Administering Vaccines |
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General Issues |
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Notation: Specific information about the assistants of most vaccines is included in the Ask The Experts set for that vaccine. For additional questions and answers about routine vaccination during the COVID-19 pandemic, please see the COVID-19 and Routine Vaccination department of Enquire the Experts, www.immunize.org/askexperts/experts_covid19.asp. For questions and answers about COVID-nineteen vaccination, delight come across the COVID-19 vaccine section of Ask the Experts, www.immunize.org/askexperts/experts_cov.asp. |
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I was recently told past a colleague that pregnant healthcare personnel were non to administer live vaccines to others. I had never heard that in school or practise. Is that truthful? |
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This is not true. Pregnant healthcare personnel may administer any vaccine except smallpox vaccine. |
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Is it acceptable to administer vaccines in the nurses' station where vital signs and other patient care is performed? |
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Yes. Vaccines can be administered in a patient intendance area. The recommendation from CDC'southward safe injection practices experts is that storing and preparing vaccines should non exist done in the same expanse where patient intendance is conducted. These activities should be done in a separate area. |
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What is the appropriate anatomic site and needle length for intramuscular and subcutaneous vaccine injection? |
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Appropriate site and needle length depends on age, road of injection, and torso mass. Most injected vaccines are administered by the intramuscular route. |
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Please refer for details to the IAC handouts on administering intramuscular and subcutaneous vaccines to children and adults at www.immunize.org/catg.d/p2020.pdf and to adults only at www.immunize.org/catg.d/p2020a.pdf. |
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A summary of needle length and site selection by age is below. |
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For intramuscular injections (apply a 22- to 25-approximate needle for all ages): |
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• | | For neonates (first 28 days of life) and preterm infants the anterolateral thigh should be used. A ⅝-inch needle usually is adequate to penetrate the thigh muscle if the pare is stretched flat between the pollex and forefinger and the needle is inserted at a 90-degree angle to the pare. | | | | • | | The anterolateral thigh is preferred for infants younger than age 12 months. For the bulk of infants a 1-inch needle is sufficient. | | | | • | | For toddlers age 12 months through two years the anterolateral thigh muscle is preferred. The needle should exist at least 1 inch long. The deltoid muscle can be used if the muscle mass is adequate. | | | | • | | For children age 3 through x years, the deltoid musculus is preferred; the needle length for deltoid site injections can range from ⅝ to 1 inch on the basis of technique. The anterolateral thigh can also be used. In this case the needle length should be 1 inch to one.25 inches. | | | | • | | For adolescents 11 through 18 years, the deltoid muscle is preferred. The anterolateral thigh can also be used. For injection into the anterolateral thigh, most adolescents will require a i-1.5-inch needle. | | | | • | | For adults age 19 years and older, the deltoid muscle is preferred. The anterolateral thigh also can exist used. | |
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� | | For men and women who weigh less than 130 pounds (less than 60 kg), a ⅝-inch needle is sufficient to ensure intramuscular injection in the deltoid muscle if the injection is made at a xc-degree bending and the tissue is not bunched. | | | | � | | For men and women who counterbalance 130–152 pounds (60–70 kg), a 1-inch needle is sufficient. | | | | � | | For women who weigh 152–200 pounds (70–xc kg) and men who weigh 152–260 pounds (lxx–118 kg), a 1- to 1�-inch needle is recommended. | | | | � | | For women who weigh more than 200 pounds (more than 90 kg) or men who weigh more than than 260 pounds (more than 118 kg), a ane�-inch needle is recommended. | |
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For subcutaneous injections (use a 23- to 25-guess needle for all ages): |
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Subcutaneous injections are administered at a 45-degree bending, usually into the thigh for infants younger than age 12 months and in the upper-outer triceps area of people age 12 months and older. Subcutaneous injections may be administered into the upper-outer triceps area of an infant if necessary. A ⅝-inch needle length should be used for all ages. |
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More information on injection technique is in the ACIP General Best Practices Guidelines for Immunization, available at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/administration.html. |
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Why are some vaccinations given subcutaneously (SC) while others must be given intramuscularly (IM)? |
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In general, vaccines containing adjuvants (a component that enhances the antigenic response) are administered IM to avoid irritation, induration, pare discoloration, inflammation, and granuloma formation if injected into subcutaneous tissue. This includes most of the inactivated vaccines, with a few exceptions (such as IPV and pneumococcal polysaccharide vaccines, which may be given either SC or IM). Vaccine efficacy may also exist reduced if non given by the recommended road. |
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A 5 year onetime came in today for her preschool vaccines. She needed MMR and varicella. She has a broken arm which is in a bandage. Can the anterolateral thigh be used to administer a subcutaneous vaccine in a v year old? |
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Yes. There is no historic period limit for utilise of the anterolateral thigh for either subcutaneous or intramuscular vaccines. |
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I have a 2-calendar month-old child with a bandage for hip dysplasia that completely covers the entire anterolateral thigh on both legs. She is not due to have it removed for 10 weeks. What options practice we take for her injectable vaccines? |
