Ensuring the integrity of vaccines is essential. Healthcare providers can refer to the following tips for the safe preparation and administration of vaccines.
Vaccine Preparation
For proper vaccine preparation, it is important to use aseptic techniques and adhere to infection prevention guidelines:
- Make sure you have all the necessary supplies for administering the vaccine.
- Wash your hands thoroughly before preparing the vaccine.
- Inspect the vial for any signs of damage before using it.
- Check the storage temperature of the vaccine to ensure it is correct.
- Prepare the vaccines in a clean area, free from any patients or distractions.
- Follow the instructions provided by the manufacturer in the package inserts.
- Check the expiration dates of the vaccines, diluents, syringes, and needles.
- Use a separate needle and syringe for each injection.
- Prepare the vaccines immediately before administering them.
- Only administer vaccines that you have prepared yourself.
- Dispose of used syringes and needles in a sharps container.
- Store vaccines in the recommended conditions to maintain their potency.
- Keep a record of vaccines administered, including lot numbers and expiration dates.
- Monitor patients for any adverse reactions after vaccination and follow up as needed.
Vaccine Presentations
Vaccines are available in various forms:
Single-dose Vial (SDV)
Most vaccines come in Single-Dose Vials (SDVs) to prevent contamination. Use SDVs for one patient only and discard any leftover vaccine.
Manufacturer-Filled Syringe (MFS)
Manufacturer-Filled Syringes (MFSs) contain a single dose of vaccine and should be used for one patient only.
Multidose Vial (MDV)
Multi-dose Vials (MDVs) contain multiple doses of vaccine and have preservatives. Use MDVs for one patient and store them in a clean area.
Oral Applicator and Nasal Sprayer
Oral applicators are used for oral vaccines. Refer to the manufacturer’s instructions for proper usage.
Nasal sprayers are used for intranasal vaccines. Follow the manufacturer’s instructions for correct administration.
It is important to always check the expiration date and storage requirements of vaccines to ensure their effectiveness.
Needle Selection
Select the needle size based on the administration route, patient characteristics, and injection site. Clinical judgment plays a crucial role in needle selection.
Needle Length and Gage Charts
Subcutaneous injections require 5/8-inch needles. The injection site may vary depending on the patient’s age.
The needle sizes for intramuscular injections in children and adolescents are based on age and weight.
For adults, specific needle sizes are used based on weight and gender for intramuscular injections.
It is important to consider the viscosity of the medication being administered when selecting a needle size. Thicker medications may require a larger gauge needle to allow for easy administration.
Always ensure that the needle is sterile and properly disposed of after each use to prevent infections and promote patient safety.
Site and Route Selection
There are five different routes for vaccine administration. Proper administration is vital for the effectiveness of the vaccine and the safety of the patient.
Oral Route (PO)
- Oral vaccines are administered through drops in the mouth.
- Routine vaccines like Rotavirus should not be injected.
- Examples of oral vaccines include polio vaccine.
Intranasal Route (NAS)
- Intranasal vaccines are administered through each nostril using a nasal sprayer.
- Live attenuated influenza vaccines are administered intranasally.
- Examples of intranasal vaccines include FluMist.
Subcutaneous Route (Subcut)
- Subcutaneous injections are given under the skin, below the muscle tissue, with specific vaccines.
- Some vaccines can be given either intramuscularly or subcutaneously.
- Examples of subcutaneously administered vaccines include MMRV (Measles, Mumps, Rubella, Varicella).
Intradermal Injection
- Intradermal administration involves a shallow injection between the skin layers on the forearm.
- The recommended vaccine for intradermal injection is Jynneos standard regimen. In emergencies, an alternative intradermal route is allowed.
Intramuscular Route (IM)
- Intramuscular injections penetrate the muscle tissue. The injection sites are determined by age, weight, and proper needle selection according to age, weight, and gender.
- The vaccines routinely recommended for intramuscular injection include COVID-19, DTaP, DTaP-IPV-HepB, DTaP-IPV/Hib, Hib, HepA, HepB, and others. Note: IPOL, MMRII, and Pneumovax 23 can also be administered subcutaneously.
- Examples of intramuscularly administered vaccines include the flu shot.
Filling Syringes
Follow the standard guidelines for medication preparation. Before each dose, mix the vaccine properly by agitating the vial. Never reuse, mix, or transfer syringes, and label vaccines immediately after drawing them into a syringe.
Multiple Vaccinations / Coadministration
It is possible to administer multiple vaccines simultaneously. Use different limbs for specific vaccines, with the thigh being the preferred site for children.
