For patients at risk of hemonhage following intramuscular
injection, the ACIP recommends "it should be administered
intramusculady if, in the opinion of the physician
familiar with the patients bleeding risk, the vaccine can be
administered with reasonable safety by this route. lf the
patient receives antihemophilia or other similar therapy,
intramuscular vaccination can be scheduled shortly after
such therapy is administered. A fine needle (23 gauge or
smaller) can be used for the vaccination and firm pressure
applied to the site (without rubbing) for at least 2
minutes. The patient should be instructed concerning the
risk of hematoma from the injection.