Cook Ian F
School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
Hum Vaccin. 2011 Aug;7(8):845-8. doi: 10.4161/hv.7.8.16271. Epub 2011 Aug 1.
Upper arm injury related to vaccine administration (UAIRVA) is an infrequent but increasingly recognised complication of deltoid muscle vaccination. Vaccine administration reported injury to the subdeltoid/subacromial bursa, anterior branch of the axillary nerve and the radial nerve presumably reflects the lack of awareness of the anatomical position of these structures in and near this muscle and the multiplicity of methods for the selection of the injection site in the muscle. An evidence based protocol for safe vaccine administration into the deltoid muscle is presented. This was developed using anthropometric measurements of the surface anatomical landmarks in adults who regularly receive intramuscular injection of vaccines into the deltoid muscle (adults ≥ 65 years old) and mapping the position of structures potentially injured by injection observed in ultrasonographic and cadaveric studies. The mid point of the muscle (midway between the acromion and the deltoid tuberosity) with the arm abducted to 60° is a safe site for injection. The protocol for vaccine administration in this way involves the vaccinee placing the hand on the ipsilateral hip with the vaccinator then placing their index finger on the acromion and their thumb on the deltoid tuberosity and administering the vaccine at midpoint between these anatomical landmarks.
上臂疫苗接种相关损伤（UAIRVA）是三角肌接种疫苗时一种罕见但日益被认识到的并发症。疫苗接种报告的损伤涉及三角肌下/肩峰下滑囊、腋神经前支和桡神经，这大概反映出对该肌肉及其附近这些结构的解剖位置缺乏认识，以及在肌肉中选择注射部位的方法多样。本文提出了一种基于证据的三角肌安全疫苗接种方案。该方案是通过对定期接受三角肌肌内注射疫苗的成年人（≥65岁）的表面解剖标志进行人体测量，并绘制超声和尸体研究中观察到的可能因注射而受损结构的位置而制定的。手臂外展至60°时肌肉的中点（肩峰与三角肌粗隆之间的中点）是一个安全的注射部位。以这种方式进行疫苗接种的方案包括受种者将手放在同侧臀部，接种者将食指放在肩峰上，拇指放在三角肌粗隆上，并在这些解剖标志之间的中点进行疫苗接种。
