Reduce the Risk of Pain or Injury From IM Vaccinations

You play a key role in minimizing pain and preventing injury from intramuscular (IM) vaccines...even if you're not an immunizer.

It's common for patients to have arm soreness or discomfort for a couple days after getting any IM vaccine (COVID-19, Tdap, etc).

But shoulder injury or other serious issues can occur if a vaccine isn't given properly.

Take steps to reduce the risk of pain or injury with IM vaccines.

Tell patients scheduled for a vaccine to wear a sleeveless shirt...or one with sleeves that can easily be rolled up...to completely expose their shoulder for the injection.

Pulling the shirt down over their shoulder can increase the risk of injecting too high and causing shoulder injury.

Gather the right-size needle...based on the vaccine, route, and patient. For example, a 22- to 25-gauge, 1- to 1.5-inch needle is appropriate for most adults receiving an IM vaccine in the deltoid.

Be aware, COVID-19 vaccine "kits" may include certain syringes and needles...partly to maximize how many doses you can draw up from the vial.

If you're trained to give vaccines, focus on proper technique.

Give IM vaccines in the central, thickest part of the deltoid in patients over age 3. Aim for about 2 inches...or 2 to 3 finger widths...below the bony part of the shoulder, and inject at a 90-degree angle.

Sit or kneel to vaccinate a seated patient...but adjust if needed. For example, in a drive-thru clinic, you may need to open a vehicle door, or use a stool to get to eye level if a patient's seated in a truck.

Ensure patients get pharmacist counseling on managing arm pain or discomfort after vaccination. Using the arm...applying a cool compress...and taking acetaminophen or an NSAID (ibuprofen, etc) if needed may help.

Don't expect your pharmacist to suggest oral analgesics as "premeds"...taking them before vaccination might decrease the immune response. But don't defer vaccination if patients already took them.

Get more tips in our Vaccine Administration checklist.

Consider getting trained to administer vaccines. Our Pharmacy Technicians University's PTU Elite: Immunizations training program will help you meet requirements...and be confident and prepared.

Key References

  • https://ismp.org/resources/prevent-shoulder-injuries-during-covid-19-vaccinations (2-25-21)
  • Can Fam Physician 2019;65(1):40-2
  • www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html (2-25-21)
  • www.immunize.org/technically-speaking/20181023.asp (2-25-21)
  • www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html (2-25-21)
Pharmacy Technician's Letter. March 2021, No. 370302



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