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Danish professor says injection technique could be to blame for clots

27 replies

doireallyneedaname · 18/03/2021 12:36

Speculation of course, but an interesting theory.

www.berlingske.dk/nyheder/dansk-professor-forkert-vaccineteknik-kan-udloese-blodpropper

Is it really the way AstraZeneca vaccines have been administered that has triggered fatal blood clots in several people in Europe? Niels Høiby suspects so.

"It may explain the few cases where it has gone completely wrong," he says.

Use of AstraZeneca has now been suspended in several European countries following the deaths, including in Denmark after the death of a 60-year-old woman. But the professor of clinical microbiology at Rigshospitalet [National hospital] has now zoomed in on the jab itself rather than the vaccine.

Coronavaccines have to be injected deep into the muscle, intramuscularly it is called. This means that the skin must be stretched before the needle is inserted, as is also stated in the guidelines of the Danish Health Authority. To make sure that the needle does not enter or damage the blood vessels, the plunger should be pulled back slightly to check for blood. If this happens, you should insert the needle somewhere else.

However, Niels Høiby has found that this does not always happen. Instead, for example, people's skin has been squeezed between their index finger and thumb prior to vaccination, which in extremely rare cases can have fatal consequences.

"This can mean that some of the vaccine can go into the bloodstream instead, if the needle has damaged the blood vessels, and from there on to the heart and lungs. And in the worst case, it can cause such a violent inflammatory reaction that it can cause several small blood clots in the lungs, among other places, which is what we have seen," says Niels Høiby, who has also been contacted by several nurses and general practitioners with similar concerns about the vaccine technique.

Nanna Wulff was also puzzled when she had to be vaccinated with AstraZeneca a few weeks ago.

"I was completely shocked, to say the least. I thought no one would believe this," says Nanna Wulff, who is a dentist herself and therefore experienced in injecting her patients.

So she knew the vaccine had to be inserted deep into the muscle. Instead, the vaccinator squeezed her skin while Nanna Wullf protested. A doctor was therefore called in, who confirmed the dentist was right.

"The nurse just stood there shaking her head and saying, 'I didn't learn that. I've given so many vaccines and I've never done this'. Then I sit there and think 'shut up', because it was pretty scary for all three of us to find out that the person had obviously been taught wrong. And no one has ever corrected or helped," says Nanna Wulff, who has sent a so-called concern letter to the Patient Safety Agency.

Niels Høiby is not really surprised that an incorrect technique may have been used to administer coronavaccination.

"The technique is not good enough, but unfortunately it is a technique that is accepted by many because it is so rare that it really goes wrong," says the professor, who stresses that he is working with a thesis that cannot be proven immediately.

However, he has done some reading up on the issue and has come across an article in the scientific journal The Lancet in which a 65-year-old American woman had similar side effects to those in Denmark, but after being vaccinated with either Moderna or Pfizer - the study does not say which of the two it is.

He therefore does not really believe that the problem of incorrectly injected vaccines relates only to AstraZeneca.

"If it was only AstraZeneca, I would be more inclined to believe that it was only related to the particular vaccine, but when it has also happened with the others, then it is more likely to be related to the vaccination itself," says Niels Høiby, whose thesis has also been described in the Health Policy Journal:

"And we know that when there are so many people to be vaccinated all over the world, there are also people who are not so used to vaccinating who will do the job."

At the same time, he believes the problems have been particularly evident at AstraZeneca because it has been quickly given to younger healthcare workers, unlike the other vaccines - many countries including Denmark initially chose not to use the UK vaccine for over-65s. And the immune system simply reacts more weakly the older you get, so the side effects are weaker, while the strong reactions are seen mainly in younger people. And this is where a vaccine given incorrectly could potentially provoke the deadly blood clots.

"It's deeply tragic and it makes a huge impression that people die when they really need to be vaccinated to protect themselves. We can now see that this has happened in Denmark and Norway, but at the same time the risk is so extremely small compared to how many millions have already been vaccinated," says the professor.

B.T. has been in contact with the Danish Health Authority, which does not wish to comment on Niels Høiby's theory. It refers to the announcement that the use of AstraZeneca was put on hold in the wake of the 60-year-old Danish woman's death.

'The Danish Health Authority is now waiting for the pharmaceutical authorities in the EU to carry out a closer investigation into a possible link between the Covid 19 vaccine from AstraZeneca and the serious cases of blood clots that have been reported,' it said at the time.