Remember to label each syringe with:
- Names of the vaccines
- Date and time of administration
- Name of the person administering the vaccine
Best practices for administering multiple injections include using separate syringes, avoiding mixing vaccines, administering in different sites, and labeling each syringe.
Procedural Pain Management
There are strategies to alleviate pain associated with injections in children. Using distraction techniques, topical anesthetics, and quick administration can help reduce pain and anxiety.
Distraction Techniques
Distraction techniques such as letting a child play with a toy or watch a video can help take their mind off the pain of the injection. Engaging the child in conversation or singing a song can also be effective distractions.
Topical Anesthetics
Topical anesthetics, like numbing creams or sprays, can be applied to the skin before the injection to help numb the area and reduce pain. Make sure to follow the instructions for applying the anesthetic properly.
Quick Administration
Administering the injection quickly and efficiently can help minimize the duration of pain. Ensure that the healthcare provider is skilled in giving injections and follows proper techniques.
Safe vaccine administration relies on proper preparation. Follow aseptic techniques and infection prevention guidelines.
Before administering a vaccine, make sure to check the expiration date and proper storage of the vaccine. Use clean equipment and dispose of sharps properly to prevent infections.
Vaccine Preparation
Ensure that vaccine preparation takes place in a clean area, following the manufacturer’s instructions, and using separate syringes for each injection.
Vaccine Presentations
Single-dose Vial (SDV)
Most vaccines are provided in single-dose vials intended for use by one patient. Discard any remaining contents after withdrawal and never reuse a single-dose vial.
Manufacturer-Filled Syringe (MFS)
Multi-dose vials contain preservatives for multiple uses. Use multi-dose vaccines according to the manufacturer’s instructions.
Multidose Vial (MDV)
Manufacturer-labeled multi-dose vials can be used for multiple patients. Do not combine partial doses from different vials.
Oral Applicator and Nasal Sprayer
Oral applicators are used for oral vaccines with a single dose of medication. In the US, the Rotavirus vaccine is administered using an oral applicator. The live, attenuated influenza vaccine is administered using an intranasal sprayer.
Needle Selection
For optimal immune response and to reduce injection-site reactions, vaccines must reach the tissues. Needle selection is crucial, based on the administration route, patient age, sex, weight (for adults aged 19+), injection site, and technique. A table outlines the recommended needle gauges and lengths, with clinical judgment required for selection.
Needle Length and Gage Charts
Subcutaneous Injection
| Age | Recommended Needle Size and Type | Preferred Injection Site |
|---|---|---|
| All age groups | 5/8-inch (16 mm) needle with 23-25 gauge | Thigh for babies under 12 months; upper outer triceps for 12 months and older |
When it comes to giving intramuscular injections to young patients, certain factors need to be taken into consideration in order to ensure safety and effectiveness. Here are some key points to keep in mind:
Choose the Right Injection Site
Selecting the appropriate muscle for injection is crucial for avoiding any potential complications. Common sites for intramuscular injections in children and adolescents include the deltoid muscle in the upper arm and the vastus lateralis muscle in the thigh.
It is important to remember that the needle length should also be selected based on the type of injection being administered. For intramuscular injections, the recommended needle length is typically 1 to 1.5 inches for adults and 5/8 to 1 inch for children. However, for subcutaneous injections, shorter needles ranging from 3/8 to 5/8 inches are usually sufficient. Always consult with a healthcare provider or pharmacist to ensure that the correct needle length is being used for each specific medication and patient.
Ensure Proper Technique
Administering an intramuscular injection requires a certain level of skill and precision. Make sure to aspirate before injecting the medication to avoid hitting a blood vessel, and massage the area gently after the injection to promote absorption.
By following these guidelines and always seeking guidance from a healthcare professional, you can safely and effectively administer intramuscular injections to children and adolescents.
| Age | Needle Length and Gauge | Injection Site |
|---|---|---|
| Newborn, up to 28 days old | 5/8-inch (16 mm)*: 22- to 25-gauge | Vastus lateralis muscle of anterolateral thigh |
| Infants, 1–12 months old | 1-inch (25 mm): 22- to 25-gauge | Vastus lateralis muscle of anterolateral thigh |
| Toddlers, 1–2 years old | 1- to 1.25-inch (25–32 mm): 22- to 25-gauge | Vastus lateralis muscle of anterolateral thigh (preferred site) |
| 5/8*- to 1-inch (16–25 mm): 22- to 25-gauge | Deltoid muscle of arm | |
| Children, 3–10 years old | 5/8*- to 1-inch (16–25 mm): 22- to 25-gauge | Deltoid muscle of arm (preferred site) |
| 1- to 1.25-inch (25–32 mm): 22- to 25-gauge | Vastus lateralis muscle of anterolateral thigh | |
| Children, 11–18 years old | 5/8*- to 1-inch (16–25mm): 22- to 25-gauge | Deltoid muscle of arm (preferred site) † |
When the skin is taut and the subcutaneous tissues are not gathered, another option is to use the vastus lateralis muscle on the anterolateral thigh. Typically, a needle measuring 1 to 1.5 inches (25–38 mm) is needed for intramuscular injection in most teenagers and adults.
