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

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

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

4. 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

5. 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

7. 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

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

9. 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

10. 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

11. Intramuscular Site - Infant
Anterolateral Thigh (vastus lateralis muscle)

12. Intramuscular Injection Technique

13. 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)

14. 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

15. 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

16. 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

17. 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

18. 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)

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

20. 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.