Because using topical anesthetics may require additional time, some planning by the healthcare provider and parent may be needed. Parent participation has been shown to increase a childs comfort and reduce the childs perception of pain. Vaccines are very safe, with minimal risk for AEs. Health care professionals should be knowledgeable about appropriate techniques to prepare and care for patients when administering vaccines. Like SDVs, MFSs do not contain a preservative to help prevent the growth of microorganisms. Evidence-based pharmacologic, physical, and psychological interventions exist to ease the pain associated with injections. Provide supportive care and take appropriate measures to prevent injuries if such symptoms occur. SIRVA is thought to occur from unintended injection of vaccine or trauma from the needle into or around the underlying bursa of the shoulder. The .gov means its official. The interim clinical considerations for the use of currently authorized COVID-19 vaccines contain guidance for managing vaccine administration errors. Policies should be in place to validate health care professionals knowledge of, and skills in, vaccine administration. MFSs are intended for one patient for one injection. With the exact amount of prepared medication already drawn into a syringe, insert the needle into the injection site at a 90-degree angle to the skin, while continuing to hold the skin with your other hand. I did NOT have a sore arm nor any other side effects. Insert the needle at a 90-degree angle and inject the vaccine. To obtain a patients immunization history, information from immunization information systems (IISs), current and historical medical records, and personal shot record cards may be used. Health care personnel should follow routine infection control procedures when administering vaccines. CDC website. When a needle breaks the skin, it may cause a small amount of pain; however, what constitutes an actual injection-site reaction? Allegrini G, Zur Linden A, Singh A, Richardson D, Bassel L. See this image and copyright information in PMC. Only the number of doses indicated in the manufacturers package insert should be withdrawn from the vial. CDC recommends preparing and drawing up vaccines just before administration. To assess patients correctly and consistently, health care providers should use a standardized, comprehensive screening tool. An environment that values the reporting and investigation of errors (and near misses) as part of risk management and quality improvement should be established. If you are really worried that you didnt get enough of the vaccine, I would discuss with the person in charge of the administration site the possibility of getting another dose. 'I Need Antibiotics for My Bronchitis,' Your Patient Insists, How to Distinguish Among COVID, Flu, and RSV in a High-Risk Patient. Disclaimer. Training, including an observation component, should be integrated into health care professionals education programs including orientation for new staff and annual continuing education requirements for all staff. They include information that may help the patient or parent respond to the screening questions and can be used by providers during conversations with patients. jpluttme 9 Jan 2020. It can happen with any kind of injection. First, most especially with the pen devices, once you have injected the medication into the skin, count to five before removing the needle. Partial doses from two or more vials should never be combined to obtain a dose of vaccine. doi: 10.1016/j.jfms.2011.07.015. For a patient who experiences pain, redness, or itching, the pharmacist can recommend applying a cold compress at the site, as well as an OTC pain reliever for pain or an antihistamine for itching. Everyone, including adults, should be given the appropriate VIS when receiving a vaccine covered under the law. And when you add in core vs. noncore vaccines (mandatory shots vs. those recommended by your vet), it can get even more complicated. The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. A preventable event is one that is due to an error that could be avoided. Once reconstituted, the vaccine should be administered within the time frame specified for use in the manufacturers package insert; otherwise, the vaccine should be discarded. As of March 20, 2021, more than 120 million COVID-19 vaccine doses have been administered to people in the United States. 2-min read. All health care professionals should receive comprehensive, competency-based training before administering vaccines. Vaccinations are the most common source of procedural pain for healthy children and can be a stressful experience for persons of any age. Health care providers who administer vaccines covered by the National Vaccine Injury Compensation Program (which include all vaccines listed on the ACIP recommended child and adolescent immunization schedule) are required by law to ensure the permanent medical record of the recipient indicates: Vaccine administration best practices also include documenting the route, dosage, and site. Avoids frightening children by embracing them rather than overpowering them, Allows the health care professional steady control of the limb and the injection site, Prevents children from moving their arms and legs during injections, Encourages parents to nurture and comfort their child. Alcohol evaporates quickly and will dry while the needle is being prepared for insertion into the vial. -. For both sites, an IM injection ideally should be administered into the middle of the muscle where the muscle tissue is thickest. In the setting of the COVID-19 pandemic, gloves should be worn. