetition inside the medication and injections unit.
Get started free| Route | Angle | Gauge | Length |
|---|---|---|---|
| Intradermal (TB test) | 10 to 15 degrees, bevel up | 27 G | About 1/2 inch |
| Subcutaneous vaccine | 45 degrees | 23 to 25 G | 5/8 inch |
| Subcutaneous medication | 45 degrees (90 with enough tissue) | 25 to 29 G | 3/8 to 5/8 inch |
| Intramuscular vaccine | 90 degrees | 22 to 25 G | By age and weight (below) |
| Intramuscular medication | 90 degrees | 20 to 25 G aqueous; 18 to 21 G viscous | By age and weight (below) |
| Patient | Length | Site |
|---|---|---|
| Neonate (28 days and younger) | 5/8 inch | Vastus lateralis, only if the skin is stretched tight and the tissue is not bunched |
| Infant 1 to 12 months | 1 inch | Vastus lateralis (anterolateral thigh) |
| Toddler 1 to 2 years | 1 to 1.25 inch in the thigh, or 5/8 to 1 inch in the deltoid | Vastus lateralis preferred; deltoid if muscle mass is adequate |
| Child 3 to 10 years | 5/8 to 1 inch in the deltoid, or 1 to 1.25 inch in the thigh | Deltoid preferred |
| 11 to 18 years | 5/8 to 1 inch in the deltoid, or 1 to 1.5 inch in the thigh | Deltoid preferred |
| Adult 60 kg (130 lb) or less | 1 inch (some experts allow 5/8 inch with the skin stretched) | Deltoid |
| Adult 60 to 70 kg | 1 inch | Deltoid |
| Women 70 to 90 kg, men 70 to 118 kg | 1 to 1.5 inch | Deltoid |
| Women over 90 kg (200 lb), men over 118 kg (260 lb) | 1.5 inch | Deltoid |
| Adult, anterolateral thigh | 1.5 inch (1 inch with the skin stretched) | Vastus lateralis |
The angle summary to memorize is ID 10 to 15 degrees (nearly flat), SC 45 degrees, IM 90 degrees, and the needle comes out at the same angle it went in. The three IM sites in use are the deltoid, the vastus lateralis and the ventrogluteal; the dorsogluteal is avoided because of the sciatic nerve. Aspiration is not recommended before IM vaccines because the recommended sites have no large vessels, and it is never done for SC injections. When several vaccines are given at one visit, each goes at a different site, at least 1 inch apart in the same limb.
The explainer is injection angles, needle gauges and sites, and the whole medication administration unit is in the free NHA CCMA course.
This tool is a study aid for the CCMA exam, not clinical guidance. Real care follows the provider's orders and your facility's protocols. This guide holds no doses or drug-specific instructions; the order, the drug label and your facility's policy decide those.
Injection angles, needle gauges and sites the CCMA exam tests: ID at 10-15 degrees, SubQ at 45, IM at 90, CDC needle lengths by age and the Z-track method.
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The NHA CCMA exam has 150 scored items, 30 pretest items and 3 hours. Here is what each of the 7 domains covers, the item counts, and the 390 passing score.
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Heart rate from an EKG strip by the 1500, 300 and 6-second methods, with the R-R interval and when each method fits, as a CCMA study aid.
Open tool →Enter an adult systolic and diastolic reading and see the ACC/AHA category: normal, elevated, stage 1 or stage 2 hypertension, with the rule that decides it.
Open tool →Body mass index from kilograms and centimeters or pounds and inches, with the formula shown and the CDC adult categories.
Open tool →Put the PPE steps in the CDC donning order and the CDC doffing order, then check your sequence and see where it went wrong.
Open tool →Enter adult temperature, pulse, respirations, blood pressure and SpO2 and see each flagged against the typical ranges, with a reference table.
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