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Ideally, you can suit to take the bandage cut to administer vaccines in the anterolateral thighs. If that option is not available, the gluteal region can be used if not covered by the cast. There are no other sites we recommend for vaccination; however, the inactivated polio vaccine could be given subcutaneously in either arm, if the child is big enough. Rotavirus vaccine is given orally and should be administered. If vaccines cannot be given for the 10 weeks, delight propose the family to keep people with whatsoever illness away from the child until she has been vaccinated. More information see ACIP'due south General Best Practices Guidelines for Immunization, available at world wide web.cdc.gov/vaccines/hcp/acip-recs/full general-recs/administration.html. |
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I demand data about the administration of vaccines to 3-month-old conjoined twins (joined at the buttocks). For their routine immunization, do we provide one fix of vaccinations or two, given that they are conjoined at the buttock simply share no major organs? |
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ACIP does not accost this issue. Nevertheless, CDC recommends that these children should each exist vaccinated, notwithstanding they are conjoined. Nosotros believe even in conjoined twins who share organs and/or blood supply, vaccination of each kid would likewise exist indicated. The rationale is one cannot be sure, even in the latter case, that the common organs/claret supply would eliminate vaccine antigens less quickly, or the immune system(due south) would respond adequately, to one dose of each vaccine for the two children. Therefore two doses seems appropriate, that is, one dose of each vaccine for each child. |
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If I need to requite more 1 injection in a muscle, are certain vaccines best given at different anatomic sites? |
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Since DTaP and pneumococcal cohabit (PCV) are the vaccines most likely to crusade a local reaction, it is prudent to requite DTaP and PCV in carve up limbs (if possible), so there is no confusion about which vaccine caused the reaction. |
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How many vaccines can exist given during an office visit? |
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With rare exceptions*, all vaccines tin exist administered at the same visit. At that place is no upper limit for the number of vaccines that tin can be administered during 1 visit. ACIP and AAP consistently recommend that all needed vaccines be administered during an office visit. Vaccination should not be deferred because multiple vaccines are needed. All live vaccines (MMR, varicella, live adulterate flu, yellow fever, and oral typhoid) can exist given at the same visit if indicated. If live vaccines are not administered during the same visit, they should exist separated past 4 weeks or more. |
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When giving several injections at a single visit, split IM vaccines past at least i inch in the torso of the muscle if possible to reduce the likelihood of local reactions overlapping. Here are some helpful site maps for unlike ages and then you lot tin record where shots were given: |
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For infants and toddlers: eziz.org/assets/docs/IMM-718.pdf |
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For older children: www.aimtoolkit.org/docs/Giving_all_the_doses_12mths.pdf |
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For adults: world wide web.eziz.org/assets/docs/IMM-718A.pdf |
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For details run into ACIP's Full general All-time Practices Guidelines for Immunization, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html. |
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*There are 3 exceptions to this general rule: ane) if both pneumococcal conjugate vaccine (PCV13, Prevnar 13, Pfizer) and pneumococcal polysaccharide vaccine (PPSV23, Pneumovax 23, Merck) are indicated for a high-risk patient, these vaccines should not be given at the same visit. The PCV13 should be given beginning followed past PPSV23 at least 8 weeks afterwards. If PPSV23 has already been given, expect eight weeks (for a kid) or 1 year (for an adult historic period 19 years or older) before giving PCV13 to avoid interference betwixt the two vaccines. 2) A person with anatomic or functional asplenia or HIV should receive both PCV13 and meningococcal ACWY (MenACWY) vaccines. If Menactra make (Sanofi) MenACWY is used, the person should start receive all recommended doses of PCV13 followed by Menactra at least four weeks afterwards. Menveo (GSK) or MenQuadfi (Sanofi) MenACWY brands can be given at the aforementioned time or at whatever fourth dimension earlier or afterward PCV13. 3) Cholera vaccine should exist administered before TY21a vaccine, and viii hours should carve up cholera vaccine and the first dose of TY21a. |
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A 5-yr-old is in the part for vaccines and is due for MMR, polio, varicella, and DTaP. Is there a specific order I should exist giving these vaccines? |
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The Advisory Commission on Immunization Practices (ACIP) does not accost this issue. There is no recommended order in which the vaccines should be given. A all-time practice strategy to subtract injection or procedural pain is to administer the vaccine that causes the most pain (stinging, for example) terminal. For more data on vaccine administration, please run across the "Vaccine Administration" chapter of Epidemiology and Prevention of Vaccine-Preventable Diseases at www.cdc.gov/vaccines/pubs/pinkbook/chapters.html. |
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Do nosotros demand to wait for the vaccine to reach room temperature before we administer it to a patient? |
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There is no recommendation to expect until a vaccine reaches room temperature earlier administration. The vaccine should be administered as soon every bit it is prepared. |
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What is the adequate volume for a single dose of allowed globulin (IG) to inject into the deltoid muscle of a normal-weight developed? What is the acceptable volume for a single dose of IG to inject into the vastus lateralis of a normal-weight adult? |
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Here are the suggested volumes: |
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Deltoid: |
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• | | Average 0.v mL | | | | • | | Range 0.5–2 mL | |
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Vastus Lateralis: |
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• | | Average ane–4 mL | | | | • | | Range 1–5 mL | |
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Infants and toddlers would fall at the lower finish of the range, whereas adolescents and adults would mostly fall on the college end of the range. |
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If all needed vaccines aren't administered during the same visit, does one need to wait a certain catamenia of fourth dimension before administering the other needed vaccines? |
