Immunisation and Injection Technique Flashcards Preview

CAM201 Clinical Skills > Immunisation and Injection Technique > Flashcards

Flashcards in Immunisation and Injection Technique Deck (20):

Definition of safe injection

  1. One that does not harm the recipient
  2. One that does not expose the health worker at risk
  3. 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


  • 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)

  1. Check expiry date and prepare correct medication
  2. Prepare correct equipment
  3. Identify correct patient and obtain informed consent
  4. Select correct site
  5. Swab area with alcohol wipe
  6. Hold syringe between thumb and forefinger of dominant hand


Technique subcutaneous injection

  1. Hold as a dart at 45-90 degrees
  2. Pinch skin and piece skin
  3. Avoid moving syringe
  4. Aspirate drug (if blood appears remove, discard and repeat)
  5. Inject slowly


Technique IM injection

  1. If patient muscle mass is small, grasp the body of the muscle between thumb and finger
  2. Insert needle at 90 degree angle into muscle
  3. Aspirate (if opiate)
  4. Inject slowly
  5. Apply pressure to site after injection



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


Anaphylaxis symptoms

  • Skin - erythema, urticarial lesions
  • Upper airway obstruction - hoarseness and stridor
  • Lower airway obstruction - chest tightness, dyspnoea and wheeze
  • Profound hypotension
  • Sinus tachycardia and severe bradycardia
  • Addominal cramps, diarrhoea, and/or vomiting
  • Limpness and pallor in children


Anaphylaxis management

  • Lie patient down
  • Give IM adrenaline if any cardiovascular or respiratory signs
  • If no improvement in 5 mins, repeat IM adrenaline
  • Rpt every 5 mins until improvement occurs
  • Give oxygen if available
  • Call ambulance
  • Begin CPR if required
  • Admit to hospital for further observation and treatment

Note: antihistamine and/or hydrocortisone not recommended for emergency management of anaphylaxis. 


Adrenaline in anaphylaxis

Use 1:1000 - contains 1mg of adrenaline in 1ml of solution. 

Recommended dose is 0.01ml/kg body wt (=0.01mg/kg) up to maximum of 0.5ml or 0.5mg deep IM injection into thigh (not deltoid). 

Never give adrenaline 1:1000 IV


Vaccine documentation

For vaccines

  • Patients clinical notes
  • Child's health records (blue book*)

You need to record:

  • Vaccine given - name and dose
  • Date given
  • Batch number
  • Expiry
  • Site given
  • Next due dose
  • Signature
  • Any adverse reaction


Documentation for any drugs

  • Type of drug
  • Amount given
  • Site
  • Reaction
  • Signature