Preparing/Giving Vaccines

 

 Authorised by:
Charge Nurse Newborn
August 2008
Clinical Guidelines Back Newborn Services Home Page
Process Site for Administering Vaccines Other Related Documents

Process

Registered Nurses who are required to administer Hepatitis B and Hep B Immunoglobulin after birth and designated Registered Nurse who has completed the Vaccination Programme Training and Checking Registered Nurse follow the steps below to ensure vaccine is given correctly and that vaccine is only out of fridge for the shortest possible time before administration.


Step

Action

1

 Check with baby’s nurse that baby is well and it is appropriate to administer vaccine at that time.

2

 Both nurses check consent for vaccine has been signed by parent.

Hepatitis B Surface Antigen Positive or Status Unknown Mother

  • On the National Hepatitis B Immunisation Programme Form (HNN2)
  • Also parent has signed for the Hep B Immunoglobulin consent on the above form. (There is no need for parent to sign the medication chart if HNN2 form has been signed.)

3

 Check Dr/NS-ANP has prescribed the immunisations on medication chart stat drugs page.

4

 For mothers Hep B Neg, and all babies receiving Infanrix-hexa and Prevenar Vaccinations, parent to countersign on the medication chart stat drugs page and to print surname under signature.

5

 Collect baby’s Multidisciplinary Notes, Medication Chart, Well Child Health Book, appropriate syringe(s) and needles.

6

 Nurse checks the fridge temperature sheet (on fridge door) for previous 5 days that it was within +2° to +8° C (ideally +4° to +5°C). Removes the vaccines to be used (NOT THE CONTAINER).

7

 Perform checking procedure.

8

 Infanrix-hexa must be reconstituted prior to use as follows:
  • Attach needle to prefilled syringe.
  • Transfer the syringe’s liquid suspension to the vial containing the Hib pellet.
  • Shake the vial well to ensure the Hib pellet is completely dissolved.
  • Draw the reconstituted vaccine back into the syringe.
  • Attach the appropriate sized needle to the syringe for vaccine administration. Do not prime needle.
  • After reconstitution the vaccine should be injected promptly.

9

 Do not swab top of vial with alcohol wipe.

10

 All vaccinations are SINGLE USE ONLY.

11

 Use suitable needle. Size depends on baby’s current weight. Babies < 2500 grams 25 gauge needle and babies >2500 grams 23-25 gauge needle. DO NOT PRIME NEEDLE.

12

 Checking nurse positions baby on appropriate side and holds baby’s leg with knee bent and calf of leg touching back of thigh.

13

 Do not swab skin prior to vaccination.

14

 See below for details on injection site.
  • Administering nurse then injects vaccine into muscle at a 90° angle.
  • When vaccine has been injected, leave needle there for further 5 seconds to allow for dispersal of vaccine. Withdraw needle quickly. There should be no ooze of vaccine.
  • If blood spot, dab with cotton wool. Do not rub vaccination site. Observe for further 30 seconds.
  • Then baby may be turned and further vaccine given.

16

 Console baby. Then complete documentation.

17

 Baby must be nursed on apnoea mattress for 24 hours after vaccine given.

18

 Documentation:

7 places (or 9 places if Mum Hep B surface antigen positive or status unknown).
Record batch no, dose, expiry date, which leg, date, and signature.

  • Well Child Health Book (last page in book is the immunisation record)

Infanrix-hexa: remove the square sticker from the Hib vial and place in Well Child Book. (Sticker states batch number and expiry date.) Place the second sticker from the Hib vial on the drug chart

Prevenar: record batch number & expiry date in space provided

  • Baby’s medication sheet
  • Multidisciplinary notes
  • NIR form filled in and placed in folder for faxing
  • Baby’s Feeding/observation Sheet
  • Baby’s Care Map
  • NWH NICU computer database

N.B If Mum is Hep B surface antigen positive,  2 additional signatures are required.

  • sign the Red National Consent Hep B Immunisation Programme Form (HNN2) in two places. (Hep B status unknown sign HNN2 Form for Hep B. If HBIG is required to be given later on nurse then to sign on HNN2 Form.)

 
   

Site for Administering Immunisations to Babies in Newborn Service

Intramuscular (IM) injection site Thigh (Vastus Lateralis)

The vastus lateralis is the recommended injection site for the IM immunisations.

Vastus Lateralis Muscle

The vastus lateralis is a thick, well developed muscle located on the anterolateral aspect of the thigh. The injection site is above the junction between the middle and upper third so that vaccine is deposited at the junction. The needle should be angled at a 90° angle. (More superficial injections of toxoid vaccines result in greater rates of local reaction than deeper ones), depending on the size of the baby.

NB: The buttocks are not used because of poor vaccine uptake in fat, possible increased risk of abscess formation and possible risk of sciatic nerve involvement.

Prevenar® and Infanrix®-hexa are intra muscular injections

Image: WHO 2004


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