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All inactivated vaccines, including COVID-19 vaccines, tin can be given on the same mean solar day, or on any mean solar day earlier or subsequently giving other inactivated or live vaccines. Early guidance from ACIP recommended against coadministration of COVID-19 vaccines with other vaccinations; however, ACIP updated its guidance in mid-2021 to state that these vaccines may be coadministered with other vaccinations when necessary. |
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If 2 live vaccines are non given on the same mean solar day, they demand to be spaced at least 4 weeks apart. As noted above, if both PCV13 and PPSV23 are indicated for a high-risk patient, these vaccines should non be given at the same visit. The PCV13 should be given first followed past PPSV23 at least viii weeks afterward. If PPSV23 has already been given, wait eight weeks (for a child) or 1 year (for an adult age xix years or older) before giving PCV13 to avert interference betwixt the 2 vaccines. A person with anatomic or functional asplenia should receive both pneumococcal cohabit vaccine (PCV13) and meningococcal conjugate vaccines (MenACWY). If Menactra brand MenACWY is used the person should first receive all recommended doses of PCV13 so Menactra at least 4 weeks later. Menveo or MenQuadfi brands of MenACWY can be given at the same fourth dimension or at any fourth dimension before or after PCV13. |
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What does "simultaneous administration" of vaccines mean? Does information technology mean the same twenty-four hour period, 60 minutes, or what? |
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Simultaneous means the same day—the aforementioned clinic mean solar day. If someone receives a vaccine in the morning and then another that same afternoon, it would be considered simultaneous administration. |
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Some manufacturers' package inserts state that a vaccine should be used immediately after reconstitution. In the context of reconstitution and administration of vaccines, how does CDC define "immediately"? |
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There are diverse requirements for the utilise of vaccines after reconstitution. Some manufacturers' parcel inserts crave that the vaccine be used or discarded in varying fourth dimension frames ranging from 24 hours after reconstitution to immediately later reconstitution. While the specific timeframes are uncomplicated to interpret, there can exist some confusion as to what the requirement of "immediately" really means. |
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CDC considers "immediately" to exist the reasonable time it takes to prepare and send the vaccine to the patient to exist administered. This would include whatever limited documentation that may be related to this process. Information technology is up to the judgment of a provider to determine if a vaccine has not been used in the appropriate time. Some manufacturers have indicated to providers that "immediately" tin be up to 30 minutes. The definition of "immediately" varies from manufacturer to manufacturer. Some practise not have the information to put forth a full general time frame as to what "immediately" means. CDC recommends that the provider contact the manufacturer whatsoever time (s)he has any question about whether or not the vaccine has been used in the advisable time frame. |
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Does live oral cholera vaccine (Vaxchora, PaxVax) need to be administered at an interval from other live oral or injectable vaccines? |
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In general, no. According to ACIP's General Best Practice Guidelines for Immunization, concerns near spacing between doses of live vaccines non given at the same visit applies only to live injectable or intranasal vaccines. So live oral cholera vaccine may be administered simultaneously or at whatsoever interval before or after administration of most other vaccines. One exception is Ty21a oral typhoid vaccine (Vivotif, Berna) and oral cholera vaccine. Oral cholera vaccine should be administered earlier Ty21a vaccine, and at least 8 hours should split the cholera vaccine and the first dose of Ty21a. |
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We have a nurse in one of our clinics who gave divide doses of hepatitis A and hepatitis B vaccine in the gluteus. Are the doses of each antigen considered invalid? If so, can they be repeated at whatever time or do I demand to count the spacing betwixt doses from the date when the invalid dose was administered? |
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Although the gluteus muscle is non a recommended site for vaccination, in general, a dose given in that location can be considered valid. The exceptions to this general rule are hepatitis B and rabies vaccines, and then the hepatitis B vaccine should not be counted in this situation. The hepatitis B vaccine tin be repeated immediately. See the Advisory Commission on Immunization Practice's (ACIP) General All-time Practices Guidelines for Immunization, available at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/assistants.html. |
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Is the "Z-rail" method recommended for IM injections? |
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ACIP does not address the utilize of this method for vaccination in its All-time Practices Guidelines for Immunization (www.cdc.gov/vaccines/hcp/acip-recs/general-recs/assistants.html). If you choose to use this method, yous should still attach to the ACIP's recommendations regarding needle length and anatomical site. |
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Is it safe to give a vaccine directly into an area where there is a tattoo? |
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Both IM and SC vaccines may be given through a tattoo. |
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Practice you need to aspirate before giving a vaccination? |
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No. ACIP does not recommend aspiration when administering vaccines because no data be to justify the need for this exercise. In that location are data that show that aspiration is more painful for the vaccine recipient. IM injections are not given in areas where large vessels are present. Given the size of the needle and the angle at which you inject the vaccine, it is difficult to cannulate a vessel without rupturing it and even more difficult to really deliver the vaccine intravenously. Nosotros are aware of no reports of a vaccine being administered intravenously and causing damage in the absence of aspiration. |
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While giving an injection, a nurse had blood return in the syringe upon aspirating. What should she take washed with the vaccine? |
