Where will the flu shot be injected

The magazine for medical professionals

As a preventive measure against various infectious diseases, vaccinations are an important part of modern medicine. There are vaccines against a large number of viral and bacterial infectious diseases and up to four partial vaccinations are necessary for a basic vaccination.

For some vaccinations, a booster is recommended after ten years in order to maintain protection - even in adulthood. The table on page 9 shows an overview of the vaccination schedule for adolescents and adults.

With a few exceptions (such as the earlier oral vaccination against polio), vaccination is parenteral, i.e. bypassing the gastrointestinal tract. This is important because many vaccines contain proteins and sugars that would be digested and excreted in the gastrointestinal tract before they can even get into the bloodstream, where they are needed for antibody production. Different application methods can be used depending on the vaccine and type of immunization (passive or active immunization).

In the case of vaccine injections, a distinction is made between intradermal (into the skin), subcutaneous (under the skin) and intramuscular (into the muscle) injections (shown in the figure on page 8). Intramuscular (IM) injection, by far the most common method of vaccination, involves injecting the vaccine (usually a depot vaccine) into a skeletal muscle. It is well supplied with blood, so the vaccine is slowly absorbed into the blood. This allows the body to react to the vaccine, which contains weakened or killed pathogens. The intramuscular injection may also be carried out by trained assistant staff - i.e. by MFA.

STIKO recommendations

The Standing Vaccination Commission (STIKO) generally recommends injection into the deltoid muscle, the large triangular muscle of the upper arm. Here, about 5 cm below shoulder level, the highest protrusion of the muscle is pierced in the middle and sufficiently deep; the method is suitable for small quantities (<2ml). An injection into the vastus lateralis muscle of the thigh is only recommended if the deltoid muscle is not yet sufficiently developed, as in small children. This muscle is located in the outer area of ​​the middle thigh. Important nerves and vessels run along the inside of the thigh; it is taboo for injections. The top right illustration also shows how you can best find the corresponding muscles. Injection in the buttocks is considered out of date. There is often a thick, annoying layer of fat here, as well as large nerve tracts that could be injured.


Different forms of injection.
1. intramuscular injection,
2. subcutaneous injection,
3. intradermal injection.

How to do it

You will need the following items for the intramuscular vaccination:

  • Disinfectants
  • sterile vaccine solution
  • Disposable plastic syringe
  • sterile swabs
  • Gloves
  • Withdrawal cannula
  • Injection cannula
  • Drop container

After the patient has been informed accordingly and the material has been laid out, he or she must clear the upper arm. The deltoid should be relaxed; this is best done sitting down when the arm hangs loosely forward. Then do the following:

  • Disinfect hands.
  • Draw up the medication with the withdrawal cannula. Carefully push any remaining air out of the syringe, then dispose of the cannula directly in the disposal container.
  • Place the second cannula sterile on the syringe. Leave the protective cap on!
  • Inspect the injection site. There must not be any recognizable skin problems such as rashes, wounds or scars. Now, at the latest, put on gloves to protect yourself.
  • Spray some disinfectant on the injection site and after 30 to 60 seconds, wipe the skin dry with a swab.
  • Tense the skin, prick quickly.
  • Do not push the cannula as far as it will go, about 1 cm remains visible.
  • Aspirate, d. H. hold the syringe in this position and pull the syringe plunger back slightly to avoid puncturing the vessel. If blood arrives, stop the injection immediately, remove the cannula, and squeeze the puncture site. If a vacuum is created, injections are allowed.
  • Inject the drug slowly so that the solution can be distributed painlessly in the muscle tissue (approx. 2 ml / min).
  • Pull out the cannula quickly and dispose of it immediately in the waste container.
  • If necessary, fix the plaster on the puncture site.
vaccination12-17 years18-60 years> 60 years
tetanusA.A refresher is given every 10 years after the last
Vaccination recommended
DiphtheriaA.
PertussisA.
poliomyelitisA.  
Hepatitis B.G  
Pneumococci – –S *
Influenza  –  –S (annually)
TBErecommended in endangered areas and for certain occupational groups
Vaccination schedule for adults according to the recommendations of the STIKO. A = booster vaccination, G = basic vaccination, S = standard vaccination, * = only for certain indications

Tips and Tricks

  • Make sure that the injection cannula is dry. Vaccine on the cannula makes the injection painful and can lead to inflammation in the area of ​​the puncture canal.
  • You can engage anxious patients in conversation as a distraction.
  • Inquire about the patient's condition immediately after removing the cannula.
  • A slight pain up to about three days after the injection is not a complication, but a local reaction that cannot be ruled out even with a professional injection.
  • If you have to change the puncture site because you hit a vessel, discard the solution for injection completely and repeat with new material at another point.
The puncture point on the upper arm is in the deltoid, about 5 centimeters below shoulder level in the middle.The vastus lateralis muscle of the thigh is located in the outer area of ​​the middle thigh.

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