Reduce Risk of Injury and Manage Pain From IM Vaccinations

The COVID-19 vaccine rollout will put more focus on giving IM immunizations properly and helping patients manage a sore arm.

Administration. Drive-thru and mass clinics can pose new issues.

For example, continue to sit or kneel to vaccinate a seated patient...to target the right spot and inject at a 90-degree angle.

But adjust if needed. You may need to open a vehicle door...use a stool to get to eye level if a patient's seated in a truck...or ask patients to relax their arm instead of resting it on an open window.

Keep in mind, injecting too high can result in "shoulder injury related to vaccine administration" (SIRVA)...with damage to tendons, ligaments, or bursae. Hundreds of cases are reported annually.

Refocus your efforts to give IM vaccines in the central, thickest part of the deltoid in patients over age 3. Aim for about 2 inches...or about 2 to 3 finger widths...below the bony part of the shoulder.

Managing arm discomfort. Tell patients to expect arm soreness or pain for a couple days after any IM vaccine...including COVID-19 doses.

Don't suggest using acetaminophen or NSAIDs as "premeds"...but don't defer vaccination if patients already took them.

Premedicating might decrease the immune response, based on a hodgepodge of evidence...mostly with routine vaccines in kids. But there aren't good data on whether this reduces vaccine efficacy.

Save acetaminophen or NSAIDs for AFTER vaccination if needed. Remind patients that these work quickly to treat symptoms if they occur.

Recommend using the arm...not resting it...after vaccination.

Also suggest applying a cool compress for pain if needed.

But don't rely on topicals (arnica, diclofenac, salicylates, etc). There's no evidence that these help reduce pain after immunization.

Find more guidance in our Vaccine Administration checklist...such as other ways to limit pain and how to choose the right needle.

See our chart, Communicating About COVID-19 Vaccination, for other possible COVID-19 vaccine side effects...and how to manage them.

Also help your techs meet requirements to give vaccinations...and be confident and prepared. Review our Pharmacy Technicians University's PTU Elite: Immunizations training program for details.

Key References

  • https://ismp.org/resources/prevent-shoulder-injuries-during-covid-19-vaccinations (2-24-21)
  • Can Fam Physician 2019;65(1):40-2
  • www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html (2-24-21)
  • www.immunize.org/technically-speaking/20181023.asp (2-24-21)
  • www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html (2-24-21)
Pharmacist's Letter. March 2021, No. 370302



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