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Although aspiration is not recommended, if y'all do aspirate and get a flash of blood, and then the procedure is to withdraw the needle and showtime over. The syringe, needle, and contaminated dose of vaccine should be discarded in a sharps container, and a new syringe and needle should be used to depict upward and administer another dose of vaccine. This is a waste of expensive vaccine that could be avoided past simply not aspirating. |
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Is it necessary to clothing gloves when nosotros administer vaccinations? |
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In general, no. Occupational Safe and Wellness Administration (OSHA) regulations practice not require the wearing of gloves when administering vaccinations, unless the person administering the vaccine is likely to come up into contact with potentially infectious body fluids or has an open lesion on their hand. If a healthcare worker chooses to wear gloves, he or she must alter them betwixt each patient come across. |
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In response to the 2022 COVID-xix pandemic, CDC has recommended the apply of gloves when administering oral and intranasal vaccines to patients in communities where SARS-CoV-2, the virus that causes COVID-19, is circulating. Gloves are recommended to forbid contact with the recipient's potentially infectious mucous membranes or respiratory secretions. For more guidance on safe vaccination practices during the COVID-19 pandemic, see www.cdc.gov/vaccines/pandemic-guidance/alphabetize.html. |
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The Immunization Action Coalition (IAC) has adult a handout on protective measures to have when vaccinating during the COVID-nineteen pandemic, available at www.immunize.org/catg.d/p2009.pdf. |
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Is protective eyewear needed for those who administer vaccines so they tin can avert claret spatter? |
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ACIP does not specifically recommend center protection when administering vaccines to prevent exposure to blood spatter. |
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In response to the COVID-19 pandemic, CDC has made recommendations concerning the utilize of protective eyewear by immunization providers in communities where SARS-CoV-2, the virus that causes COVID-19, is circulating. In areas with moderate to substantial community transmission of SARS-CoV-two, healthcare providers should wear eye protection given the increased likelihood of encountering asymptomatic COVID-19 patients. In areas with no or minimal customs transmission of SARS-CoV-2, universal centre protection is considered optional, unless otherwise indicated equally a part of standard precautions. For more than guidance on safety vaccination practices during the COVID-19 pandemic, see www.cdc.gov/vaccines/pandemic-guidance/index.html. |
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The Immunization Activity Coalition (IAC) has developed a handout on protective measures to accept when vaccinating during the COVID-19 pandemic, available at www.immunize.org/catg.d/p2009.pdf. |
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It is fall 2022 and we are preparing our supplies for an immunization clinic in the context of COVID-19. Do surgical masks or cloth face coverings need to be worn in immunization settings while COVID-xix is circulating? Are N95 respirators recommended to be worn while administering any vaccinations? |
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In order to reduce the risk of exposure to SARS-CoV-ii, the virus that causes COVID-19, CDC recommends that all health care providers administering vaccines in whatever setting wear a medical confront mask at all times and that they implement policies for the use of textile face coverings by all patients age two years and older who can tolerate them. |
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Administration of oral or nasal spray vaccines is not considered to be an aerosol generating process and N95 respirators are not recommended for vaccine assistants. See the next question for links to more information. |
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Where tin can I notice current information on how to protect myself and my patients when administering vaccines during the COVID-nineteen pandemic? |
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CDC has published guidelines for safe vaccine administration during the COVID-19 pandemic that will be updated as needed. These guidelines focus on reducing the adventure of SARS-CoV-ii transmission while in the location where immunizations are being given and during vaccine administration and can be found here: www.cdc.gov/vaccines/pandemic-guidance/alphabetize.html. |
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IAC has assembled key resources, handouts and links related to COVID-nineteen and vaccination on our Vaccination and COVID-19 page, world wide web.immunize.org/vax-and-covid-19/, and in our Enquire the Experts section on COVID-19 and Routine Vaccination, at world wide web.immunize.org/askexperts/experts_covid19.asp. |
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Some unmarried-dose manufacturer-filled vaccines come with an air pocket in the syringe chamber. Do we need to expel the air pocket before vaccinating? |
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No. You do not need to expel the air pocket. The air will be captivated. This is not true for syringes that yous make full yourself; you should expel air bubbles from these syringes prior to vaccination to the extent that you tin can practice and so. |
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I've seen the recommendation stating air bubbles in manufacturer-filled syringes practice non need to be expelled. Can you lot explain why those air bubbles can be injected but air bubbles in user-filled syringes must be expelled? |
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It is not incorrect to miscarry the air from syringes filled past manufacturers, but typically information technology is such a minor amount of air (0.2cc–0.3cc) that it is CDC'southward opinion that it would non cause a problem. When the syringe is inverted during an injection, that small amount of air would typically just clear the medication from the needle. This is based on the recommendation that when the Z-track method is used for intramuscular injection of irritating medication (e.g., iron preparations), the guidance is to leave 0.2cc–0.3cc in the syringe to be sure that all of the medication leaves the needle and is not tracked back through subcutaneous tissue as the needle is withdrawn. While the Z-track injection technique is non recommended for vaccine administration, the Z-track method demonstrates the acceptability of leaving a very small amount of air in the syringe for intramuscular injections. |
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CDC does, however, recommend that when cartoon vaccine from a vial into a regular syringe, the air exist expelled considering the amount of air drawn into the syringe may be larger than the amount in a manufacturer-filled syringe. Expelling the air is part of general medication guidelines for drawing medication into a syringe. |
