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Covid Vaccine

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I’m giving Covid vaccines in our community. I’m looking for tips on deltoid IM injections from other nurses. Many needle phobic people I want to give the least painful shot as possible. Also many frail people with small arms. 

Orca, ASN, RN

Specializes in Corrections, psychiatry, rehab, LTC. Has 26 years experience.

The biggest issue that I see (not just with COVID shots) is people pushing the needle in instead of darting it in. If you push it in slowly, you are tearing the tissue instead of piercing it, and it exposes more tissue to the often irritating effects of what is being injected.

Thanks for your  tip. I have been darting it in.  Any advice for small frail arms?

nursej22, MSN, RN

Specializes in med/surg,CV. Has 36 years experience.

Know your landmarks and avoid injecting into the shoulder joint. Let the rubbing alcohol dry. And skin should be taut. Either spread it out with your non-injecting hand for loose skin or small arms, or bunch it up by grasping the muscle. And definitely dart it in. 

Meliza Marcos, BSN, RN

Specializes in Orthopaedic Surgery/Medical Surgical. Has 4 years experience.

do it a quick and as smooth as possible. practice makes perfect. I was hated for giving out flu shots but after a few tries my patients couldn't believe that they already got the shot.

Is bunching up the arm a standard of practice for frail or small arms? I’ve seen online that is my a technique that should be used for Covid vaccine. 

21 minutes ago, mariaconcetta said:

Is bunching up the arm a standard of practice for frail or small arms? I’ve seen online that is my a technique that should be used for Covid vaccine. 

Helps with small muscle mass individuals. 

nursej22, MSN, RN

Specializes in med/surg,CV. Has 36 years experience.

51 minutes ago, mariaconcetta said:

Is bunching up the arm a standard of practice for frail or small arms? I’ve seen online that is my a technique that should be used for Covid vaccine. 

It depends on the arm. The person's arm should be relaxed, bunch if you can, but if there is little muscle sometimes spreading the skin out is more effective than bunching. But you want the skin taut. 

Edited by nursej22

MTRN18, BSN

Specializes in CVICU. Has 3 years experience.

Thanks for all the tips!

Orca, ASN, RN

Specializes in Corrections, psychiatry, rehab, LTC. Has 26 years experience.

On 3/4/2021 at 3:35 PM, mariaconcetta said:

Thanks for your  tip. I have been darting it in.  Any advice for small frail arms?

There was an item on the news this morning about COVID vaccine clinics locally. They showed 3-4 injections being given, and every one of them was pushed in. I wanted to yell at the television. These are licensed nurses who were supposedly taught how to give injections.

Edited by Orca

grad2012RN

Has 1 years experience.

Thanks for the advice. I've been giving flu shots and other immunizations for a few years, and just learned something new. Also, we get yearly training for flu clinics.

I wonder if the pharmacists and firefighters that are administering vaccinations get this expert training?

I am giving COVID vaccines, too. I hadn't given deltoid injections in a while: I am usually injecting a larger volume (>1 mL), so I favor the dorsal gluteal or ventral gluteal sites. I was required to take the CDC website training on giving the vaccines: anyone else do this? And I read up about vaccination techniques, which said that the Z-track method is recommended (though ACIP doesn't mention it). 

I've now given 100 or so deltoid injections using Z-track, and it's been truly life-changing. It's so easy, and most people don't feel it. https://www.CDC.gov/vaccines/covid-19/downloads/COVID-19-Clinical-Training-and-Resources-for-HCPs.pdfhttps://www.immunize.org/askexperts/administering-vaccines.asp

SweetLizaBeth, BSN

Specializes in Hospice. Has 7 years experience.

The main thing I have seen— yes, even a couple of times it was a nurse— is that it’s being given too high! It’s shocking how many of the photos with news stories (a lot of them pharmacy staff or even doctors!) are giving them at the top of the shoulder. Site selection is so important especially on those skinny minis like older adults. Select a site where you know there’s muscle underneath. Make sure your needle is the correct size— heavier people who have a lot of subcutaneous fat you probably don’t want to pinch the skin up, and you might need a longer needle. 
As to darting vs sliding, I was taught the sliding technique at school. I also was taught by my preceptor at my first job that sliding ensures that your angle is 90 degrees, that you don’t go in too far and accidentally hit bone, and it is less painful for the patient.  I have probably given 200-300 shots since I graduated, so I’m no expert, but I have been told I give a great shot. People say they barely feel it, and that they hate “the stab”. And as others have said, pinching some skin up on thinner patients, or pulling the skin taut, and/or using the Z-track method with average to large arms are all fine. I’ve read that if you inject a vaccine into subcutaneous fat, it won’t absorb correctly and it won’t challenge the immune system properly.    Please correct me if I said anything wrong, we can all learn from each other. 

I could not agree more! The media perpetuate this notion of injecting the vaccine up high, too close to the shoulder. Ouch. Both times I got the COVID vaccine, the person injected it much too high. It felt like it hit bone. I was worried it had not gone into the muscle. I wish I had said something. Neither time did they palpate my arm: they just jabbed. No Z-track, either. 

Working in a mass vaccination event, you may not have a choice of needle, so "modifying the arm" (bunching or not bunching the tissue, or Z-track -- try it! it's so amazing -- and considering depth of injection) are ways to best administer a vaccine. I keep the injection guidelines in my head about depth to inject. I palpate the area to make sure there's not going to be scar tissue in my way and to locate the muscle. 

ACIP Vaccine Recommendations

SweetLizaBeth, BSN

Specializes in Hospice. Has 7 years experience.

6 minutes ago, Allison T said:

Working in a mass vaccination event, you may not have a choice of needle, so "modifying the arm" (bunching or not bunching the tissue, or Z-track -- try it! it's so amazing -- and considering depth of injection) are ways to best administer a vaccine.

Love that— “modifying the arm”— is exactly what we need to do when we can’t get a longer needle. I can’t imagine giving an injection without palpating first. I plan to mark the spot before I get mine done, walk in and say please inject right here. But I know in the actual moment we’re a little intimidated and uncomfortable telling someone how to give you your vaccine.  

We don’t have needle size choices, appears to be 1 “. So I do need to modify the arm or not go in all the way on the frail and small arms. Our online prep course says give 2-3 finger widths below shoulder bone. I spend a lot of time palpating the arm and picking the right site.