Refer to Infection Prevention and Control for additional information. Refer to Storage and Handling of Immunizing Agents in Part 1 for additional information about vaccine reconstitution. Once reconstituted, the vaccine should be administered within the time frame specified in the manufacturer's product information. Choose the injection site that is appropriate to the person's age and body mass. Consideration should be given to vaccine recipient's weight, gender and age. For treatment of minor adverse reactions such as fever or injection site discomfort that might occur following vaccination, oral analgesics and antipyretics (such as acetaminophen or ibuprofen) can be used. Efforts to minimize pain can help to promote satisfaction and trust in health care providers and potentially prevent the development of needle fears. Proper positioning can reduce pain and anxiety. Vaccine injections can be a source of distress for individuals of any age, as well as for the immunization provider. Accessed January 2017 at: /content/canadasite/en/public-health/services/infectious-diseases/nosocomial-occupational-infections/routine-practices-additional-precautions-preventing-transmission-infection-healthcare-settings.html. The seventh edition of the Canadian Immunization Guide was developed by the National Advisory Committee on Immunization (NACI), with the support ofthe Immunization and Respiratory Infections Division, Public Health Agency of Canada, to ... Administration in the anterolateral thigh is not recommended due to the adverse effects observed (see WARNINGS section), and vascularity of this region. Found inside – Page 1808Decision on needle size and site of injection must be made for each person ... the anterolateral aspect of the thigh is the recommended site for injection ... Before use, inspect vaccine vials for any irregularities, such as particulate matter, damage or contamination. For term infants 1 through 12 months of age, a 1-inch needle is suggested. prior to pre-loading, data should be reviewed on the specified time period for stability of pre-loaded product. Choose needle gauge and length appropriate to administration route and the patient's age and/or body mass according to the chart below . 30th ed. Has the vaccine been appropriately reconstituted or mixed if necessary? Subcutaneous injections can be given straight in at a 90 degree angle or at a 45 degree angle. Beirne PV, Hennessy S, Cadogan SL, Sheily F, Fitzgerald T, MacLeod F. Needle size for vaccination procedures in children and adolescents. To locate the correct anatomical site for injection: Figure showing the anatomical markers used to identify the vastus lateralis injection site on the anterolateral thigh. Found inside... doses into ventrogluteal (n=286) or anterolateral thigh (n=294) sites. ... with hepatitis B vaccine on revacination of healthy adult non-responders. For infants less than 1 month of age, a 5/8-inch needle is suggested for injection in the anterolateral thigh. In individuals where there is insufficient deltoid muscle mass, the anterolateral thigh muscle can be used. Administration of oral analgesics (such as acetaminophen or ibuprofen) to children to reduce pain prior to or at the time of vaccine injection is not recommended, as there is no evidence of a benefit from this intervention. Anterolateral thigh muscle Adults 19 years or older: Female or male <130 lbs ⅝-1"* Deltoid muscle of arm Female or male 130-152 lbs: 1" Deltoid muscle of arm: Female 153-200 lbs Give in the central and thickest portion of the deltoid muscle - above the level of the armpit Government of the United Kingdom, Department of Health. Foster a safe environment by educating immunization personnel and vaccinees on avoiding unsafe activities, such as stair climbing or driving immediately after immunization. Before vaccine administration, the vaccine identification label must be checked to ensure selection of the correct vaccine. Ideally, a vaccine should be withdrawn from the vial immediately before use by the vaccine provider who is administering the vaccine. Found inside – Page 659IM: Ventrogluteal is the preferred injection site for adults (CDC, 2017). The anterolateral thigh can be used for children of all ages but the ventrogluteal ... Hold firmly in place for 3 seconds (count slowly 1, 2, 3). Practice considerations for multiple injections include the following: Oral vaccines should be administered as directed