# Presentation: 351251

## The Immunization Encounter: Critical Issues

Encounter Activities

**Encounter Activities**

**National Center for Immunization and Respiratory Diseases**
**Centers for Disease Control and Prevention**

**These graphics are in the public domain**
**December 2008**

## Subcutaneous Vaccines

**Anthrax**
**Japanese encephalitis**
**Measles, mumps and rubella-containing vaccines**
**Meningococcal polysaccharide**
**Varicella**
**Zoster**
**Yellow fever**

## Intramuscular Vaccines

**Diphtheria, tetanus and pertussis**
***Haemophilus influenzae***** type b**
**Hepatitis A**
**Hepatitis B**
**Influenza (inactivated)**
**Pneumococcal conjugate**
**Meningococcal conjugate**
**Rabies**
**Typhoid Vi **

## Either Subcutaneous or Intramuscular

**Inactivated polio**
**Pneumococcal polysaccaride**

## Subcutaneous Needle

**Gauge:**
**23 to 25**
**Length:**
**5/8 inch**

## Intramuscular Needle

**Gauge:**
**22 to 25**
**Length:**
**newborn****	****	****	****            5/8 inch**
**infant ****	****	****	****	****        1 inch**
**older children****	****  5/8 to 11⁄4 inch**
**adolescent/adult      1 to  11⁄2 inch**

## Infection Control

**Hand hygiene**
**recommended between each patient**
**alcohol-based waterless antiseptic can be used**
**Gloves**
**not required by Occupational Safety and Health Administration (OSHA) unless potential for exposure to blood or body fluids, open lesions on the hands, or agency policy**

## Infection Control

**Equipment disposal**
**NEVER detach, recap or cut a used needle**
**place in puncture-proof container**
**dispose as infectious medical waste**

## Other Vaccine Administration Issues

**Not necessary to change needles between drawing or reconstituting vaccine and administration**

## Other Vaccine Administration Issues

**NEVER mix vaccines in the same syringe unless approved for mixing by the Food and Drug Administration (FDA)**
**No attempt should ever be made to transfer vaccine from one syringe to another**

## Other Vaccine Administration Issues

**Injection sites in same limb should be separated by at least 1 inch if possible**

## Other Vaccine Administration Issues

**Aspiration **
**not required**
**no reports of injury because of failure to aspirate**

## Latex Allergy

**Most often a contact-type allergy**
**Person with anaphylactic allergy to latex generally should not receive vaccines supplied in vials or syringes that contain natural rubber**
**Persons with latex allergies that are not anaphylactic can be vaccinated**

## Vaccine AdministrationErrors

**Administration of the wrong vaccine formulation**
**Wrong diluent**
**Wrong route of administration**

## Fever and Pain Following Vaccination

**Acetaminophen or ibuprofen can be given if necessary**
**Aspirin should NEVER be given to a child**

## Fever and Pain Following Vaccination

**Plenty of fluids**
**Dress the child in light clothing**
**Sponge the child in a few inches of lukewarm water**
**Wet a clean washcloth with cool water and place it on the tender area**

## When to Contact the Provider

**Fussy for more than 24 hours**
**Rectal temperature of 105****°**** F or higher**
**Child is pale or limp**

## When to Contact the Provider

**Crying continuously for more than 3 hours**
**High-pitched cry**
**Shaking, twitching or jerking**
**The parent has any other concerns about the way the child looks or acts**