Over the next year, hundreds of millions of Americans will be stabbed. Willingly! For most patients, the relief of finally being vaccinated against the coronavirus will overcome any anxiety or concerns about small very sharp needles being inserted into their arms, twice. But as more and more vaccines get doled out across the country, I wondered: What’s the difference between a good shot and a bad one? What do health care providers do to make shots as comfortable as possible? I asked Lindsay Gainer, a registered nurse, a vice president at Mass General Brigham Ambulatory Care, and a longtime instructor at the University of North Carolina School of Nursing. Our conversation has been edited and condensed.
Dan Kois: When you start with a group of nursing students who might be a little bit nervous about sticking needles in people, what secret wisdom do you give them?
Lindsay Gainer: First of all, the more relaxed the care provider is, the more relaxed the patient’s going to be. I think people pick up on each other’s anxieties. Intramuscular injections, like a flu shot or the COVID vaccine, these do hurt more because they’re going into your muscle, and so they’re obviously creating a little tiny tear in your muscle. What I tell students is that the instruction that you give the patient actually helps a lot. Their arm should be very relaxed. If their muscles tense, it actually is harder to get the needle into the muscle. I’ve even read some research that says that smiling, even if you’re faking it, can help with the pain associated with it.
Faking it ’til you make it.
Yeah, absolutely. There’s a lot of psychology tied into the actual physicality of what you feel when you get an injection. In terms of the technical aspect, you want the needle bevel up, which … all right, I’m going to draw you a picture.
Needles are shaped like this. That’s the bevel. That’s what you want the needle to look like when it goes in. If it’s upside down, it’s actually harder to get it in. “Bevel up” is something that you teach when you teach people how to give injections. The other thing is to be quick. The faster you pierce the skin and get into the muscle, the less trauma you’re creating. You want to also make sure that it’s a really straight path.
There used to be a school of thought around what’s called aspiration. So, for intramuscular injections, you have some blood vessels that are in your muscles. Used to be, you put the needle in and then you’d have to pull back on the plunger to see if you got any blood if you’ve hit a blood vessel, and then you would inject. There’s really no science that supports aspiration anymore. And actually, it’s shown to cause more harm than good because you can imagine what I just demonstrated. You go in, you fiddle around, you pull the plunger.
I’m wincing so much right now. Was the idea that you were trying to ensure that you weren’t hitting a blood vessel? And so if you did hit a blood vessel, you would try again?
Yeah, you would remove it and then you would get a new needle and then you would go again. The fear was in the past that you would unintentionally be, essentially, administering something IV, intravenously, as opposed to in the muscle, but the blood vessels are extremely small, and so aspiration is no longer supported by research or evidence. It’s more risky, actually, because you’re inducing more trauma into the muscle because of the wiggling around, if you will, of the needle.
Am I freaking you out?
Just the “wiggling around.”
This is why you never want to talk to a nurse over dinner.
There’s different schools of thought about whether you grab the muscle and pinch it, or spread the skin. I’ve read research on both sides. The trick is just that you want the skin relatively taut. If you imagine if you had a balloon that was really blown up and the balloon was really tight, if you touch that with a needle, it would pop. But if you had a sort of—sorry—but a flaccid balloon, it would be harder to get a needle through it. And so the idea is that you want the skin relatively taut so the needle glides in very quickly.
What about emotionally? What do nurses do with people who are afraid of shots?
Are you specifically thinking about kids, or everybody?
Mostly adults. Adults who might not have gotten a shot in a while.
What I would say is, some of the stuff for kids works for adults. Obviously, with little, little kids, you have to think about restraining them so that nobody gets kicked in the face. But with adults, it is typically the same things. It is ensuring a calming atmosphere. It’s actually distraction. You’ll often find really pro, veteran, nurses or medical assistants that do injections a lot, they’ll be talking to you, and all of a sudden you realize, “Oh, you’re done? I didn’t even feel it.” And then the biggest thing truly, physically, is that relaxed arm. I mean, like a dead rag doll arm is the best thing. People that are real pros at this, they can tell if someone’s even a little bit nervous and tensing.
Are there certain nurses who everyone knows are just, like, artists?
Oh, a hundred percent, absolutely. Vaccines, for the most part, are given in primary care clinics, urgent care clinics. The veterans who work in those clinics, everybody knows. The way you really find out is you ask the staff who work in that office, “Who does the flu shots for everybody?” You know, even at the administrative level, we’re all competent, but someone does the peer vaccination. I was the peer vaccinator for everybody in the administrative office, and I had a pretty good reputation, I will say.
Thanks for talking with me about this.
Well, nice to meet you, and if you need anything else, just let me know.
I mean, just a coronavirus vaccine.
Coming soon to a clinic near you.