Administration Technique. - Follow standard medication administration guidelines for site assessment/selection and site preparation. - To avoid injection into. All individuals who administer vaccines should reassess their vaccine administration technique and process to ensure use of proper landmark determination. Techniques of Administrative Improvement: Organisation and methods, Work study and work management; e-governance and information.
You Call The Shots. Online vaccination resources library Links to videos, job tools, reference materials, and web-based training courses. Watch this video to learn how to store FluMist in your office, and how to administer it to your eligible patients 2 years to 49 years old. PharmaJet injectors use a unique pressure profile to deliver vaccine as a fine stream of fluid to puncture the skin and deliver vaccine to the proper tissue depth for intramuscular injection.
Since the first jet injectors were introduced in the s, the technology has evolved to a single-use, sterile, disposable syringe used with a reusable injector. These innovative jet injectors have proven to be a safe and effective method of administration. Shop Now Contains information on approximately 1, drug products.
Username Please enter your username. Password Please enter your password. Not a member of APhA? Using a standardized screening tool helps staff assess patients correctly and consistently. Many state immunization programs and other organizations have developed standardized screening tools. In addition, both screening checklists are available in other languages. To save time, some facilities ask patients to answer screening questions prior to seeing the provider, such as electronically via an electronic healthcare portal or with a paper copy and pen while in the waiting or exam room.
Research shows that parents want clear, consistent information from multiple sources they consider credible. They often cite the Internet as the source of vaccine information. However, some of the information available online is not accurate and conflicting. It can be difficult for a parent to know which sites to believe. Therefore, parents may turn to their most trusted information source of vaccine information: Healthcare professionals need to be ready to provide parents with timely and transparent information about vaccine benefits and risks.
Establishing an open dialogue promotes a safe, trust-building environment in which individuals can freely evaluate information, discuss vaccine concerns and make informed decisions regarding immunizations. Not all parents want the same level of medical or scientific information about vaccines. Healthcare professionals are encouraged to assess the level of information that each parent wants and provide clear and transparent information.
Immunization providers may be asked about many topics, including vaccine-preventable diseases, specific vaccines, the immunization schedule, and vaccine safety issues. Fortunately, there are many resources available to help providers stay up-to-date on all of these vaccine-related issues. Vaccine Information Statements VISs are information sheets produced by the Centers for Disease Control and Prevention CDC that explain to vaccine recipients, their parents, or their legal representatives both the benefits and risks of a vaccine.
The VIS should be given every time a dose of vaccine is administered, even if the patient has received the vaccine and a VIS in the past. VISs can be provided at the same time as the screening questionnaire, while the patient is waiting to be seen. They include information that may help the patient or parent respond to the screening questions. In addition to traditional paper copies, VISs are increasingly available in electronic formats that can read on smart phones and other devices.
Providers can also use the CDC website titled, Provider Resources for Vaccine Conversations with Parents , to talk to parents of infants and young children. The materials available on this website are based on formative, mixed methods research, informed by risk communication principles, and reviewed annually by subject matter experts.
This allows the parent to comfort the child immediately after the injection. After-care instructions should include information and strategies for dealing with side effects such as injection site pain, fever, fussiness infants especially and for determining when medical attention should be sought.
An age-appropriate dose of a non-aspirin-containing pain reliever may be considered to decrease discomfort and fever after vaccination. The prophylactic use of antipyretics before or at the time of vaccination is not recommended. Examples of after-care instructional materials for parents and patients are After the Shots [1 page] and After Receiving Vaccines [1 page]. Patients should be prepared for vaccination with consideration for their age and stage of development.
Vaccine safety concerns and the need for multiple injections have increased anxiety associated with immunizations for patients, parents and health-care personnel. Health-care providers need to display confidence and establish an environment that promotes a sense of security and trust.
Everyone involved should work to provide immunizations in the safest and least stressful way possible. Simple strategies that can be used by both parents and providers to make receiving vaccines easier include:. If the parent is uncomfortable, another person may assist or the patient may be positioned safely. Comforting Restraint for Immunizations [2 pages] outlines positioning techniques.
