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Follow instructions for SARS-COV2 vaccine administration provided on Elsevier’s Vaccination Hub https://elsevier.health/en-US/preview/sars-cov2-vaccine or Clinical Key for Nursing https://www.clinicalkey.com/nursing/#!/content/drug_monograph/6-s2.0-5295.
Take steps to eliminate interruptions and distractions during medication preparation.
Take extra care with a patient who takes medications that increase the risk for bleeding.9
Vaccination typically begins shortly after birth and continues into adulthood. During infancy and childhood, vaccine administration is more frequent, and multiple vaccines are typically administered, according to the recommended immunization schedule.4 If vaccines are missed, there are alternative schedules available to make up for the needed vaccines;3 however, this also means that the child may receive more vaccinations in one visit. During adolescence and into adulthood, the frequency of immunizations decreases; however, the human papillomavirus (HPV) vaccine is typically added for this age group. During young and middle adulthood, the frequency of scheduled vaccinations decreases. Additional booster vaccines may be given depending on the age at that initial immunization.2 By late adulthood, the addition of the pneumococcal vaccine (PCV) is recommended for those 65 and over. During pregnancy and while breastfeeding, there are certain vaccines that could pose a risk to the fetus and therefore are not recommended.1 As with any medication, vaccine administration should be at the practitioner’s discretion.
Vaccines can be given in combination when more than one inoculant is in one prefilled syringe (e.g., measles, mumps, and rubella [MMR] vaccine). This allows more immunizations with fewer injections. Combination vaccines are those that are licensed and sold already combined in a single syringe or those combined at the point of care as recommended by the manufacturer.
Simultaneous inoculation is defined as multiple vaccines given during the same visit. Giving simultaneous vaccines can allow for fewer visits but should be balanced with the discomfort of receiving several vaccines in one day. If the family seems unlikely to return for additional vaccines or is unwilling to comply with a catch-up schedule, simultaneous vaccines should be provided.6 Consideration should be given to the patient’s age and size and to vaccines with a greater risk of causing a local reaction (e.g., PCV, diphtheria, tetanus, and pertussis [DTaP]). Two live vaccines should not be given in the same muscle mass.5,6
The manufacturer’s instructions for use should be followed for storage and administration of vaccines. Prefilled syringes are considered activated once the cap is removed or a needle is attached. Activated vaccines should be used by the end of the facility’s day and then discarded. Activation should be avoided until the vaccine is needed.
There are very few strict contraindications for vaccines. Generally, a previous severe anaphylactic reaction or encephalopathy not attributable to another cause are contraindications. Precautions surrounding specific vaccines should be reviewed (e.g., live attenuated vaccines should not be given to immunosuppressed patients).
There are several routes by which vaccines may be given. These include oral, intramuscular (IM), intradermal, subcutaneous (Figure 1), and intranasal. The manufacturer’s instructions should be followed for recommended routes. For IM injections, the anterolateral aspect of the thigh (vastus lateralis muscle) (Figure 2) is recommended for infants (up to 12 months old) as the largest muscle mass. For children more than 12 months old and adults, the upper outer aspect of the deltoid (Figure 3) is recommended.6 For subcutaneous injections, the skin over the lateral thigh or upper outer aspect of the upper arm is recommended. The Centers for Disease Control and Prevention’s (CDC’s) guidelines should be followed for needle sizes and lengths according to age and muscle size.7
Adverse reactions rarely occur after vaccinations but may include anaphylaxis, anaphylactic shock, and neurologic deficits.6 Vaccine adverse event reporting is monitored by the CDC.
If the patient expresses concern regarding the accuracy of a medication, the medication should not be given. The patient’s concern should be explored, the practitioner notified, and the order verified.
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Do not use any medication that is cloudy or precipitated unless such is indicated by its manufacturer as being safe; otherwise, this may lead to harmful reactions.
Rationale: A comfortable position reduces strain on the muscle and minimizes injection discomfort.
Rationale: A vapocoolant spray decreases pain at injection site.
Rationale: Massage damages underlying tissue.
Rationale: Discarding the uncapped needle helps prevent injury to the patient and health care team members. Recapping needles increases the risk for a needlestick injury.
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