Injection site reactions are common after vaccines or treatments delivered through a shot. The authors received no specific funding for this study except for the journal publication charges. Intramuscular injections are used when other types of delivery methods are not recommended. Injection Site Reactions, Fever, Swelling, and More, Nicole Galan, RN, is a registered nurse and the author of "The Everything Fertility Book.". Less commonly,injection reactions are due to an infection or allergy. In contrast, spontaneous muscular hematomas are often the site of active bleeding. Health Resources and Services Administration website. reactions. If treatment is needed, it may include: 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. Read on to learn more about the different types, including their uses and possible injection sites. Using proper administration technique can help to minimize injection-site reactions. government site. Am J Emerg Med. Reporting serious reactions enables corresponding agencies to track data and look for trends in reactions to particular vaccines, avoiding delays in identifying potentially dangerous trends while keeping patients safe. To return blood to the heart, the veins in the legs must work against gravity. This descri All rights reserved. If there is blood, it means the needle is in a blood vessel and not a muscle. Many drugs that must be taken daily, or injected at home, are designed for subcutaneous injection. Government immunization advisories, standard anatomy textbooks, and researchers have proposed various injection techniques and sites, but specific guidelines are lacking for the administration of IMIs in the increasingly used deltoid site. Can poor sleep impact your weight loss goals? Nakajima Y, Mukai K, Takaoka K, Hirose T, Morishita K, Yamamoto T, Yoshida Y, Urai T, Nakatani T. Hum Vaccin Immunother. Allow the alcohol to dry completely before the injection. Draw air into the syringe by pulling back the plunger. A caregiver, friend, or family member can assist with injections into this muscle. Your doctor or pharmacist will give you specific guidelines about which needle and syringe are appropriate to administer your medication. This is known as a pulmonary embolism. Its also difficult to use this site for self-injection. axillary nerve; deltoid muscle; intramuscular injections; needle depth; safe site for injection. The authors have declared that no competing interests exist. De Avila Oliveira R, et al. Accessed Nov. 11, 2022. Otherwise, it might cause stinging. Fevers higher than 101 F following an injection warrant a call to your healthcare provider or visit the nearest emergency room. These may include a little swelling, tenderness, pain, itching, or redness around the area where the injection was given. The purpose of VAERS is to compile and analyze data related to reports of AEs associated with vaccinations.7 Both health care providers and patients can submit reports to VAERS. The purpose of this study was to investigate the technique registered nurses (RNs) use during IM injections and incidence of blood aspiration. The deltoid muscle is a large, rounded, triangular shape. Several drugs and almost all injectable vaccines are delivered this way. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://opentextbc.ca/clinicalskills/chapter/6-8-iv-push-medications-and-saline-lock-flush/, https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunizations/Practice-Management/Pages/Vaccine-Administration.aspx, https://www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html. The Z-track method of IM is used to prevent tracking, For small amounts of delicate drugs, a subcutaneous injection can be a convenient way of getting a medication into your body. Subcutaneous injection can be used to give many types of medications for various medical conditions. It's a very rare complication of sclerotherapy that needs immediate medical care. Sometimes looking at the shot makes it hurt more. Left upper arm: A) upper end of anterior axillary line (AAL); B) upper, Figure 10. Shoulder injury related to vaccine administration and other injection site events, A needling problem: shoulder injury related to vaccine administration, Dont aim too high: avoiding shoulder injury related to vaccine administration, An evidence based protocol for the prevention of upper arm injury related to vaccine administration (UAIRVA), Best vaccination practice and medically attended injection site events following deltoid intramuscular injection, Canadian immunization guide. The .gov means its official. Patients: After care Ice the area immediately after injection as described above. The thigh may be used when the other sites are not available or if you need to administer the medication on your own. The provider might tape a pad onto the injection site to keep pressure on the area before moving