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?

[Leader25, ASN, BSN, RN]

I have had flu  shots yearly and   covid vaccine at Walgreens by nurse,so far all good.Preferred a drive thru but got tired of waiting for state to do things.

[mariebailey, MSN, RN]

On 4/3/2021 at 9:14 AM, Pixie.RN said:

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. 

"Bunch up" is the literal wording used in the CDC "Pink Book" Epidemiology of Vaccine-Preventable Disease trainings. I think we are in agreement though; it's just a matter of semantics. It's about stabilizing the muscle tissue, & isn't always necessary. 

"Spread the skin tight to isolate the muscle. Another acceptable technique for pediatric and geriatric patients is to grasp the tissue and “bunch up” the muscle." CDC Reference from "Pink Book" Using "Bunch Up"

 

[mariebailey, MSN, RN]

On 3/27/2021 at 4:14 PM, sideshowstarlet said:

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. 

For IM VACCINES, the deltoid muscle & anterolateral thigh (vastus lateralis) are the only acceptable injection sites. Administering an IM VACCINE anywhere else, including the ventrogluteal regions, may result in reduced serum antibodies (I.e., a less robust immune response). That's why it's important for nurses to realize this. I don't think it's common knowledge for people who don't routinely administer vaccines though.

[mariebailey, MSN, RN]

On 3/28/2021 at 2:29 PM, hppygr8ful said:

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.

The ventrogluteal is NOT a recommended site for IM VACCINE administration. Immune Globulin = yes. Vaccines = no 

[mariebailey, MSN, RN]

https://www.immunize.org/catg.d/p2020.pdfhttps://www.CDC.gov/vaccines/hcp/admin/administer-vaccines.html

On 4/3/2021 at 3:00 PM, nursej22 said:

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. 

I think the CDC's 2-3 finger breadths recommendation is a more realistic rule of thumb than attempting to measure in centimeters, & it gives you enough wiggle room to tailor it to your specific patient. Imagine us all at mass vaccination sites trying to literally measure a specific set of centimeters prior to administration. Probably not so realistic or even necessary.

[mariebailey, MSN, RN]

On 3/26/2021 at 2:59 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.

I've had positive experiences at Walgreens & CVS getting vaccines for travel, flu, etc. I stepped away from public health nursing for a while, so it is news to me that an egg-free option exists. This news rocks my world. 

[mariebailey, MSN, RN]

I just want to make 1 more comment; the reality is I could talk about vaccines until I'm blue in the face b/c, gosh darn it, I love what they have done for humankind.

As a Public Health Nurse, I received a lot of good training on the topic at hand, so, when in doubt, I recommend going to your local public health clinic. I was a Team Lead for immunizations & had the opportunity to write a grant & start a travel immunization clinic, so I would audit records, including my own. If I spotted a missed opportunity to vaccinate or an administration error, I was allowed to contact the patient, apologize, & offer a convenient time for them to come back to the clinic for services. How often does that happen in the private sector? Also, we were a resource for private providers, keeping them up to date of ACIP recommendations. This started b/c of the frequency with which we observed administration errors in the state registry. 

If someone ends up with a wrong-site injection, they may need to be re-vaccinated, depending on the site & vaccine. immunize.org & CDC.gov/vaccines have info on this.

My point is, when in doubt, reach out to your local or state health department, whether for a patient or yourself. I also contacted the CDC on several occasions with questions prior to immunizing patients with complicated situations (e.g., recently finished chemo/wants live vaccine/how long should I wait, liver failure patients/Should I use Twinrix or standard HepA/B vaccine, etc.). I always received a prompt, thorough response too. 

Quality matters, & I think we all agree there is much more to vaccines than sticking a needle in an arm. Just wanted to share my thoughts. Enjoyed reading yours.

[suigeneris801]

the price of nursing incompetency can range from mild to severe. My reaction falls into the “moderate” category; as I can’t move it, in either direction, any further than 20° without sustaining enormous pain. 

I received the 2nd vaccination earlier this evening. It was administered in the leading hospital in my entire state. (Same as the 1st dose)

While the first shot made me appear as if I had mumps near my supraclavicular area (it was a gorgeous immunological response, LOL)— I DID NOT LOSE FUNCTION OR MOBILITY IN MY ARM. Like most people, my arm ached for (about) 36 hours after the injection, but that achy feeling faded and I did not have any cause for concern. 
 

Today, I returned to the same hospital for the 2nd dose. I bled far more than I typically do (following any type of injection) — and then my arm began to hurt within 5 minutes after receiving the injection. It also became very red and hot to the touch. 

 

they kept me there for an hour to be certain I wasn’t having an anaphylactic reaction... but a few hours later, my arm is practically immobile. 

I fear that the nurse injected it in the bursa, rather than the muscle. As someone who already deals with bursitis and arthritis, I am livid. 

& there’s no recourse? (For complete idiocy?)  and improperly administering a vaccination? 

this seems bizarre and illegal. We shouldn’t just let medical errors go unanswered. 

[JKL33]

6 hours ago, suigeneris801 said:

I fear that the nurse injected it in the bursa, rather than the muscle. As someone who already deals with bursitis and arthritis, I am livid. 

& there’s no recourse? (For complete idiocy?)  and improperly administering a vaccination? 

this seems bizarre and illegal. We shouldn’t just let medical errors go unanswered. 

This is not a situation that requires complete idiocy.

Contact the hospital and let them know of your situation.

I hope it is better soon.

[Jake Seboly]

Is this too high? My shot was today so I can't differentiate standard shot pain vs. injury yet, but I'm concerned...

[CABGpatch_RN, BSN]

Dang.  That's most definitely NOT where I would place the injection.  Was your vaccinator standing?  I would say yes, that's too high and off center.  I'm not sure about it going into the shoulder joint however.  I wish you the best.

[CrunchRN, ADN, RN]

Hmmmm. Not where I would have placed it.