1.4 Administration of vaccines

Please note: due to continuous updates being made to the Immunisation Handbook, the page number on the electronic version will not always match the hard copy version.

Preparing for vaccination

• Depending on the vaccine(s) that are to be administered, and the age and size of the person to be vaccinated, decide on the appropriate injection site and route, and the injection equipment required (ie. syringe size, needle length and gauge).
• The equipment chosen will vary depending on whether the vaccine is a reconstituted vaccine, a vaccine from an ampoule or vial, or a vaccine in a pre-filled syringe.

Equipment may include:

• medical waste (sharps) container,
• vaccine, plus diluent if reconstitution is required,
• 2 or 3 mL syringe (unless vaccine is in pre-filled syringe),
• appropriate drawing-up needle (19 or 21 gauge needle if required, to draw up through rubber bung and for reconstitution of vaccine),
• appropriate injecting needle (see Table 1.4.2 Recommended needle size, length and angle for administering vaccines),
• clean cotton wool and hypoallergenic tape to apply to injection site after vaccination, and
• a rattle or noisy toy for distraction after the injection.

Preparing the vaccine

• Wash hands carefully and prepare the appropriate injection equipment for the vaccine to be administered.
• Ensure that the minimum/maximum thermometer displays temperatures within the +2°C to +8°C range before removing vaccine from the refrigerator.
• Ensure that the correct vaccine is taken from the refrigerator and that it is within the expiry date.
• Check that there is no particulate matter or colour change in the vaccine.
• Ensure that the diluent container is not damaged and potentially contaminated.

Preparing vaccine provided in a pre-filled syringe, ampoule or liquid vial

• If the vaccine is in a vial, remove the cap carefully to maintain sterility of the rubber bung. Do not wipe the rubber bung. Use a 19 or 21 gauge needle to draw up the recommended dose through the bung.
• If the vaccine is in an ampoule, use a 23 gauge, 25 mm needle to draw up the recommended dose.
• Needles should be changed after drawing up from a vial with a rubber bung, but it is not necessary to change needles between drawing up a vaccine from an ampoule and giving the injection.
• Small air bubbles do not need to be extruded through the needle.
• A needle or syringe that has already been used to inject an individual must never come into contact with the vial because of the risk of cross-contamination.

Preparing vaccines requiring reconstitution

• Reconstitute the vaccine as needed immediately before administration.
• Never mix other vaccines together in the one syringe (unless that is the manufacturer’s registered recommendation, eg. Infanrix hexa).
• Never mix a local anaesthetic with a vaccine.
• A sterile 21 gauge needle should be used for reconstitution and a separate 23 or 25 gauge needle, 25 mm in length, should be used for administration of the vaccine in most circumstances.
• Use only the diluent supplied with the vaccine; do not use sterile water for injection instead of a supplied diluent. Ensure that the diluent and vaccine are completely mixed.
• Reconstituted vaccines should be checked for signs of deterioration, such as a change in colour or clarity.
• Reconstituted vaccines may deteriorate rapidly and, in general, should be administered as soon as practicable after they have been reconstituted.
• Never freeze a vaccine after it has been reconstituted.