Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

COLLEGE OF HEALTH SCIENCES

Name: ___________________________________________ Grade: _________

PROCEDURE CHECKLIST
IMMUNIZATION
Instruction: Below is the grading scale which will be used in rating your performance.

5 EXCELLENT 95 - 100
4 VERY SATISFACTORY 88 - 94
3 SATISFACTORY 82 – 87
2 FAIR 76 – 81
1 NEEDS PRACTICE 70 – 75

A. ASSESSMENT
 Age and weight (if preterm infant)
 Current immunization record.
 Type of vaccine to be administered (inactivated or live, attenuated) and route of
administration.
 Contraindications or precautions including:
» Current state of health, including any concerns with the immune system;
» Medications taken in past 3 months that may have caused immunosuppression
(e.g. high dose corticosteroids, cancer treatments, etc.);
» Previous adverse events following immunization;
» History of allergy, particularly anaphylactic reactions to any substance;
» Past health history;
» Pregnancy/lactation;
» Receipt of blood transfusions or antibody-containing blood products within the past
year;
» Receipt of vaccines within the previous four weeks (Exception: yellow fever where
there is a minimum 30-day interval recommended).
 Informed consent, including discussion of risks of disease, benefits of the vaccine, the
expected vaccine side effects and possible adverse events following immunization

B. EQUIPMENT:
The equipment chosen will vary depending on whether the vaccine is a reconstituted
vaccine or a vaccine in a pre-filled syringe. Equipment may include;
Sharps container
 Vaccine, plus diluent if reconstitution is required
 3mL syringe (unless vaccine is in pre-filled syringe)
 19 gauge drawing up needle (to draw up through rubber bung once vaccine reconstituted)
 23 gauge 25mm injecting needle (intramuscular)
 25 gauge 16mm injecting needle (subcutaneous)
 Clean cotton wool and micro pore tape to apply to injection site after vaccination

C. PROCEDURES 5 4 3 2 1
PRE-VACCINATION
1. Ensure that the correct vaccine is taken from the refrigerator and that it is
within the expiry date and cold chain has been maintained
2. Prepare the appropriate injection equipment for the vaccine to be
administered
Injectable vaccines that do not require reconstitution
a. If the vaccine is in a vial, remove the cap carefully to maintain sterility
of the rubber bung. There is no need to wipe the rubber bung of a
single-dose vial with an alcohol swab if it is visibly clean.
b. Use the 19 gauge needle to draw up the recommended dose through
the bung
Change the needle after drawing up from a vial before giving the

Page 1 of 3
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

injection
Injectable vaccines that require reconstitution
a. Reconstitute the vaccine as needed immediately before
administration
b. Use a sterile 19 gauge needle for reconstitution and a separate 23
gauge needle, 24 mm in length for administration of the vaccine
Use only the diluent supplied with the vaccine; do not use sterile
water for injection instead of supplied diluent.  Ensure that the
diluents and vaccine are completely mixed.
d. Administer reconstituted vaccines as soon as practicable after they
have been reconstituted, as they may deteriorate rapidly.
For all injectable vaccines
a. In the instance of a large air bubble in a pre-filled syringe, expel the
air through the needle, taking care not to prime the needle with any
of the vaccine. This prevents the potential for partial loss of vaccine
dose.
b. Never mix a local anaesthetic with a vaccine
ADMINISTERING THE VACCINE
3. Prior to performing the procedure, introduce self and verify the client’s
identity using agency protocol. Explain to the client what you are going to
do, why it is necessary, and how he or she can participate. Discuss how
the results will be used in planning further care or treatments.
4. Perform hand hygiene and observe other appropriate infection prevention
procedures.
5. Provide for client privacy.
Intramuscular injection technique
a. For intramuscular (IM) injection, use a 23 gauge 25 mm needle
b. Depending on the injection site, position the limb so as to relax the
muscle into which the vaccine is to be injected
Pierce the skin at an angle of 90° to the skin, so the needle can be
safely inserted to the hub.
d. It is not necessary to draw back on the syringe plunger before
injecting the vaccine
Subcutaneous injection technique
a. For subcutaneous (SC) injection, administer the injection at a 45°
angle to the skin.
b. The standard needle for administering vaccines by SC injection is a
25 or 26 gauge needle, 16mm in length.
Oral Rotavirus vaccine technique
The liquid formulation is presented as a clear liquid contained in a
squeezable plastic, latex-free dosing tube with a twist-off cap.  Keep
the cap – you need this to pierce the tube (see product information)
b. The current 1.5 ml dose of vaccine should be administered orally
from the oral applicator onto the inside of the infant’s cheek in small
aliquots.
If most of an oral rotavirus vaccine dose has been spat out or
vomited within minutes of administration, a single repeat dose can
be administered during the same visit.
d. If an infant regurgitates or vomits only a small part of a vaccine dose,
it is not necessary to repeat the dose
POST - VACCINATION
6. Dispose of clinical and sharps waste, including vaccine vials
7. The live oral Rotavirus vaccine squeezable plastic container should also
be discarded in clinical waste or sharps container
8. Cover the injection site quickly with cotton wool and tape as needed
9. Gently apply pressure for 1-2 minutes (do not rub the injection site, as
may lead to local irritation)
10 Inform patient to remain on the ward for a minimum of 15 minutes after
the vaccination (to observe for any immediate adverse event, such as
anaphylaxis)

D. DOCUMENTATION

Page 2 of 3
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

1. All vaccines administered to infants and children should be documented in the MAR on
EPIC as well as in the parent held Child Health record book
2. Details which should be recorded include;
Vaccine given, including brand name, batch number, dose number
Date and time of vaccination
Site of administration
Name of the person providing the vaccination

E. SPECIAL CONSIDERATIONS
 Vaccine side effects
» The most common adverse events following immunization are; local reactions
(such as pain, redness or swelling at the injection site), fever, irritability and
injection site nodules.  These responses are usually mild and self-limiting and
generally, do not require specific treatment.
» Routine use of paracetamol at the time of, or immediately after, vaccination is not
recommended, unless the doctor told so.
 Adverse Events Following Immunization (AEFI)
» The most serious AEFI following immunization is anaphylaxis.  Nursing staff must
be aware of anaphylaxis management
» Fainting is relatively common after vaccination of adults and adolescents.  If this
occurs, lie the patient in a supine ‘head-down and feet-up’ position

REMARKS:__________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Date & Time: ______________________

Page 3 of 3