Kindergarten Vaccines

Specialties Pediatric

Published

I have been a peds nurse for about 4 years now. I have always worked out patient. I started in a VERY busy office with 4 doctors and 1 NP. In that office we had no help to give vaccines and had to come up with a method that we could do alone. I was trained by a nurse that had been in peds for 30 years and I respected her method. I now work for a single Med/Peds doctor and I am the only nurse. To give vaccines to anyone 5 and under I have the patient lay down and I do their legs. I can give 4 shots in under 30 seconds (have very specific safety syringes). All of my patients love my method because I am so fast. I have always given my kindergarten vaccines in the legs. I use a 1" for my IM DTaP and a 5/8" for my other 3 subqs. My IM goes in the muscle and my subqs go in the outside leg fat. I have had no complaints from any of my parents with this method. Today I had one mom call to state that the site of her son's MMR was red and swollen. The patient has no pain, fever, can walk on the leg, but has a red spot the size of a quarter. My office manager came down on me for using legs even though I have been doing this the last 3 years that I have worked here. She told me that her old nurse did arms and maybe I should start to do that. Honestly, I am not comfortable with arms on a 5 year old. There is less control than legs and the child has to remain still for a longer period of time. I researched this topic and legs are not contraindicated at this age as long as the proper needles are used. What do you do in your office? What do you think about using the legs for kindergarten vaccines?

Specializes in Primary Care, OR.

Ahhhh that time of year!!! School physicals!

i have always used either or for kiddos above toddler age. In my experience by the time they've reached five years old I usually have easier access to a deltoid and use a 5/8 in rather than a thigh muscle unless they're wearing shorts. It also allows them to sit on mom/dad's lap.

Im im interested to hear if anyone has any EBP on this subject.

and that office manager..... Is she a licensed practitioner? If so what was her suggestion?

if not she can stick it...... Can't tell you how many times our office manager has given "suggestions" and complained bc she picked up these kinds of calls. These things are better left to the medical team :yes:

Specializes in Complex pedi to LTC/SA & now a manager.

What's the manufacturer's suggestion? Some specifically state deltoid past a certain age/weight.

I have never, ever had a kid sit on a parent's lap. I never trust a parent to hold their kid for me. At my previous ped job we had a kid on a mom's lap who what getting a vaccine in the deltoid. The mom let go, the kid flailed his arm and the nurse got stuck in the face with the needle. That really stuck with me. That is why I prefer the legs. With the kid laying down, knees bent over the end of the table and tucked between my knees they cannot reach me without sitting up and I will know if they try because I will feel their legs flex. This position gives me the most control and I do not have to rely on anyone to help me. I feel that it is the safest and fastest.

As for the office manger... she was a ICU nurse 10+ years ago but is no longer licensed.

I also would love some EBP input. I looked but have not found anything.

Specializes in Primary Care, OR.

Thanks for adding that JustBeachy..... I thought of that after I hit post!!!

Specializes in Primary Care, OR.

Holy wow you just gave me a visual! That will stick with me too now! I must be too trusting.... Time to change up my practice.

I just looked at the manufacturer info on each. The outer leg is preferred for Varicella and IPV. DTaP is anything but glute and MMR states deltoid for all children but that cannot be true because most 1 year olds do not get deltoid vaccines.

For anyone under 8 we use the thigh area (sub q vs IM). It is a lot easier to control them this way. We will lay them down on the table. Parents keep control of the top half and either we manage the 2nd half or we have another staff member assist. With any vaccine you can get redness and swelling at the site. Your manager should brush up one the VIS sheets if she doesn't remember this is a common side effect of vaccines.

Well I am only a pre nursing student but I can tell you as a mom of a 5 year I know he had his 5 year shot in his arm. He preferred it that way and asked if they could do it in his arm and not his leg. But it totally depends on the child...if they are freaking out screaming and flailing then they don't get a choice, in the leg it should go! I'd say keep doing what you are comfortable with. My son and daughter have had those quarter size red marks at the site of injection, they go away in a couple days.

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