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If a patient is not able to receive rotavirus vaccine orally, can we give it through a Grand-tube? |
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You can give rotavirus vaccine through a tube every bit long as the child is otherwise eligible. |
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If the lymph nodes nether a patient's arm were surgically removed, should we avoid giving vaccines in that arm? |
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We are aware that some surgeons advise against vaccination in an arm where lymph nodes were dissected. ACIP does not accost this, so experience free to utilise your professional person judgment in determining whether to utilise the arm that was operated on, the other arm (if non affected), or the anterolateral aspect of the thigh, which is an adequate secondary road for adult immunization. |
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What are the special recommendations for administering intramuscular injections in people with clotting disorders? |
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This consequence is discussed in ACIP's Best Practices Guidelines for Immunization (www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html). Intramuscular (IM) injections should be scheduled before long after antihemophilia therapy or prior to a dose of anticoagulant. For both IM and subcutaneous (SC) injections, a fine needle (23 gauge or smaller) should be used and business firm pressure applied to the site, without rubbing, for at least 2 minutes. Providers should non administrate a vaccine by a road that is non approved by the FDA for that particular vaccine (e.g., administration of IM vaccines by the SC route). |
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We have a question concerning delaying vaccinations for an baby born to a heroin-addicted female parent. We had a foster parent come into our health department requesting only certain vaccines for a 3-month-old, stating that the individual doc recommends delaying the schedule due to the possible residual effects of the heroin. The baby appeared to exist healthy. |
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Heroin use or addiction of the mother is not a reason to delay vaccination of an otherwise salubrious infant. |
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Is it okay to draw up vaccines at the beginning of the shift? If it isn't, how much in accelerate can this exist done? |
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The ACIP discourages the practice of prefilling vaccine into syringes, primarily because of the increased possibility of administration and dosing errors. An exception may be considered when but a single type of vaccine is to be administered during a clinic (e.g., influenza). Some other reason to discourage the exercise in general is that some vaccines have a very limited shelf life after reconstitution. If the reconstituted vaccine is not used within the designated time period, information technology must be discarded. A chart of the time allowed betwixt reconstitution and use, "Vaccines with Diluents: How to Utilize Them," is available at world wide web.immunize.org/catg.d/p3040.pdf. For more information on prefilling syringes, delight read world wide web.immunize.org/technically-speaking/20110901.asp. |
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If you place a needle on a manufacturer-filled syringe and then don't administer the vaccine, how long can you store the syringe with the needle attached? |
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In general, a vaccine should not be prepared until the provider is ready to administer it to a patient. This is because once the syringe cap is removed or a needle is attached, the sterile seal is cleaved. However, if a sterile seal has been cleaved, staff should be certain to maintain the syringe at the appropriate temperature and either utilise it or discard it at the end of the clinic day. This effect is addressed in the CDC Storage and Handling Toolkit, available at www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storage-treatment-toolkit.pdf, page 20. |
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My nurse removed the protective cap from a preservative-free single dose vial, but the vial was not used. How long can we keep a vial of vaccine later we remove the protective cap of a preservative-free vial of vaccine? |
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Removing the protective cap increases the likelihood the septum or stopper could be punctured. The puncture may non be visible. It is important to ensure that the rubber seal on single-dose vials is not punctured because single-dose vials do not incorporate a preservative. Once the protective cap has been removed, the vaccine should exist discarded at the cease of the workday considering it may not exist possible to determine if the rubber seal has been punctured. For additional details, see CDC'southward Vaccine Storage & Handling Toolkit at www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storage-treatment-toolkit.pdf. |
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Is it necessary to permit alcohol to dry completely on a patient�s skin prior to injection? |
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Information technology is prudent to allow the booze to evaporate, just it is unlikely that the small amount residual alcohol on the pare will affect the vaccine or increase the run a risk of an agin reaction. |
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Is it recommended to use a new alcohol swab to cleanse the skin before administering a vaccine, or can we swab the skin with the same alcohol swab that we used to wipe off the stopper on the vial? |
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You lot should use separate alcohol wipes to clean the vial top and the patient's pare. |
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I know that it is advisable to clean the vaccine vial stopper with an alcohol wipe after removing the protective cap from a vaccine or diluent vial. Do you take to wait for the alcohol to dry before you insert the needle in to the stopper? |
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The stopper of a unmarried-dose vial is often assumed to be sterile. However, not all vaccine manufacturers guarantee the tops of unused vials are sterile, and the fashion in which the cover over the stopper is removed can potentially contaminate the stopper. Therefore, using friction and a sterile alcohol pad to swab the stopper may help to assure aseptic technique in preparing the single-dose vial prior to inserting a sterile syringe. Alcohol evaporates quickly and will dry out while the needle is being prepared for insertion into the vial. |
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In cleaning the vaccine vial stopper or the patient'due south peel, is it okay to utilize a non-sterile cotton fiber ball or do we need to apply a pre-packaged sterile booze prep pad? |
