Vaccine injection technique

Intradermal vaccination

Intradermal vaccination is disposable tuberculin syringe with a capacity of 1.0 ml and thin needles (number 0415) with a short cut. The vaccine is administered at the boundary of the upper and middle thirds of the outer surface of the shoulder after pretreating the skin with alcohol 70 °. The needle is inserted into the cut-up layer surface parallel to the skin surface. To verify that the needle has entered accurately injected intradermally first minor amount of the vaccine, and then the entire drug dose (0.1 ml). With the correct technique is to form a papule white ("lemon peel") with a diameter of 7-9 mm, which disappears after 15-20 minutes. It is not allowed dressing and processing of the injection site with antiseptics. With the introduction of BCG or BCG-M under the skin develops a cold abscess; when it appears, especially in re-establishing the urgent need to check the quality of medical staff training, conducting vaccinations.

Intramuscular vaccination

Intramuscular vaccination is required for the introduction of the adsorbed (DTP, DT, Td, HBV) drug that reduces the risk of granulomas - by the reaction of aluminum hydroxide ("sterile abscesses"). Patients with hemophilia / m introduction is replaced by subcutaneous.

The best place for children 0-3 years old is the front-outer thigh area (lateral portion of the quadriceps), and for children older than 3 years of age and adults - deltoid (section below acromion process and above the armpit). In both cases, the needle is inserted at an angle of 80-90 °. Intramuscular injection in the gluteal muscle is undesirable because:

• In infancy gluteal muscle is not developed, so there is a risk that the introduction of the vaccine in the fatty tissue with the formation of persistent infiltrates.
• 5% of children nerve trunk passes in the upper-outer quadrant of the buttocks, which creates the possibility of damage during injection.
• Increased frequency and intensity of the reaction temperature.
• With the introduction of the vaccines (hepatitis B, rabies) in the muscle of the thigh or the deltoid muscle is more intensive antibody production.

There are 2 ways to insertion of the needle into the muscle:

• assemble muscle with two fingers in the fold, increasing the distance to the bone;
• stretch the skin over the site of injection, reducing the thickness of the subcutaneous layer; This is especially useful in children with a thick fat layer, but the depth of insertion of the needle must be smaller.

On the thigh thickness of the subcutaneous layer until the age of 18 months. It is 8 mm (a maximum of 12 mm) and the muscle thickness - 9 mm (maximum 12 mm), so that the needle length of 22-25 mm is sufficient for the administration of the vaccine deep into the muscle when taking its pleated. The children of the first months of life, the needle 16 mm in length should be used only when the skin stretched. In a special study has shown that by using a needle 16 mm in length, local reactions occur much more frequently than with 22-25 mm needle.

In his hand is less than the thickness of the fat layer - 5-7 mm, and the thickness of the muscle - 6-7 mm. It is useful after the injection to delay the plunger of the syringe and inject the vaccine only in the absence of blood. Otherwise, the procedure is repeated.

According to the technique of injection itself recently received data to reduce her pain. "Standard" method - slow introduction of the needle - pulling the piston to avoid falling into the vessel - the slow introduction of the vaccine to eliminate tissue injury - a slow recovery of the needle - was much more painful than a quick method - the rapid introduction of a needle - a quick introduction of the vaccine - rapid removal of the needle. With regard to the feasibility of aspiration in the literature there is no convincing evidence, and whether it is running is not always in many vaccination programs.

Performing National calendar g. 2008 involves performing, using monovalent, 3 intramuscular injections (at the age of 3 and 6 months) in syringes different in different areas of the body. In view of the undesirability of introducing vaccines the buttocks, one injection is performed in thigh muscle of one leg and two others - in the thigh muscle other leg - the distance between injection sites when it should be at least 3 cm in order to be able to separately note the local reaction. In case of failure of the parents of 3 injections 2 injections are performed, and the third is carried out in a few days (it is quite acceptable for inactivated vaccines).

Subcutaneous vaccination

Subcutaneous vaccination is normally used for introducing drugs is not adsorbed (influenza, measles, rubella, mumps, and meningococcal vaccines and other polysaccharide). When injected into the subscapular region less developed both local and general reactions, but it is possible to introduce in the outer surface of the shoulder region (on the border of the upper and middle third). The needle is inserted at an angle of approximately 45 °.

Cutaneous (scarification) vaccination

Cutaneous (scarification) vaccination is used during vaccination with live vaccines against especially dangerous infections (plague, tularemia, etc.), Leather interior surface of the forearm after evaporation of antiseptic applied drops of the vaccine dilution and through the lancet perpendicular to the stretched skin make superficial cuts, in the course of which only a small drop of blood should act. The number of drops and cuts through them, their length and distance from each other defined instructions for use. In place of scarification can not apply dressings and treat it with antiseptics.

As the number of microbial cells in the vaccine for cutaneous application of the maximum, preparation, prepared for this purpose, it is prohibited to enter in other ways, because it is fraught with the development of toxic and allergic shock. To avoid this error, you should inculcate in different ways on different days.

Oral vaccination

Oral vaccination is polio, rotavirus infection, plague, cholera. Polio vaccine instilled into his mouth with a sterile pipette, a dropper or a special syringe for 1 hour before meals. Wash down with a vaccine, to eat and drink within an hour after the vaccination is not permitted. If a child or vomited immediately after the vaccinations, he should be given a second dose; if in this case it was regurgitation, a new dose given only on your next visit.