on to the next vein. The reaction may happen right away. The ventrogluteal muscle is the safest site for adults and children older than 7 months. Repeat this procedure if needed. All rights reserved. Being in the sun can lead to dark spots on the skin, especially for those with dark skin. J Clin Epidemiol. Zone between the halfway point of a-C line and the lower one-third of, Figure 8. For instance, if you received a cortisone shot in your shoulder, avoid heavy lifting. On the outside of the arm above the armpit in the deltoid muscle. Most people return to their regular activities on the same day, but you might want to have someone drive you home after the procedure. An intramuscular injection is a technique used to deliver a medication deep into the muscles. What is SIRVA? Sclerotherapy of varicose veins and spider veins. An injection site reaction is your body's response to an immunization or other injection at the site where it was administered. (2021). You may experience . Primary care providers are well positioned to prevent injury through proper injection technique and by recognizing, diagnosing, and offering treatment to patients with SIRVA. Importance. Less commonly, injection reactions are due to an infection or allergy. Site 3 fingerbreadths (5 cm) below the mid-acromion: a) midpoint of lateral border, Figure 4. Pay careful attention to the area between the fingers and under the fingernails. Muscle tissue can also hold a larger volume of medication than subcutaneous tissue. When administering IM injections, immunizers must be sure to identify the location of the deltoid muscle and attempt to administer the vaccination deep into its middle. Please ask the person administering the vaccine for a compression bandage to the injection site. The correct area to give the injection is two finger widths below the acromion process. Thus, shoulder injury related to vaccine administration is a term that describes improper landmarking of vaccinations that results in shoulder injuries such as adhesive capsulitis or bursitis. The following discussion describes the adverse effects (AEs) that make up true injection-site, or local, reactions and how pharmacists should respond to them. Apply ice to the injection site as needed to relieve pain. Kim, H., Park, H., & Lee, S. J. Injection site reactions are usually caused by an immune response to the needle, vaccine, or other medicine. For a patient who experiences pain, redness, or itching, the pharmacist can recommend applying a cold compress at the site, as well as an OTC pain reliever for pain or an antihistamine for itching. Cochrane Database of Systematic Reviews. Triangular injection site, formed by, Figure 4. Advertising revenue supports our not-for-profit mission. Accessed Dec. 1, 2022. After removing the needle, your provider applies pressure to the area and massages it to keep blood out of the vein and to spread the solution. (2017, August 29). Vaccine recommendations and guidelines of the ACIP. 1961;61:5657. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, absorbed into the bloodstream slowly and steadily, Medications used in subcutaneous injections, https://www.npr.org/sections/health-shots/2016/07/12/485140592/parents-can-help-reduce-pain-and-anxiety-from-vaccinations, https://www.cc.nih.gov/ccc/patient_education/pepubs/subq.pdf, https://www.nature.com/articles/s41598-017-10110-w, https://rcni.com/sites/rcn_nspace/files/ns.29.3.53.e9183.pdf, https://www.hopkinsarthritis.org/patient-corner/how-to-give-a-subcutaneous-injection/. Give the injection in the center of the triangle. Theyre used to deliver drugs and vaccines. The number of shots depends on the number of veins being treated. Or it may start hours after the injection. These types of reactions are typically mild and resolve in a day or two without treatment. Reviewed June 21, 2019. Alternatively, a trained family member or caregiver can deliver the shot. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Would you like email updates of new search results? If youll be giving the injection more than once, make sure to rotate injection sites to avoid injury or discomfort to the muscles. For women who weigh 152-200 lbs (70-90 kg) and men . Medication is injected into the wrong area Redness, swelling, increasing pain, excessive bleeding, or any discharge from the injection site Rash or hives develop Difficulty breathing Fever If you think you have an emergency, call for medical help right away. The only difference is that the shoulder symptoms will have started within days of a vaccination. Establishing a new appropriate intramuscular injection site in the deltoid muscle. The procedure also can improve symptoms related to varicose veins, including: Experts suggest waiting to have sclerotherapy done after pregnancy or breastfeeding. The review protocol was submitted with PROSPERO (ID: 319251). You