9 Correct Administration-REVISED

8/13/2019 9 Correct Administration-REVISED

1/20

Core Topic 9

Correct administration ofvaccines


2/20

Immunisation Department, Centre for Infections

Learning Outcome

To reconstitute and administer vaccines

correctly


3/20


Learning Objectives

Identify the correct dose and site of administration of allvaccines for each age group

List true contraindications for all vaccines and describe

common false contraindications for vaccines

Position patients of different ages for safe and effective

vaccination

Reconstitute vaccines correctly

Explain how to prepare and dispose of vaccination

equipment


4/20


Vaccine Administration

Preparation

Injection technique

Choice of needle length

Injection site

These are all important

considerations as each

factor can affect both the

immunogenicityand the

risk of local reactionsat

the injection site


5/20


Reconstitution of vaccine

Each vaccine should only be reconstituted and drawn up whenrequiredin order to:

-Avoid errors

-Maintain efficacy and stability

Reconstitution of freeze-dried vaccines:

-Only use diluent supplied and use within specified time period

-Only mix vaccines that are licensed and recommended to be mixed with othervaccines

-Diluent should be drawn up using a green (21G) needle and added slowly tovaccine to avoid frothing

Before administration:

-Check colour and composition of vaccine is as specified in description in vaccinesSPC

-Check vaccine to ensure is right product and correct dose for patient

-Check expiry date


6/20


Route of Injection

Vaccines should not be given intravenously

Most vaccines* should be given intramuscularly:

This reduces the chance of local reactions and leads to a betterimmune response to the vaccine

It is important the vaccine is injected into muscle and not into fat.This is why the deep subcutaneous route is no longerrecommended for most vaccines

However:

Individuals with a bleeding disorder should receive their vaccines by deepsubcutaneous injection to reduce risk of bleeding

*exceptions are BCG (intradermal injection), Japanese Encephalitis & Varicella vaccines (subcutaneousinjection) and Cholera vaccine (oral)


7/20


Needle Size

Orange 25 gauge 16 mm long

25 mm long

Blue 23 gauge 25 mm long

Green 21 gauge 38 mm long

For IM injection, needle needs to be long enough to ensure vaccine

is injected into muscle

A 25mm needle length is preferable and suitable for

all ages

16mmneedle length is only recommended for pre-

term or very small infants

In larger adults, a longer length (38mm) may be

requiredindividually assess patients


8/20


Injection site

For infants under 1 year:

Anterolateral aspect of the thigh is preferred site as it provides alarge muscle mass

For older infants and adults:

Deltoid area of upper arm generally preferred but anterolateral

aspect of thigh can also be used

When 2 or more injections need to be given at the same time, theyshould preferably be given at separate sites in different limbs

If more than one injection needs to be given into the same limb,they should be given at least 2.5cm apart. The site at which eachvaccine was given should be recorded


9/20


Injection Site

The injection site needs to avoid major nerves and bloodvessels

Immunisations should not be given into the buttock due to

risk of:

-sciatic nerve damage

-injecting the vaccine into fat rather than muscle

Injection of vaccine into fatty tissue of the buttock has been

shown to reduce the immunogenicity of HepB and rabiesvaccines


10/20


Skin cleansing

Clean skin does NOT require cleansing

Visibly dirty skin need only be washed with soap + water

If alcohol and other disinfecting agents are used, skin must

be allowed to dry as these could inactivate live vaccines


11/20


Injection Technique

IM injections should be given with needle at a 90 angle tothe skin

The skin should be stretched flat (NOT bunched)

It is not necessary to aspirate the syringe after the needle isput into the muscle

muscle

subcutaneous layer

dermis (skin)


12/20


Prior to Administration..

Vaccinators should ensure that:

There are no contraindications to the vaccines being given

Consent has been obtained

The vaccinee or carer is fully informed about the vaccines

that are being given and understands the vaccination

procedure

The vaccinee or carer is aware of possible adversereactions and how to treat them


13/20


True Contraindications

Vaccination in moderately or severely unwell individuals

Live vaccines in immunocompromised individuals

Anaphylaxis to previous dose of vaccine or a vaccinecomponent

Definition of anaphylaxis:

Typically rapid and unpredictable with variable severity and clinicalfeatures including cardiovascular collapse, bronchospasm,angioedema, pulmonary oedema, loss of consciousness and urticaria


14/20


15/20


The following are also NOT

contraindications to vaccination:

Family history of any adverse reactions following immunisation

Previous history of pertussis, measles, rubella or mumps infection

Prematurity: immunisation should not be postponed

Stable neurological conditions such as cerebral palsy and Downssyndrome

Contact with an infectious disease

Asthma, eczema, hay fever or snuffles

Treatment with antibiotics or locally-acting (eg topical or inhaled) steroids

Childs mother is pregnant

Child being breast fedHistory of jaundice after birth

Under a certain weight

Over the age recommended in immunisation schedule

Replacement corticosteroids


16/20


Positioning of Patient

All ages: ensure vaccination area is completely exposed

Babies and young children:

sit child sideways on parents lap

ensure child is held securely

if anterolateral aspect of thigh being used: parent to cuddle childclosely and place childs nearest arm around parents back. Parent toplace one of their arms over childs other arm and hold both legs firmlyby placing their hand just above the childs knees

if deltoid being used: parent to hold arm to be injected close to childsbody and tuck other arm behind parents back. Tuck childs legsbetween parents legs or ask parent to hold legs firmly


17/20


Post Vaccination

Observe vaccine recipients forimmediate adverse reactions

Suspected adverse drug

reactions (ADRs) to vaccines

should be reported to the

Committee on Safety of Medicinesusing the Yellow Card Scheme:

-For established vaccines, only serious

ADRs should be reported

-For newly licensed vaccines labelled

with an inverted black triangle (),serious and non-serious reactions

should be reported

-All suspected ADRs occuring in

children should be reported by

healthcare professionals or parents


18/20


Disposal of vaccination equipment

All:

-reconstituted vaccines

-opened single and multidose vials

-empty vials and ampoules

-used needles and syringes

should be disposed of in yellow sharps bins (except for BCG)

BCG vaccine and equipment should be disposed of in the purple lidded wastecontainer for cytotoxic waste

Sharps bins should be replaced once 2/3rds full


19/20


Recording

The following information

should be recorded accurately:

Vaccine name, batch number and

expiry date

Dose administered

Site(s) usedincluding clear

description of which injection was

administered in each site,

especially where two injections

were administered in the same

limb

Date immunisation(s) were given

Name and signature of vaccinator

This information should be

recorded in:

Patient held record or Personal Child

Health Record (PHCR) for children

Patients GP record or other patient

record depending on location

Child Health Information System

Practice computer system


20/20

I i ti D t t C t f I f ti

Minimum slide set created by:

Immunisation Department,

Centre for Infections,

Health Protection Agency

to assist teaching of the Core Curr icu lum for

Immun isation Train ing

(see http://www.hpa.org.uk/infections/topics_az/vaccination/training_menu.htm)

Documents

9 Correct Administration-REVISED