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Wellness & HealthCare
     Flu Clinics
     by Tammy Marie Baker- Ortega R.N.
           The Wellness Series
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
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
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
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
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
What is the Maxim Policy?


        Pregnant Woman
        Can be given in
       ANY TRIMESTER
        PER CDC                                   Standard Policy is
    RECOMMENDATIONS                     Only Children >4 yrs old with parental
                                                      consent
                                       (6 mos and up in controlled specialized
No Flumist for pregnant women in any                   clinics)
State
                                                   Standard Policy 
                                       We immunize individuals ages 4 and older
                                        with parental Consent if under 18 unless
                                              otherwise stated on protocol.
TDAP :Tetnus~Diptheria~Pertusis
 NEW 2010
 Tetnus~Diptheria~Pertusis Booster
 Indications 10-64 years old
 Boostrix :Indications 10-64 years old
              損 Prefiled syringes
 Adacel : Indications 11- 64 years
              損 Single dose vials
 Pregnant woman check with MD
Pneumovax 23
  Was the person aged > 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? >5 years elapsed since the first
dose? then Vaccination indicated Yes


       Note: For any person who has received a dose of
        pneumococcal vaccine a age( >or = 65) years,
                 revaccination is not indicated.
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**
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
? 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?
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        Dialysis Shunt
mastectomy
              DO NOT GIVE ON AFFECTED SIDE.
         Bilateral mastectomy must go to their physician
               MAXIMS POLICY IS DELTOID ONLY
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
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 1:1000

       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.
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
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 -18属C
          (0属F) to 37属C (99属F)
 HARD     Accuracy 賊 1属C
COOLERS   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        WARM MARK
          medical products, vaccines, blood, plasma, diagnostics, gelatin
          capsule products, chemicals, paint, and temperature sensitive food    TEMP CARDS
          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.
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.
BD Integra Syringe
                   Retracting 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
Intramuscular 90 Degrees
 Needle bevel side up
 Darting motion
 Sharps precautions
The Injection
      Technique, 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
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
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
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                                            25
Honesty~ Integrity ~ Professionalism
                 You Represent The Profession of Nurses
                      Compliance is our Hallmark



           Please carry and conduct yourself accordingly
Dress Appropriately                           Treat the client with respect
No eating in the clinic                       Be polite
No smoking on site                            Be courteous

More Related Content

Flu power point_2011

  • 1. Wellness & HealthCare Flu Clinics by Tammy Marie Baker- Ortega R.N. The Wellness Series
  • 2. 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
  • 3. 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
  • 4. 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
  • 5. 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
  • 6. 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
  • 7. What is the Maxim Policy? Pregnant Woman Can be given in ANY TRIMESTER PER CDC Standard Policy is RECOMMENDATIONS Only Children >4 yrs old with parental consent (6 mos and up in controlled specialized No Flumist for pregnant women in any clinics) State Standard Policy We immunize individuals ages 4 and older with parental Consent if under 18 unless otherwise stated on protocol.
  • 8. TDAP :Tetnus~Diptheria~Pertusis NEW 2010 Tetnus~Diptheria~Pertusis Booster Indications 10-64 years old Boostrix :Indications 10-64 years old 損 Prefiled syringes Adacel : Indications 11- 64 years 損 Single dose vials Pregnant woman check with MD
  • 9. Pneumovax 23 Was the person aged > 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? >5 years elapsed since the first dose? then Vaccination indicated Yes Note: For any person who has received a dose of pneumococcal vaccine a age( >or = 65) years, revaccination is not indicated.
  • 10. 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**
  • 11. 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
  • 12. ? 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?
  • 13. 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 Dialysis Shunt mastectomy DO NOT GIVE ON AFFECTED SIDE. Bilateral mastectomy must go to their physician MAXIMS POLICY IS DELTOID ONLY
  • 14. 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
  • 15. 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 1:1000 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.
  • 16. 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
  • 17. 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 -18属C (0属F) to 37属C (99属F) HARD Accuracy 賊 1属C COOLERS 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 WARM MARK medical products, vaccines, blood, plasma, diagnostics, gelatin capsule products, chemicals, paint, and temperature sensitive food TEMP CARDS 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.
  • 18. 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.
  • 19. BD Integra Syringe Retracting 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
  • 20. Intramuscular 90 Degrees Needle bevel side up Darting motion Sharps precautions
  • 21. The Injection Technique, 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
  • 22. 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
  • 23. 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
  • 24. 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 25
  • 25. Honesty~ Integrity ~ Professionalism You Represent The Profession of Nurses Compliance is our Hallmark Please carry and conduct yourself accordingly Dress Appropriately Treat the client with respect No eating in the clinic Be polite No smoking on site Be courteous

Editor's Notes

  1. Yielding = ability to grow/ reproduce