1. Administration of Vaccine via Subcutaneous Route Hand hygiene is the first step in medication administration is hand hygiene. Use either an alcohol-based hand rub or a soap and water hand wash Verify the medication. Note the expiration date and lot number. Check for particulate matter or turbidity that is abnormal for the vaccine Remove the plastic cap from the top of the vial. Swab the top of the vial with a sterile alcohol swab. For subcutaneous injection, check your equipment to ensure an adequate syringe and needle size. Subcutaneous injections should use a 25 ga 5/8 inch needle Make sure you know how to activate the safety device before using the equipment Connect the sterile end of the syringe into the sterile end of the needle. Take care to avoid touching the area where these two items are joined. If you are going to set the needle and syringe aside while preparing your vaccine, leave the items inside their packaging to avoid contamination. This subcutaneous vaccine is using a sterile diluent. Make sure the diluent is the correct one to use with the vaccine. The diluents are single- patient use items. There is no preservative, so nothing to protect the diluent in the event it is contaminated during the preparation process. Pull all of the diluent into the syringe. You will use it all to mix with the power vaccine that you will be administering Withdraw all of the diluent taking care to avoid touching the area where the needle enters the septum. Make sure the tip of the needle stays below the level of the fluid so you are able to withdraw as much of the diluent as possible Control your needle and syringe so the needle does not slip out of the vial and either stick you or contaminate the end of the needle Double check the vial of vaccine that you will be diluting with the sterile diluent you just prepared. Note the name of the vaccine, lot number, expiration date, and the condition of the vaccine itself (turbidity, particulate matter, etc.) Make sure the vaccine has been maintained under the appropriate conditions. For example, if this is a vaccine that must be kept frozen, has it been properly maintained? Remove the plastic cap from the vaccine vial. Swab the rubber septum with a sterile alcohol swab. Allow to dry for several seconds Once the site is Insert the needle into the septum trying to insert it into the center. Inject all of the diluent Keep the needle in the vial Do not remove the needle from the vial Gently agitate the vial to help mix the diluent with the vaccine powder. Do not shake and avoid touching the area where the needle enters the vial as well as the place where the needle and syringe connect to each other Invert the vaccine vial and withdraw all of the mixture. The powder absorbs and mixes with the diluent so your final administration amount will be less than the volume of the diluent you injected into the vaccine vial. Do not save any leftover vaccine. Vials, as well as needles and syringes, are disposed of as regulated waste. Vials containing more than the miniscule amount left in the vial may need to be disposed of as pharmaceutical waste. Ask your pharmacists for assistance in those types of decisions. Recap your clean needle to prevent contamination You should develop the habit of maintaining your needle cover until you are directly with the patient and ready to administer Avoid showing the needle to the recipient, as some patients may become anxious at the sight There are several different types of diluents. Each is designed to be given with a specific vaccine(s). Make sure you are using the diluent that is appropriate for use with that particular vaccine. Diluents do not need to be stored in the refrigerator and they should NEVER be frozen. For subcutaneous administration, visualize the injection site and make sure it is easily visible. Make sure there are no constricting clothing or sleeves. Pinch the skin in order to pull the subcutaneous tissue so you can access it for the injection Swab the injection site with a sterile alcohol swab Make sure you use this chance to double check your vaccine and dose. You will be using the 25 a 5/8 inch needle for a subcutaneous injection Continue to pinch the subcutaneous tissue and insert the needle at a 45 degree angle. This helps ensure that the medication is injected into the subcutaneous tissue and not into the muscle. Release the pinch when you have almost injected all of the vaccine.