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Using a pre-packaged sterile alcohol prep pad is recommended to maintain aseptic technique. Not only are cotton balls non sterile, but neither is a bottle of sterile alcohol, once it's opened. |
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Some unmarried dose vials (SDV) contain more than the recommended dosage of the vaccine. Should we administer the recommended dose of the vaccine, or the unabridged contents of the vial fifty-fifty if it contains more than than the recommended dose? |
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In general the entire volume should be used even if information technology is a lilliputian more than than 0.v mL. Discarding the excess vaccine is not required or recommended. An exception to this is recombinant zoster vaccine (RZV; Shingrix, GSK). The RZV adjuvant solution may contain upwardly to 0.75 mL of liquid. The entire volume of the adjuvant solution should exist withdrawn and used to reconstitute the lyophilized vaccine. After mixing, withdraw the recommended dose of 0.5 mL. Any reconstituted vaccine left in the vial should be discarded. |
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Where can I obtain standing orders for vaccination? |
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The Immunization Activeness Coalition (IAC) has adult suggested standing orders for all vaccines commonly given to children and adults. They are based on CDC's Advisory Committee on Immunization Practices (ACIP) recommendations. You can notice the continuing orders and protocols for medical management of vaccine reactions at www.immunize.org/standing-orders. |
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What is the provider's liability when using continuing order protocols? |
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While y'all did not say this explicitly, we assume the concern is about a vaccine injury in a person who was vaccinated using a standing order. Of course, as long as the person is properly screened for contraindications and precautions, an injury from a vaccine is very unlikely. In the effect that an injury does occur, the National Vaccine Injury Compensation Program (VICP) provides liability protection for the vaccinator and the clinician who signed the standing order for any vaccine that is covered by the vaccine injury compensation program (all vaccines that are routinely administered to children are covered by the program for all ages of patients). More information almost the VICP is available on their website at www.hrsa.gov/vaccinecompensation/index.html. |
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A 2009 article in The Lancet reported that infants who received 3 doses of paracetamol following immunization had reduced immune responses to certain vaccines. Based on these findings, should we stop recommending acetaminophen for fever or discomfort afterward infant immunizations? |
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Findings of this study discourages the prophylactic use of paracetamol (similar to acetaminophen) prior to or immediately following vaccination. Acetaminophen can be used to treat hurting or fever if it should occur following vaccination. ACIP'south General Best Practices Guidelines for Immunization land: "Evidence does not support use of antipyretics before or at the time of vaccination; however, they can be used for the treatment of fever and local discomfort that might occur following vaccination. Studies of children with previous febrile seizures take not demonstrated antipyretics to be effective in the prevention of febrile seizures." For more information on this issue, meet Methods for Alleviating Discomfort and Pain Associated with Vaccination at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html. |
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What guidance is in that location for preventing patients from fainting subsequently vaccination? |
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All providers who administer vaccinations should be enlightened of the potential for syncope (fainting) after vaccination and take appropriate measures to preclude information technology. Thus, clinicians should (ane) brand sure that people who are beingness vaccinated are always seated; (2) be aware of symptoms that precede fainting (weakness, dizziness, pallor, etc.); and (3) take appropriate measures to forbid injuries if such symptoms occur. |
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IAC has ii pertinent educational pieces for healthcare professionals: "Medical Management of Vaccine Reactions in Children and Teens" at www.immunize.org/catg.d/p3082a.pdf and "Medical Management of Vaccine Reactions in Adult Patients" at www.immunize.org/catg.d/p3082.pdf. |
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Since 2005, VAERS has received an increasing number of reports of syncope, coinciding with the licensure of 3 vaccines for adolescents—HPV, meningococcal conjugate, and Tdap. Fainting among girls and young women ages 11–18 accounted for about of the increment. Serious injuries have occurred, including i fatality from intracranial hemorrhage caused by head trauma. The May ii, 2008, MMWR included a summary of findings on the increase in fainting afterwards vaccination (run into www.cdc.gov/mmwr/preview/mmwrhtml/mm5717a2.htm). In people for whom vaccination fourth dimension and fainting time were reported, it was discovered that eighty% occurred within xv minutes of receiving the vaccine. Vaccine providers should strongly consider observing vaccinated people for 15 minutes after vaccination in accord with ACIP'southward Full general Best Practices Guidance for Immunization (see www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/administration.html). This is particularly of import when vaccinating adolescents and young adults. CDC has posted often asked questions on this topic at www.cdc.gov/vaccinesafety/Concerns/syncope_faqs.html. |
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Are vaccine diluents interchangeable? |
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Diluents are not interchangeable, except for the sterile h2o used in Merck's measles-mumps-rubella (MMR), measles-mumps-rubella-varicella (MMRV), and varicella vaccines. No other diluent tin can be used for these vaccines, and these diluents must not be used to reconstitute any other lyophilized vaccine. |
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If the wrong diluent is used, the vaccination should always be repeated. If an inactivated vaccine is reconstituted with the incorrect diluent and is administered, the dose is invalid and should be repeated as soon equally possible. If a live vaccine is reconstituted with the wrong diluent and is administered, the dose is invalid. If the dose can't exist repeated on the same dispensary day, it needs to exist repeated no earlier than four weeks after the invalid dose. This spacing is due to the effects of generating a fractional allowed response that could suppress the live replication of subsequent doses, fifty-fifty of the aforementioned live vaccine. |
