Vaccine administration technique

Intradermal vaccination

Intradermal vaccination is performed with disposable 1.0 ml tuberculin syringes and thin needles (No. 0415) with a short bevel. The vaccine is administered at the junction of the upper and middle thirds of the outer surface of the shoulder after preliminary treatment of the skin with 70° alcohol. The needle is inserted with the bevel upwards into the superficial layer of the skin parallel to its surface. In order to ensure that the needle has entered accurately intradermally, a small amount of the vaccine is first administered, and then the entire dose of the drug (0.1 ml). With the correct technique, a white papule ("lemon peel") with a diameter of 7-9 mm should form, which disappears after 15-20 minutes. Do not apply a bandage or treat the injection site with antiseptics. When BCG or BCG-M is administered subcutaneously, a cold abscess develops; if it appears, especially repeatedly in an institution, it is necessary to urgently check the quality of training of the medical personnel performing the vaccinations.

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Intramuscular vaccination

Intramuscular vaccination is mandatory for the administration of sorbed (DPT, ADS, ADS-M, VHB) drugs, which reduces the risk of developing granulomas - a reaction to aluminum hydroxide ("sterile abscesses"). In patients with hemophilia, intramuscular administration is replaced by subcutaneous.

The optimal site for children aged 0-3 years is the anterolateral thigh (lateral quadriceps), and for children over 3 years and adults - the deltoid muscle (the area below the acromial process and above the armpit). In both cases, the needle is inserted at an angle of 80-90°. Intramuscular injection into the gluteal muscle is undesirable because:

• In infancy, the gluteal muscle is not developed, so there is a high risk of the vaccine being injected into the fatty tissue, causing persistent infiltrates.
• In 5% of children, the nerve trunk passes through the upper outer quadrant of the buttock, which creates the possibility of its damage during injection.
• The frequency and intensity of the temperature reaction increases.
• When vaccines (HBV, rabies) are administered into the thigh muscle or deltoid muscle, more intensive antibody formation occurs.

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

• gather the muscle into a fold with two fingers, increasing the distance to the bone;
• stretch the skin over the injection site, reducing the thickness of the subcutaneous layer; this is especially convenient for children with a thick fat layer, but the depth of needle insertion should be less.

In the thigh, the thickness of the subcutaneous layer up to the age of 18 months is 8 mm (maximum 12 mm), and the thickness of the muscle is 9 mm (maximum 12 mm), so a needle 22-25 mm long is quite sufficient for injecting the vaccine deep into the muscle when taking it into a fold. In children of the first months of life, a needle 16 mm long should be used only when stretching the skin. A special study showed that when using a 16 mm needle, local reactions are observed significantly more often than when using a 22-25 mm needle.

On the arm, the thickness of the fat layer is less - 5-7 mm, and the thickness of the muscle is 6-7 mm. It is useful to pull back the plunger of the syringe after the injection and inject the vaccine only if there is no blood. Otherwise, the procedure is repeated.

Recently, data have been obtained on the injection technique itself that make it less painful. The "standard" method - slow needle insertion - pulling back the plunger to avoid entering a vessel - slow injection of vaccine to avoid tissue injury - slow needle withdrawal - has proven to be much more painful than the fast method - fast needle insertion - fast vaccine injection - fast needle withdrawal. There is no convincing data in the literature on the advisability of aspiration, and it is far from always performed in many vaccination programs.

The implementation of the 2008 National Calendar involves, when using monovalent vaccines, 3 intramuscular injections (at the age of 3 and 6 months) in different syringes in different parts of the body. Considering the undesirability of administering vaccines into the buttocks, 1 injection is administered into the thigh muscle of one leg, and the other 2 into the thigh muscle of the other leg - the distance between the injection sites should be at least 3 cm so that the local reaction can be noted separately. If the parents refuse 3 injections, 2 injections are administered, and the third is administered a few days later (this is quite acceptable for inactivated vaccines).

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Subcutaneous vaccination

Subcutaneous vaccination is usually used when administering non-sorbed drugs (influenza, measles, rubella, mumps, as well as meningococcal and other polysaccharide vaccines). When injected into the subscapular region, both local and general reactions develop less frequently, but administration into the area of the outer surface of the shoulder (at the border of the upper and middle third) is also possible. The needle is inserted at an angle of approximately 45°.

Cutaneous (scarification) vaccination

Cutaneous (scarification) vaccination is used when vaccinating with live vaccines against particularly dangerous infections (plague, tularemia, etc.), drops of the vaccine dilution are applied to the skin of the inner surface of the forearm after the antiseptic has evaporated and through them, with a scarifier, superficial cuts are made perpendicular to the stretched skin, along which only small drops of blood should appear. The number of drops and cuts through them, their length and distance from each other are determined by the Instructions for Use. The scarification site must not be bandaged or treated with antiseptics.

Since the number of microbial cells in the vaccine for cutaneous application is maximum, the preparation prepared for this purpose is prohibited to be administered by other methods, as this is fraught with the development of toxic-allergic shock. To avoid this error, vaccination should be carried out by different methods on different days.

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Oral vaccination

Oral vaccination is carried out against poliomyelitis, rotavirus infection, plague, cholera. Polio vaccine is instilled into the mouth with a sterile pipette, a special dropper or a syringe 1 hour before meals. It is not allowed to wash down the vaccine, eat or drink for an hour after vaccination. If the child burps or vomits immediately after vaccination, he should be given a second dose; if there was burping in this case, a new dose is given only at the next visit.

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