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Be sure you know the anatomical landmarks for administering intramuscular injections in the arm

May 2021

Technically Speaking
A Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
IAC Executive Director Dr. Deborah Wexler writes Technically Speaking, a column featured in each issue of Vaccine Update for Healthcare Professionals, the monthly e-newsletter from the Vaccine Education Center (VEC) at the Children’s Hospital of Philadelphia. Technically Speaking columns cover practical topics in immunization delivery such as vaccine administration techniques, storage and handling, contraindications and precautions, and scheduling.
Subscribe to VEC’s Vaccine Update for Healthcare Professionals to stay up to date on vaccine-related issues, including reviews of recently published journal articles, media recaps, and announcements about new resources and webinars. To subscribe, visit the Vaccine Update Newsletter Sign-up Form
The archive of past Technically Speaking columns is also available.
Be Sure You Know the Anatomical Landmarks for Administering Intramuscular Injections in the Arm
Published May 2021
With tens of thousands of new vaccinators and millions of doses of COVID-19 vaccine being given each month, it is critical that vaccinators – both new and experienced – know how to precisely locate where intramuscular (IM) injections in the arm should be given.

For people age 3 years and older, a correctly placed IM injection is given in the upper arm, in the deltoid muscle, into its middle and thickest part, at a 90-degree angle to the skin. CDC has helpful instructional handouts for vaccinating children age 7 through 18 and adults that illustrate the anatomical landmarks for where to inject into the deltoid muscle.

For COVID-19 vaccinators, CDC highlights this same information on web pages specifically addressing vaccine administration of the three COVID-19 vaccines authorized for use in the U.S.:

One of the most common errors in IM injection is introducing the needle either too high on the shoulder or too low on the arm. Injections given too high (into the shoulder joint) or too low (into tendons and soft tissue) have the possibility of leading to serious shoulder or arm pain that can last several months. SIRVA (shoulder injury related to vaccine administration) is preventable by paying careful attention to the anatomical landmarks for correct placement in the deltoid.

The Immunization Action Coalition (IAC) has free print materials available on its website that teach vaccine administration techniques. Downloads of these IAC materials have skyrocketed since December 2020 when COVID-19 vaccinations began. Here are IAC’s most popular materials on this topic:

Additional IAC materials on vaccine administration

Additional CDC resources on vaccine administration

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