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Is it recommended to change needles after a vaccine dose has been drawn into a syringe? |
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No. Information technology is also unnecessary to change the needle if it has passed through two stoppers, which is done when a lyophilized vaccine is reconstituted. Changing needles is a waste of resources and increases the risk of needle stick injury. |
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When patients demand multiple vaccines (such as influenza and pneumococcal), tin we just combine them in the aforementioned syringe? |
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Absolutely non. No vaccines should ever exist mixed in the same syringe unless the combination has been specifically canonical by the FDA. |
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The needle came loose while I was injecting a dose of vaccine, and approximately half the dose was lost. Should we revaccinate the patient? If then, when? |
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When injectable vaccine volume is lost (patient moves, syringe leaks), information technology may be difficult to judge how much vaccine the patient actually received. Use your discretion to make up one's mind whether an adequate dose was given. In full general, y'all should care for this as a nonstandard injectable dose and should not count information technology. If it was an inactivated vaccine, you should re-immunize the person as soon as possible. In the instance of Shingrix (RZV; GSK) if the person is withal in the part the dose tin be repeated immediately. If the repeat dose cannot be given on the aforementioned day CDC recommends that it should be given four weeks after the invalid dose. |
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If it was a live vaccine, yous can give another dose if you discover the mistake on the same dispensary 24-hour interval; otherwise, you should wait 28 days to give the next dose. Nevertheless, if part of a dose of an oral vaccine (rotavirus) was spit out past an baby, count the dose and do not administer a 2nd dose. If a person sneezes after alive attenuated flu vaccine (Flumist; AstraZeneca) the dose tin be counted as valid. |
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If a patient pulls away during administration of a vaccine and the needle comes out, is information technology okay to reintroduce the same needle and terminate the injection? |
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No. The needle should be considered to exist contaminated. The needle and syringe should be discarded. A new syringe, needle, and dose of vaccine should be used. Generally, a full repeat dose should exist given, but yous may apply your clinical judgment to decide whether an adequate dose was administered before the patient pulled away. |
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Nosotros run a student wellness center and are wondering what the position is on discarding empty vaccine vials. Do they demand to get in a sharps container after they are drawn up or tin they go in the trash? |
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Empty or expired vaccine vials are considered medical waste material and should be tending of according to land regulations. |
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Vaccine Assistants Errors | Back to top | |
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We received a study of an infant who received rotavirus vaccine intramuscularly rather than orally. Is this dose valid? If not, when should it be repeated? |
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The rotavirus vaccine dose given by the intramuscular route is non valid and should be repeated past the oral road as soon as possible. In a review of such rotavirus vaccine assistants errors, at that place usually were not adverse reactions, and those documented were express to local reactions and general, brief irritability. Delight meet www.cdc.gov/mmwr/pdf/wk/mm6304.pdf, folio 81, for more information. |
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Please take steps to ensure that such vaccine administration errors are avoided in the hereafter. This issue should be reported to the Vaccine Agin Event Reporting Organization at https://vaers.hhs.gov even if an agin reaction does non event from it. |
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What should we practise if a dose of expired vaccine is given to a patient? |
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The dose should be repeated. If the expired dose is a live virus vaccine, you should look at least iv weeks after the previous (expired) dose was given before repeating information technology. If the expired dose is non a alive vaccine, the dose should be repeated equally before long as possible. Although only repeating the dose is preferred, serologic testing to check for immunity later sure vaccinations (e.g., measles, rubella, varicella, hepatitis A) may be accustomed. |
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MMRV was mistakenly given to a 31-year-old instead of MMR. Tin this be considered a valid dose? |
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Yes, however, this consequence is non addressed in the 2010 MMRV ACIP recommendations. Although this is off-characterization utilize, CDC recommends that when a dose of MMRV is inadvertently given to a patient age thirteen years and older, it may be counted towards completion of the MMR and varicella vaccine serial and does not demand to exist repeated. |
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An expired dose of ProQuad (MMRV, Merck) was given to a patient. We assume that the repeat dose should be given in three months because the spacing betwixt doses of a combination vaccine depends on the longest minimum interval of a component (in this case the varicella vaccine component). Is this correct? |
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In the example of an expired alive vaccine, the issue is non necessarily the routine minimum interval (iii months in the case of varicella and ProQuad vaccines), but the interval that would forestall viral interference if the expired vaccine happened to be still viable. This interval is considered to be iv weeks (28 days). The repeat dose should be administered four weeks after the expired dose. |
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What should nosotros practise if we requite an injection by the incorrect route (SC instead of IM)? |
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Your exercise should put procedures in place to ensure that you always give vaccines past the recommended route because data regarding prophylactic and efficacy of alternate routes are limited. If this does inadvertently happen, ACIP and/or CDC recommends that if hepatitis B, rabies, HPV and inactivated influenza vaccines are administered subcutaneously the doses should non be counted equally valid and should be repeated. |
