Covid Vaccine Given Too High On Arm

[andrusia]

 

The bruise was the injection site administered by a pharmacy tech at Walgreens.  Can't remember how far away my arm was from the side, so it's possible that the bursa was irritated.  Appears to be 3 cm below the lower edge of the acromion, though I think it should be 5-6 cm to avoid the bursa.  Any nurses care to comment?  I know that you would get your vaccines at the hospital, but would you go back to a Walgreens for shots?

[scuba-girl, BSN]

On 3/27/2021 at 12:15 AM, CABGpatch_RN said:

Nurse vaccinator here.  I would go lower, but for what it's worth I don't think the picture above depicts an injection too high.  Wishing you nothing but the best.

https://healthjade.net/deltoid-muscle/

Can't u give vaccines in the anterolateral thigh? Like in the vastus lateralis? I always dislike receiving injections in my little delt! 

[sideshowstarlet, BSN, RN]

On 3/27/2021 at 3:41 PM, scuba-girl said:

Can't u give vaccines in the anterolateral thigh? Like in the vastus lateralis? I always dislike receiving injections in my little delt! 

You can technically administer it anywhere, as long as it gets in the muscle. When I help out with vaccine administration, people are vaccinated from their cars, so the deltoid is generally more convenient for giving the shot. 

[CABGpatch_RN, BSN]

On 3/27/2021 at 3:41 PM, scuba-girl said:

Can't u give vaccines in the anterolateral thigh? Like in the vastus lateralis? I always dislike receiving injections in my little delt! 

I suppose we could, but maybe in a super private setting.  Definitely not where I am currently vaccinating. 

[2BS Nurse, BSN]

I have gotten some great influenza vaccinations at pharmacies and I've known medical assistants in clinics to give them wrong. I don't think the venue matters that much.

[hppygr8ful, ASN, RN, EMT-I]

This is a really cool and professional discussion. I know another poster mention the vastus lateralis and my personal preference is the ventrogluteal. I have on occasion given my vaccines to myself using this site, but only when I really don't trust the vaccinator.

[Marie Bailey, MSN]

That looks like a perfectly appropriate injection site to me. 2-3 finger breadths below the acromion process, aiming for the center of the muscle = adequate. If you’re skinny, maybe you need a 5/8” needle instead of a 1”. It also helps to bunch up the muscle while administering. Also , it’s never necessary to aspirate with a deltoid IM. Other than that, needles might leave you sore with a bruise (b/c they’re needles), but it’s better than going too low & inadvertently administering it SQ; this could result in reduced serum antibodies. 
Wanna see my pet peeve? See photo on right. Too low!

[pinkdoves, BSN]

On 3/26/2021 at 3:59 PM, scuba-girl said:

Are you saying your arm is hurting more than you expected?

I've received shots from walgreens because they offer preservative free, and tri and quad and egg free, etc.  

Maybe next time point to exactly where you want the shot, that could help.

no one should have to tell the person giving a shot how to do it!! lmao 

[SansNom]

I think the individual person giving the injection is the problem, not the facility you got it at. I got my first one at the hospital by an RN and thought it was too high and it was very uncomfortable for the next 24 hours. I asked the nurse giving my second one to be mindful of that and it was much better. The idea is to be INTRAMUSCULAR, not intraosseous, haha. The diagrams everyone is posting are to give you an idea of landmarks to look for, but you should still be finding the fleshy/muscular part of the upper deltoid, not just strictly measuring two finger widths from the landmark. Different arms and body sizes will call for adjusting the site a little. If the fleshiest part of their deltoid is 3-4 finger widths from the acromion instead of 2, then stick there instead.

[JKL33]

Here's a page for visualization (and interesting facts).

I am surprised with the wide range of what is considered an appropriate deltoid injection. It is really not a difficult muscle to palpate in most instances. If you have a person abduct their arm even a little it's quite palpable.

I also don't think it's necessarily the location (office, retail, etc) that is the difference. Ask the person to show where they are going to do it ahead of time.

[Lunah, MSN, RN]

On 3/30/2021 at 8:55 PM, Marie Bailey said:

It also helps to bunch up the muscle while administering.

That is not universally recommended - it increases the risk (in some arms) that less of the injectate will go into the muscle, and may instead infiltrate the surrounding tissue. I only pinch it up a bit in those super bony arms! LOL. Stabilizing the arm is good. The picture that @NRSKarenRN posted showing hand position is good - stabilizing more than pinching or bunching. I have been volunteering at mass vaccination sites, and they reiterated this in our training. 

[LibraNurse27, BSN, RN]

It does look a little high to me, but I don't think high enough to be injected into the joint or bone. I really hope not!

[nursej22, MSN, RN]

Another useful tip is that the vaccinator should be at the same level as the recipient. If you are standing and the recipient is seated, it is easy to go too high. In the case of drive-in clinics, vaccinators need to be very conscientious  about the injection site. I  haven't done one of these, but I have done drive-up testing, and crouching to swab tough on knees and back.

And yes, every arm is different as are the width of fingers. A large man is going to have different size musculature than a petite woman. 3 of my fingers equal the width of 2 of my hubby's.