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, ensure your team knows to sit or kneel to vaccinate a seated patient...to target the right spot and inject at a 90-degree angle.

But educate to adjust if needed. They 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 the 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.

Remind your team 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 advise your team to 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 patients use their arm, not rest it, postvaccination.

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.

Share more guidance with your team using our checklist, Vaccine Administration Strategies...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.

Key References
  • https://ismp.org/resources/prevent-shoulder-injuries-during-covid-19-vaccinations (2-26-21)
  • Can Fam Physician 2019;65(1):40-2
  • www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html (2-26-21)
  • www.immunize.org/technically-speaking/20181023.asp (2-26-21)
  • www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html (2-26-21)
Prescriber's Letter. March 2021, No. 370302


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