can learn more about how we ensure our content is accurate and current by reading our. To establish that the product manufacturers addressed safety and efficacy standards, we: We do the research so you can find trusted products for your health and wellness. People who need to self-administer an injection should ask their doctor for advice and guidance, and familiarize themselves with the process before they inject themselves. When the body secretes too little of its own HGH, it can cause, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. Understanding the basics: general recommendations on immunization. Effectivemethod for drug injection into subcutaneous tissue. When blood pools in the veins, the veins become larger, making them show under the skin. Wempe BM. However, the likelihood of hitting a blood vessel in the subcutaneous fat is extremely rare. Osborne SR, Alston LV, Bolton KA, Whelan J, Reeve E, Wong Shee A, Browne J, Walker T, Versace VL, Allender S, Nichols M, Backholer K, Goodwin N, Lewis S, Dalton H, Prael G, Curtin M, Brooks R, Verdon S, Crockett J, Hodgins G, Walsh S, Lyle DM, Thompson SC, Browne LJ, Knight S, Pit SW, Jones M, Gillam MH, Leach MJ, Gonzalez-Chica DA, Muyambi K, Eshetie T, Tran K, May E, Lieschke G, Parker V, Smith A, Hayes C, Dunlop AJ, Rajappa H, White R, Oakley P, Holliday S. Med J Aust. Dolan SB, Patel M, Hampton LM, Burnett E, Ehlman DC, Garon J, Cloessner E, Chmielewski E, Hyde TB, Mantel C, Wallace AS. National Vaccine Injury Compensation Program. Accessed Nov. 11, 2022. sharing sensitive information, make sure youre on a federal Your health care provider might tell you to avoid hard exercise for two weeks after the procedure. Site for intramuscular injection at, Figure 5. In addition to VAERS, health care providers should familiarize themselves with the National Vaccine Injury Compensation Program (VICP). This site complies with the HONcode standard for trustworthy health information: verify here. -. Malkin B. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Please join this discussion about bleeding after deltoid injection within the Anabolic Steroids category. But symptoms might include seeing light flashes, having headaches, fainting and having nausea. When should I contact my healthcare provider? Affiliation 1 Department of Anesthesia, McMaster . Sclerotherapy generally has few serious complications. However, you might need more than one treatment to get the results you want. Figure 2. The next time you give a vaccine to a patient, pay attention to your technique. Some medications can cause a bruise or irritation at the injection site. Traumatic hematomas are generally managed conservatively, especially in patients who are not currently receiving treatment with anticoagulants. An intramuscular injection site, 7.4, Figure 8. Shoulder injury related to vaccine administration (SIRVA) is a preventable occurrence caused by the injection of a vaccine into the shoulder capsule rather than the deltoid muscle. Most post-injection inflammation is mild. To avoid injury, a safer site is proposed of 5 fingerbreadths/10 cm below the midpoint of the lateral border of the acromion. 2014 Apr;19(2):e16. Before doctors began using the hip as an injection site, they used the dorsogluteal muscles in the buttocks. PRISMA flowchart of the systematic, Figure 2. Renita White, MD, FACOG, is a board-certified obstetrician/gynecologist who practices at Georgia Obstetrics and Gynecology. What is the latest research on the form of cancer Jimmy Carter has? Have someone you trust give you the injection. A sharps container is a red container that you can purchase at any pharmacy. Out of the 39 selected articles, 18 focused on the administration of deltoid IMIs, whereas seven focused on the variations in the underlying neurovascular structures in proximity to the deltoid muscle. Resources Family DoctorAmerican Academy of Family Physicians http://familydoctor.org official website and that any information you provide is encrypted The thumb should point toward the groin. Bancsi A, Houle SKD, Grindrod KA. An evidence based protocol for the prevention of upper arm injury related to vaccine administration (UAIRVA). How to give a subcutaneous injection. A new class of self-injectable medications are showing promise in treating high cholesterol. People should ask for help from a medical provider and not shy away from asking questions about the benefits of treatment or how best to minimize pain. Before To avoid, SRIVA, proper administration technique should always be used. It can only receive small volumes of medication, usually 1 milliliter or less. Radiological Society of North America. Your muscles have lots of blood flowing through them, so medications injected into them are quickly absorbed. Or use sunscreen with at least 30 SPF. General rule #6. Pharmacists and other immunizers should continually