Technically Speaking: Be Sure You Know the Anatomical Landmarks for Administering Intramuscular Injections in the Arm
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Vaccine Update for Healthcare ProvidersWith 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. The 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 webpages 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:
- How to Administer Intramuscular and Subcutaneous Vaccine Injections
- How to Administer Intramuscular and Subcutaneous Vaccine Injections to Adults
- Skills Checklist for Vaccine Administration
Additional IAC materials on vaccine administration
- IAC’s Handouts: Administering Vaccines gateway page with links to more than 20 print pieces on vaccine administration
- IAC’s Clinic Tools: Administering Vaccines gateway page provides links to dozens of resources from IAC, CDC, EZIZ and others
Additional CDC resources on vaccine administration
Contributed by: Deborah Wexler, MD
Categories: Vaccine Update May 2021, Technically Speaking
Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.
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