Well-Baby Notes
III. Give vaccines safely
IMMUNIZATION
I. Set up the immunization session
Keep in mind the location of the
injection sites
BCG
Outer upper right arm
Perform hand hygiene
Take vaccines and their diluents out
of the refrigerator
Inspect the vaccines, and check for:
PENTA
Outer upper right thigh
IPV, PCV
Outer upper left thigh (2.5 cm
apart)
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MMR
Outer upper right arm
Storage under app. cold-chain conditions
Expiration date
Vaccine Vial Monitor (VVM)
For multidose vials:
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Date and time of initial administration
Vaccine vial septum (seal) not been
submerged in water
Aseptic technique used to withdraw all
doses
Ask the parent/significant other to
hold the infant
Cuddle
- Expose the
infant’s arm and
shoulder
- Instruct the
mother to support
the infant’s head
and hold the arms
close to the body
Perform hand hygiene
Prepare equipment needed for the
session:
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Syringes and needles
Cotton and micropore
Safety box and waste container
New Child Immunization Records (infant
immunization cards)
Immunization tally sheets or forms
Vaccination area (with tables and chairs)
Bed
- Lying on back
against flat
surface
Layout the immunization workplace
with the following considerations:
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Separate infants to be immunized from
those who have just been immunized
Have a distance or barrier between the
infant and all needles and sharp objects
Immediately dispose of the needles (do
not put them down/carry them around)
Upright
- Sitting upright
on s/o’s lap,
facing straight
outwards
II. Assess and screen infants
Greet the parent/significant other
Determine the s/o’s knowledge about
vaccination and encourage
questions.
Assess infant for immunization
Age
Vaccines received
All vaccines infant is eligible based
on the national schedule
Screen for immunization
Enumerate conditions when
vaccination should NOT be withheld
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Mild and minor illness (URI, diarrhea with
fever <38.5 C)
Malnourished infants
Prematurity, low birth weight
Treatment with antibiotics
Dermatoses, eczema, localized skin
infection
Allergy, asthma
Stable neurological conditions: cerebral
palsy, down syndrome
Enumerate conditions when it is
safer to wait and not vaccinate
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High fever and under medication
HIV infection (for BCG)
Enumerate conditions when a senior
health care worker must decide
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Very ill infants
Needing hospitalization
Advise:
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on the vaccine(s), its purpose, no. of
doses, and timing
on the importance of completing the
vaccine series
on the vaccination procedure and that
the needle may hurt, but it is normal
s/o’s participation in positioning the infant
potential side/adverse effects and what
to do
Encourage breastfeeding at the time
of the vaccination (this helps with
relaxation and pain relief)
Administer the vaccines
Perform hand hygiene
Inspect the vaccines
Prepare necessary vaccines for each
infant
Organize vaccines in order of the
administration
Order of vaccine administration:
1. Oral vaccines (OPV)
2. Intradermal vaccines (BCG)
3. Subcutaneous vaccines (MMR)
4. Intramuscular vaccines (Penta, PCV,
IPV)
Oral vaccines (OPV)
Make sure that the infant’s chin and
cheeks should be dry
Ask the s/o to hold the infant with
head supported and tilted slightly
back
Open the infant’s mouth gently
Squeeze 2 drops of vaccine from the
dropper onto the tongue/buccal
mucosa
Intradermal (BCG)
Reconstitute the vaccine
immediately before use
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Open the vial/ampoule of vaccine
Ensure that the appropriate diluent for
the vaccine will be used
Aspirate the diluent using a new
disposable mixing syringe and needle
Insert the mixing syringe with diluent into
the vaccine vial/ampoule
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Swirl the vial to mix the vaccine with the
diluent
Indicate the date and time of
reconstitution in the vaccine label
Locate the injection site:
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Penta: outer upper right thigh
IPV, PCV: outer upper left thigh
Aspirate the prescribed dose using a
new special small syringe and
needle
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BCG: 0.05 mL
Change the needle to the 26g 10mm
needle
Locate the injection site: outer, upper
right
The infant must be already in a
cuddle position
Clean and dry the injection site
before vaccination
Administer the vaccine using app.
injection technique
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Note that the
injection sites of
IPV and PCV
should be 2.5
cm apart
Hold the syringe barrel with fingers and
thumb on the sides, bevel facing
upwards
Gently stretch out flat and support the
skin with the thumb and forefinger
Lay the syringe and needle almost flat
along the skin, bevel facing up
Gently stretch the skin flat
Insert the needle at 90° angle
Quickly push the entire needle
through the skin and into the muscle.
Inject slowly to reduce pain.
Pull the needle out quickly and
smoothly.
Press the site gently with cotton.
Discard the needle and syringe.
Do not rub or massage the site.
Document
IV. End the session
Encourage and praise the
parent/caregiver for having the infant
vaccinated
Provide instructions on aftercare
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Press the plunger with your thumb
Inject 0.05 mL of the vaccine slowly
and smoothly. Create a small wheal.