review the proper administration technique to be sure to provide the safest administration possible. Bleeding at the site can be contained by applying pressure until bleeding has stopped and then covering the site with an adhesive bandage or compress.4 Some patients may develop a low- grade fever after receiving an injection, which is usually self-limiting, but this can be treated with antipyretics, if needed. cdc.gov/vaccines/hcp/acip-recs/general-recs/ adverse-reactions.html. Recommended site: Deltoid muscle in the upper arm Use anatomical landmarks to determine the injection site. PRISMA flowchart of the systematic literature search performed for articles focused on administering, Figure 3. Pain might result from the solution leaking from the vein into the tissue around it. Expert: Infusion Pharmacy Technicians Can Reduce Workload in Oncology Pharmacy, Clinical Forum Recap Data Show Melanoma Site to Be Independent High-Risk Factor for Recurrence, Poor Outcomes, Complete Immunization Services Start With Gathering Patient Information, Encouraging Immunization Information System Use in Community Pharmacy Practice, Exploring Techniques to Increase Vaccination Rates Among Adult Patients with Chronic Disease, The Community Pharmacist as a Provider of Immunizations, Injection-Site Reactions and How to Manage Them, Pharmacy Intern and Technician Roles in Immunizing Are Growing, HPV Update: Making Sense of the New ACIP Recommendations, Immunization Guide for Pharmacists November 2019. To locate this area, lay three fingers across the deltoid muscle and below the acromion process. The solution, usually a liquid, works by irritating the lining of the vein, causing it to swell shut and block the flow of blood. CDC website. ROBIS: A new tool to assess risk of bias in systematic reviews was developed. Enter multiple addresses on separate lines or separate them with commas. People can follow the instructions on the package if they are using an auto-injector. Generally, needles should be 1 inch to 1.5 inches for an adult and will be smaller for a child. Use a piece of gauze to apply light pressure to the injection site. What is the latest research on the form of cancer Jimmy Carter has? Extreme bleeding (blood flows visibly at the surgery site) can be controlled by rinsing or cleaning old clots from the mouth first, then placing gauze (folded to about 1 square inch) over the part biting vigorously for half an hour. Or it may be a reaction to both. Sign In to Email Alerts with your Email Address. Before the procedure, a health care provider does a physical exam. What causes postoperative bleeding? Before putting medication into the syringe, warm the vial up by rubbing it between the hands. Intramuscular (IM) injections are used to deliver medication deep into your muscles. Position the index and middle fingers into a V then administer the shot in the middle of the V. Typically, people who need to self-administer injections use the vastus lateralis muscle in the thigh. There is a lump, swelling, or bruising where the injection was given that does not go away. After the procedure However, they can also happen at the healthcare providers office or hospital if the person administering the injection does not adhere to aseptic techniques. Mayo Clinic is a not-for-profit organization. Insert the needle into the muscle at a 90-degree angle. To locate this site, feel for the bone (acromion process) thats located at the top of your upper arm. While many infections occur due to a self-administered injection, such as with diabetes or autoimmune disorders. Can diet help improve depression symptoms? Hold the needle like a dart and insert it into the muscle at a 90-degree angle. But call your health care provider for problems with moving or feelings in arms or legs after the procedure. Accessed September 9, 2019. Find out about the benefits of common insulin injection, Injections of human growth hormone or HGH are used medically in children and adults. your particular bleeding disorder. Epub 2011 Aug 1. The following steps can help people deliver a safe injection into a muscle: Wash the hands thoroughly with soap and warm water. Some subcutaneous injections come in the form of an auto-injector. Locate the injection site according to the instructions above. You might need more sessions. Shoulder injury related to vaccine administration is an under-reported, preventable series of events caused by incorrect technique or landmarking for intramuscular deltoid injections.1,2 Specifically, SIRVA occurs when an intramuscular deltoid injection is administered into the shoulder joint.1,2 This results in an inflammatory process that causes damage to the musculoskeletal structures including the bursae, tendons, and ligaments.2 The main symptoms include persistent shoulder pain and a limited range of motion.2 The keys to distinguishing SIRVA are that the symptoms typically begin within 48 hours of vaccine administration and that they do not improve with over-the-counter analgesic medications.2 Patients will often visit their physicians months later because they are not able to carry out daily tasks that were possible before the vaccination.2 These patients are often diagnosed with inflammatory injuries such as bursitis, rotator cuff tears, and adhesive capsulitis.1,2 During physical examination and on ultrasound scan, SIRVA will not appear to be any different from routine shoulder injuries. Up to one-fourth of them are caused by excessive bleeding (called postpartum haemorrhage). 