Administering flu/pneumonia vaccines

[Dempather, RN]

On my floor, I've only administered a handful of flu or pneumonia vaccines. I know pneumonia is IM, I think flu is too.. however, when I was at the MD yesterday to receive my flu shot, I received it in my left arm with a #25 gauge needle... isn't that SC(?) .. while my blood was drawn with a #21 .

I personally hate IMs.. ! For example, Haldol. Let's find our most AGITATED patient, and give em' the most painful shot we can find. At least that's how it feels to me.

Curious from you guys - what gauge to you use on what person for flu/pneu vaccines? I've heard people tell me that inject in arms, legs, and use a variety, depending on size of people (we're talking general adult population, not peds). But my understanding is that they're both IM, yes?

[LaeDeesNP]

I work at a health clinic and have been administering the flu and pneumonia vaccines for months now...(I can't even tell you how many flu shots I've given...I'll be glad when flu season is over!) :) It's not "wrong" to administer an IM shot in the arm with a 25 gauge needle. You're correct when you say it depends a lot on the size of the patient. We use tuberculin syringes (which are 25 gauge 5/8") for a lot of our immunizations and they're sufficient for most adults when given in the arm and most pediatrics when given in the leg.

[KYCNM]

Both injections should be given intramuscularly. Choice of the needle depends upon the patient. I don't have the reference here at home, but a student of mine did an evidence based practice review of needle length required for intramuscular injections and found a number of research articles indicating that we should be using BMI (body mass index) to help determine the length of needles used for IM especially with our obese and morbidly obese patients. Many medications (for example, vistaril) are painful, but even more so if the medication leaks back up through the needle track to the SQ tissues. I will see if I can find the resource on Monday.

On another note, there was an article on Medscape about young women fainting after receiving the Gardasil shot because it was so painful.

[Simba&NalasMom, LPN]

25 is sufficient for 90% of people I've injected if I'm going in the deltoid. When I give Rocephin I use a 21 and it goes in the gluteus.

Pneumovax may actually be given IM OR SC.

[Dempather, RN]

On another note, there was an article on Medscape about young women fainting after receiving the Gardasil shot because it was so painful.

I had that shot. It hurts.. yeah, but c'mon...

[Dempather, RN]

"When I give Rocephin I use a 21 and it goes in the gluteus"

I've always given that IV, I didn't know IM was a choice.

[Simba&NalasMom, LPN]

Well most of my experience is in long-term care where IV isn't really an option, but people still get nasty URIs. Docs will commonly order Rocephin IM and you mix it with Lidocaine. I had a Rochephin shot myself once which was given by the doc, and he used the vastus lateralis; worst dang charlie horse I've ever had! :angryfire

How is it given IV? Do they have to have a PICC or other central line or have you given it peripherally?

[Dempather, RN]

Generally, as with several IVs meds, we mix the drug with 50 or 100cc NS or D5W and run it from 30-60 minutes. I don't remember precisely. I want to say Rocephin 1gm IV in 50cc D5W over 30 minutes. I could be mistaken. I'd have to see the order or look it up, for sure. :)

[Chloe'sinNYNow]

On another note, there was an article on Medscape about young women fainting after receiving the Gardasil shot because it was so painful.

If the flu vaccine is a dead dead/inactivated (is that the right word?) virus, then why does it hurt when it is injected?

Chloe

[sirI, MSN, APRN, NP]

Please, let's stick to the topic of flu/pneumonia vaccines. If you wish to discuss other injection techniques/issues, please start another thread.

Thanks!!

[pagandeva2000, LPN]

To be honest, I have injected with either 23 or 25 gauge needles based on what was available. At times, central supply has not sent us the 23 gauge that we usually use, making the supplies run out. I was taught that as long as it is administered IM in the deltoid, the patient has received their full dose.

[Little Panda RN, ASN, RN]

I spent many years working in the clinic and I have always used a 25 gauge needle for flu/pnemonia vaccines. 25 gauge stands for the diameter of the needle not the length. A 21 gauge is larger in diameter for injections such as rocephin that is a much thicker liquid than the flu/pnemonia vaccines.

You can get a 25 gauge needle in different lengths such as 5/8, 1", 1 1/2" and so on.

I have always used a 25 gauge 1" needle in the delt. I will use a 5/8" for the elderly who do not have much adipose tissue.