10. Vaccine Administration

Objectives

a. Review the Rights of Medication Administration adapted for vaccines.
b. Describe the steps for proper vaccine administration.
c. Describe how to prepare a vaccine from a single-dose vial.
d. Describe how to prepare a vaccine from a multidose vial.
e. Describe how to prepare a vaccine in a manufacturer-filled syringe.
f. Describe proper vaccine reconstitution using the diluent supplied with the vaccine.
g. Identify the recommended sites for intramuscular, subcutaneous, intranasal, and oral vaccine administration.
h. Identify age-appropriate sites for administration of vaccine.
i. Identify age-appropriate needle lengths and gauges for administration of vaccine.
j. Describe proper administration of vaccines via the intramuscular, subcutaneous, intranasal, and oral routes.
k. Describe age-appropriate patient positioning when administering vaccines.
l. Describe strategies to prevent syncope (specifically among adolescents).
m. Describe techniques to reduce procedural pain associated with vaccination.
n. Describe best practices to prevent vaccine administration errors.
o. Locate resources on current vaccine administration practice.
p. Discuss the role of mass administration of vaccines (during a public health emergency or an influenza vaccination clinic).
q. Describe nursing roles and responsibilities related to administration: vaccine administration or supervision of vaccine administration, educator, care coordinator, records manager, and lifelong learner.
Web pages
American Academy of Pediatrics (AAP)–Immunization: Vaccine Administration
CDC Injection Safety–Information for Providers
CDC Vaccines and Immunizations

 
Immunization Action Coalition (IAC)
Institute for Safe Medication Practices (ISMP)–Recommendations for Practitioners to Prevent Vaccine Errors,
Part 2: Analysis of ISMP Vaccine Errors Reporting Program (VERP)
HANDOUTS
CDC Vaccines and Immunizations

​Intramuscular Influenza (Flu) Vaccination Infographic ​
Recommended and Minimum Ages and Intervals Between Vaccine Doses
​(Shingrix) Shingles Vaccine Fact Sheet for Healthcare Providers  

jOURNAL articles
  • Hibbs BF, Miller ER, Shimabukuro T. Notes from the field: rotavirus vaccine administration errors—United States, 2006–2013. MMWR Morb Mortal Wkly Rep. 2014;63(4):81.
  • Su JR, Miller ER, Duffy J, Baer BM, Cano MV. Notes from the field: administration error involving a meningococcal conjugate vaccine—United States, March 1, 2010–September 22, 2015. MMWR Morb Mortal Wkly Rep. 2016;65:161–162.
  • Taylor L, Greeley R, Dinitz-Sklar J, Mazur N, Swanson J, Wolicki J, Perz J, Tan C, Montana B. Notes from the field: injection safety and vaccine administration errors at an employee influenza vaccination clinic—New Jersey, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(49):1363–1364.
lEARNING mODULES
CDC Epidemiology and Prevention of Vaccine-Preventable Diseases (Pink Book) webinar series–Vaccine Storage and Handling and Administration
EZIZ website–Vaccine Administration Lessons
Nursing Initiative Promoting Immunization Training (NIP-IT) Module 5: Vaccine Administration
videos
CDC YOUTUBE CHANNEL
Assemble a Manufacturer-Filled Syringe
Vertical Divider
Beyond Use Date (BUD)
Vertical Divider
Comfort and Restraint Techniques
Documentation of Vaccinations After Administration
Intramuscular (IM) Injection: Sites
Intramuscular (IM) Injection: Supplies (Children Birth Through 18 Years of Age)
Intramuscular Injection: Supplies (Adults 19 Years of Age and Older)
Live, Attenuated Influenza Vaccine (LAIV)
Reconstitute Lyophilized Vaccine
Subcutaneous (SC or Subcut) Injection: Administration
Subcutaneous (SC or Subcut) Injection: Sites
Subcutaneous (SC or Subcut) Injection: Supplies
BOOKS
  • American Academy of Pediatrics. Active and Passive Immunization. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases, 31st ed. Itasca, IL: American Academy of Pediatrics; 2018:1–111.
  • CDC. Vaccine Administration. In: Hamborsky J, Kroger A, Wolfe S, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th ed. Washington, DC: Public Health Foundation; 2015:79–105. Available at www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html.
  • Fraser, D. Health Problems of Infants. In: Hockenberry MJ, Wilson D, Rodgers CC, eds. Wong’s Essentials of Pediatric Nursing, 9th ed. St. Louis, MO: Elsevier Health Sciences; 2012:228–307.
  • Marshall G. General Recommendations. In: Marshall G. The Vaccine Handbook: A Practical Guide for Clinicians, 5th ed. West Islip, NY: Professional Communications, Inc.; 2015:129–144.
  • Marshall G. Vaccine Practice. In: Marshall G. The Vaccine Handbook: A Practical Guide for Clinicians, 5th ed. West Islip, NY: Professional Communications, Inc.; 2015:101–128.
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