While definitive guidelines for positioning patients during vaccination have not been established, some recommendations have been suggested. Research supports the belief that children are less fearful and experience less pain when receiving an injection if they are sitting up rather than lying down. Parents should be instructed to hold infants and children in a position comfortable for the child and parent, in which one or more limbs are exposed for injections.
All providers who administer vaccines to older children, adolescents, and adults should be aware of the potential for syncope fainting after vaccination and the related risk of injury caused by falls. The Advisory Committee on Immunization Practices ACIP also recommends that providers consider observing the patient with patient seated or lying down for 15 minutes after vaccination. Concern and anxiety about injections are common for all ages.
Fear of injections and needlestick pain are often cited as reasons why children and adults, including health-care personnel, refuse vaccines. Immunizations are the most common source of iatrogenic pain and are administered repeatedly to children throughout infancy, childhood and adolescence. If not addressed, this pain can have long term effects such as pre-procedural anxiety, fear of needles and avoidance of healthcare behaviors through the lifetime.
Decreasing pain associated with immunizations during childhood may help to prevent this distress and future healthcare avoidance behaviors.
Although pain from immunizations is, to some extent, unavoidable, there are some things that parents and healthcare providers can do to help when children and adults need vaccines. Evidence-based strategies to ease the pain associated with the injection process include:. Breastfeeding has been demonstrated as a soothing measure for infants up to 12 months of age receiving injections.
Several aspects of breastfeeding are thought to decrease pain, including holding the child, skin-to-skin contact, sweet-tasting milk and the act of sucking.
Potential adverse events such as gagging or spitting up were not reported. Breastfeeding should occur before, during and after the administration of vaccines. Allow adequate time for the infant to latch onto the nipple properly. Bottle feeding with breast milk or formula should not be considered a substitute for breastfeeding for pain management.
Sweet tasting liquids are an analgesic for infants up to 12 months of age. Sweetened liquids are recommended for infants who are not breastfed during vaccination.
Several studies have demonstrated a reduction in crying after injections when young children 12 months or younger ingest a small amount a few drops to half a teaspoon of a sugary solution prior to administration of the vaccine. Parents should be counseled that sweet tasting liquids should only be used for the management of pain associated with a procedure such as an injection. Aspiration prior to injection and slowly injecting medication are practices that have not been evaluated scientifically.
Aspiration was originally recommended for safety reasons and injecting medication slowly was thought to decrease pain from sudden distension of muscle tissue. Although aspiration is advocated by some experts, and most nurses are taught to aspirate before injection, there is no evidence that this procedure is necessary. There are no reports of any person being injured because of failure to aspirate.
In addition, the veins and arteries within reach of a needle in the anatomic areas recommended for vaccination are too small to allow an intravenous push of vaccine without blowing out the vessel. Based on behavioral and visual pain scales, the group that received the vaccine rapidly without aspiration experienced less pain.
No adverse events were reported with either injection technique. Frequently children and adults receive 2 or more injections at an immunization encounter. Some vaccines are associated with more pain than others. Because procedure pain can increase with each injection, the order the vaccines are administered may effect the overall pain response.
Some vaccines cause a painful or stinging sensation when the injecting the vaccine; examples include measles, mumps and rubella MMR and human papillomavirus HPV vaccines. Injecting the most painful vaccine e. Rubbing or stroking the skin near the injection site prior to and during the injection process with moderate intensity may decrease pain in older children 4 years and older and adults. The mechanism for this is thought to be that the sensation of touch competes with the feeling of pain from the injection, and thereby results in less pain.
Psychological interventions such as distraction in children have been demonstrated to be effective at reducing stress and the perception of pain during the injection process. Distraction can be led by the provider, child or parent. Certain types of parental behaviors e.
Parents should be encouraged to use distraction methods and instructed in appropriate distraction techniques. Distraction can be accomplished through a variety of techniques e. Topical analgesia may be applied to decrease pain at the injection site.
Parents should be educated in the appropriate use of topical analgesics including the exact site s the medication should be applied. These analgesics often need to be applied before 20 to 60 minutes depending on the product vaccine administration to be effective.
Following are other techniques used by some providers. There is insufficient evidence to recommend these techniques to relieve the pain associated with vaccine administration.
