Recommendations for Landmarking to Prevent SIRVA

As previously discussed in other posts, shoulder injuries related to vaccine administration (“SIRVA”) often occur as a result of improper administration techniques on the part of the person giving the flu shot, TDaP (tetanus booster), or other vaccination. Sometimes this comes in the form of administering the shot with an improper size needle, but more often is the result of giving the vaccination in an improper location.

Landmarking is a term that is used to describe a technique used to identify the correct location for administering an intramuscular injection.  The technique involves identifying specific anatomical landmarks on the patient’s body to ensure that the injection is given in the correct location.  The utilization of landmarking can help prevent SIRVA injuries from occurring.

Proper landmarking includes determining the proper “injection zone” of the deltoid muscle for administration. As detailed in the article by Ian F. Cook entitled “Best vaccination practice and medically attended injection site events following deltoid intramuscular injection” Hum Vaccin Immunother. 2015;11(5):1184–91, the upper border of the injection zone is found by measuring 2 to 3 finger widths from the acromion (the boney process at the end of the shoulder blade which is at the very top of the deltoid) to ensure injection below the shoulder capsule.  Two fingers are recommended for those with thicker fingers, and 3 fingers for those with slender fingers. The lower border is marked by the armpit to ensure the injection is not inserted below the deltoid. The thumb and forefinger are used to make a V to outline the deltoid muscle and keep the injection zone visible before using the needle to inject at a 90° angle.

The next time you receive a flu shot, TDaP or tetanus booster, or other vaccination, it is recommended that you observe the person administering you the shot to make sure they are properly landmarking the correct injection zone on your shoulder so that you can avoid injury.

If, however, you or someone you know, believe that you have already sustained a shoulder or SIRVA injury due to the administration of a flu shot, TDaP or tetanus booster, or other vaccination, please consider contacting our firm. We’d be happy to answer any questions that you have or to go over the possibility of potentially filing a claim on your behalf.

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