1. Vaccine Administration
Donna L. Weaver, RN, MN, Nurse Educator
National Center for Immunization and
Respiratory Diseases
Tennessee
April, 2010
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2. Be Prepared to Administer Vaccines Correctly
Ensure staff is adequately trained
Provide current immunization education
Adhere to OSHA guidelines for employee safety
Provide staff with easy to use resources and guidelines
Document immunizations correctly
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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
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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
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5. Right Vaccine Check Your Vial 3 TIMES
DTaP
Tdap
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6. Right Vaccine DTaP Tdap 6 weeks – 6 years 10 – 64 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
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7. Right Vaccine Check Your Vial 3 TIMES
PPD
(tuberculin skin test) DT
Td (dT)
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8. Produced by California Immunization Branch
Available at
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9. Right Vaccine Check Your Vial 3 TIMES
Varicella vaccine
Zoster vaccine
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10. Right Vaccine Varicella Zoster 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
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11. Right Vaccine Label clearly Include age indications
Separate look-alike and sound-alike vaccines as much as possible
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12. Right Formulation Hepatitis A, Hepatitis B, & Twinrix
Remember – always use the age-appropriate dose!!!
Vaccine
Age
Dose
Hepatitis A
12 mos thru 18 yrs
0.5 mL
19 yrs and older
1 mL
Hepatitis B
Birth thru 19 yrs
20 yrs and older
Twinrix
18 yrs and older
CDC
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13. Right Diluent Vaccine + 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
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14. Do NOT Split Pentacel
Do NOT give DTaP/IPV solution separately without the ActHIB +
Hib
DTaP/IPV
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15. Only Combine Vaccines if FDA Approved
Vaccines should NEVER be combined in the same syringe unless FDA approved for this purpose +
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16. Right Route for Vaccine
Rotavirus Vaccine
Oral Route
LAIV Vaccine
Intranasal Route
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17. Subcutaneous (subQ) Injections
45° Angle
Dermis
Fatty tissue (subQ)
Muscle tissue
Needle size
gauge
5/8” length
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18. Intramuscular (IM) Injections
90° Angle
Acromial Process
Dermis
Fatty tissue
(subQ)
Axillary Fold
Fatty tissue (SubQ)
Muscle tissue
Needle length & Site depend on:
Muscle size, Fatty tissue thickness,
Vaccine volume, Injection technique
Aspiration is NOT required
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19. NO!!!
Correct!
Incorrect!
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20.
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21. Right Needle Length
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22. Intramuscular (IM) Injections
Sex/
Weight
Needle Length
Injection Site
M & F <130 lbs
1”*
Deltoid Muscle
F 130 lbs lbs
1” - 1½”
M 130 lbs lbs
F >200 lbs
1½”
M >260 lbs
*Some experts allow for use of a 5/8” needle
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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
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24. Recommended Volume for Site
Muscle
Volume Injected
Average
Range
Deltoid
0.5 mL mL
Vastus lateralis
(anterolateral thigh)
1 - 4 mL
1 - 5 mL
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25. Syncope Following Vaccination
An increase in the number of reports of syncope has been detected by the Vaccine Adverse Event Reporting System (VAERS)
11-18 year old females have contributed most of the increase
Serious injuries have resulted
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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
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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
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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
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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
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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
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31. Do NOT Administer Expired Vaccine
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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.)
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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
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34. Right Interval
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
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35. The 4-day “Grace Period”
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
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36. Scheduling errors: giving doses without the minimum spacing
Giving 2nd 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
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37. Scheduling errors: giving doses at too young an age
Giving the 1st dose of MMR before age 12 months
Giving the 3rd dose of Comvax before age 12 months
Giving the 4th dose of DTaP before age 12 months or less than 6 months after 3rd dose
Finishing infant’s hepB series before 24 wks
Giving any vaccine (except hepatitis B) before age 6 weeks
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38. Vaccine Administration Resources
CDC
Imz Action Coalition
CA Imz Program
Michigan Imz Program
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39. CDC Vaccines and Immunization Contact Information
Telephone CDC.INFO
(for patients and parents)
(for providers)
Website
Vaccine Safety
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