As with any medication administration, the "Seven Rights" must be addressed prior to giving a vaccination. These include:
- The right patient
- The right vaccine
- The right time - correct age, interval, and prior to expiration
- The right dosage
- The right route
- The right site
- The right documentation
Allow ample time for discussion with the patient and his or her family. Screenings for contraindications and precautions to the vaccine should be done routinely, even if the child has previously had the vaccine. Contraindications will be discussed further in a subsequent section.
Discuss risks and benefits of vaccine and vaccine-preventable diseases with parents. Parents should be provided with the appropriate Vaccine Information Statements and encouraged to address questions or concerns. Include possible side effects and home care in the conversation.
Address the needs and fears of the child as necessary. Maintain a positive attitude and use a calm tone of voice. Explain what to expect and in an age-appropriate fashion, why vaccinations are needed. It is often helpful to have the parent hold the child both for restraint and comfort. Research also shows that children tend to do better when sitting upright versus lying down (CDC, 2012). Consider having two nurses administer injections simultaneously if possible.
Standard Precautions should always be taken to minimize the risk of infection while administering a vaccine. Wash hands with soap and water for at least 20 seconds. Gloves should be applied as needed, though not required by OSHA if there is little likelihood of coming in contact with bodily fluids and there are no open lesions on the hands (CDC, 2012).
It is important to choose the proper syringe and needle length based on the age of the child and the method of delivery. Vaccinations are given in either a 1-mL or 3mL syringe. For the pediatric population, needle length will vary from 5/8 inch to 1 ¼ inch with a 22-25 gauge (CDC, 2012).
The expiration date of the vaccine and diluent should be checked, and they should appear normal and free of damage. Reconstitute just prior to administering vaccine. Instill diluent as required and shake to ensure there is no particulate matter remaining. Label syringes with lot number and date (CDC, 2012).
Pediatric vaccines are delivered via the oral, intranasal, intramuscular or subcutaneous route. Rotavirus is the only oral vaccination. It is given carefully inside the cheek, taking care to not squirt too quickly or down the throat. It should be given prior to any injections that may upset the child. If the child spits out the vaccine, it is not recommended to readmininster. Instead, just follow the remaining recommended schedule (CDC, 2012).
Live attenuated influenza vaccine (LAIV) is the only vaccine to be given intranasally. A plastic clip is in place on the syringe to divide the dose into two. With the patient seated and breathing normally, insert the syringe into one nare. Depress the plunger until the clip is reached. Remove the clip and repeat in the other nare (CDC, 2012).
MMR and Varicella are both given subcutaneously (SQ). For infants, the recommended site is the thigh, and for older children, the outer tricep is the site of choice for SQ vaccination. A 5/8-inch, 23 to 25-gauge needle is used. Cleanse the skin with alcohol. Pinch the fatty tissue and insert the needle at a 45-degree angle. Depress the plunger and withdraw the needle. Apply pressure with gauze as needed (CDC, 2012).
The intramuscular (IM) route is used for vaccinations such as DTaP, Hep B, and Hib. The vastus lateralis muscle for infants and the deltoid muscle for older children are the recommended sites. A 22-25-gauge needle that is long enough to reach muscle should be used. The site of administration, the age of the child, and the method of delivering the vaccination (whether bunching the muscle or spreading the skin taut) will determine the length of the needle. Cleanse the skin with alcohol. Insert at a 90-degree angle and depress the plunger. Withdraw the needle and apply pressure with gauze (CDC, 2012).
Vaccinations should be recorded in the patient's medical record. This should include the date, manufacturer, vaccine lot number, name and title of the person administering the vaccine, route, dose and site. Also document that Vaccine Information Sheets were given to parents (CDC, 2012).