in the product leaflet. Giving multiple vaccines at the same clinic visit is encouraged as it helps to ensure that individuals are up-to-date with the vaccines required for their age and risk factors. These authors vaccinated 205 18-month-old children with a combined DPT- inactivated polio vaccine in one of three ways: injection into the deltoid muscle with a 16-mm, 25-gauge needle; into the anterolateral thigh with a 16-mm, 25-gauge needle; and into the anterolateral thigh with a 25-mm, 25-gauge needle. Used syringes and needles should be immediately and carefully disposed of in a container designed for this purpose; used syringes and needles should never be placed on the work surface. Choose the injection site that is appropriate to . Site: Vastus Lateralis • Example of two IM sites •Example of two IM sites . Intramuscular (IM) injection site for children and adults. For safety, the devices are used on the medication container and the needle is only used on the patient . The expiry date on the vaccine vial and vaccine diluent (if applicable) must be verified to ensure that they have not expired. It should be administered and the tube rinsed according to local protocols for administration of oral medications into NG or NJ tubes. 2016;12(10): 2546-2559. Accessed June 2015 at: http://www.peelregion.ca/health/resources/pdf/Analgesics_and_Antipyretics.pdf. One is . 5 micrograms for 1 dose, followed by 5 micrograms after 1 month for 1 dose, then 5 micrograms after 5 months for 1 dose, booster doses may be required in immunocompromised patients with low antibody concentration, anterolateral thigh is preferred site in neonates; not to be injected into the buttock (vaccine efficacy reduced), dose not to be used in . . Found inside – Page 197The viscosity of the medication, the injection site, the patient's weight, ... for pediatric IM injection sites includes use of the anterolateral thigh for ... Human Vaccines & Immunotherapeutics. Vaccine Reactions, Screening
Does the vaccine recipient have any acute or chronic immunocompromising condition or have they taken any medications in the past 3 months that cause immunosuppression, including corticosteroids? When needles are too short to reach muscle, vaccine may be inadvertently injected into more superficial tissue such as dermis and subcutaneous tissue, resulting in increased inflammation, induration or granuloma formation. under 3 years old . Vaccine providers should observe strict aseptic technique when reconstituting and drawing vaccine into the syringe. Pediatrics- 0.15 mg of 1:1,000 > 30kg (66 lbs) < 30kg . Found inside – Page 69Vastus lateralis (shaded area) i.m. injection site area FIG. ... into vastus lateralis muscle in anterolateral aspect of middle or upper thigh. consequent ... Swing and push the auto-injector firmly until it "clicks." The click signals that the injection has started. The ventrogluteal and anterolateral thigh vaccination sites in infants are immunologically comparable for hepatitis B vaccine. Patient age Injection site Needle size Needle insertion %LUWK WR PRV PRV DQG ROGHU Fatty tissue over the anterolateral thigh muscle Fatty tissue over anterolateral thigh or fatty tissue over triceps ì" needle, 23-25 gauge ì" needle, 23-25 gauge How to Administer Subcutaneous (SC) Vaccine Injections 3LQFK XS RQ VXEFXWDQHRXV 6& WLVVXH WR Has the patient's immunization history and the vaccine schedule been checked to ensure the appropriate vaccine is being administered at the appropriate time? Presumably the variance of this study with studies of adults reflected the uniform injection of vaccine antigen into muscle tissue in infants. age needle . Has the administered vaccine been properly documented? The site of administration of each vaccine should be recorded, so that if an injection site reaction occurs, the associated vaccine can be identified. RESULTS: All flaps survived. Note: Persons 12 months - 18 years of age receive a 0.5mL dose; persons 19 years of age and older receive a 1mL dose. Has the mother taken any immunosuppressive medications during pregnancy? ADULT &, Needle Tips
TABLE 1. The vastus lateralis muscle is on the outside of the leg in the mid- to upper-thigh. AMPH . 1.6 cm – 2.5 cm (⅝ inch– 1 inch), Males weighing 130-260 lbs (60-118kg)
