Flu shot reaction???

[NurseQT]

We are 2/3 of the way through our 3 Day flu shot clinic at the facility where I work. Today another nurse and I tackled (not literally) all the resident's.. By lunch time we had gotten almost all of the residents done plus a few employees without any problems... I had to give one of our CNAs her shot, she had pretty small arms, and she was a ball of nerves! The needles we're using are 1 inch, 25 gauge. I was afraid of hitting her bone so I didn't inject the needle all the way (over 3/4s tho), when I pulled the needle out she had a small amount of bleeding. But what shocked me was the site instantly swelled a bit (almost like a TB skin test would) and I could see it was starting to bruise! I've never had a reaction like that and I'm a lil freaked out. And I feel terrible because she had been nervous to get her shot to begin with... Does the swelling mean I didn't go in deep enough? She's very pregnant, could that have something to do with the reaction? Every other shot I gave before that one and everyone I gave after that one were done without any reaction or bleeding! But I'm still upset about that one shot!

[klone, MSN, RN]

Pregnancy wouldn't have anything to do with the reaction. Sounds like you nicked a vessel and a hematoma developed. That happens sometimes. I wouldn't worry too much about it. Today I was giving a flu shot to one of our midwives and I hit her bone (shudder).

[NurseQT]

I did hit the bone on one of our residents earlier in the morning, I think that's why I was hesitant to go too deep with this shot. I've never hit the bone before either so my reaction was much like yours.. *shudder* but I pulled the needle back a bit, aspirated-no blood, and the rest of the shot went fine. And the 20+ shots after that went beautifully until I did the CNA's shot.

[firstinfamily, RN]

It sounds like a hematoma developed, just watch it tomorrow if possible. I used 3/4" length needles on small armed people last year and did not have any problems. Were you using the auto-injection syringe, I have seen this cause bruising. Hope it goes better next time.

[klone, MSN, RN]

You should not aspirate for deltoid IM injections.

[mariebailey, MSN, RN]

It is not recommended that you aspirate with vaccines. One reason is because, even if you hit a vessel in IM sites, you're not going to cannulate it & inadvertently give it IV. Vessels aren't large enough in recommended sites for IM. For the same reason, you should not be worried. Hitting a vessel is inevitable every now & then. Don't worry!

[guest64485]

You should not aspirate for deltoid IM injections.

To clarify klone's post, the CDC states "Because there are no large blood vessels in the recommended sites [vastus lateralis and deltoid), aspiration before injection of vaccines (i.e., pulling back on the syringe plunger after needle insertion but before injection) is not necessary"

source: www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/d/vacc_admin.pdf

(with other injections you may be required to aspirate, but not with vaccines in these locations. Check manufacturer's instructions if needed.)

[klone, MSN, RN]

Vessels aren't large enough in recommended sites for IM.

With the exception of dorsogluteal. You should aspirate if you inject there. Aspiration should be done over 10 seconds.

[roser13, ASN, RN]

You should not aspirate for deltoid IM injections.

OP did not say that he/she aspirated.

[klone, MSN, RN]

Yes, she did.

but I pulled the needle back a bit, aspirated-no blood, and the rest of the shot went fine

[NurseQT]

Learned something new, I had been taught to aspirate on all IM injections. I'll definitely remember that from now on.

[mariebailey, MSN, RN]

With the exception of dorsogluteal. You should aspirate if you inject there. Aspiration should be done over 10 seconds.

You would never give a vaccine in the dorsogluteal; that site is associated with diminished absorption of vaccines, &, subsequently, lower antibody titers.