deltoid IM flu vaccine technique

Nurses General Nursing

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Specializes in Emergency Nursing.

I'm doing a flu clinic coming up and am reviewing the literature about flu vaccine recommendations. There have been a couple great threads about technique, but my specific question is the site. I understand you're to inject 2 finger breadths below the acromion process. I've always done these no problem but now I'm getting nervous and second guessing myself.

http://jagged81.hubpages.com/hub/Deltoid-Intramuscular-Injection

This gives a great visual of the injection site. However, this seems a little higher, i.e., right over the greater trochanter which makes me nervous to hit bone while injecting. Do you guys find that you inject right over the greater trochanter or just below, but still on the deltoid muscle?

Thanks

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Specializes in Emergency Department.

You're thinking too much. Relax, you won't feel a thing. :D

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Specializes in ICU.

I always inject pretty high-up when giving IMs, you shouldnt hit the bone as long as you bunch up the muscle in your fingers.

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Specializes in Emergency Nursing.

haha so true! I'm getting nervous for nothing. I'll be at some fancy law firm, not a traditional hospital or clinic setting, so I'm a little nervous. People in suits make me nervous (scrubs or white coats, not so much). ;)

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Specializes in Emergency Nursing.
I always inject pretty high-up when giving IMs, you shouldnt hit the bone as long as you bunch up the muscle in your fingers.

Thank you.

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I have a feeling that my flu shot was administered SQ instead of IM...I did not get the classic muscle soreness and it didn't hurt at all during administration. Maybe I just got lucky? Any thought?

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Specializes in Emergency Nursing.
I have a feeling that my flu shot was administered SQ instead of IM...I did not get the classic muscle soreness and it didn't hurt at all during administration. Maybe I just got lucky? Any thought?

So I think it would depend on how much SC tissue/fat you have in that region, and what size needle was selected. I'm not sure how lucky you would be if it wasn't administered via the correct route; I don't know how that would alter the effectiveness. I've had shots before that didn't hurt.

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I measure with my two fingers and poke right there. It's pretty high because two finger breadths is a small distance. :D

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No, lucky as in that if it was administered correctly, it just didn't hurt.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

This is a very confusing thread. First of all, the greater trochanter is attached to the femur. The injection site diagram for the deltoid appears very high; I'd be worried about hitting bursa. How about looking for the meatiest part of the upper third of the upper arm? Size, age, gravity, muscle mass vary so widely from one person to the next; I don't trust textbook diagrams.

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Specializes in Pediatrics.

Nurse678, if it was administered very quickly, it has a lesser chance of being sore the next day.

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I have heard that if you get the patient to let their arm hang loosely by the side of the body, you will have injected in a relaxed muscle - which is supposed to be another way to prevent pain.

I think the best way to get used to where to inject is to look at actual anatomy and remember what the deltoid muscle looks like. Shoot for that "50" sticker (first image when you scroll down).

http://www.usi.edu/science/biology/mkhopper/hopper/Haps%20Assignment/Muscles%20of%20the%20Upper%20Limb.htm

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