Some providers suggest that having two individuals simultaneously administer vaccines at separate sites will decrease anxiety from anticipation of the next injection s , while others believe this technique actually increases anxiety by making the child feel overpowered and vulnerable.
At this time there is insufficient evidence to make a recommendation either for or against this technique. There is insufficient evidence to support one route subcutaneous or intramuscular versus the other as a way to reduce injection pain, in vaccines for which either route may be used. Healthcare providers should follow appropriate precautions to minimize the risks of spreading disease during the administration of vaccines.
Hand hygiene is critical to prevent the spread of illness and disease. Hand hygiene should be performed before vaccine preparation, between patients, and any time hands become soiled, e. Hands should be cleansed with a waterless alcohol-based hand rub or, when hands are visibly dirty or contaminated with blood or other body fluids, washed thoroughly with soap and water.
Occupational Safety and Health Administration OSHA regulations do not require gloves to be worn when administering vaccines unless the person administering the vaccine is likely to come into contact with potentially infectious body fluids or has open lesions on the hands. If gloves are worn, they should be changed and hand hygiene performed between patients. Gloves will not prevent needlestick injuries. This practice helps prevent accidental needlesticks and reuse. Used needles should not be recapped, cut, or detached from the syringes before disposal.
Empty or expired vaccine vials are considered medical waste and should be disposed of according to state regulations. Vaccines should be drawn up in a designated clean medication area that is not adjacent to areas where potentially contaminated items are placed. Multidose vials to be used for more than one patient should not be kept or accessed in the immediate patient treatment area. This is to prevent inadvertent contamination of the vial through direct or indirect contact with potentially contaminated surfaces or equipment that could then lead to infections in subsequent patients.
If a multidose vial enters the immediate patient treatment area, it should be discarded after use. See other frequently asked questions on injection safety. A separate needle and syringe should be used for each injection. A parenteral vaccine may be delivered in either a 1-mL or 3-mL syringe as long as the prescribed dosage is delivered. OSHA requires that safety-engineered injection devices e.
Personnel who will be using these products should be involved in evaluation and selection of these products and should receive training with these devices before using them in the clinical area.
Some syringes and needles are packaged with an expiration date. This can be a consideration when ordering injection supplies. Never administer medications from the same syringe to more than one patient, even if the needle is changed. Vaccine must reach the desired tissue site for optimal immune response to occur.
Use of longer needles has been associated with less redness or swelling than occurs with shorter needles because of the injection into deeper muscle mass. Therefore, needle selection should be based on the prescribed route, size of the individual, and injection technique. Typically, vaccines are not highly viscous so a fine gauge needle to gauge can be used.
As with syringes, some needles are packaged with an expiration date. Check the expiration date on the needle and syringe packaging, if present. Do not use if the equipment has expired. Each vaccine and diluent vial should be carefully inspected for damage or contamination prior to use. The expiration date printed on the vial or box should be checked. Vaccine can be used through the last day of the month indicated by the expiration date unless otherwise stated on the package labeling.
The expiration date or time for some vaccines changes once the vaccine vial is opened or the vaccine is reconstituted. Regardless of expiration date, vaccine and diluent should only be used as long as they are normal in appearance and have been stored and handled properly.
Expired vaccine or diluent should never be used. Several vaccines are supplied in a lyophilized freeze-dried form that requires reconstitution with a liquid diluent. Vaccines should be reconstituted according to manufacturer guidelines using only the specific diluent supplied by the manufacturer for that vaccine.
Each diluent is specific to the corresponding vaccine in volume, sterility, pH, and chemical balance. If the wrong diluent is used, the vaccine dose is not valid and will need to be repeated using the correct diluent. Reconstitute vaccine just before using. Inject all the diluent into the vaccine vial and agitate the vial to ensure thorough mixing follow the specific instructions provided in the product information. Use all of the diluent supplied for a single dose and then draw up all of the vaccine after it is thoroughly reconstituted.
Changing the needle between drawing vaccine from the vial and administering the vaccine is not necessary unless the needle is contaminated or damaged. For additional information on reconstituted vaccines, see Preparing Reconstituted Vaccine [1 page] and Vaccine with Diluents: How to use them [1 page]. The BUD is the date or time after which the vaccine should not be used. It may not be the same as the expiration date printed on the vial by the manufacturer.