2017;13:21232129. In some cases, a person may also self-administer an intramuscular injection. Rarely, a blood clot can travel to a deeper vein in the leg, a condition known as deep vein thrombosis. Avoid touching the needle to ensure it stays clean. Accessed September 12, 2019. Wolicki J, et al. Recent illnesses or medical conditions, such as a heart condition or a history of blood clots. J Family Med Prim Care. This type of response can occur if thebody reacts adversely to the injected medication, causing acascade of severe and potentially life-threatening symptoms. 2017 Jul 1;216(suppl_1):S152-S160. Less commonly, more serious complications can arise, including: People who notice the following symptoms should call a doctor immediately: Intramuscular injections are a common and effective way to deliver medication. Clean the wound with soap and water, and cover it with a bandage, if needed, to protect it. muscle fibrosis, or scarring of muscle tissue, hematoma, where blood seeps out of blood vessels into the surrounding tissue, redness, swelling, or warmth at the injection site, signs of an allergic reaction, such as swelling or breathing problems. Physicians can mitigate SIRVA and other injection site events by refreshing their knowledge of and adopting proper landmarking and injection technique. All rights reserved. 9th ed. Do not put the cap back on the needle. When a needle breaks the skin, it may cause a small amount of pain; however, what constitutes an actual injection-site reaction? This muscle is a very safe injection site for adults and infants more than 7 months old because it is thick and located away from major nerves and blood vessels. PubMed, Google Scholar, and Websites of National Public Health Agencies were searched from 1950 up to 2022 for articles, advisories, and National Immunization Guidelines using Medical Subject Headings (MeSH) terms, including IMIs, deltoid muscle, safe injection sites, to identify recommendations for safer sites and techniques of administering deltoid IMIs. immunize.org/catg.d/p3082.pdf. Make a donation. After removing the needle, your provider applies pressure to the area and massages it to keep blood out of the vein and to spread the solution. To isolate the muscle and target where youll place the injection, spread the skin at the injection site between two fingers. Excerpt: So i did my first deltoid injection and after I pulled the needle out; blood was pouring from the deltoid till i placed a towel with rubbing alcohol on it. Read more about these alternatives to traditional statin, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Tell your provider if it hurts a lot. Awareness is crucial to identifying patients who are displaying signs of this injury so they can access treatment in a timely manner. If you buy through links on this page, we may earn a small commission Heres our process. Mastering the technique of injecting at home can take some practice. There is also a small risk of a blood clot in your lungs. Withdraw and start over with a new needle, syringe, and injection site. Kang S, et al., eds. But new veins can appear. Cardiovascular health: Insomnia linked to greater risk of heart attack. 2021; doi:10.1002/14651858.CD001732.pub3. 2020 Dec;213 Suppl 11:S3-S32.e1. Medical management of vaccine reactions in adults in a community set- ting. injections of testosterone enanthate in a castor oil vehicle, the most widely used form of androgen replacement therapy. Before sclerotherapy, a health care provider might ask for an ultrasound test of the legs. Government immunization advisories, standard anatomy textbooks, and researchers have proposed various injection techniques and sites, but specific guidelines are lacking for the administration of IMIs in the increasingly used deltoid site. Takeaway A subcutaneous injection is a minor and very safe medical procedure when done correctly.. www2.cdc.gov/nip/isd/ycts/mod1/courses/genrec/10907. Some side effects may take months or longer to go away completely. While most people dislike the idea of a shot, the good news is it is usually over quickly and causes little pain. The tissue in the muscles can also hold more medication than fatty tissue. Walking and moving helps keep blood clots from forming. The provider examines your veins and checks for blood vessel disease. