Vaccine Administration Fall 2009 Carson City Health & Human Services Carson City Fire Department

Vaccine Administration References Epidemiology and Prevention of Vaccine-Preventable Diseases National Immunization Program Centers for Disease Control and Prevention

Importance of Proper Vaccine Administration Technique Promote optimal antibody response Reduce risk of local adverse reactions

FluMist® Nasal Spray Available for healthy people aged 2 through 49 years Check expiration date Remove rubber tip protector. Do not remove dose-divider clip at the other end of the sprayer With the patient in an upright position, place the tip just inside the nostril to ensure FluMist® is delivered into the nose With a single motion, depress plunger as rapidly as possible until the dose-divider clip prevents you from going further

FluMist®, Continued Pinch and remove the dose-divider clip from plunger Place the tip just inside the other nostril and with a single motion, depress plunger as rapidly as possible to deliver remaining vaccine. Give the client a tissue to wipe any drips At the end of the slide presentation we will practice with “trainer” dispensers

Intramuscular Sites Site selection depends on person’s age muscle development Use deltoid muscle for older children, adults (toddlers: use deltoid if they are walking and have adequate deltoid muscle mass) Use anatomical landmarks to locate site

Intramuscular Sites Child / Adolescent / Adult Site of Injection Deltoid Muscle (preferred site) Vastus Lateralis Muscle (alternative site)

Intramuscular Needle Gauge: 22 to 25 Length: Newborn 5/8 inch Infant 1 inch Older Children 5/8* to 1¼ inch Adolescent/adult 1 to 1½ inch *5/8 inch needle is adequate only for the deltoid muscle of older children if the skin is stretched flat and the needle inserted at a 90o angle to the skin

IM Injection Steps Ask screening questions Verify five rights: right patient, right drug, right dose, right time, right route Select appropriate needle length, draw up correct dose if using multi-vial Choose injection site Clean injection site with alcohol wipe With the bevel up, insert the needle at 90° angle Gently and smoothly inject the vaccine Dispose of the syringe and needle in a sharps container

Intramuscular Site - Infant Anterolateral Thigh (vastus lateralis muscle)

Intramuscular Injection Technique

Infection Control Hand hygiene Gloves recommended between patients alcohol-based waterless antiseptic can be used Gloves not required by OSHA unless potential for exposure to blood or body fluids open lesions on the hands or agency policy (our policy does not require gloves)

Infection Control Equipment disposal never detach, recap or cut a used needle place in puncture-proof container dispose as infectious medical waste use safety needles or needle-free devices whenever available to reduce risk of injury

Other Vaccine Administration Issues Not necessary to change needles between drawing or reconstituting vaccine and administration unless needle is contaminated or bent NEVER mix vaccines in the same syringe unless approved for mixing by the FDA

Other Vaccine Administration Issues Injection sites in same limb should be separated by at least 1 inch if possible Aspiration not required no reports of injury from failure to aspirate can result in wastage of vaccine

Latex Allergy Most often a contact-type allergy Person with anaphylactic allergy to latex generally should not receive vaccines supplied in vials or syringes that contain rubber Persons with latex allergies that are not anaphylactic can be vaccinated

Injection Pain Pain is subjective and influenced by: Pain management person’s age anxiety level previous healthcare experiences culture Pain management medical (e.g., anesthetics) non-medical (e.g., diversionary techniques)

Vaccine Administration Errors Administration of the wrong formulation Wrong diluent Incorrect route of administration Vaccine given too soon for previous dose

Demonstration At this time the practical portion will take place. Each participant will have an opportunity to see the different types of syringes and needles used for vaccination. With normal saline, each participant will be instructed in proper techniques for drawing up a dose for an adult and for a child 35 months and under. After the demonstration, each participant will be required to draw up on their own an adult dose and a pediatric dose. They will then be required to partner with a classmate, select the adult dose, properly select and prepare a site and administer the saline. They will be observed for technique, proper handling of materials and proper disposal of the needle and syringe. A doll will be used for a child 35 months and younger for the participant to demonstrate proper dose and technique. Instructor will ensure each individual is given sufficient time to feel comfortable with the process.