How to Safely Administer an Intramuscular Vaccine in Adults

Katherine Sawyer, BSN

Have you seen a nurse eyeball a vaccine site before giving an injection? Does it make you think twice? Do you know that if a vaccine is not given in the correct location of the deltoid muscle, a vaccine-related shoulder injury or nerve injury could occur? To prevent vaccine-related shoulder and nerve injuries, it is important for the nurse to use the correct supplies, landmarking, and technique. This article will review how to:

Gather the right supplies
Use aseptic technique
Landmark the injection site
Administer the vaccine

Gather the Right Supplies

Start by gathering your needle and syringe. To avoid using a needle that is too short or too long, assess the patient's weight. This is important because a needle that is too short will inject into subcutaneous tissue, and a needle that is too long could hit bone or the axillary nerve. The CDC recommends using a one-inch 22- to 25-gauge needle for men 130-260 lbs and women 130-200 lbs. For patients who weigh under 130 lbs, use a 22 to 25-gauge 1-inch or a ⅝ inch needle for those with an especially small frame. For men greater than 260 lbs and women greater than 200 lbs, use a 22- to 25-gauge 1.5-inch needle. A 1 mL or 2 mL syringe can be used. Draw up your vaccine as indicated and gather any other supplies you will need, such as gloves, rubbing alcohol prep, gauze, and adhesive bandage.

Use Aseptic Technique

Before touching the patient, wash your hands with soap and water or use an alcohol-based hand sanitizer. To wash your hands, rub them together with soap and water for at least 15 seconds. Make sure you wash all surfaces of your hands. Rinse and use paper towels to dry. If using alcohol-based hand sanitizer, put sanitizer on hands and rub onto all surfaces until fully dry. Put on gloves.

Landmark the Injection Site

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The deltoid muscle in the upper arm is the recommended injection site for most vaccines. Administering the injection too high in the deltoid muscle can cause a shoulder injury, and administering too low could hit the radial nerve. To give the vaccine safely, it is essential that the nurse locate the correct injection site. The deltoid muscle is located in the upper arm and has a triangular shape. To find the injection site, you will need to ask the patient to expose their shoulder completely. Make sure the patient's sleeve can be rolled up over the shoulder or removed. To locate the injection site, palpate the top of the shoulder, starting at the clavicle and moving toward the shoulder joint. You will feel a bony prominence where the clavicle meets the acromion process. The small flat part of the bone just beyond this bony prominence is the acromion process (see illustration). This is the point you will use to measure to the middle or thickest part of the deltoid muscle, which is located approximately 2 inches below the acromion. You can measure using your finger widths. Depending on the size of your fingers, 2 to 3 finger widths are approximately 2 inches. Starting at the acromion, rest 2 to 3 fingers on the shoulder and note the location. This will be your injection site. The injection site should be along the midline of the shoulder. It should also be above the armpit or axillary fold.

Administer the Vaccine

Once you have found your injection site, cleanse the site with your alcohol prep and allow it to dry. Ask the patient to relax their arm along their body and take a deep breath. Some nurses like to start a conversation to keep the patient relaxed. There is no need to pinch or stretch the skin. Insert the needle at a 90-degree angle using a smooth, swift motion. Do not aspirate. Inject the vaccine and dispose of the needle and syringe in an appropriate sharps container. Use your gauze or adhesive bandage as needed. Remove your gloves and perform hand hygiene.

Following these recommended guidelines will help ensure the vaccine is effective and keep your patients safe and injury free!

References/Resources

Shoulder injury related to vaccine administration (SIRVA)

Shoulder injury related to vaccine administration and other injection site events

No Stars In My Eyes · Feb 4

How do you tell a pharmacist that she gives the vaccines too high on the shoulder?

Sandy G, BSN, RN · Feb 5

Great article! Thanks for sharing.

Nurse Alexa, MSN, RN · Feb 7

I appreciate the clear importance that you pointed out about landmarks. This is key when giving injections in the muscle 😊

CrunchRN, ADN, RN · Feb 7

No Stars In My Eyes said:

How do you tell a pharmacist that she gives the vaccines too high on the shoulder?

Leave them a copy of the article 🙂

2BS Nurse, BSN · Feb 8

I'm so glad you added "do not aspirate". A huge controversy was created around aspiration without any evidence.

KalipsoRed21, BSN, RN · Feb 9

"Do not stretch or pull the skin" So z-track is not good practice anymore more? Why not? Just curious as it is my favorite thing to do.

Also thank you for the weight and needle length recommendations

How to Safely Administer an Intramuscular Vaccine in Adults

Gather the Right Supplies

Use Aseptic Technique

Landmark the Injection Site

Administer the Vaccine

About Katherine Sawyer, BSN

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