Immunization Ordered 0.5mL---Instructor says give whole vial

[4Karrie2]

i hope someone can clarify this and fast. i am going to be giving subq and im injections starting next week with my peds instructor. today at clinical orientation, she told us that even though the dose for the immunizations may be 0.5 ml, that since we are using single use vials we do not give 0.5ml. but whatever is in the vial. frankly, this just sounds plain wrong to me, but perhaps i am mistaken and this is how it's done? i certainly do not want to over-immunize any child and need an answer fast. also, at immunization lab last week, she said we are to aspirate when giving subq injections , but all the other instructors told us that it is no longer being done, though none of them would correct her to her face. so to aspirate or not to aspirate?

[mustlovepoodles, RN]

I would absolutely NOT give the whole vial if the order reads otherwise. I can't believe your instructor told you to ignore the order and basically make up your own! NONONONONONONONO! As to whether you aspirate or not, I have no opinion. When I went through school you aspirated. My sister was diagnosed with type 1 diabetes a few years ago and she was told not to aspirate. I don't think you will hurt anything either way. In 32 years as a nurse I have NEVER drawn back blood.

[NotReady4PrimeTime, RN]

I've been directed to do that sort of thing before too. Antithrombin III is very expensive and for a while we were being told to just give the whole vial, regardless of how much the patient weighs and what the recommended dose is. I questioned that every time and had the physician write in the orders to give the whole vial, just in case... Well, a patient had an adverse event as a result of this practice and now we're following the guidelines.

[Jolie, BSN]

Is it possible that you may have misunderstood your instructor?

Might she have said or meant that the vial is to be treated as a unit dose and not used for a second patient, even if only half of the contents are used on a single patient?

If she indeed said what you heard, I would refuse to give the additional volume without a written physician order. Politely indicate that you must legally follow the written order and offer to confirm it with the practitioner. If she inists otherwise, she can give it.

As for aspirating or not, do a search of the current literature and bring your findings to class. You always need to be able to defend your practice based on current research, guidelines issued by professional organizations and facility policy and procedure.

[4Karrie2]

Thank you very much for your responses. No, she said give the whole vial, for sure. I was shadowing a Peds clinic nurse yesterday and most of the immunizations were in premeasured vials that attach right onto the syringe so hopefully I will not have to be in the unpleasant situation of confronting my instructor! Not exactly a position I want to be in! But I will not hesitate to do it if the situation arises. Thank you again!

[nursel56]

Thank you very much for your responses. No, she said give the whole vial, for sure. I was shadowing a Peds clinic nurse yesterday and most of the immunizations were in premeasured vials that attach right onto the syringe so hopefully I will not have to be in the unpleasant situation of confronting my instructor! Not exactly a position I want to be in! But I will not hesitate to do it if the situation arises. Thank you again!

I think the jury is still out on the aspiration question, but I would think it would make more sense to aspirate on an IM injection rather than a SubQ- anyway here's a thread that has some interesting discussion and links to other information about this issue.

https://allnurses.com/general-nursing-discussion/aspirate-not-aspirate-412639.html

[tewdles, RN]

Vaccine dose is not negotiable by your instructor...to change the volume is outside of her scope of practice. Aspirating prior to injecting a subQ injection is more of a professional preference these days than a mandate, IMHO.

[nursejackie86]

I know I may be a little late on this one since you posted it last week but I'm a pediatric nurse who gives immunizations daily and you are absolutely NOT to give more than the 0.5mL what's ordered. The reason is that depending on the age and size of the child, their muscle can only handle so much volume from a vaccine at a time. We have a chart up in our imm room telling us what the maximum mLs are allowed for each age. Vials can come with such variation in amounts of vaccine sometime, so giving the ordered amount is what you should do!

And as for aspirating, it has been standard practice now that vaccines DO NOT need to be aspirated anymore, especially subQ.. that doesn't even make sense!

[LA_StudentNurse]

I will add my 2 cents and don't know if it has been mentioned. One dose vials have a little more in it than what is mentioned on the outside. I have forgotten why, but there is a valid rationale. Draw up a dose from a singled dose vial, and there may be a little amount left in the bottle--so little it is almost fumes. Either way, you need to clarify what you think you heard with your clinical instructor.

[DistrictNurse19]

I know I am late to post but current standards state there is no need to aspirate when giving immunizations (vaccines). Please refer to the CDC publication "Etiology and Prevention of Vaccine-Preventable Diseases" Vaccine Administration Guidelines for the rationale. Thanks!

[LoveThisNurse]

Always go with your gut! I know, it's hard as a student because maybe you feel that these nurses have tons of nursing experience on top of yours. I always felt that way! Even though I would know in my heart that soemthing was wrong, I learned now as a new grad, since I'M LICENSED, to go with what I know is safe. It's hard to step up to authority and tell them that they are wrong. The other day I had a new onset diabetic and the day nurse told me that the father had just given the child a huge portion of mashed potatoes from outside and let her eat it and she guessed how many carbs was in it. And I said, "Omg, that's UNSAFE." Ok, my bad for thinking out loud and saying this to a veteran nurse. Oh, she let me have it. She let me know how many years nursing she's done.. and BLAH BLAH BLAH! I'm sorry, let me tell you I am the MOST HUMBLE new grad nurse you will every meet.. I take everything any experience nurse tells me and run with it.... BUT when it's a newly admitted diabetic, I will be a HAWK on what that patient eats and how many carbs is in it. The tray that come up from nutrition have listed the exact carbs. It makes things more difficult when family starts bringing in outside food, now you've got to be guessing how much insulin to give on a new diabetic? PLEASE!!!!!!

I've had classmates in nursing school have patients code on them because the nurse told them that the patient was fine and that everything was ok and there was no need to bug the MD....

So lesson learned.. go with your instinct... and if you need backup, ask your peers. =o)

[HeartsOpenWide, RN]

In my office days, MOST (not all) immunizations were single dose (1mg/0.5mg with 0.5ml in the entire vial; hence single dose). But don't assume. When in doubt; don't. Explain to your teacher why you do not feel comfortable doing it: "The order says give 1mg, the vials says 1mg/ml but there are 10mls in this vial"

Today at clinical orientation, she told us that even though the dose for the immunizations may be 0.5 mL, that since we are using single use vials we do NOT give 0.5ml. but whatever is in the vial

What was the ORDER for? An order should not go by mLs but by mg. The concentration could be different for different drug companies...i.e. 1mg/0.5ml is the same as 1mg/1ml....maybe this is what your teacher was referring to. Make sure to check what is allowed on a ped. Peds can not have as many mls IM. Make sure there was not a mix up in the pharm and an adult vial was sent