New Nurse COVID Vaccine Clinic IM Injection Advice

[CamperNurse, ADN, RN]

So, I am a new grad and newly licensed RN who went straight into an RN-BSN program and will be doing my Community Health clinical hours in a COVID vaccine clinic. My question is about IM vaccine administration.

I was taught the z-track method, but while observing nurses administering the COVID vaccine both on TV and while receiving my COVID vaccine, I saw them pinching the deltoid like a Sub Q administration. What am I missing? I start in the clinic on Monday and do not want to look dumb, but I have no RN experience and have not administered an IM shot since my third semester of nursing school. ?

Note: the vaccine is being offered to all students/volunteer RNs in the clinic and I begin my residency in a couple of weeks. 

[LovingLife123]

I don’t think you use z-track for the deltoid. Honestly, it’s a super tiny needle.  Just inject it into the the deltoid.  The needle is as small as a subq needle.  

[SmilingBluEyes]

no z-track

[dream'n, BSN, RN]

A million years ago when I was in school, we were taught to use the Z Track method for dorsal gluteal (which has been replaced by ventral gluteal) injections that you didn’t want leaking up onto the skin, such as Iron or Kenalog.  I’ve never heard it used in the deltoid ever

[nursej22, MSN, RN]

No z track, no aspiration. You can smooth the skin taut or grab and bunch. 90 degree angle. 

https://www2.CDC.gov/vaccines/ED/vaxadmin/VA/ce.asp

[Wuzzie]

58 minutes ago, nursej22 said:

No z track, no aspiration. You can smooth the skin taut or grab and bunch. 90 degree angle. 

https://www2.CDC.gov/vaccines/ED/vaxadmin/VA/ce.asp

If you don’t grab and bunch on my arm you’re going straight into the bone. No thank you. ?

 

Yes, I’m that out of shape. ?

[Nunya, BSN]

15 hours ago, Wuzzie said:

If you don’t grab and bunch on my arm you’re going straight into the bone. No thank you. ?

 

Yes, I’m that out of shape. ?

Ooh, I did that once to a patient, still makes me nauseous to think about it.

[GrumpyRN, NP]

20 hours ago, Wuzzie said:

If you don’t grab and bunch on my arm you’re going straight into the bone. No thank you. ?

 

Yes, I’m that out of shape. ?

 

5 hours ago, Nunya said:

Ooh, I did that once to a patient, still makes me nauseous to think about it.

Yeah.... That horrible feeling as you scrape the needle on to bone, (shudder) ? 

[Davey Do]

21 hours ago, Wuzzie said:

If you don’t grab and bunch on my arm you’re going straight into the bone. No thank you. ?

 

Yes, I’m that out of shape. ?

I would really enjoy discussing my deltoids.

But this is a family show.

[bitter_betsy, BSN]

I haven't given a Covid injection, but with just about any other deltoid IM injection, I've learned to release the "pinch" wait just a second and then remove the needle --- med doesn't squirt right back at ya that way.

[CommunityRNBSN, BSN, RN]

I am working Covid vaccine clinic now (unfortunately dragging me away from my real duties at my FQHC). I neither z-track nor bunch. I just go straight in. Unless the patient is very skinny or has very little muscle mass, and I need to avoid hitting the bone, as mentioned above. Because only group 1A is being vaccinated where I live, they are all young to middle-aged, relatively healthy, working adults. No elderly, no kids, etc. So I just take the syringe, aim at the muscle, stab, and remove. 

Main thing is to just look confident (haha). When they say “Have you done this before?” you give an exasperated look and say “Yes I’ve done it many times”. They don’t need to know that you did it on the mannequin in skills lab! 

[guest464345]

I've been working at a COVID vaccination site.  The needles are really small gauge - I think we're using 25's? - and the vaccine volume is only 0.3 mL.

So it's easy-peasy - get 2-3 fingers below the acromion process.  Don't be like those TV fools, hitting halfway between shoulder and elbow; certainly don't be poking anything into the actual capsule of the shoulder bones.  Picture that nice deltoid V on someone with toned arms (see attached photo), and aim for the middle of it.

Bunch up the muscle for skinny-to-moderate sized arms (will help you avoid hitting bone on scrawny arms like mine), or go straight in for your bigger-armed folks.  Be decisive, jab straight in at 90 degrees, inject, straight back out. No aspiration, no z-track. 

Small-gauge needles, low volume, not viscuous, everyone will tell you how good you are at injections, they barely felt it! ?

One other tip - check what they're using & make sure you know how the needle safety device works. Some covers you flip up, some retract on a Spring and require an extra push after the vaccine goes in.