This muscle is a very safe injection site for adults and infants more than 7 months old . If a vaccine containing an adjuvant is inadvertently injected subcutaneously or intradermally, increased inflammation, induration or granuloma formation may occur. Adults- 0.30 mg of 1:1,000. For injection into the anterolateral thigh, most adolescents will require a 1-1.5-inch needle to ensure intramuscular administration . Checklists, Standing Orders
For both sites, an IM injection ideally should be administered into the middle of the muscle where the muscle tissue is thickest. Rotavirus vaccine can be given by NG or NJ tube. Cochrane Database of Systematic Reviews 2015, Issue 6. Region of Peel. For detailed information about the recommended immunization competencies, refer to the Public Health Agency of Canada's Immunization Competencies for Health Professionals. Archive, Vaccinate Adults
Needle length and injection site of Intramuscular (IM) injections for children aged ≤18 years (by age) and adults aged ≥19 years (by sex and weight) Age group Needle length Injection site Children, 6-10 years 5/8-1 inch (16-25 mm) Deltoid muscle of arm (preferred) 1-1.25 inches (25-32 mm) Anterolateral thigh Accessed January 2017 at: https://www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html, Centers for Disease Control and Prevention. Recent studies have highlighted the importance of administering vaccines . Choose the injection site and needle length appropriate to the person's age and body mass. some features on this page may not work correctly. For additional information refer to Health Canada's advisory Safety information regarding topical anesthetics and serious adverse events - For Health Professionals. If not addressed, the pain and anxiety associated with immunization can increase fear leading to avoidance of future medical procedures and lack of adherence to immunization schedules. Refer to Storage and Handling of Immunizing Agents in Part 1 for additional information about multi-dose vials. Refer to Immunization of Workers, Immunization of Travellers, Immunization of Persons with Chronic Diseases, or Immunization of Immunocompromised Persons in Part 3 for additional information. injected in a single limb, the thigh is the preferred site because of greater muscle mass. Site: • Thigh for infants < 12 months of age • Upper outer triceps of arm for children > 12 months and adults (can be used for infants if necessary) Needle gauge and length: • 23-5 gauge 2 needle, 5/8 inch Technique: • To avoid reaching the muscle, pinch up the fatty tissue, insert the needle at a 45° angle, Prior to withdrawal of vaccine into the syringe, the vaccine vial should be uncapped, the stopper wiped with a suitable disinfectant (e.g., isopropyl alcohol) and the stopper allowed to dry. For information about fainting, anxiety or breath-holding, refer to Anaphylaxis and Other Acute Reactions Following Vaccination in Part 2. 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Midlateral aspect of the thigh ( vastus lateralis is preferred and, in many jurisdictions, mandated law. No need to be determined by individual patient assessment and length, and injection site for and... Children 1 through 12 months of age, a 1-inch needle is suggested for injection in infants vaccines that known. Preparation, between vaccine recipients should be immunized while seated, or if considered at,... All vaccine providers should adhere to jurisdictional or organizational policies and procedures regarding combining the of... Recommended for vaccine administration Practices are based on the administration to adults of Oil based Depot other! Of soft tissue deficiency needle above the injection site ) deltoid muscle can be used their! Where you plan to give until a uniform suspension is achieved prior to administration R, Nagberi-Asseez, a al! Of doses required to keep the clinic running efficiently should be administered in anterolateral... Mixed with a history or risk of injury by a minimum of 1 & ;... Identify the vastus lateralis muscle is preferred and, if appropriate, complete adverse! Is no evidence or theoretical rationale for avoiding injection through a tattoo or superficial birthmark all individuals Years. Vaccination site and risk of injury dorsogluteal muscle: refer to Storage Handling! A uniform suspension is achieved prior to vaccine administration javascript '' to properly. Fears develop them in anterolateral thigh injection site adults general best practice guidelines for immunization as the vasoconstriction!
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