Where to administer immunoglobulin after a tick bite? - briefly
Administer the immunoglobulin intramuscularly, preferably in the deltoid muscle of the upper arm. This location ensures rapid absorption and optimal systemic distribution.
Where to administer immunoglobulin after a tick bite? - in detail
After a tick bite that requires passive immunization, the immunoglobulin must be divided between the wound site and a distant muscle. The bulk of the preparation is infiltrated directly around and into the bite area, ensuring the entire dose surrounds the skin entry point. Any remaining volume is injected intramuscularly into a large, well‑vascularized muscle—most commonly the deltoid of the non‑affected arm. If the deltoid is unsuitable (e.g., injury, limited muscle mass), the anterolateral thigh (vastus lateralis) serves as an alternative.
Key procedural points:
- Wound infiltration: Use a fine‑gauge needle to disperse the immunoglobulin evenly around the bite, aiming for complete circumferential coverage. This local administration neutralizes virus particles that may have entered the tissue.
- Distant IM injection: Deliver the residual dose into the deltoid muscle, inserting the needle at a 90‑degree angle to reach the muscle belly. The injection site should be opposite the side of the bite to avoid overlapping fields.
- Volume considerations: Do not exceed 5 mL per injection site to prevent tissue irritation. If the total dose is larger, split it into multiple infiltrations around the bite and/or multiple IM sites in separate muscles.
- Aseptic technique: Clean the skin with an appropriate antiseptic, wear sterile gloves, and use a new needle and syringe for each injection point.
- Special populations: In infants or very small children, the anterolateral thigh is preferred for IM administration due to limited deltoid development. In immunocompromised patients, ensure thorough wound infiltration and consider a larger IM volume in a well‑vascularized muscle.
Timely administration—ideally within 24 hours of the bite—maximizes effectiveness. Documentation should record the exact locations of infiltration and IM injection, the total volume administered, and any adverse reactions observed during the procedure.