Administering Intramuscular Injections to Adults (19 years and older)
| Weight and Gender | Needle Size and Thickness | Injection Location |
|---|---|---|
| Less than 130 lbs (60 kg), both male and female | 1-inch (25 mm)*: 22- to 25-gauge | Deltoid muscle in the arm (recommended area) † |
| 130–152 lbs (60–70 kg), both male and female | 1-inch (25 mm): 22- to 25-gauge | |
| Men, 153–260 lbs (70–118 kg) | 1- to 1.5-inch (25–38 mm): 22- to 25-gauge | |
| Women, 153–200 lbs (70–90 kg) | 1- to 1.5-inch (25–38 mm): 22- to 25-gauge | |
| Men, over 260 lbs (118 kg) | 1.5-inch (38 mm): 22- to 25-gauge | |
| Women, over 200 lbs (90 kg) | 1.5-inch (38 mm): 22- to 25-gauge |
*For individuals weighing less than 60 kg, experts advise using a 5/8-inch needle, ensuring the skin is tightly stretched to avoid bunching of tissues.
†Intramuscular administration often requires a 1- to 1.5-inch needle, with the vastus lateralis muscle in the anterolateral thigh being a suitable option for adolescents and adults.
Site and Route Selection
There are five different routes for vaccine administration, each recommended based on clinical trials, practical experience, and theoretical considerations. Opting for a different route may impact vaccine effectiveness or lead to increased local adverse reactions, potentially necessitating revaccination in case of incorrect dosing.
Oral Route (PO)
- Oral vaccines are administered as drops in the mouth, with the Rotavirus vaccine being the only one recommended for oral rather than injection delivery.
- To see demonstrations for guidance, click here.
Intranasal Route (NAS)
- Intranasal vaccines are sprayed into each nostril, primarily for the live, attenuated influenza vaccine.
- For step-by-step guidance, watch the demonstration here.
Subcutaneous Route (Subcut)
- Subcutaneous injections target the tissue just beneath the skin, with several vaccines suited for this method.
- To learn more, check out the provided factsheet and video demonstration.
Intradermal Injection
- Intradermal administration involves injecting the vaccine superficially between skin layers, typically on the inner forearm.
- For Jynneos vaccination, the standard regimen involves subcutaneous administration, with an intradermal option available under EUA.
- Find a demonstration for guidance here.
Intramuscular Route (IM)
- Intramuscular injections are administered directly into the muscle based on individual age, with various vaccines recommended for this route.
- To access video tutorials and job aids for guidance, click here.
Filling Syringes
Adhere to standard guidelines when preparing vaccine doses for administration, ensuring cleanliness by wiping the vial stopper with a sterile alcohol swab and checking for any particulate matter or discoloration before injecting.
Remember:
- Use a new syringe for each vial
- Avoid mixing different vaccines in one syringe
- Do not transfer vaccine between syringes
- Avoid combining partial doses from separate vials
Label syringes promptly to guarantee accurate vaccine administration.
Multiple Vaccinations / Coadministration
Multiple vaccines can be administered simultaneously, a practice known as coadministration. When multiple injections are necessary, target the thigh for infants and young children, and the deltoid muscle for older children and adults.
Key information to record:
- Include vaccine name and dosage, lot number, preparer’s initials, and beyond-use time if applicable
Additional tips for multiple injections:
- Use a separate syringe for each vaccine
- Consider combination vaccines to minimize injections, but do not mix vaccines in the same syringe
- Administer each vaccine in a different site, spacing at least 1 inch apart
- Administer painful vaccines last
- Administer vaccines likely to cause local reactions in different limbs
For more information on vaccine coadministration, consult Chapter 6 of the Pink Book by the CDC.
Dealing with Injection Pain
Vaccine injections can be painful, particularly in children. To reduce distress, consider:
- Using topical anesthetics
- Offering sweet liquids or breastfeeding during vaccination
- Administering vaccines swiftly and without aspiration
- Implementing distraction techniques and proper breathing
Managing fear and pain during injections is important for adults as well. Strategies effective for children can also benefit adults. More details can be found in the Pink Book.