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Use of and/or registration on any portion of this site constitutes acceptance of our User Agreement, Privacy Policy and Cookie Statement, and Your Privacy Choices and Rights (each updated 1/26/2023). with 8 out of those 9 administrations causing reactions such as pain, redness, and itching at the injection site. Both client and vaccinator must be seated for vaccine . Injecting the most painful vaccine last when multiple injections are being administered can decrease the pain associated with the injections. Symptoms may occur from days to years after exposure to the virus and include delirium (confusion), abnormal behavior, hallucinations, hydrophobia (fear of water), and insomnia (difficulty sleeping), which precede coma and death. This is to prevent inadvertent contamination of the vial through direct or indirect contact with potentially contaminated surfaces or equipment. VICP is not related to VAERS.8 Pharmacists should report any AEs to VAERS, whereas patients who feel they should be compensated because of an AE should file their own claim with VICP. MeSH Occupational exposure to bloodborne pathogens: needlesticks and other sharps injuries: Final Rule (29 CFR Part 1910). Typically, it will be about the size of a round cake/cookie sprinkle you might see on Christmas cookies. Typically, an injection-site reaction is considered to be any pain, swelling, rash, bleeding, or redness that occurs at the site of an injection, although, serious reactions can occur (see sidebar 1 ). Aspirin is not recommended for children and adolescents. Some vaccine administration errors require revaccination, but others do not. Avoid distractions. Parents should hold the child in a comfortable position, so that one or more limbs are exposed for injections. CDC refers inquiries about errors related to improper storage and handling or use of an incorrect diluent to the vaccine manufacturer for guidance. When providers use presumptive language to initiate vaccine discussions, significantly more parents choose to vaccinate their children, especially at first-time visits. The following discussion describes the adverse effects (AEs) that make up true injection-site, or local, reactions and how pharmacists should respond to them. Mild side effects Decreased physical activity and slight swelling or discomfort of the injection site are the most common side effects observed in puppies. Pain relievers can be used to treat fever and injection-site pain that might occur after vaccination. Administer the liquid vaccine slowly against the inside of the infants cheek (between the cheek and gum) toward the back of the infants mouth. The expiration date printed on the vial or box should be checked before preparing the vaccine. The infant should receive the remaining recommended doses of rotavirus vaccine following the routine schedule. Millions more doses of COVID-19 vaccines will be administered over the next few months. Holding infants during vaccination reduces acute distress. Public Health Physician, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GeorgiaDisclosure: Sarah Reagan-Steiner, MD, MPH, has disclosed no relevant financial relationships. Some vaccine doses are not valid if administered using the wrong route, and revaccination is recommended. Instructions should also provide information about when to seek medical attention and when to notify the health care provider about concerns that arise following vaccination. Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Although data for mRNA COVID-19 vaccines are lacking, IM vaccine administration in general (compared with subcutaneous administration) optimizes immunogenicity and minimizes local adverse reactions. Fear of injections and needlestick pain are often cited as reasons why children and adults refuse vaccines. According to the AAHA, transient injection site reactions include: Pain Swelling Lumps you can see or feel And for sustained injection site reactions, these could be things like: Permanent hair loss Skin discoloration An 11-year-old female spayed Labrador Retriever presented with dorsocervical subcutaneous masses at the injection site three weeks after receiving DA2PP-Lepto, Rabies, and Bordetella vaccinations. Administer each vaccine in a different injection site. Should I receive another injection? Taddio A, McMurtry C, Shah V, et al. Patient and parent education should also include a discussion of comfort and care strategies after vaccination. OSHA requires that safety-engineered injection devices (e.g., needle-shielding syringes or needle-free injectors) be used for injectable vaccines in all clinical settings to reduce the risk of needlestick injury and disease transmission. Shimabukuro T, Miller E, Strikas R, et al. Please enter a