All patients should be screened for contraindications and precautions every time a vaccine is administered, even if the patient has previously received a dose of that vaccine. The patient's status can change from one visit to the next or a new contraindication or precaution may have been added. Screening questions are available
Some vaccines need to be reconstituted; a specific diluent will be provided by the manufacturer. It is important to follow manufacturer guidelines in reconstituting the vaccine. See
Vaccines with Diluents: How to Use Them. Measles, mumps, rubella (MMR); varicella; zoster; meningococcal polysaccharide (MPSV); and rotavirus vaccines all require reconstitution
This includes administering at the correct age, the appropriate interval, and before vaccine or diluent expires.
schedule to ensure the patient is getting the vaccine at the right time, and the
appropriate interval (Log-in required). Each vaccine vial should be checked for the expiration date. A vaccine should never be used if it is expired. Once reconstituted, the vaccine must be administered according to the guidelines or discarded. In most cases, if not used within 30 minutes, the vaccine will lose its potency and the patient will not be properly immunized.
Immunizations are administered through the following routes: intramuscular (IM), subcutaneous (SQ), oral, nasal, and intradermal. The majority of immunizations are administered IM, but MMR, varicella, zoster, and MPSV are administered SQ. In administering IM injections, it is important to use a needle with the correct length to reach the muscle mass and not seep into SQ tissue. (see Table 1 below)
When administering IM injections, the needle should be inserted at a 90° angle—and quickly. It is not necessary to aspirate after needle insertion. SQ injections are administered at a 45° angle, and the SQ tissue is pinched up to prevent injection into the muscle. It is not necessary to aspirate after needle insertion. Multiple immunizations should be a minimum of 1 inch apart. Another method of immunization is nasal spray, which has recently become available for live attenuated influenza vaccine. Intradermal is now available for Fluzone, an influenza vaccine. Oral polio vaccine has not been used in the United States since 2000 but is still used in other countries. In the United States, inactivated polio vaccine is given and can be administered SQ or IM.
Children of different sizes and ages will need vaccines administered in different locations on the body. (see Table 2 below).