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Assessing the client

Screening a client for immunization
information about the age,
immunization status
health of the client
Is this the right time to give a child an
Does the child need another BCG injection?
How many doses has the child already had?
Assessing the client
If assessment is not performed carefully
you may miss an opportunity to
immunize. Two of the commonest
reasons for missing such an opportunity
failure to give in one visit all the
vaccines for which a child is eligible;
failure to give a vaccine because of false
contraindications to immunization.
Preparing vaccines
washing hands,
opening a sterilizer,
assembling a sterile syringe and needle,
checking vial labels,
If the label has come off, throw the vial away.
If the vaccine inside has passed its expiry date, throw
the vial away.
checking a vaccine vial monitor (VVM),
check whether the vaccine has been exposed to
excessive heat.
cleaning a clients skin,
opening a vial and ampoule,
drawing vaccine from the vial, and
reconstituting BCG, measles vaccines.
Injection equipment

Types of injection equipment

(can be used to administer injectable vaccines)

single-use syringes and needles

prefilled syringes
Injection equipment
Sizes of syringes and needles

Use Syringe size Needle size

BCG (for intradermal 0.1 ml Single-use
injections) 10 mm, 27 or 28 gauge
All other EPI vaccines (for 1.0 ml Single-use
intramuscular or 25 mm, 23 gauge
subcutaneous injections)
Reconstitution 5.0 ml 76 mm, 18 gauge
Position the child
on the outer part of the right/left
upper arm. Load the syringe with
BCG vaccine.
Do NOT shake the BCG vaccine
ampoule. Shaking can damage a special BCG needle (10
the vaccine. mm, 26 gauge) (reusable).
Hold the childs arm with your
left hand
Hold the syringe in your right
hand, with the bevel of the
needle facing up towards you.
Lay the syringe and needle
almost flat along the child's arm.
BCG immunization
Insert the tip of the needle just under the skin insert only the bevel
and a little bit more
Do NOT push too far and do NOT point down or the needle will go
under the skin. If BCG is injected under the skin an abscess or
enlarged glands may result.

If you have injected BCG correctly you will see a clear, flat-
topped swelling on the skin, like a mosquito bite. The swollen skin
may look pale with small pits.
When an intradermal injection is given correctly the plunger is hard
to push.
If the vaccine goes in easily you may be injecting too deeply.
Remove the metal cap.
Remove the rubber
Cut open the plastic bag
containing the dropper.
Fit the dropper on the
open vial.
Put the dropper and vial
on the foam in a vaccine
carrier to keep them cold.
Give the OPV
the dropper at an angle
DPT & Hepatitis
Position the child
The parent's left arm should
be around the child,
supporting her or his head
and holding the outside
The child's inside arm
should be tucked around
the parent's body.
The parent's right hand
should hold the child's legs
Inject DPT/Hepatitis vaccine
into the thigh, NEVER into
the buttock.
DPT & Hepatitis
Put your finger and thumb on
the OUTER part of the middle
of the child's thigh.
Stretch the skin flat between
your finger and thumb.
Quickly push the needle
straight down through the skin
between your fingers. Go
deep into the muscle.
Press the plunger with your
thumb to inject the vaccine.
Withdraw the needle and press
the site with cotton wool.
Measles immunization
Position the child
the child's left upper arm

Inject measles vaccine

PINCH UP the skin.
Push the needle into the
pinched-up skin. The needle
should go in at a sloping angle,
not straight down.
Press the plunger with your
thumb to inject the vaccine.
Withdraw the needle and press
the site with cotton wool