OP posts:
notrub · 18/03/2021 12:47

Speculative, but interesting.

vintagenurse · 18/03/2021 12:50

I am a nurse and have also done vaccine training. Years ago when I trained we were always taught to draw back on IM injections to check for blood, however the vaccine training stated we did not need to do this as the needles are not long enough to hit any blood vessels. We were however specifically taught to 'flatten' the skin when injecting rather than 'pinching'.

JabAndGo · 18/03/2021 12:54

Totally unmedical person here but due to pandemic I have had to learn to give myself my B12 injections as my GP stopped doing them.

I have not heard of this I just watched some Youtube videos and learned which size syringes to buy and how to do it. Was never mentioned about drawing back. I do it in the middle and to the side of my thigh, a Google search as shown it is ok as this area is mostly muscle. I just jab the needle in as far as it will go and DH slowly and steadily depresses the plunger.

I have been doing them every 6 weeks for a year, I am still alive and kicking atmGrin

QueenOfPain · 18/03/2021 12:57

Flattening the skin and drawing back to check for blood flashing back into the syringe was certainly how I was trained to give an IM injection - I qualified as a nurse in 2013. However, I’ve heard bits and bobs since then from people saying that it’s no longer necessary.

If I was giving an IM injection I would always flatten the skin and draw back to check for flash back.

Squeezing the skin would make a thicker layer of subcutaneous fat to get through, doesn’t make any sense.

RagzReturnsRebooted · 18/03/2021 12:57

I trained recently (last 5 years) as a nurse and we were taught to stretch the skin as it reduces bleeding/oozing and keeps the needle stable. Also taught no need to draw back because you won't hit a blood vessel if you're in the right place, but to be fair I've seen many injections given shoddily eg too low down as the person hadn't pulled their sleeve up far enough. Would still have gone into a muscle, just not the right one (unless they're obese then it have gone into fat). However if you go too high up you can go into the joint space and damage the shoulder. It's not actually as easy as it looks!

I doubt that it was the cause of blood clots though, blood clots are so common that given the number of vaccines being given it's difficult to attribute causation to the vaccine.

ittakes2 · 18/03/2021 12:58

Thanks helpful thread.

mamakoukla · 18/03/2021 17:42

Really interesting and a reminder to look at problems from different viewpoints. I’d love to know if we get to a better understanding of what happened. Tough decision to have to halt a vaccination program but it’s the duty of public health to respond to red flags

BungleandGeorge · 18/03/2021 17:50

The injection technique required is quite clear, bit worrying if this is true. Recommendation in UK is not to draw back on the needle and to go reasonably high away from blood vessels. Was this nurse getting confused with a subcutaneous injection? All a bit strange to pinch the skin.
I’ve certainly had IM injections given to me that were much lower in the arm, not sure if technique has changed or it was an error

HazelWitch · 18/03/2021 17:52

I think there were suspicions of this once two of the highly-unusual events happened at the very same clinic in Austria - a statistical impossibility if it were a problem with the vaccine itself given the millions of doses given.

HSHorror · 18/03/2021 19:48

wouldnt a leg be better then?
I hardly have anything in upper arm certainly little muscle.

They can hardly find a vein for a blood test though.

Anaemia seems a cause for these clots too. Some people do seem to be anaemic after covid.

Greybeardy · 18/03/2021 20:46

Sounds like utter nonsense! Although it’s still taught, there’s barely any point in aspirating before injecting because the force with which most people do aspirate will ‘suck’ a blood vessel closed so no blood actually comes out even if the needle tip’s in a vessel (you can see this phenomenon in small veins too if you aspirate too hard taking bloods). Injecting into subcut fat (which is what they seem to be describing by pinching skin between index finger and thumb) would result in slower not faster absorption of drug than an IM injection because the blood supply to fat is much less than that to muscle. IM injections are absorbed pretty quickly (think about it.... the initial treatment for anaphylaxis is IM adrenaline) so the speed at which peak concentrations of vaccine are reached with an IM injection probably isn’t wildly different to that with a partially administered IV dose. Injectors should aim for ‘approved’ techniques, but minor deviations are pretty unlikely to make a massive difference.
(Is this the same Niels Høiby who, a year ago, said he didn’t think corona was particularly contagious or anything be be concerned about....?)

x2boys · 19/03/2021 08:15

It's called z tracking isn't it I qualified as a nurse in the mid 90,s and I was taught to flatten the skin and draw back for blood ,but some older nurses pinched the skin, incidentally I trained as a RMN so most of the injections I gave were depots which we gave in the upper buttock , in the upper outer quadrant to avoid the sciatic nerve.

jackstini · 19/03/2021 08:22

I had the AZ this week and nurse flattened/stretched skin so definitely some doing it correctly

Interesting though

PuzzledObserver · 19/03/2021 08:35

Non-medically trained here, but curious.