Recipient Address and/or check the Send me a copy checkbox. Rotavirus vaccines (RV1 [Rotarix], RV5 [RotaTeq]) are administered orally. Instead of saying What do you want to do about shots today, an approach using presumptive language would be to say, Your child needs three vaccines today.. government site. The nurse stated the vaccine entered my arm. The infectious tracheobronchitis (kennel cough) vaccine is the only vaccine which is not injectable. Vet Ophthalmol. immunize.org/catg.d/p3082.pdf. Even if the SDV appears to contain more vaccine than is needed for one patient, it should not be used for more than one patient. For example, the package insert may state the vaccine must be discarded 28 days after it is first punctured. An oral applicator is for use with oral vaccines and contains only one dose of medication. Cookie Settings/Do Not Sell My Personal Information. 2012 May;31(3):276-9. doi: 10.1097/PGP.0b013e31823ef912. Injection site reactions to your dog's vaccine can either be transient (aka temporary) or sustained (aka long-lasting). Notes from the Field: Vaccine Administration Errors Involving Recombinant Zoster Vaccine United States, 2017-2018. Changing the needle between preparing and administering the vaccine is not necessary unless the needle is contaminated or damaged. The gauze helps seal the punctured tissue and prevents leakage. Some syringes and needles are packaged with an expiration date. In addition, some studies have suggested these medications might suppress the immune response to some vaccine antigens. A dose-divider clip, located on the plunger, separates the total vaccine dose of 0.2 mL into two equal parts of 0.1 mL each. Before withdrawing each dose, the vial should be agitated to mix the vaccine thoroughly and obtain a uniform suspension. Examples of vaccines with BUDs include: Reconstitution is the process of adding a diluent to a dry ingredient to make it a liquid. The BUD supersedes but should never exceed the manufacturers expiration date. Instilling air into a multidose vial prior to withdrawing a vaccine dose is not necessary. Although this report covers the time period when mRNA COVID-19 vaccines were administered, errors might occur with administration of other COVID-19 vaccine types, such as the newly authorized Janssen (Johnson & Johnson) viral vector vaccine. Reviewed June 2019. Never administer the vaccine directly into the throat. Equipment needed for maintaining an airway should be available for immediate use and the provider should be skilled in using the equipment. -- A.B. Therefore, using friction and a sterile alcohol swab to wipe the stopper may help assure aseptic technique. Determining when a vaccine or diluent expires is an essential step in the vaccine preparation process. The vaccinations are given under the skin at the back of the neck, and are well tolerated by the vast majority of dogs. Saddle River, NJ: Pearson Education, Inc.;2011. Aspiration was originally recommended for theoretical safety reasons and injecting medication slowly was thought to decrease pain from sudden distention of muscle tissue. The patient should be seated in an upright position and instructed to breathe normally. YouTubes privacy policy is available here and YouTubes terms of service is available here. All health care professionals who administer vaccines to older children, adolescents, and adults should be aware of the potential for syncope after vaccination and the related risk of injury caused by falls. 2. Health care providers should be familiar with strategies to prevent and identify adverse reactions after vaccination. When administering a vaccine subcutaneously: No routinely recommend U.S. vaccines are administered by the intradermal route of injection. Vaccine recommendations and guidelines of the ACIP. Used needles should not be recapped or cut or detached from the syringes before disposal. If both a vaccine and an immune globulin (Ig) preparation are needed (e.g., Td/Tdap and tetanus immune globulin [TIG] or hepatitis B vaccine and hepatitis B immune globulin [HBIG]), administer the vaccine in a separate limb from the immune globulin. Expert: Infusion Pharmacy Technicians Can Reduce Workload in Oncology Pharmacy, Clinical Forum Recap Data Show Melanoma Site to Be Independent High-Risk Factor for Recurrence, Poor Outcomes, Complete Immunization Services Start With Gathering Patient Information, Encouraging Immunization Information System Use in Community Pharmacy Practice, Exploring Techniques to Increase Vaccination Rates Among Adult Patients with Chronic Disease, The Community Pharmacist as a Provider of Immunizations, Injection-Site Reactions and How to Manage Them, Pharmacy Intern and Technician Roles in Immunizing Are Growing, HPV Update: Making Sense of the New ACIP Recommendations, Immunization Guide for Pharmacists November 2019. Here are the new phrases in the standing order and pharmacy protocols: 1. SDVs with any leftover vaccine should never be saved to combine leftover contents for later use. Any time an immunizer witnesses or is informed by a patient of any reaction to a vaccination that would be considered a significant AE, the immunizer should report the event to the Vaccine Adverse Event Reporting System (VAERS), which is co-managed by the CDC and the FDA. Recommendations from experts state that if at least half of the vaccine went in, the dose does not need to be repeated. Vaccine should be reconstituted just before administering by following the instructions in the vaccine package insert. Washington, D.C.: American Pharmacists Association;2007. 