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Vaccine Administration Donna L. Weaver, RN, MN, Nurse Educator National Center for Immunization and Respiratory Diseases Tennessee April, 2010.

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Presentation on theme: "Vaccine Administration Donna L. Weaver, RN, MN, Nurse Educator National Center for Immunization and Respiratory Diseases Tennessee April, 2010."— Presentation transcript:

1 Vaccine Administration Donna L. Weaver, RN, MN, Nurse Educator National Center for Immunization and Respiratory Diseases Tennessee April, 2010

2 Be Prepared to Administer Vaccines Correctly Adhere to OSHA guidelines for employee safety Provide staff with easy to use resources and guidelines Document immunizations correctly Ensure staff is adequately trained Provide current immunization education

3 Vaccine Administration Errors The Right Drug The Right Dose The Right Route The Right Technique The Right Time The Right Patient The Right Documentation

4 Right Vaccine or Formulation Errors occur because both types of vaccine stored in the same refrigerator, similarity of appearance of packaging, and small print

5 Right Vaccine Check Your Vial 3 TIMES DTaP Tdap

6 Right Vaccine DTaP –6 weeks – 6 years –Schedule = 5 doses –Main contents Diphtheria toxoid Tetanus toxoid aPertussis antigens Tdap –10 – 64 years –Schedule = 1 dose ONLY –Main contents diphtheria toxoid = 1/3 amount in DTaP Tetanus toxoid = same as amount in DTaP apertussis antigens = less than amount in DTaP

7 Right Vaccine Check Your Vial 3 TIMES PPD (tuberculin skin test) DT Td (dT)

8 Produced by California Immunization Branch Produced by California Immunization Branch Available at

9 Right Vaccine Check Your Vial 3 TIMES Varicella vaccine Zoster vaccine

10 Right Vaccine Varicella –12 months and older –Schedule = 2 doses –Main contents Live attenuated varicella vaccine virus Zoster –60 years and older –Schedule = 1 dose ONLY –Main contents Live attenuated varicella vaccine virus – 14 times as much as in varicella vaccine

11 Right Vaccine Label clearly Include age indications Separate look-alike and sound-alike vaccines as much as possible

12 Right Formulation Hepatitis A, Hepatitis B, & Twinrix Remember – always use the age-appropriate dose!!! VaccineAgeDose Hepatitis A12 mos thru 18 yrs0.5 mL 19 yrs and older1 mL Hepatitis BBirth thru 19 yrs0.5 mL 20 yrs and older1 mL Twinrix18 yrs and older1 mL CDC

13 Right Diluent ActHIB ® + 0.4% Sodium chloride Hiberix + 0.9% Sodium chloride TriHIBit = ActHIB ® + Tripedia ® Pentacel = ActHIB + DTaP(Daptacel)/IPV Rotarix = RV1 + Sterile water/ calcium carbonate/ xanthan M-M-R + Sterile water Varivax + Sterile water ProQuad ® = MMRV + Sterile water Zostavax ® + Sterile water Menomune ® + Sterile water/ Thimerosal Menveo = Serogroup A + Serogroups C/Y/W-135 Vaccine + Diluent

14 Do NOT Split Pentacel Do NOT give DTaP/IPV solution separately without the ActHIB + Hib DTaP/IPV

15 Only Combine Vaccines if FDA Approved Vaccines should NEVER be combined in the same syringe unless FDA approved for this purpose +

16 Right Route for Vaccine Rotavirus Vaccine Oral Route LAIV Vaccine Intranasal Route

17 Subcutaneous (subQ) Injections Needle size gauge 5/8” length Muscle tissue Fatty tissue (subQ) Dermis 45° Angle

18 Intramuscular (IM) Injections Needle length & Site depend on: Muscle size, Fatty tissue thickness, Vaccine volume, Injection technique Aspiration is NOT required Fatty tissue (SubQ) Dermis Fatty tissue (subQ) Muscle tissue 90° Angle Acromial Process Axillary Fold

19 Correct! Incorrect! NO!!!

20

21 Right Needle Length

22 Intramuscular (IM) Injections Sex/ Weight Needle Length Injection Site M & F <130 lbs1”*Deltoid Muscle F 130 lbs lbs1” - 1½” M 130 lbs lbs F >200 lbs1½” M >260 lbs *Some experts allow for use of a 5/8” needle

