FLU Vaccine

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Wellness HealthCare Flu Clinics by Tammy Marie
Baker- Ortega R.N. The Wellness Series
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Sanofi Fluzone

• Multidose Vials PEDS Prefilled .25 ml Adult
  Prefilled 25 mcg/0.5
• Multi dose vial thimerosal content 25mcg/0.5mL
  dose.Prefilled Indicated for individuals Age 6
  months and older
• Maxim Standing policy 4 years and older
• Prefilled syringes are Thimerisol free

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Novartis Fluvirin

• MDVs and pre filled syringes Indicated for
  individuals Age 4 years and older.
• Maxim Standing policy 4 years and older
• MDV Thimerosal content 25mcg/0.5 mL dose
• Prefilled syringe Thimerosal content 1 mcg
  mercury per 0.5-mL dose.
• Needles are supplied separately for pre filled
  doses

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GSK FluLaval

• Indicated for individuals Age 18 years and
  older ONLY
• DO NOT GIVE TO PEDIATRIC PATIENTS!!
• 10 dose Vials
• Thimerosal content 25mcg/0.5 mL dose

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MedImmune FluMist

• Live attenuated influenza virus vaccine
• indicated for individuals Age 2 49 years
• Maxim policy ages 4 - 49 unless stated
  otherwise on protocol
• Contraindications Pregnancy, Asthma and Immune
  Compromised
• Do not to be used to immunize pregnant women in
  any state
• INTRANASAL ADMINISTRATION ONLY -Never injected

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Flumist

• DO NOT GIVE TO PREGNANT WOMEN
• MAXIM POLICY IS 4 YRS TO 49
• DO NOT INJECT THIS IS INTRANASAL ADMINISTRATION
  ONLY
• ADMINISTERED 0.1 ML PER NOSTRIL
• Total dosage 0.2 mL
• No active sniffing when administered
• LIVE ATTENUATED VACCINE

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What is the Maxim Policy?
Pregnant Woman Can be given in ANY TRIMESTER
PER CDC RECOMMENDATIONS No Flumist for pregnant
women in any State
Standard Policy is Only Children gt4 yrs old
with parental consent (6 mos and up in controlled
specialized clinics) Standard Policy We
immunize individuals ages 4 and older with
parental Consent if under 18 unless otherwise
stated on protocol.
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TDAP TetnusDiptheriaPertusis

• NEW 2010
• TetnusDiptheriaPertusis Booster
• Indications 10-64 years old
• Boostrix Indications 10-64 years old
• Prefiled syringes
• Adacel Indications 11- 64 years
• Single dose vials
• Pregnant woman check with MD

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Pneumovax 23
Was the person aged gt 65 years at the time of
last vaccination? Yes or No or unsure???

• NO the Vaccination is indicated
• If YES then Vaccination Not indicated
• Unless? gt5 years elapsed since the first dose?
  then Vaccination indicated Yes

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Pneumovax 23

• Do not pre fill syringes
• Do not give to children under 18 with out MD
  order
• Recommended once before 65
• Once after if 5 years since last vaccine.
• Check label before you administer
• Keep refrigerated
• Pregnant woman with specific
• Doctor Prescription only

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Pre filing Syringes

• Pre filling syringes is STRONGLY DISCOURAGED
• Pre filled syringes can lead to mistakes.
• Pre filled syringes can not be returned or used
  at another clinic and must be wasted at end of
  clinic in sharps box
• If you are at a very a large clinic and clients
  are lined up
• out the door you may only pre fill 10
  syringes at time.
• They must be place in a zip lock bag ,labeled
  ,dated and initialed with lot number.
• The must be wasted and witnessed if not used at
  the end of clinic.
• DO NOT MIX VACCINATIONS TOGETHER

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? Question your Client ?DO NOT ADMINISTER IF

• Sensitivity to latex?
• Do not give if answer is yes
• Allergy to chicken eggs or egg products?
• Allergy to thimerosal?
• Symptoms other than mild cough, runny nose or
  diarrhea.?
• History of Guillian Barre
• History of serious reaction to previous flu or
  pneumovax?

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GIVING MORE THAN ONE VACCINE

• RECOMMEND ONE INJECTION PER ARM
• OR
• 1 INCH APART ON SAME ARM 15 MINUTES APART
• Special precautions
• FYI mastectomy or dialysis
• DO NOT GIVE ON AFFECTED SIDE.
• Bilateral mastectomy must go to their physician
• MAXIMS POLICY IS DELTOID ONLY

Dialysis Shunt
mastectomy
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• SPECIAL PRECAUTIONS
• FYI mastectomy or dialysis
• DO NOT GIVE ON AFFECTED SIDE.
• Bilateral Mastectomy must
• GO TO THEIR PHYSICIAN
• MAXIMS POLICY IS DELTOID ONLY
• Apologize to the Patient
• And refer them back to their MD

Mastectomy
Dialysis Shunt
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Reactions ?

