ROP Breaking News: Vaccine Refresher
Vanessa Cardy, MD
- This is a refresher as with the pandemic many of us are being called on to help with vaccine administration
- This information applies to adult vaccinations
- Majority of adult vaccinations are given via the intramuscular (IM) route, however, there can be intranasal and oral routes
- Always read about the vaccine specific dosing, indications and contra-indications before administering one to a patient
- Informed Consent
- Explain the purpose of the vaccination
- Outline local vs systemic risks of vaccine (examples below)
- Pain, swelling, redness
- Bleeding at the site
- Infection at the site
- Nerve damage
- Determine if patient has a history of allergies, to medications or other vaccinations
- Ask if patient has any questions or concerns
- For most adults choose a 22-25 gauge, 1- 1 ½ inch needle
- Draw up vaccine from vial or reconstitute vaccine with diluent
- Have epinephrine available
- Be prepared to deal with vasovagal episode
- Consider pre-treatment with topical anesthesia or ice for pain control
- Make distractions available if needed (music, meditation, etc)
- Have patient relax their arm
- Identify target for injection (usually the deltoid for adults receiving IM injection)
- Clean target site with alcohol swab
- Place needle at 90 degrees to skin
- Warn patient of imminent injection
- Inject vaccine
- Remove needle and cover area with bandaid if needed
- All patients to be monitored for 15 minutes (monitor for signs of allergy/anaphylaxis, vasovagal reaction or other local and systemic concerns)
- Document anatomic location of vaccine as well as lot and expiration date of vaccine in patient’s chart
- As patient leaves remind them of local and systemic effects for which to monitor, and give advice on how to deal with mild pain, swelling and local grade fever (ice, acetaminophen, ibuprofen)
ACIP Vaccine Administration Guidelines for Immunization | Recommendations
Vaccine Administration - General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP)
Determination of deltoid fat pad thickness. Implications for needle length in adult immunization.
Poland GA, Borrud A, Jacobson RM, McDermott K, Wollan PC, Brakke D, Charboneau JW. JAMA. 1997 Jun 4;277(21):1709-11. PMID: 9169899.
Infectious Diseases Society of America. Immunization programs for infants, children, adolescents, and adults: clinical practice guidelines by the Infectious Diseases Society of America.
Pickering LK, Baker CJ, Freed GL, Gall SA, Grogg SE, Poland GA, Rodewald LE, Schaffner W, Stinchfield P, Tan L, Zimmerman RK, Orenstein WA; Clin Infect Dis. 2009 Sep 15;49(6):817-40. doi: 10.1086/605430. Erratum in: Clin Infect Dis. 2009 Nov 1;49(9):1465. PMID: 19659433.
Ian L. - January 10, 2021 1:51 PM
With very nervous vasovagal prone patients they can have the vaccine lying on a surgical height adjustable couch head elevated 20 degrees an allowed to lie on couch for five minutes then slowly sat up . -Do you aspirate for blood ? -With the needle ought it be inserted fully ? -Focussing on Covid 19 after how many days do the antibody levels increase to give some protection after the first vaccine ?
Vanessa C. - January 12, 2021 10:34 AM
Thanks for the suggestions about seating options. Can definitely be helpful for those patients who are known for bad vasovagal reactions to needles! For the vaccination itself you don't need to aspirate for blood as the deltoid is far away from the major vessels of the upper arm. With regards to the depth of needle insertion, that will depend a bit on your patient and both the amount of adipose tissue in their upper arm and the size of their deltoid. Basically, you need to insert far enough to get the vaccine into the muscle.
With regards to the questions on COVID-19 vaccines itself I will refer you to some of our COVID resources on the EM:RAP site for more detailed information but for Pfizer vaccine itself here are few details from the NEJM paper from Dec 2020. Within interval of 1st and 2nd doses there was apparently 52% observed vaccine efficacy, and in first 7 days after the second dose this went up to 91% observed efficacy before reaching max efficacy after that time.
Thanks again for listening