8 ways to avoid injuring a vaccination recipient

Access to the site and your sitting rather than standing are important factors

One of the risks with administering vaccines is causing a shoulder injury.

vaccination in the shoulder

The problem occurs when the vaccine is administered into the shoulder capsule instead of the deltoid muscle, according to a report in the Canadian Pharmacists Journal.

This leads to an immune response and inflammation of shoulder tendons, ligaments and bursae, resulting in pain beyond typical vaccination pain and a limited shoulder range of motion.

Here are eight tips to avoid and manage injury:

  1. Ask patients to wear a short-sleeved shirt or one where the sleeves can easily be rolled up. Discourage them from pulling down the neck of their shirt to give access to the shoulder as this increases the risk of the vaccine being administered into the shoulder instead of the arm.
  2. Completely expose the shoulder and landmark rather than eyeball the injection site, which should be 2-3 fingers form from the acromion;
  3. A too-short needle may decrease vaccine effectiveness and increase skin reaction. A needle that is too long causes a risk of hitting bone or a nerve. Choose a needle of about 1.6cm for patients weighing less than 60kg and a 2.5cm needle for those weighing 60-70kg. Women weighing 70-90kg and men weighing 70-118kg need a 2.5-3.8 cm needle. A 3.8cm needle is best for women over 90kg and men over 118kg.
  4. Ask the patient to put their hand on their hip with their elbow out to help relax the deltoid muscle and reduce pain.
  5. Always sit or kneel to inject. Standing increases the risk of injecting too high.
  6. If the needle accidentally lands outside of the landmarked area or hits a bone or nerve, pull out, insert a new needle and try again.
  7. If you have injected too high or suspect the patient has a shoulder injury, tell them to consult their doctor if their shoulder pain increases or if they lose range of motion after two days and it doesn’t improve.
  8. If a patient has a shoulder injury related to a vaccination, an ultrasound will be necessary to assess the level of damage. Treatment options include a corticosteroid injection into the shoulder and physiotherapy.

More information: Canadian Pharmacists Journal 2018