Getting it in the right spot: Shoulder injury related to vaccine administration (SIRVA) and other injection site events

Best practice for deltoid intramuscular injections in older adults: Study in cadavers

“…The client and the nurse should both be seated at the same level, to ensure the needle is injected at 90 degrees to the skin. [12] The question of whether bunching or flattening technique is more successful in delivering vaccine at least 5 mm into the deltoid muscle of older adults is also answered by our study. Overall, bunching technique with a 25 mm needle is nearly 80% successful in delivering the vaccine without overpenetrating the deltoid, whereas flattening technique with a 25 mm needle is the opposite: more than 85% unsuccessful.…”

“…The use of this evidence will provide the nurse with the knowledge, skills and abilities to avoid arm and shoulder injuries related to deltoid vaccination, [12,16] and to avoid improper vaccine administration technique which may contribute to vaccine hesitancy. We owe it to our clients and to the nursing profession to be part of the solution.…”

“…However, upper arm and shoulder injury related to vaccine administration is an emerging, and likely under-reported, phenomenon. [12,[15][16][17] The standard deltoid landmark needs to be updated: three fingers below the acromion should be considered the upper (superior) boundary for safe deltoid injections, and an additional lower boundary, at the axillary line, should be added for optimal client safety. The safe injection zone is between these upper and lower boundaries, along the coronal (vertical) axis of the outer aspect of the client's arm.…”

“…[5,10] As well, nurses fear striking bone when giving injections, described by Wilkoff as a "fingernails-on-the-blackboard experience" for the nurse (p. 20), [11] although the patient is unlikely to feel it. [12] "You don't want to hit bone" is a frequently-given rationale for the universal use of 25 mm needles, employing bunching technique and leaving a few millimetres of the needle out of the skin. However, the over-emphasis on avoiding the humerus deflects attention from more serious adverse outcomes of a poorly-administered deltoid vaccine, such as decreased immunogenicity, increased local reaction, and potential damage to the axillary nerve.…”

Post-Influenza Vaccine Subdeltoid bursitis

“…Influenza vaccine can routinely cause some pain and swelling in the shoulder, but it usually resolves a few days after vaccination. Shoulder injury related to vaccine administration (SIRVA) is a serious albeit rare complication of vaccination [ 1 , 2 ]. According to the Vaccine Adverse Event Reporting System, 731 patients self-reported either bursitis or bursa infection from vaccination in the 30 years between 1990 and 2020, a small number of cases considering that over 155 million doses are administered annually in the United States [ 3 , 4 ].…”