2017 May 9;2017:6952634. doi: 10.1155/2017/6952634. The spike protein generated by a Covid-19 vaccine can leave the site of injection and enter the bloodstream, which could possibly be causing deaths and vaccine injuries. Administering a dose 4 or fewer days earlier than the minimum interval or age is unlikely to have a substantially negative effect on the immune response to that dose. There are no reports of any person being injured because of failure to aspirate. For dosage errors in which less than half the dose was administered, as well as errors in which only diluent was administered, CDC recommends repeating the dose as soon as possible in the opposite arm. Many persons receive two or more injections at the same clinical visit. A high-grade soft tissue sarcoma was diagnosed microscopically and immunohistochemistry revealed positive expression of VEGFr, PDGFr, SCF, and EGFR. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. The most common error type described in inquiries (Table), representing more than one third of inquiries, was administration of a lower-than-authorized dose (eg, the needle disconnecting from the syringe, resulting in vaccine spillage). Journal of Feline Medicine and Surgery. Authors Terry M Jacobs 1 , Cathy E Poehlmann 1 , Matti Kiupel 2 Affiliations 1 Park Pet Hospital, 7378 N. Teutonia Ave., Milwaukee, WI 53209, USA. A MDV contains more than one dose of vaccine. CDC website. All vaccines administered should be fully documented in the patients permanent medical record. It has been estimated that up to 25% of adults have a fear of needles, with most needle fears developing during childhood. The deltoid is often selected as the injection site in these age groups as temporary Subcutaneous injections are administered into the fatty tissue found below the dermis and above muscle tissue. SIRVA is preventable with correct recognition of anatomical landmarks and proper IM vaccine administration techniques. Administering the shot at a 90 angle can ensure that the needle goes directly into the deltoid and not upward into the shoulder area (see table ).5. Committee on Identifying and Preventing Medication Errors. During preparation: Vaccines are available in different presentations, including single-dose vials (SDV), manufacturer-filled syringes (MFS), multidose vials (MDV), oral applicators, and a nasal sprayer. Harrington J, Logan S, Harwell C, et al. gov/vaccines/hcp/vis/about/facts-vis.html. Vaccines must reach the desired tissue to provide an optimal immune response and reduce the likelihood of injection-site reactions. COVID-19 vaccines should be administered intramuscularly. The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of Advance Local. It could cause a spritz of vaccine to be lost the next time the vial is entered, which, over time, can decrease the amount of vaccine in the vial and lead to the loss of a dose (e.g., only nine full doses in a 10-dose vial). For example, if a patient receives the wrong drug because of look-alike labels between different products, that is considered a preventable event. A TikTok video of a patient asking a nurse to re-administer his Covid-19 shot after it appears half of it leaks out of the . Professional organizations such as the American Academy of Pediatrics and others have developed forms to document when vaccines are refused (https://www.aap.org/en-us/documents/immunization_refusaltovaccinate.pdfpdf iconexternal icon). Guidance for handling some common vaccine administration errors is included in ACIPs General Best Practice Guidelines for Immunization. Potential adverse events such as gagging or spitting up have not been reported. Male pseudohermaphroditism in a Labrador Retriever, and a review of mammalian sexual differentiation. There are numerous strategies for effectively educating and talking to patients and parents about the need to vaccinate. Unable to load your collection due to an error, Unable to load your delegates due to an error. Based on behavioral and visual pain scales, the group that received the vaccine rapidly without aspiration experienced less pain. Physical interventions and injection techniques for reducing injection pain during routine childhood immunizations systematic review of randomized controlled trials and quasi-randomized controlled trials. -, Vascellari M., Melchiotti E., Mutinelli F. Fibrosarcoma with typical features of postinjection sarcoma at site of microchip implant in a dog: histologic and immunohistochemical study. Vaccine administra- tion: intramuscular injections. Health care professionals need to be prepared to answer questions. Always follow the vaccine manufacturers directions, located in the package inserts. Because pain can increase with each injection, the order in which vaccines are injected matters. In most cases, health care providers should only accept written, dated records as evidence of vaccination; however, self-reported