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ACIP states that If PCV13, Hib, and/or DTaP are administered by the subcutaneous route, providers have the discretion to repeat the doses. There is no minimum interval between the invalid dose and the echo dose. ACIP and/or CDC recommends that if HepA, MenACWY, IPV, PPSV23, COVID-19, and RZV vaccines are administered subcutaneously, the doses can count and do not demand to be repeated. ACIP/CDC has no recommendation for Tdap, Td, MenB, Typhim VI, or JE-VC. |
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One of our staff gave a dose of pediatric hepatitis A vaccine to an adult patient by mistake. How practise we remedy this error? |
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In full general, if the error is discovered on the same clinic day, you can administrate the other "half" of the dose on that same day. If the error is discovered later, the dose should not be counted, and then the person should be recalled to the part and given a full historic period-advisable repeat dose. |
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There are, withal, two exceptions to the general rule: (1) If a patient sneezes after receiving nasal-spray alive adulterate flu vaccine, count the dose as valid. (2) If an infant regurgitates, spits, or vomits during or after receiving oral rotavirus vaccine, count the dose every bit valid. |
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If you give more than than an age-appropriate dose, count the dose equally valid and notify the patient/parent virtually the error. Using larger than recommended dosages can be hazardous because of excessive local or systemic concentrations of antigens or other vaccine constituents. Avoid such errors by checking the vaccine vial characterization iii times. |
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A dose of Kinrix (DTaP-IPV; GSK) should have been administered to a 4-year-old, just Pentacel (DTaP-IPV-Hib; Sanofi Pasteur) was administered instead. Does the dose of DTaP count? |
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Aye. The DTaP in the Pentacel can be counted. Although Pentacel is licensed as a 4-dose serial and this may represent a fifth dose of Pentacel (in which example it would be off-label use), the dose of DTaP counts as the fifth dose of DTaP. |
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A dose of pneumococcal conjugate vaccine was administered into my patient's dialysis port. Does this dose count? |
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At that place are no data on the effectiveness of pneumococcal conjugate vaccine given by the intravenous road. The patient has renal disease, so information technology is important to ensure that the dose they receive is effective. CDC recommends repeating the dose. |
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A 2-calendar month-one-time was mistakenly given PPSV23 instead of PCV13. What should exist done? |
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PPSV23 is not effective in children younger than 24 months of age. PPSV23 given at this age should non exist considered to be part of the pneumococcal vaccination series. PCV13 should be administered as soon as the error is discovered. Whatever fourth dimension the wrong vaccine is given, the parent/patient should be notified. |
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Rather than giving PCV13 offset and waiting eight weeks to requite PPSV23 every bit recommended for an immunocompromised kid (two years or older) or adult patient, we inadvertently gave both vaccines at the same visit. We are looking for guidance. |
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Although PCV13 and PPSV23 should non exist administered at the same visit, CDC does not recommend repeating either vaccine dose should this occur. You should inform the patient of the error and let them know that they volition non need to repeat either dose. |
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A 60-year-old patient was inadvertently given varicella vaccine instead of zoster vaccine. Should the patient still be given the zoster vaccine? If so, how long an interval should occur between the two doses? |
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CDC recommends that if a provider mistakenly administers varicella vaccine to a person for whom zoster vaccine is indicated, no specific safety concerns exist, but the dose should not exist considered valid. Recombinant zoster vaccine (RZV; Shingrix, GSK) should exist administered at least 8 weeks subsequently receipt of the varicella vaccine. However, if RZV is administered less than 8 weeks subsequently the varicella vaccine, it does not need to be repeated. A second dose of RZV should be given 2–half dozen months later the first dose of RZV. Avert such errors by checking the vial label 3 times to brand sure y'all're administering the product you intended. |
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If RZV (Shingrix) is erroneously given to a child for prevention of varicella, the dose is invalid, only is in that location a waiting period earlier a valid dose of varicella vaccine tin be given? Is information technology OK to requite a dose of varicella vaccine as soon as the mistake is discovered? |
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There is no waiting period. The varicella vaccine dose can be given at any fourth dimension subsequently the RZV dose. |
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While giving a dose of RZV (Shingrix) the syringe came loose from the needle and part of the dose was lost. Volition the patient be protected with this partial dose or does information technology demand to exist repeated? |
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A dose less than the full 0.5 mL dose is non valid and should exist repeated. If the patient is withal in the role the dose can be repeated immediately. If the echo dose cannot be given on the aforementioned day CDC recommends that it should be given 4 weeks afterward the invalid dose. |
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My medical assistant inadvertently administered a 0.5 mL dose of the RZV (Shingrix) diluent only. The dose did not comprise any antigen. When tin nosotros administrate a properly reconstituted dose? |
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The CDC zoster discipline affair experts recommend that in this situation you should wait 4 weeks before giving a repeat dose. |
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Several doses (antigen and diluent) of RZV (Shingrix) were mistakenly stored in our office freezer. I of these doses was administered to a patient. Is this dose valid and if not, when can it be repeated? |
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Any RZV, either antigen or diluent, that is exposed to freezing temperature should not be used. If a dose exposed to freezing temperature is given to a patient the dose should be considered invalid and should be repeated iv weeks after the invalid dose. |
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