Remove the needle quickly and
smoothly at the same angle it was
inserted.
Discard the needle and syringe.
Do not rub or massage the site.
Document
Alert possible mild side effects after
getting the vaccine
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MMR: 0.5 mL
Change the needle to the 23-25g 16mm
needle
Locate the injection site: outer upper
right arm
Position the infant sideways on the
adult’s lap with the whole arm
exposed. The adult must also hold
the infant’s leg.
Pinch the skin, quickly push the
needle at a 45° angle
Depress the plunger smoothly
Pull the needle out quickly and
smoothly at the same angle
Discard the needle and syringe
Do not rub or massage the site
Document
Intramuscular (Penta, PCV, IPV)
Aspirate the prescribed dose
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Penta: 0.5 mL
PCV: 0.5 mL
IPV: 0.5 mL
Change the needle to the 23-25g 25mm
needle
Position the infant sideways on the
adult’s lap with the infant’s whole leg
exposed. The adult must hold the
infant’s leg.
infant being irritable
some redness and swelling at the
site—may place clean, cold damp cloth
to help ease pain
mild fever—may take antipyretics as
prescribed
BCG—flat-toped swelling is normal
Measles/MMR—rash or fever after 6-12
days (give extra fluids and keep them
cool)
When to seek medical attention
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Subcutaneous (MMR)
Reconstitute the vaccine
immediately before use
Aspirate the prescribed dose
Breastfeed the infant more frequently
Extra hugs and attention but avoiding
pressure to the site
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severe allergic reaction (swelling of face
and throat, hives, difficulty of breathing,
cyanosis)
serious side effects (seizures)
BCG-signs of abscess and enlarged
glands
infant’s condition worsens or reactions
continue for more than a day or two
Complete the immunization card,
write the date of next appoinrment
Ask if the parent has any questions
Ensure safety and viability of
vaccines
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Follow multi-dose vial policy
Label opened vials that can be used for
following session “USE FIRST”
Discard opened BCG and measles
vaccine at the end of each session or
after 6 hours, whichever comes first
Properly dispose used equipment
Document by completing the
immunization tally sheet and
immunization register
sediment that suspends
when swirled (do not shake
vaccine vials)
Side effects:
- Soreness or swelling, fever,
fussiness, feeling tired, loss
of appetite, and vomiting
Inactivated
Poliovirus
(IPV)
Left
anterolateral
thigh
0.5 mL
10 weeks
Protects against:
Polio
Type and appearance:
- Ready-to-Use
- Clear, colorless
Side effects:
- Fever and redness or
soreness
Pneumococc
al Conjugate
Vaccine(PCV
13)
Left
anterolateral
thigh
0.5 mL
Type and appearance:
- Ready-to-Use
- Clear, colorless
6, 10, 14
weeks
Vaccine
and
Schedule
Site and
Dosage
Oral
Poliovirus
(OPV)
Tongue or
buccal mucosa
2 drops
Protects against:
Polio
Type and appearance:
- Vial with Oral Dropper
- Clear pink or orange liquid
6, 10, 14
weeks
Side effects:
- Fever and redness or
soreness
INTRADERMAL VACCINES
Bacillus
Calmette–Gu
érin (BCG)
Right Upper Arm
0.05 mL
Protects against:
Tuberculosis
Type and appearance:
- Powder + Diluent
- White cloudy liquid with
sediment that suspends
when swirled (do not shake
vaccine vials)
At birth
Side effects:
- Flat-toped swelling followed
by a small ulcer
SUBCUTANEOUS VACCINES
Measles,
Mumps,
Rubella
(MMR)
Right Upper Arm
0.5 mL
Protects against:
Measles, Mumps, Rubella
Type and appearance:
- Powder + Diluent
- Clear, slightly yellow liquid
9, 12 months
Side effects:
- Sore arm or redness, fever,
and a mild rash
INTRAMUSCULAR VACCINES
Pentavalent
(DPT-HepBHib)
6, 10, 14
weeks
Right
anterolateral
thigh
0.5 mL
Side effects:
- Redness, swelling, pain, or
tenderness, and fever, loss
of appetite, fussiness
(irritability), feeling tired,
headache, muscle aches,
joint pain, and chills.
Description and Side
Effects
ORAL VACCINE
Protects against:
Diphtheria, Pertussis,
Tetanus, Hepatitis B,
Influenza
Type and appearance:
- Ready-to-Use
- White cloudy liquid with
Protects against:
Pneumonia, meningitis,
bacteremia
Hepatitis B
At birth
Vitamin K
(not a
vaccine)
At birth
Right
anterolateral
thigh
0.5 mL
Protects against:
Hepatitis B
Left
anterolateral
thigh
0.1 mL
Protects against:
Bleeding
Side effects:
- Soreness and fever