In the explanatory leaflet for its vaccine against Covid-19, marketed in France since December 27, the Pfizer laboratory notifies it: its product is to be injected "intramuscularly into the deltoid muscle after dilution", that is, that is, prick deeply with a needle, so that the product directly reaches the muscle.
Pfizer also warns: "Do not inject this vaccine intravascularly (into the blood vessels), subcutaneously (into the layer of fat directly under the skin) or intradermally (into the dermis).
"
However, point out our colleagues from France 2, on many photos of these injections, we can see the caregivers pinching the skin of the patients, to inoculate the vaccine, which would correspond to the technique used for a subcutaneous injection.
With the channel, Professor Stéphane Gendry, resuscitator at the Avicennes hospital in Bobigny commented: “What should not be done is a skin fold, inject at 45 degrees and use small needles.
[…] You have to take the muscle, prick perpendicularly with a needle of the same size.
"
Updated recommendations
How to explain this misuse of the vaccine?
It would be necessary, still according to France 2, to look on the side of the Ministry of Health.
In the first version of its "guide to the organization of vaccination in nursing homes and long-term care units", dated December 22, the ministry makes some recommendations to the doctors and nurses responsible for the injection, which confuse the issue. message.
“Take the pre-filled syringe with vaccine.
Purge the needle and push the air bubble out of the syringe.
Make a skin fold between the thumb and forefinger.
Inject the vaccine intramuscularly ”, it is written, thus advising to use a technique of subcutaneous injection, to realize an intramuscular injection.
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In addition, another element questions: some caregivers photographed use 25 G type needles (the G being the Anglo-Saxon Gauge unit of measurement related to the diameter), orange, which are used in France for subcutaneous injections.
However, the latter correspond to the recommendations of the health authorities of the United States, which advise the use of needles of 22 to 25 G. The ministry recommends for its part 23 G or 25 G needles, also intended for the latter type of 'injection.
But remember that these guidelines vary a lot from country to country and Pfizer has not commented on the diameter of the needles.
A “mess”?
After requests from France 2, the Directorate General of Health has in all cases modified the recommendations contained in its guide, now recommending that the caregiver "firmly stretch the skin between the index finger and the thumb, without making a skin fold ".
Before this turnaround, many doctors had protested against this first advice on social networks.
VIDEO. Covid-19: the first dose of the vaccine administered in a hospital in Seine-Saint-Denis
Here, one of them underlines the "inconsistency between the skin fold and IM injection (intramuscular)", when another protests against a "mess", "we see a vaccine being made subcutaneously which must be done intramuscularly ”.
The risk is potentially having an ineffective vaccine because it is injected subcutaneously and not intramuscularly.
I don't know if this risk is true, but all precautions are good to take.
Ideally, the French vaccination guide would specify the length.
- Dr Rachid Bahi (@docteurbahi) January 3, 2021
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"The risk is potentially having an ineffective vaccine because it is injected subcutaneously and not intramuscularly", explained another doctor, specifying that he did not know "if this risk is proven but all precautions are good to take".