• Vasovagal Syncope versus Anaphalaxis
• Did the client faint or are they having an
• Allergic reaction?
• Anaphylaxis
• Symptoms Feeling of impending doom, flushed,
  rash, difficulty breathing, wheezing, low BP ,
  increased HR
• Emergency Kit ready and on site.
• Epinephrine solution 11000
• Adults 0.1 mL per 10 kg ( 10 kg 22 lbs)
  subcutaneous
• Dosage may be repeated in 5-10 minutes if
  initial dose was 0.5 mL x one dosage
• Children Administer 0.01 ml per kg ( 10 kg 22
  lbs) maximum dose 0.5
• subcutaneous DO NOT REPEAT DOSE.

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Cold Chain Policy
-Do not Freeze the Vaccine -Keep Vaccine in hard
plastic Cooler -WARM MARIK TEMPERTURE CARDS IN
COOLER -Keep above 36-46 degrees F -Temp log on
Refrigerator BID -No food in Medication
Refrigerator BMW STICKER ON REFRIDGE
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NEW COLD CHAIN 2010

• Warm Mark Time Temperature Labels
• Adhesive backed tag records warming temperatures
  for shipping and storage.
•                           
• Monitors temperatures from 8 to 48 hours,
  depending on model.
• Red coloring indicates exposure to
  warmer-than-acceptable conditions
• Available in a variety of response temperatures
  ranging from -18C (0F) to 37C (99F)
• Accuracy 1C
• Dimensions 1.81 x 0.75 x 0.06 (Length x Width
  x Thickness)
• WarmMark Time Temp Tags are a convenient,
  accurate tool for monitoring temperature during
  shipping and storage of drug and medical
  products, vaccines, blood, plasma, diagnostics,
  gelatin capsule products, chemicals, paint, and
  temperature sensitive food products.Response
  temperatures and run-out times (length of
  exposure time to a certain temperature) vary with
  each Warm Mark model.The red coloring indicates
  exposure to temperatures above the rated
  temperature for that tag. Color movement through
  the windows indicates passage of time. If the
  temperature cools below the threshold, the color
  stops moving.

HARD COOLERS
WARM MARK TEMP CARDS
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THE 5 RIGHTS

• Drug- check the vaccine vial twice
• Patient ID and insurance or paid
• Dosage - 0.5 ml
• Route IM in Deltoid
• Time Patient must stay 15 minutes after
  injection to rule out reaction.

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                                          BD
Integra SyringeRetracting Syringes

• What sets the BD Integra Syringe apart from
  other syringes on the market? Its design. The BD
  Integra Syringe with Retracting BD Precision
  Glide Needle was designed to provide clinicians
  with superior clinical benefits.
• Detachable Needle
• Low Waste Space... Maximize Medication...
  Experience It!
• Low Waste Space
• Dosing Accuracy
• BD Precision Glide Needle Technology
• NEEDLE SAFETY

Possible to obtain 11 to 12 doses from a Single Influenza Vial  
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Intramuscular 90 Degrees

• Needle bevel side up
• Darting motion
• Sharps precautions

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The InjectionTechnique, Accuracy, and Nursing
Skill Maxim Nurses are on the Mark

• Tighten needle
• Check vaccine type and brand twice , Avoid
  medication Errors
• Wipe off vial with alcohol
• Inject .05 ml of air into vaccine vial before
  drawing up
• Draw up vaccine
• Inoculate client at 90 degree angle into Deltoid
  muscle
• Retract needle downward and away from client
  after the injection
• Properly Dispose of the syringe into the sharps
  box

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BIOHAZARD DISPOSAL

• Wear gloves
• Make sure lid is snapped on tightly Lock and
  Load
• Do not over fill container.
• Proper tight Syringe disposal
• Empty Vaccine vials are returned to office
  biohazard drop site
• Any left over Pre filled vaccine syringes are
  discarded in a biohazard container on site
• All gloves and garbage is properly bagged at site
  and returned to Office bio hazard drop site

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Verify and Validate VERIFY AND VALIDATE

• Check your Vaccine vials three times
• 1. arrival at clinic
• 2. drawing up
• 3. Administration
• 4. Initial and Date your vaccine vials when
  opened
• Keep your vaccinations in Separate coolers if
  possible
• Label vials in Zip locks
• Know your Medications
• A SMART NURSE IS SAFE NURSE
• Be Cautious and Proactive
• Prevents Mistakes

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2010 STRAINS

• Pandemic H1N1
• a poor yielding strain
• Now included in the Seasonal vaccine
• an A/California/7/2009 (H1N1)like virus
• Perth
• first time being produced As of 6/14, yielding
  good results
• an A/Perth/16/2009 (H3N2)like virus
• B Brisbane
• very poor yielding strain that caused much of the
  seasonal delay in 2009
• a B/Brisbane/60/2008like virus

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Honesty Integrity Professionalism

• You Represent The Profession of Nurses
• Compliance is our Hallmark
• Please carry and conduct yourself accordingly

• Dress Appropriately
• No eating in the clinic
• No smoking on site

• Treat the client with respect
• Be polite
• Be courteous

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