Intradermal vaccination

Intradermal vaccination is carried out with 1.0 ml disposable tuberculin syringes and thin needles (No. 0415) with a short cut. The vaccine is injected on the border of the upper and middle third of the outer surface of the shoulder after pre-treatment of the skin with 70 ° alcohol. The needle is injected cut up into the surface layer of the skin parallel to its surface. In order to make sure that the needle entered exactly intracutaneously, a small amount of the vaccine was first injected, and then the entire dose of the drug (0.1 ml). With the right technique, a white papule (“lemon peel”) with a diameter of 7-9 mm should be formed, which disappears in 15-20 minutes. Imposition of a bandage and treatment of the site of introduction of antiseptics is not allowed. With the introduction of BCG or BCG-M, a cold abscess develops under the skin; when it appears, especially when it is repeated in the institution, it is necessary to urgently check the quality of the training of the medical staff conducting the vaccinations.

[1], [2], [3], [4], [5], [6], [7], [8], [9],

Intramuscular vaccination

Intramuscular vaccination is required for the introduction of sorbed (DTP, ADS, ADS-M, HBV) drugs, which reduces the risk of granulomas - reaction to aluminum hydroxide ("sterile abscesses"). In patients with hemophilia, i / m administration is replaced with subcutaneous.

The best place for children 0-3 years old is the anteroposterior region of the thigh (lateral part of the quadriceps muscle), and for children over 3 years old and adults the deltoid muscle (the area below the acromion process and above the axillary cavity). In both cases, the needle is inserted at an angle of 80-90 °. Intramuscular administration to the gluteus muscle is undesirable because:

• In infancy, the gluteus muscle is not developed, so there is a high risk of vaccine introduction into the fatty tissue with the formation of persistent infiltrates.
• In 5% of children, the nerve trunk passes in the area of the upper outer quadrant of the buttock, which creates the possibility of its damage during injection.
• Increases the frequency and intensity of the temperature reaction.
• With the introduction of vaccines (HBV, rabies) in the thigh muscle or deltoid muscle, more intensive antibody formation occurs.

There are 2 ways to insert a needle into a muscle:

• to collect the muscle with two fingers in the crease, increasing the distance to the bone;
• stretch the skin over the injection site, reducing the thickness of the subcutaneous layer; This is especially useful in children with a thick fat layer, but at the same time the depth of insertion of the needle should be less.

On the hip thickness of the subcutaneous layer to the age of 18 months. Is 8 mm (max. 12 mm), and muscle thickness is 9 mm (max. 12 mm), so needles 22-25 mm long are enough to inject the vaccine deep into the muscle when it is taken into the fold. In children of the first months of life, a 16 mm needle should be used only for stretching the skin. A special study showed that when using a 16 mm long needle, local reactions are observed significantly more often than when using a 22–25 millimeter needle.

On the arm, the thickness of the fat layer is less - 5-7 mm, and the muscle thickness - 6-7 mm. It is useful after the injection to pull off the plunger of the syringe and inject the vaccine only in the absence of blood. Otherwise, the procedure is repeated.

According to the technique of the injection itself, recently obtained data to reduce its pain. The “standard” method — slow needle insertion — pulling the piston off to prevent it from entering the vessel — slow vaccine insertion to exclude tissue injury — slow needle removal — turned out to be much more painful than the quick method — quick needle insertion — quick vaccine insertion — quick needle removal. With regard to the desirability of aspiration in the literature there is no convincing data, and it is far from being always carried out in many vaccination programs.

The implementation of the National Calendar of 2008 involves carrying out, when using monovaccine, 3 intramuscular injections (at the age of 3 and 6 months) in different syringes in different parts of the body. Taking into account the undesirability of introducing vaccines into the buttocks, 1 injection is carried out into the thigh muscle of one leg, and 2 others into the thigh muscle of the other leg — the distance between the injection sites must be at least 3 cm so that local reaction can be noted separately. In case of refusal of parents from 3 injections, 2 injections are performed, and the third is carried out in a few days (this is quite acceptable for inactivated vaccines).

[10], [11], [12], [13], [14]

Subcutaneous vaccination

Subcutaneous vaccination is usually used with the introduction of non-sorbed drugs (influenza, measles, rubella, parotitis, and meningococcal and other polysaccharide vaccines). When injected into the subscapular region, both local and general reactions develop less frequently, but it can also be introduced into the area of the outer surface of the shoulder (on the border of the upper and middle third). The needle is inserted at an angle of approximately 45 °.

Cutaneous vaccination

Skin (scarification) vaccination is used when vaccinations are performed with live vaccines against especially dangerous infections (plague, tularemia, etc.), after the antiseptic evaporates the skin of the inner surface of the forearm, drops are diluted with a scarifier, perpendicular to the stretched skin, make superficial cuts along the way which should be only small droplets of blood. The number of drops and cuts through them, their length and distance from each other are determined by the instructions for use. In place of scarification can not bandage and treat it with antiseptics.

Since the number of microbial cells in a vaccine for percutaneous administration is maximal, the preparation prepared for this purpose is forbidden to be administered in other ways, since this is fraught with the development of toxic-allergic shock. To avoid this error, should be vaccinated by different methods on different days.

[15], [16], [17],

Oral vaccination

Oral vaccination is carried out against polio, rotavirus infection, plague, cholera. Polio vaccine is instilled into the mouth with a sterile pipette, special dropper, or syringe 1 hour before meals. Wash down a vaccine, eat and drink within an hour after an inoculation is not allowed. If the child burped or vomited immediately after vaccination, he should be given a second dose; if, in this case, there was regurgitation, a new dose is given only at the next visit.

[18], [19], [20], [21]