Pharmacist talking points - a vaccination message from NSW Health

Locating the Deltoid injection site

The deltoid muscle is the recommended site for intramuscular vaccination in adolescents and adults. Vaccination into the incorrect location is associated with a condition known as shoulder injury related to vaccine administration (SIRVA). In order to ensure that the correct site is injected, the Australian Immunisation Handbook provides the following advice:

1. Expose the person’s arm completely, from the top of the shoulder to the elbow. Roll up the person’s sleeve or remove their shirt, if needed.
2. Locate the shoulder tip (acromion) and the muscle insertion at the middle of the humerus (deltoid tuberosity).
3. Draw an imaginary inverted triangle below the shoulder tip, using the identified anatomical markers (see Figure. Anatomical markers used to identify the deltoid injection site). The deltoid site for injection is halfway between the acromion and the deltoid tuberosity, in the middle of the muscle.

Dispensing Private Script Vaccines

Vaccines dispensed from a pharmacy on a script should be managed in accordance with section 7.3 of the National Vaccine Storage Guidelines – Strive for 5, Third Edition. Customers should be advised that the vaccine needs to be refrigerated and that they should purchase/collect it immediately before attending  the practice or clinic appointment (they should not take it home and store it in their own fridge). Advice should also be provided that they need to notify the practice staff at reception on arrival that they have a vaccine and request that it is refrigerated appropriately.

Note: Alfoil bags commonly provided by pharmacists when vaccines are privately purchased are not effective in keeping vaccines at the correct temperature — for example, when the vaccine is left in a car or stored in a domestic refrigerator.

NSW Pharmacist Vaccination Standards