When I had my jab (Pfizer), the vaccinator said “oh, it’s bleeding on me” and held the cotton wool over the site a bit longer. Where would that blood have come from?? (I’m fine by the way)

I wasn’t looking, so couldn’t tell whether she stretched or pinched - but I have a lot of subcutaneous fat she’d have to get through. Would it be a problem if the vaccine went into fat instead of muscle?

I remember watching news coverage of some of the first few vaccines being given, and I’ll swear that on one very skinny old man, the vaccinator was pinching, and I assumed it was to try to locate the muscle in someone who hadn’t got very much.

x2boys · 19/03/2021 08:37

Maybe the nicked a capillary when withdrawing the needle?

EasterIssland · 19/03/2021 08:45

Sure if this was the case we would see adverse problems with all vaccines ?(not only az or COVID related ones )

JabAndGo · 19/03/2021 09:58

@EasterIssland

Sure if this was the case we would see adverse problems with all vaccines ?(not only az or COVID related ones )
Exactly, I was just thinking about this. Why focus on one particular vaccine? Doesn't make sense
XiCi · 19/03/2021 10:07

Sure if this was the case we would see adverse problems with all vaccines ?(not only az or COVID related ones
I had the flu jab last year just at a local chemist and am sure it wasn't administered properly. Really hurt and was left with a very sore arm, I've had flu jabs every year and have never felt pain on injecting. I had terrible side effects, again have had many vaccines and never had an inking of a side effect, so had been wondering whether an inexperienced vaccinator at the chemist had caused this. Definitely won't be going back there next year in any case.

MarinPrime · 19/03/2021 10:40

That's interesting about flattening the skin reducing bleeding. When I had the AZ vac the only thing I felt was the nurse stretching the skin, absolutely no pain at all and no bleeding.
I've always bled a bit after vacs before.

indy2please · 19/03/2021 10:49

"To make sure that the needle does not enter or damage the blood vessels, the plunger should be pulled back slightly to check for blood. If this happens, you should insert the needle somewhere else."

This is true for IV but not for IM?

Cookerhood · 19/03/2021 11:23

I was trained to vaccinate by St John Ambulance. We have been taught to stretch the skin, to lessen any subcutaneous fat between the skin & the muscle. We have not been told to pull the needle back (& no, that wouldn't be for IV, of course you would get blood then, you are in the vein- it would be worrying if you didn't). The pharmacist I vaccinated with the other day said that she bunched the muscle up if they were very skinny, to give her more muscle to inject into. I have seen a fair few photos/TV footage where they have been oinching the arm, & I did comment that it wasn't what I hadbeen taught. Maybe 1/50 bleed a tiny bit, presumably after nicking a capillary.

Backyard72 · 19/03/2021 12:12

So does pinching the skin mean it's more likely to get into a blood vessel?

BigWoollyJumpers · 19/03/2021 12:43

Just watching vaccinations in Russia, they all had their skin pinched. Do other countries therefore, have different protocols? Assume so. If they don't have increased blood clotting issues, then this is a another causation/correlation story, rather than fact.

FatCatThinCat · 19/03/2021 13:37

I had my vaccine yesterday here in Sweden and the nurse pinched my skin to do it. This was the pfizer vaccine. It's just been announced that 2 people have died here just after receiving the AstraZeneca one, hence the suspension in using it. It will be very interesting to see if this is because of how it was administered.

Flaxmeadow · 19/03/2021 14:32

the vaccine training stated we did not need to do this as the needles are not long enough to hit any blood vessels

I've been thinking this too. The needle, and the syringe, is really tiny. I'm usually nervous of needles, dentist, bloods etc, but I hardly felt this one go in and could hardly even see it. It's so short and fine