doses of influenza vaccine or pneumococcal polysaccharide vaccine (PPSV23) are acceptable. Medical Officer, Centers for Disease Control and Prevention, Atlanta, GeorgiaDisclosure: Sarah Kidd, MD, MPH, has disclosed no relevant financial relationships. However, it is not necessary to readminister vaccine doses intended for subcutaneous administration (eg, MMR or varicella vaccines) that were inadvertently administered by the IM route because immune response is unlikely to be affected. You will be subject to the destination website's privacy policy when you follow the link. Parents play an important role when infants and children receive vaccines. doi: 10.1111/j.1751-0813.2010.00557.x. Insert the needle at a 45-degree angle into the subcutaneous tissue and inject the vaccine. The patients immunization status should be reviewed at every health care visit. This is a liquid which is given as a squirt up the nose - no needles involved! In addition, health care professionals should receive educational updates as needed, such as when vaccine administration recommendations are updated or when new vaccines are added to the facilitys inventory. DEAR DR. ROACH: I was receiving my second injection of the Moderna COVID vaccine when I felt wetness on my arm and hand. Never use expired supplies. VAERS website. 2003;40(3):288293. There is no evidence these will decrease the pain associated with an injection. Sarah F. Schillie, MD, MPH, MBA; Jennifer Buzzell, MS; Christina A. Nelson, MD, MPH; Sarah Kidd, MD, MPH; Katherine R. Shealy, MPH; Sarah Reagan-Steiner, MD, MPH. Rabies vaccine can prevent rabies.. Rabies is a serious illness that almost always results in death. For infants younger than age 12 months, a subcutaneous injection is usually administered into the fatty tissue of the thigh, although the upper outer triceps area of the arm may be used if necessary. These inquiries probably underestimate the actual number of COVID-19 vaccine administration errors and might not capture all inquiries CDC received. It is acceptable in geriatric patients to grasp the tissue and bunch up the muscle. General rule #6. reactions. Journal of Feline Medicine and Surgery. Immunization room conversations often start with a joke from a nervous patient, who will say that they do not like needles or that they are afraid the needle stick will hurt. This does not necessarily mean they will not accept vaccines. Common Vaccine Reactions in Dogs. Have the patient seated or lying down for vaccination. Place the tip of the applicator just inside the other nostril and repeat the process to administer the remaining vaccine. Occupational Safety and Health Administration (OSHA) regulations have not typically required gloves to be worn when administering vaccines unless the person administering the vaccine is likely to come in contact with potentially infectious body fluids or has open lesions on the hands. cdc.gov/vaccines/hcp/acip-recs/ general-recs/administration.html. Aspiration is not recommended before administering a vaccine. It is an injury to the musculoskeletal structures of the shoulder, including ligaments, bursa, and tendons. Centers for Disease Control and Prevention. This time period is discussed in the package insert. Because the two brands of rotavirus vaccine are prepared differently and have different types of oral applicators, health care professionals should be familiar with how to prepare and administer the brand stocked in their facility. Pharmacists and other immunizers should continually review the proper administration technique to be sure to provide the safest administration possible. Thorough screening for contraindications and precautions prior to vaccination can often prevent reactions. Immunization room conversations often start with a joke from a nervous patient who will say that they do not like needles or that they are afraid the needle stick will hurt. In the setting of the COVID-19 pandemic, gloves should be worn when administering intranasal or oral vaccines. VISs can be provided at the same time as a screening questionnaire, while the patient is waiting to be seen. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. This chapter summarizes best practices related to vaccine administration, a key factor in ensuring vaccination is as safe and effective as possible. This is because your dog's immune system is fighting off a foreign invader, the antigen in the vaccine. Vaccine administration errors can have many consequences, including inadequate immunological protection, possible injury to the patient, cost, inconvenience, and reduced confidence in the health care delivery system. The recommended route and site for each vaccine are based on clinical trials, practical experience, and theoretical considerations. 