The BUD varies among vaccines and can be found in the package insert. Check the package insert to determine if the vaccine has a BUD and for the correct time frame e. If the reconstituted vaccine is not used immediately, write the BUD and your initials on the label and store it properly.
Prepare vaccine just prior to administration. Agitate the vial to mix the vaccine thoroughly and obtain a uniform suspension prior to withdrawing each dose. Whenever solution and container permit, inspect the vaccine visually for discoloration, precipitation or if it cannot be re-suspended prior to administration. If problems are noted e. Standard medication preparation guidelines should be followed for drawing a dose of vaccine into a syringe. A vaccine dose should not be drawn into the syringe until it is to be administered.
The cap on top of a vaccine vial functions as a dust cover. Once removed, cleansing the exposed rubber stopper with a pre-packaged sterile alcohol wipe is recommended. Do not enter a vial with a used syringe or needle. Once the syringe s are filled, label the syringe with the type of vaccine. Administer the doses as soon as possible after filling. CDC recommends that providers draw up vaccines only at the time of administration.
Do NOT predraw doses before they are needed. See Vaccine Preparation in the Storage and Handling chapter Medications packaged as single-use vials or syringes should never be used for more than one patient. Single-dose vials and manufacturer-filled syringes are designed for single-dose administration and should be discarded if vaccine has been withdrawn or reconstituted and subsequently not used within the time frame specified by the manufacturer. Vaccines should never be combined in a single syringe except when specifically approved by the FDA and packaged for that specific purpose.
Most combination vaccines will be combined by the manufacturer. As of March , there are two binary vaccines i. Vaccine should never be transferred from one syringe to another.
Partial doses from separate vials should not be combined to obtain a full dose. Both of these practices increase the risk of contamination. Instilling air into a multidose vial prior to withdrawing a vaccine dose may not be necessary.
The recommended route and site for each vaccine are based on clinical trials, practical experience and theoretical considerations. There are five routes used to administer vaccines. Deviation from the recommended route may reduce vaccine efficacy or increase local adverse reactions. RV1 Rotarix requires reconstitution prior to oral administration.
Oral vaccines should generally be administered prior to administering injections or performing other procedures that might cause discomfort. Care should be taken not to go far enough back to initiate the gag reflex. Never administer or spray squirt the vaccine directly into the throat.
ACIP does not recommend readministering a dose of rotavirus vaccine to an infant who regurgitates, spits out, or vomits during or after administration. No data exist on the benefits or risks associated with readministering a dose. The infant should receive the remaining recommended doses of rotavirus vaccine following the routine schedule.
The vaccine dose 0. A plastic clip on the plunger divides the dose into two equal parts. The patient should be seated in an upright position with head tilted back.
Instruct the patient to breathe normally. The tip of the nasal sprayer should be inserted slightly into the nostril. Half of the contents of the sprayer 0. The dose-divider clip is then removed and the procedure is repeated in the other nostril.
The dose does not need to be repeated if the patient coughs, sneezes, or expels the dose in any other way. It is possible for the LAIV spray to cause low-level contamination of the environment with vaccine virus, but there have been no reports of vaccine virus transmission by this route.
No instances of illness or attenuated vaccine virus infections have occured among inadvertently exposed health-care personnel or immunocompromised patients. Health-care personnel at increased risk for influenza complications, including those with underlying medical conditions, pregnant women, persons 50 years of age or older, or with immunosuppressive conditions, may safely administer LAIV. The only exception is personnel with immunosuppression severe enough to require a protective environment e.
However, healthcare personnel with this level of immunosuppression are not likely to be administering any vaccines. Subcutaneous injections are administered into the fatty tissue found below the dermis and above muscle tissue.
Tools and Techniques of Administration]. Bertram J. Black. The author is Assistant Executive Director of the Jewish Board of Guardians, New York, N. Y. When special administration techniques are required, there are several considerations that must be assessed before establishing that a technique is achievable. Acta Oncol. ;35(2) Different intravenous administration techniques for 5-fluorouracil. Pharmacokinetics and pharmacodynamic effects. Larsson.