The below resources are available for those interested in learning additional information about each module's specific topics. You can jump to a specific module using the links to the right.
Safe Vaccine Storage
CDC Vaccine Storage Practices
Vaccine Transport Information by Immunization Action Coalition
Techniques for Administering Vaccines Safely
Vaccine Immunization Information and Consent
Vaccine Immunization Statement
Oklahoma State Department of Health Vaccine Immunization Consent Form
More information on positioning children from Immunization Action Coalition
http://www.immunize.org/news.d/comfrten.pdf (also found in Appendix D of CDC's current Pink Book)
Disposal of Unused Vaccine
Vaccine Administration Skills
CDC Pictures of IM and SQ routes
Injection site selection
Immunization Action Coalition
CDC Pink Book Site Map
Injection Sites to avoid
Small, S. P. (2004). Preventing sciatic nerve injury from intramuscular injections: Literature review. Journal of Advanced Nursing, 47(3), 287-296.
Helpful map to find anatomical sites
Needle size selection
Research study on impact of vaccines in obese adolescents
Middleman, A. B., Anding, R., & Tung, C. (2010). Effect of needle length when immunizing obese adolescents with Hepatitis B vaccine. Pediatrics, 125(3), e508-512. doi:10.1542/peds.2009-1592
Latest recommendations from the CDC
Kroger, A., Atkinson, W. L., Marcuse, E. K., & Pickering, L. K. (2006). General
Recommendations on Immunization: Recommendations of the Advisory
Committee on Immunization Practices (ACIP). MMWR, 55(RR-15), 1-48 Retrieved
Akinsanya-Beysolow, I. (2010). Update on Vaccine Administration Recommendations
(PowerPoint Slides). Current Issues in Immunization Netconference. Education,
Information and Partnership Branch, NCIRD/CDC. Retrieved from
CDC Pink Book needle size recommendations for children
To glove or not to glove?
Immunization Action Coalition information on gloving
To aspirate or not to aspirate?
As nurses we like evidence but there sometimes is not a great deal of evidence to support what we do. Aspiration is one of those areas that we have traditionally done when giving injections but the evidence into knowing if it is an essential part of practice just isn’t there. Here’s some information about this area that needs further investigation.
Background: The reason nurses aspirate when they give an injection is to ensure that they are not in a vein, which can happen when you are giving injections, especially those injections that will go deep into the muscle near veins. When nurses pull back on the syringe and find blood pooling into the needle hub (similar to a flashback when starting an IV), they take out the needle immediately, hold pressure, discard the original needle and start over again. In fact, ACIP recommends this same procedure if blood is found in the hub of the needle (Atkinson et al., 2002) yet they do not recommend aspiration even though other experts do.
Significance: Why is aspiration important? Some drugs are not recommended for injection directly into the venous system, they need more time to absorb within the muscle. Giving the injection into the venous system could result in serious problems for patients.
What to do? At this time, since the evidence is not clear, nurses are expected to follow the safest practice that is possible. If the drug manufacturer clearly says that a drug cannot be given IV, other than aspirating, we are not clear how you would know if you are in a vein or not.
Evidence? Lately there has been research recommending not aspirating so that the client is more comfortable and has less pain (Ipp, Taddio, Gladbach & Parkin, 2007). Others have recommended not aspirating based on surveying nurses and their experiences of finding blood in the needle hub (Waibel, 2006). So far as we know, though, no one has addressed the larger issue of safety in ensuring that nurses are not injecting into a vein when they give an injection without aspirating. It is important that further research be done in this area.
What do you think? We think this is a worthy discussion that nurses and nursing students need to have. The best practice for now is to follow the practice guidelines within the organization you are working.
Atkinson, W., Pickering, L. K., Schwartz, B., Weninger, B. G., Iskander, J. K., & Watson, J. C. (2002). General recommendations on immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP). MMWR, 51(RR02), 1-36. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5102a1.htm
Ipp, M., Taddio, A., Sam, J., Gladbach, M., & Parkin, P. C. (2007). Vaccine-related pain: randomized controlled trial of two injection techniques. Archives of Disease in Childhood, 92,1105-1108. Retrieved from http://adc.bmj.com/content/92/12/1105.full.pdf
Waibel, K. H. (2006). Aspiration before immunotherapy injection is not required. Journal of Allergy & Clinical Immunology, 188(2). doi: 10.1016/j.jaci.2006.04.008 Retrieved from http://www.mdconsult.com/das/article/body/220229073-4/jorg=journal&source=&sp=16381394&sid=0/N/542804/1.html?issn=0091-6749
See also CDC powerpoint under last section, “Responding to Reactions.”
A new way to give flu vaccines (FluMist®)
Eligibility for FluMist®
CDC Questions and Answers about Smallpox
CDC Picture of Bifurcated Needle
CDC Picture of Primary Vaccination Site Reaction
Vaccine Documentation Components
Screening Questionnaire from Immunization Action Coalition
Responding to Reactions
How Safe is the HPV Vaccine?
CDC Pink Book Medical Management of Vaccine Reactions in Children and Teens and Medical Management of Vaccine Reactions in Adults http://www.cdc.gov/vaccines/pubs/pinkbook/pink-appendx.htm#appd
Side effects of different vaccines
Centers for Disease Control (2009). Vaccine administration: Techniques and guidelines [PowerPoint slides]. CDC Vaccine Administration Training for Nurses. Retrieved from CDC website - Click here for copy.