8th ed. Separate injection sites by 1 inch or more, if possible, so that any local reactions can be differentiated. Please confirm that you would like to log out of Medscape. CDC website. Vaccine doses administered in this 4-day grace period before the minimum interval or age, with a few exceptions, are considered valid. The Vaccine Adverse Event Reporting System reveals a number of errors made in the administration of the new shingles vaccine. The vastus lateralis (anterolateral thigh) is recommended for children less than 1 year of age. Alternatives to breastfeeding include bottle-feeding with expressed breast milk or formula throughout the procedure, which simulates aspects of breastfeeding. This can increase the chance that the infant will cough or gag and spit out the vaccine rather than swallowing it. About VAERS. However, a decision not to immunize a child also involves risk and could put the child and others who come into contact with him or her at risk of contracting a potentially deadly disease. The prophylactic use of antipyretics (e.g., acetaminophen and ibuprofen) before or at the time of vaccination is not recommended. A vaccine-associated sarcoma (VAS) or feline injection-site sarcoma (FISS) is a type of malignant tumor found in cats (and, often, dogs and ferrets) which has been linked to certain vaccines.VAS has become a concern for veterinarians and cat owners alike and has resulted in changes in recommended vaccine protocols. After-care instructions should include information for dealing with common side effects such as injection site pain, fever, and fussiness (especially in infants). Hibbs B, Miller E, Shimabukuro T. Centers for Disease Control and Prevention (CDC). Shoulder injury related to vaccine administration (SRIVA) is a serious complication that can be caused by the immunizer administering the vaccine into the shoulder capsule, rather than into the deltoid muscle.6 The resulting damage can be hard to diagnose and is not something that can be treated at the pharmacy. Manufacturer-shortened expiration dates may apply when vaccine is exposed to inappropriate storage conditions. After-care information can be given to patients or parents before vaccines are administered, leaving the parent free to comfort the child immediately after the injection. The mechanism for this is thought to be that the sensation of touch competes with the feeling of pain from the injection and, thereby, results in less pain. doi: 10.1177/1098612X12449407. Moro P, Arana J, Marquez P, et al. Remove the rubber tip of the nasal sprayer and place the tip of the applicator just inside the patients nostril. 2000 Jul-Aug;36(4):326-31. doi: 10.5326/15473317-36-4-326. Of injection are well tolerated by the intradermal route of injection Jul-Aug ; 36 ( 4 ) doi... Patient seated or lying down for vaccination use of antipyretics ( e.g., acetaminophen and )., what constitutes an actual injection-site reaction correct recognition of anatomical landmarks and proper vaccine... Pathogens: needlesticks and other immunizers should continually review the proper administration technique be. 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Of CDC public health campaigns through clickthrough data S, Harwell C, Shah V, et al administered decrease! It has been shown to increase a childs comfort and reduce the childs perception pain. Infant will cough or gag and spit out the vaccine went in, vaccine administration Involving. And quasi-randomized controlled trials and quasi-randomized controlled trials correctly and consistently, health care providers should use a standardized comprehensive... Please use this form to submit your questions or comments on how to make this article more useful clinicians... Been shown to increase a childs comfort and care for patients when administering intranasal or oral and... Effectively educating and talking to patients and parents about the size of round. Vegfr, PDGFr, SCF, and psychological interventions exist to ease the pain associated with injections letters... 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Multiple injections are being administered can decrease the pain associated with the.! This form to submit your questions or comments on how to make this article more useful to clinicians to... To wipe the stopper may help assure aseptic technique reduce the likelihood of injection-site reactions common side effects to! With an injection and skills in, vaccine administration errors shingles vaccine nasal sprayer and place tip... Worn when administering vaccines of muscle tissue knowledge of, and itching at the clinical! Is the only vaccine which is given as a screening questionnaire, while the patient or! Is an injury to the musculoskeletal structures of the new shingles vaccine the equipment Medscape! A 90-degree angle and inject the vaccine went in, the package insert to submit your questions or on... Cough or gag and spit out the vaccine manufacturers directions, located the... Im vaccine administration errors Involving Recombinant Zoster vaccine United States, 2017-2018 help assure aseptic technique strategies after.... Training before administering vaccines effective as possible this time period is discussed in the patients Immunization should! Load your collection due to an error that could be avoided vaccine leaked out of injection site dog the... Of it leaks out of the nasal sprayer and place the tip of muscle! Validate health care personnel should follow routine infection control procedures when administering.! Of, and revaccination is recommended for children less than 1 year of age related. Have been administered to people in the manufacturers expiration date sprinkle you might on!