23 Multiple Vaccinations Use the thigh for multiple IM injections in infants and young children The deltoid muscle can be used for older children and adults Separate each injection by at least 1” Administer vaccine and immune globulin at separate sites Combination vaccines can reduce the number of injections needed

24 Recommended Volume for Site Muscle Volume Injected AverageRange Deltoid 0.5 mL mL Vastus lateralis (anterolateral thigh) mL1 - 5 mL

25 Syncope Following Vaccination An increase in the number of reports of syncope has been detected by the Vaccine Adverse Event Reporting System (VAERS) year old females have contributed most of the increase Serious injuries have resulted

26 Administer Immunizations SAFELY! Have patients seated for vaccination Strongly consider observing patients for 15 minutes after they are vaccinated If syncope develops, patients should be observed until symptoms resolve

27 Handle Vaccines with Care Do NOT refreeze vaccines after thawing –Unreconstituted varicella and MMRV may be stored for up to 72 hours at 35º- 46ºF (2º -8º C) –Unreconstituted zoster vaccine may not be stored in this manner Do NOT uncap vials until ready for use Remember, the clock is ticking once a lyophilized vaccine is reconstituted

28 Provider Prefilled Syringes Prefilling syringes from a multidose vial is STRONGLY DISCOURAGED by CDC May result in vaccine administration errors and wastage Consider using manufacturer-supplied prefilled syringes (if available) for large immunization events

29 Provider Prefilled Syringes Provider prefilled syringes should be discarded after 30 minutes (total) exposure to room temperature Provider prefilled syringes should be discarded at end of the clinic day

30 Manufacturer Prefilled Syringes Do not contain a preservative Removing the syringe cap or attachment of a needle breaks the sterile seal Do NOT remove the cap or attach a needle until ready to use Manufacturer prefilled syringes with a needle attached should be discarded at end of the clinic day

31 Do NOT Administer Expired Vaccine

32 IMPORTANT RULE: Vaccine doses should not be administered at intervals less than the recommended minimal intervals or earlier than the minimal ages. But, there is no maximum interval! (Except for oral typhoid vaccine in some circumstances.)

33 Scheduling Errors Giving TriHIBit (DTaP+Hib) at 2, 4, and 6 months Giving rotavirus vaccine after 8 months 0 days Giving PPSV23 every 5 years Not allowing 6 months between the next-to-last and last doses of IPV Using Kinrix other than for the 5th dose of the DTaP and the 4th dose of IPV in children age 4-6 years Giving live vaccines not administered at the same visit less than 4 weeks apart

34 Doses administered 5 or more days before the minimum age should be repeated on or after the patient reaches the minimum age and 4 or more weeks after the invalid dose. Doses administered 5 or more days earlier than the recommended minimum interval between doses are not valid and must be repeated. The repeat dose should be spaced after the invalid dose by the recommended minimum interval Right Interval

35 Vaccine doses administered up to 4 days before the minimum interval or age can be counted as valid This grace period should not be used when scheduling future vaccination visits, or applied to the 28-day interval between live parenteral vaccines of two different vaccines not administered at the same visit Use of the grace period may conflict with state daycare or school entry vaccination requirements The 4-day “Grace Period”

36 Scheduling errors: giving doses without the minimum spacing Giving 2 nd dose of hepatitis A vaccine less than 6 months after the first dose Giving the hep B vaccine series without at least 4 wks between doses 1 and 2; 8 wks between doses 2 and 3; and 16 wks between doses 1 and 3 Giving the HPV vaccine series without at least 4 wks between doses 1 and 2; 12 wks between doses 2 and 3; and 24 wks between doses 1 and 3

37 Scheduling errors: giving doses at too young an age Giving the 1 st dose of MMR before age 12 months Giving the 3 rd dose of Comvax before age 12 months Giving the 4 th dose of DTaP before age 12 months or less than 6 months after 3 rd dose Finishing infant’s hepB series before 24 wks Giving any vaccine (except hepatitis B) before age 6 weeks

38 Vaccine Administration Resources CDC Imz Action Coalition CA Imz Program Michigan Imz Program

39 CDC Vaccines and Immunization Contact Information Telephone 800.CDC.INFO (for patients and parents) (for providers) Website Vaccine Safety


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