Covid Vaccine

mariaconcetta · Mar 10, 2021

Share any tips you have for me.

Allison T · Mar 10, 2021

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 · Mar 12, 2021

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.

Allison T · Mar 12, 2021

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 · Mar 12, 2021

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.

mariaconcetta · Mar 12, 2021

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.

allnurses Guide · Mar 13, 2021

On 3/5/2021 at 10:36 AM, 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.

You are right the CDC does not recomend bunching the muscle. Rather with small muscles such as in elderly, frail or pediatric patients use a smaller needle.

SansNom · Mar 15, 2021

My first shot felt like it was given way too high on my deltoid. It was so uncomfortable it kept me awake that night, and I'm quite sure it wasn't because of the vaccine itself. My second shot was better (in my other arm) and I felt very minimal discomfort. Anyway, what I'm saying is be sure you're well below the acromiom and in the fleshy part of the deltoid. It is, after all, intraMUSCULAR, not intraOSSEOUS. haha

mariaconcetta · Mar 16, 2021

1 hour ago, SansNom said:

My first shot felt like it was given way too high on my deltoid. It was so uncomfortable it kept me awake that night, and I'm quite sure it wasn't because of the vaccine itself. My second shot was better (in my other arm) and I felt very minimal discomfort. Anyway, what I'm saying is be sure you're well below the acromiom and in the fleshy part of the deltoid. It is, after all, intraMUSCULAR, not intraOSSEOUS. haha

Point well taken! I’m very careful to avoid the shoulder joint. I make people undress enough to expose the shoulder to be able to palpate the acromion. Thanks for sharing your experience.

SweetLizaBeth, BSN · Mar 16, 2021

48 minutes ago, mariaconcetta said:

I make people undress enough to expose the shoulder

Did you see the top Dolly Parton wore? It had a cutout so she didn’t have to undress — it also covered her shoulder LOL. Her doctor, however, did no palpitation at all, scrubbed with alcohol, waited 30 seconds, then darted in at about a 30 degree downward angle. She sang (Vaccine to the tune of Jolene) and talked all the way through it. I need to find a top like that for whenever I get to finally get my own vaccine. I’m hoping that I get someone I don’t have to coach through the experience.

CABGpatch_RN, BSN · Mar 17, 2021

Do not squeeze the arm (see picture). I always give IM injections of any kind using the z-track method at a 90 degree angle while sitting (when possible) next to the patient. The injection site should be 1 to 2 inches below the acromion process and I always draw back a bit to check for blood first before injecting.

From Google: The Z-track method is a type of IM injection technique used to prevent tracking (leakage) of the medication into the subcutaneous tissue (underneath the skin). During the procedure, skin and tissue are pulled and held firmly while a long needle is inserted into the muscle.

Good luck!

On 3/5/2021 at 10:57 AM, toomuchbaloney said:

Helps with small muscle mass individuals.

As long as you are grabbing muscle and not skin.

curious nature, ADN, RN · Apr 11, 2021

On 3/3/2021 at 5:30 PM, mariaconcetta said:

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.