Madison Clarke
The route and site of vaccine administration are critical factors in ensuring the effectiveness of the vaccine and the safety of the patient. Different vaccines require different routes of administration, such as intramuscular, subcutaneous, oral, or intranasal, and each route has specific injection sites. For instance, the BCG vaccine is injected intradermally into the upper right arm, whereas the measles vaccine is injected subcutaneously into the upper arm. The choice of needle length and gauge is also dependent on the route, age, patient size, and injection technique. In addition, certain vaccines, such as the hepatitis B vaccine, can be administered through different routes, including intramuscular or intradermal injections, depending on the patient's characteristics and medical history.
| Characteristics | Values |
|---|---|
| Injection site | Upper right arm |
| Injection angle | 90° angle |
| Injection technique | Needle inserted deep into the muscle layer |
| Injection type | Subcutaneous (SC) injections |
| Injection equipment | 25–27 gauge needle, 16 mm long |
| Injection preparation | Wash hands with soap and water or use an alcohol-based hand rub |
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What You'll Learn
- Oral vaccines are administered through drops to the mouth
- Intranasal vaccines are administered into the nostrils using a nasal spray
- Intramuscular injections are administered into the muscle
- Subcutaneous injections are administered into the fatty tissue below the skin
- Intradermal injections are administered into the skin
Oral vaccines are administered through drops to the mouth
During the COVID-19 pandemic, gloves should be worn when administering oral vaccines. If gloves are worn, they should be changed, and hand hygiene should be performed between patients.
Oral vaccines must reach the desired tissue to provide an optimal immune response and reduce the likelihood of injection-site reactions.
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Intranasal vaccines are administered into the nostrils using a nasal spray
The only vaccine currently administered by the intranasal route is the live attenuated influenza vaccine (LAIV), with the most prominent example being FluMist, also known as FluMist Quadrivalent in the United States and Fluenz in Europe. FluMist was approved for at-home administration and is the only flu vaccine on the market that does not use a needle.
Nasal sprays deliver a fine mist of medication into the nostrils, which is then easily absorbed into the bloodstream through the rich vascular lining of the nose. This direct delivery method can result in less drug degradation compared to oral administration. Additionally, nasal sprays can bypass the initial layers of the nasal mucosa, delivering vaccine particles directly to the mucoadhesive layer, where they can trigger an immune response and prevent infection.
The use of nasal sprays for vaccination is not limited to the flu. Several intranasal COVID-19 vaccines have been developed, including inCOVACC, Razi Cov Pars, Sputnik, and Convidicia. These vaccines aim to improve availability and reduce the spread of COVID-19 globally.
The technique for administering a nasal spray vaccine is relatively simple. The user should gently shake the bottle, remove the cap, and prime the dispenser if needed. They should then tilt their head slightly forward, close one nostril by gently pressing against the side of their nose, and insert the tip of the nasal spray into the other nostril. The spray should be directed towards the back and outer side of the nose, ensuring it goes straight back and not up into the tip of the nose. The user can then squeeze the bottle as they slowly breathe in through their nose. After removing the spray from the nostril, they should breathe out through their mouth and wipe the tip of the spray with a tissue or alcohol pad before replacing the cap.
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Intramuscular injections are administered into the muscle
Intramuscular injections are shots delivered into the muscle. They can be administered by a healthcare provider or self-administered into the upper arm, thigh, buttock, or hip. The specific site chosen depends on the patient's age, the type and dose of medication, and the size of the needle. For example, the deltoid muscle in the upper arm is recommended for adults, while the vastus lateralis muscle in the anterolateral thigh is an alternative site if the deltoid is not available.
When administering an intramuscular injection, it is important to follow proper procedures to ensure the safety and comfort of the patient. Before giving the injection, wash your hands with soap and warm water to prevent potential infection. Clean the injection site with an alcohol swab and allow it to air dry. If desired, apply ice or topical numbing cream to the injection site beforehand to reduce discomfort.
The needle used for an intramuscular injection should be long enough to reach the muscle without penetrating the nerves and blood vessels underneath. Typically, needles range from 1 inch to 1.5 inches for adults and are smaller for children. To isolate the muscle and target the correct injection site, spread the skin between two fingers. The needle should be inserted at a 90-degree angle to the skin, with the skin spread and tissues not bunched. For geriatric patients, it is acceptable to "bunch up" the muscle.
Intramuscular injections are commonly used for people of all ages, including infants. They are often used for assisted fertility treatments, gender-affirming hormone therapy, vitamin B12 supplementation, and disease-modifying treatments for autoimmune diseases. However, they may be avoided for individuals taking blood thinners or those with bleeding disorders due to the risk of bleeding. Additionally, intramuscular injections should not be administered to areas with evidence of infection or injury, and injection sites should be rotated to avoid muscle injury and discomfort.
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Subcutaneous injections are administered into the fatty tissue below the skin
To administer a subcutaneous injection, it is important to first clean the injection site with an antiseptic solution to prevent infection. Then, pinch the skin and insert the needle all the way in at a 90-degree angle (or a 45-degree angle if there is not much fatty tissue). Once the needle is in place, release the skin and inject the medicine by pushing the plunger. After the injection is complete, remove the needle quickly and apply pressure to the injection site with clean gauze to stop any bleeding.
There are several areas of the body suitable for subcutaneous injections, including the thighs, buttocks, abdomen, and upper arms. It is important to rotate the injection site daily to avoid the formation of fatty lumps, which can slow down the absorption of medicine.
Subcutaneous injections should be administered with caution, as incorrect needle insertion or movement during the injection can cause pain or irritation at the injection site. Additionally, some medications can cause bruising or irritation at the injection site.
Subcutaneous injections are a safe and effective way to administer medications that require slow and steady absorption into the bloodstream.
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Intradermal injections are administered into the skin
The injection is administered at a shallow depth, and the goal is to form a small wheal or bubble just under the surface of the skin, which confirms the injection technique is correct. The dosage is usually less than 0.5 ml, and a fine, short, 26 or 27 gauge hypodermic needle is used. Common injection sites include the inner forearm, upper back, deltoid, thigh, and under the shoulder blade, with the inner forearm being the most common site. These sites are chosen for accessibility and skin thickness, with thicker skin being preferred.
Before administering an intradermal injection, it is important to clean the injection area with an alcohol pad and allow it to air dry. The syringe is then held at a 5- to 15-degree angle with the bevel facing up, and the needle is slowly inserted just into the skin until it is fully covered. The solution is then administered slowly, forming the small wheal under the skin. After the injection, the needle is gently removed at the same angle, and the safety shield is engaged for safe disposal.
It is important to educate the patient on proper post-injection care, such as avoiding rubbing or scratching the injection site and applying a cold compress if needed.
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Frequently asked questions
The BCG vaccine is injected intradermally into the upper right arm.
The measles vaccine is injected subcutaneously into the upper arm.
The hepatitis B vaccine is generally given in the arm as a three-dose series on a 0, 1, and 6-month schedule. It can be given intradermally to healthcare workers who are negative for hepatitis B and who do not respond to a primary vaccination course.