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Authors Harsha Shanthanna 1 , Jason W Busse. Table 3: needle selection guidelines, Determining if and how older patients can safely stay at home with additional services, Managing type 2 diabetes in primary care during COVID-19, Effectiveness of dermoscopy in skin cancer diagnosis, Examens et traitements reconsidrer en mdecine du sport et de lexercice pdiatrique, Tests and treatments to question in pediatric sport and exercise medicine, Optimizing delirium assessment, management, and prevention, http://www.cfpc.ca/Canadianfamilyphysician/, https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-1-key-immunization-information/page-8-vaccine-administration-practices.html#t3, Landmarking to prevent SIRVA and other injection site events, Copyright the College of Family Physicians of Canada. Larger veins might take 3 to 4 months. To give a subcutaneous injection, people should follow these steps: The best location for a subcutaneous injection depends on a persons pain sensitivity and where they have some subcutaneous fat. Find out about the benefits of common insulin injection, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. What are the complications of intramuscular injections? These include the age and size of the person receiving the medication, and the volume and type of medication. For example, certain drugs that treat multiple sclerosis or rheumatoid arthritis may require self-injection. Injection site reactions are usually mild when they do occur. The sclerotherapy solution causes the vein to scar. asp?seg=A#targetText=mostly%20local%20and%20may%20occur,of%20reac- tion%20to%20learn%20more. While it is not uncommon to have localized swelling or redness for a day or two following an injection (or even longer for certain types of intramuscular shots), some symptoms warrant further investigation. Answer (1 of 3): No, not normal. FAQs. Intramuscular injections are a common practice in modern medicine. Bookshelf Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. On the outside of the thigh between the hip and the knee. Its used to collect medical waste, like needles and syringes. Clean the skin with the alcohol swab and allow to air-dry. Best food forward: Are algae the future of sustainable nutrition? the particular drug would irritate the veins, the digestive system would render pills ineffective, a puncture-resistant container to dispose of the needle. Am J Nurs. Turn the vial and syringe upside down so that the needle points upward. This site needs JavaScript to work properly. Evid Based Med. Inject all the air into the vial. Healthline Media does not provide medical advice, diagnosis, or treatment. People self-administering medication rarely use the deltoid, as an injection site, because it is difficult for them to reach. Some tips for IM injection administration are listed in the table.5, SHOULDER INJURY RELATED TO VACCINE ADMINISTRATION. The person receiving the injection should get into a position that is comfortable, provides easy access to the location, and keeps the muscles relaxed. Hum Vaccin Immunother. Ruffing, V. (2012, December 18). There is a range of types, and people use them in the treatment of diabetes and other. Philadelphia, USA: Wolters Kluwer: Lippincott Williams & Wilkins; 2015. After surgery, you're at risk of blood clots developing in your legs. There are fewer blood vessels in the fatty layer of connective tissue just beneath the skin than the muscle tissue. The most common side effect of a cortisone shot is pain at the injection site. People can receive intramuscular injections in the following areas: The deltoid muscle is the most common site for vaccines. Call your doctor or healthcare professional right away if you experience: You may have some anxiety about performing or receiving an injection, especially an intramuscular injection, due to the long needle. After-care information can be given to patients or parents before vaccines are administered, leaving the parent free to comfort the child immediately after the injection. 2011 Aug;7(8):845-8. doi: 10.4161/hv.7.8.16271. It goes away on its own in hours to days. Sclerotherapy also treats spider veins, a mild form of varicose veins. Typically, an injection-site reaction is considered to be any pain, swelling, rash, bleeding, or redness that occurs at the site of an injection, although, serious reactions can occur (see sidebar1).2 A small amount of pain or redness is expected with an intramuscular (IM) or subcutaneous injection, and a warning to this effect is included in the Vaccine Information Statement for a majority of vaccines.3 Local reactions are usually quite easy to treat at the time of vaccination or with a simple recommendation post administration.