Immunisation and Injection Technique Flashcards
Definition of safe injection
- One that does not harm the recipient
- One that does not expose the health worker at risk
- One that does not result in waste that is dangerous for the community
How is needle selection made?
Needle selection is determined by:
- Age of patient
- Size of patient
- Type drug being given
- Amount of drug being given
What can the use of short needles in IM injection result in?
Inadvertent subcutaneous (SC) injection and increased risk of signfiicant local adverse events, particularly with aluminium-adjuvanted vaccines.
Recommended needle sizes
Infant, child or adult for IM vaccine
- 23 or 25 gauge (25mm in length)
- 90 degrees to skin plane
Preterm babies (<37 weeks gestation) up to age of 2 months, very small infants
- 23 or 25 gauge (16mm in length)
- 90 degrees to skin plane
Very large or obese patient
- 23 gauge, 38 mm in length
- 90 degrees to skin plane
Subcutaneous injection in all individuals
- 25 or 26 gauge, 16mm in length
- 45 degrees ot skin plane
Preparation for vaccination
The five R’s
- Right drug
- Right route
- Right dose
- Right patient
- Right time
Patient preparation
- Patient history including allergies and illnesses.
- Informed consent.
- Explanation.
- Patient comfort - relaxation minimizes discomfort, reduces muscle strain.
- Stabilise the site
Injection site
Inspect the skin surface over the site for bruises, inflammation, oedema, masses or tenderness.
Note integrity and size of the muscle.
Sites for IM injection
Adults
- Vastus lateralis
- Deltoid
Paediatric patients
- Anterolateral aspect of thigh
- Deltoid
Sites for SC injection
Injecting into loose CT under the dermis (absorption is slower due to poorer blood supply).
Increased pain receptors in this region lead to greater discomfort
Best site options
- Outer posterior aspect of upper arms
- Abdomen, below the costal margins to the iliac crest
- Anterior aspect of thighs
Technique (general)
- Check expiry date and prepare correct medication
- Prepare correct equipment
- Identify correct patient and obtain informed consent
- Select correct site
- Swab area with alcohol wipe
- Hold syringe between thumb and forefinger of dominant hand
Technique subcutaneous injection
- Hold as a dart at 45-90 degrees
- Pinch skin and piece skin
- Avoid moving syringe
- Aspirate drug (if blood appears remove, discard and repeat)
- Inject slowly
Technique IM injection
- If patient muscle mass is small, grasp the body of the muscle between thumb and finger
- Insert needle at 90 degree angle into muscle
- Aspirate (if opiate)
- Inject slowly
- Apply pressure to site after injection
Intradermal
10 to 15 degree angle
Assessment post-immunisation
Keep under observation for 10-15 minutes in cause *anaphylaxis *occurs.
Examine injection site for:
- Swelling
- Bleeding
- Excessive redness
- Patient discomfort
Anaphylaxis definition
A severe and rapid systemic allergic reaction to an allergen
