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.
Specializes in ICU/community health/school nursing.
10 hours ago, laflaca said:
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.
I LOVE THIS! Thank you for the down and dirty, @laflaca
Former vaccine clinic nurse here. Z-track is one of those sacred nursing cows that should go away. I will also say that while I'd tell you to use gloves for the COVID vaccine....if you're giving a bunch of scheduled vaccines to squirmy kids we did not always use gloves, either.
Best of luck!
On 1/4/2021 at 2:49 PM, bitter_betsy said:
I haven't given a Covid injection, but with just about any other deltoid IM injection, learned to release the "pinch" wait just a second and then remove the needle --- med doesn't squirt right back at ya that way.
So I am having a terrible time trying to start a new post here. I received mine at A pharmacy no z track.
However, if someone could help me post that would be great.
The “fine facility” that I work at made receiving a vaccination difficult. Long story. It was easier to go to a pharmacy to receive it, the pharmacy stated I would need to call he week before the 2nd dose was due to see if they had any and then call around or go to my facility to receive the second dose. I received the Moderna vaccine. I am the only one in my department that missed the first dose of Pfizer (they didn’t offer another time to go an get this dose at our facility until they offered the same group of employees their second dose. I had to schedule at another facility, at least 30 minutes away when they did finally have it I couldn’t leave work to go get it)
anyhoo, my facility has decided since they didn’t give me the first dose they can refuse to give the second dose...can they do this, the government is the one through the states supplying this vaccine, to deny a person that wants it seems wrong. And if I can’t find a dose at that time, one of my coworkers suggested just go ahead and sign up for your first dose and don’t tell them it’s your second. Carry both vaccinations cards to show you had both doses. Very frustrating when you feel your employer cares very little about you or the patients you care for.
Specializes in ICU/community health/school nursing.
21 hours ago, Sunni2017 said:
anyhoo, my facility has decided since they didn’t give me the first dose they can refuse to give the second dose...can they do this, the government is the one through the states supplying this vaccine, to deny a person that wants it seems wrong. And if I can’t find a dose at that time, one of my coworkers suggested just go ahead and sign up for your first dose and don’t tell them it’s your second. Carry both vaccinations cards to show you had both doses. Very frustrating when you feel your employer cares very little about you or the patients you care for.
Open to suggestions
thanks
I would not mix the vaccines. As a former vaccine nurse while I could tell you that mixing the meningococcal 4-strain vaccines from different companies *might* convey protection - we were told not to do it, and that doing so would be a medical error.
If your work site has the Moderna vaccine at the time you need dose #2 I'd just ask for that.
One of the things I fear is that some of us won't get dose #2 because the incoming administration apparently advocates getting more first doses out there and hoping that the private companies can make more in time. So I would tell you to be unusually persistent starting the day before the second vaccine is due and the week after. Maybe there are cancellations. Maybe they've got three doses left and an hour before these expire. Best of luck.
ruby_jane, BSN, RN
3,142 Posts
I LOVE THIS! Thank you for the down and dirty, @laflaca
Former vaccine clinic nurse here. Z-track is one of those sacred nursing cows that should go away. I will also say that while I'd tell you to use gloves for the COVID vaccine....if you're giving a bunch of scheduled vaccines to squirmy kids we did not always use gloves, either.
Best of luck!
Also a gold mine of advice!