Prevention is better than cure which is why vaccines have taken on added importance. Correctly administering a vaccine is crucial to make sure the patient has the most optimal immune response and to prevent injury.
For the vast majority of vaccines, there are two means of being administered with both set to minimize any chance of side effects. Those are the intramuscular route and the subcutaneous route.
In this guide, we will look at site preparation before the vaccine is administered, the various preferred sites by age, and those two different routes.
Getting The Site Prepared To Administer A Vaccine
Before a nurse should decide on which route of administration is best, the site needs to be prepared for the injection (see also ‘How To Open Ampule‘). That may mean a quick wipe with an alcohol swab to ensure that the skin at the chosen site is visibly clean and then dried out completely.
Check for any infection or eczema present at the site to see off any risk of an abscess at the injection point. If it is not possible to find another point for the injection then try some extensive alcohol swabbing first.
The Preferred Injection Sites Based On Age
Depending on the recipient’s age, some specific injection sites are preferred. This is largely due to how the body develops from the youth of an infant under twelve months to that of a child, a teenager, and an adult.
A Child Over A Year Old, Teenagers, And Adults
For children over 12 months old, then teenagers, and adults, the preferred injection site is typically the deltoid. This is found in the upper arm and requires a nurse to expose the chosen arm from the elbow up to the top of the shoulder.
This may require a sleeve to be rolled up or an item of clothing, like a jacket or a sweater, to be removed.
It helps to find the lower and upper anatomical landmarks of the arm such as the acromion at the tip of the shoulder and the muscle insertion point of the deltoid tuberosity itself. A nurse could even create a triangle from below the shoulder tip to the deltoid tuberosity.
About halfway between those two landmarks, directly in the middle of the triangle and the deltoid muscle should be the preferred injection site. If two injections are required for a vaccine then these can be around 2.5cm apart.
An Infant Under Twelve Months Old
An infant may be a little easier when it comes to finding the preferred injection site. That’s because it is not in the arm but in the middle third of the anterolateral thigh, also known as the vastus lateralis.
Again, complete exposure of the limb is required and the nurse can look for the patella and greater trochanter of the femur as the lower and upper anatomical landmarks.
An imaginary line can be drawn between those landmarks from the front of the thigh then divide that into thirds. The correct injection site should be in that middle third of the thigh towards the outer part of that imaginary line. Furthermore, if two vaccines are required then these can be around 2.5cm apart.
Try not to use the anterior part of the thigh as an injection point as there may be some underlying structures which can be damaged.
The Intramuscular Route
Certain vaccines are best administered via the intramuscular route and these include Hepatitis A and B, Diphtheria-tetanus and Diphtheria-tetanus-pertussis, Human papillomavirus, and inactivated influenza. The needle insertion should be at a 90° angle through the skin with a quick thrust.
Once the needle is through the subcutaneous tissue, it should meet the muscle.
The Subcutaneous Route
There is a more limited amount of vaccines that should be administered via the subcutaneous route. These include measles, mumps, and rubella (better known as MMR), varicella, and zoster, live.
Both inactivated polio and pneumococcal polysaccharide vaccines can be administered via either the intramuscular or subcutaneous route. For the subcutaneous route, the needle is presented at a 45° angle through the skin into the subcutaneous tissue.
Final Thoughts
There is a certain technique that comes with administering vaccines to ensure they work as they should. That means making sure that the injection site is clear and clean by giving it a quick swab with an alcohol wipe.
The nurse’s hand hygiene is also important, as is how the injection is administered itself. There are two administration routes and the choice largely depends on the vaccine itself.
The intramuscular route goes through the skin and subcutaneous tissue to reach the muscle at a 90° angle and is best for vaccines including those for Hepatitis A and B. However, for the measles, mumps and rubella vaccine and a few others, the subcutaneous route is best which does not reach the muscle and goes in at a 45° angle.
There is also the age of the patient to consider as infants require the injection in the middle third of their anterolateral thigh. For children, teenagers, and adults, the preferred injection site is typically at the deltoid tuberosity.
Frequently Asked Questions
Why Is Hand Hygiene A Vital Aspect Of Administering Vaccines?
It is unlikely that a nurse will be expected to wear gloves when administering vaccines as this can make the procedure more difficult (see also ‘How To Measure For NG Tube‘). However, they would be required if the nurse had open lesions on their hands or had come into contact with potentially infectious bodily fluids.
This is to ensure that the safety of the patient is preserved and if gloves are worn these should be changed repeatedly.
How Important Is It To Record Vaccines In A Patient’S Medical History?
It is not only important for record-keeping to ensure that a patient’s medical history is up-to-date for vaccines, it is required by law. That record can be in paper form or made electronically but should note down the date of the vaccine administration.
The vaccine manufacturer, vaccine lot number, the name and title of the nurse who administered the vaccine, and the address of the facility where that patient’s medical record will reside needs to be noted too.
There is also a vaccine information statement which includes the date and the date the statement was given to the patient or their parent/guardian.