Medication is administered in subcutaneous tissue. The effect on pain of three different methods of intramuscular injection: A randomized controlled trial. The preferred injection site in older children and adults is the deltoid muscle in the upper arm. If the patients shirt cannot be removed, the sleeve should be rolled up so that landmarks can be visualized and used appropriately.4. Take the quiz and choose the answers best of your knowledge. Do you feel confident enough to crack this test? Small muscles absorb small volumes. https://www.clinicalkey.com/nursing/#!/content/drug_monograph/6-s2.0-5295, https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html, https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2022/npsg_chapter_hap_jan2022.pdf, https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=FEDERAL_REGISTER&p_id=16265, https://www.cdc.gov/vaccines/pubs/pinkbook/safety.html, https://www.cdc.gov/vaccines/hcp/admin/admin-protocols.html, https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html. U.S. Food and Drug Administration (FDA). Needles should be stored in Food and Drug Administrationapproved containers or in containers that are in compliance with community guidelines. Ensure the six rights of medication safety: right medication, right dose, right time, right route, right patient, and right documentation. (2020). See chart below to identify the route for each injectable vaccine. CDC and the Advisory Committee on Immunization Practices (ACIP) guidance states COVID-19 vaccines can be given during the same visit with other vaccines, including flu vaccine, if the recipient is eligible for the vaccines. a. The recommended site is based on age. The Z-track method is an intramuscular injection (IM) technique used to ensure the medication stays in the muscle instead of leaking into the surrounding tissue. Place the palm on the greater trochanter and the index finger on the anterior superior iliac spine. For a well-developed adult, no more than 3 ml of medication should be administered in a single IM injection because the muscle tissue does not absorb it well in larger volumes.5 For smaller adults or those with less muscle mass, the volume injected may need to be adjusted. However, all vaccination providers should be familiar with the office emergency plan and currently certified in cardiopulmonary resuscitation. Using the Z-track method does not add any appreciable time to the process of an intramuscular injection. E. all of these. Palpate for tenderness or hardness and avoid hardened areas. Assist the patient to a comfortable position. Chapter 4: Vaccine safety. Displace the skin using the Z-track technique by pulling the skin to one side 1 inch. However, there are some conflicting practices which warrant investigation to determine their effectiveness in this aspect of . Smoothly, quickly, and steadily withdraw the needle and release the skin. If additional cleaning is necessary, perform that first and make the alcohol swab the final preparation. If blood appears in the syringe, what should a nurse do next? Donning sterile gloves. For older children and adults, the deltoid muscle can be used for more than one intramuscular injection. Aspiration in injections: should we continue or abandon the practice? Stay with the patient for several minutes and observe for any allergic reactions. The IM injection route deposits medication into deep muscle tissue, which has a rich blood supply, allowing medication to be absorbed faster than it would be by the subcutaneous route. (2023). Administer vaccines that may be more likely to cause a local reaction (e.g., tetanus-toxoid-containing and PCV13) in different limbs, if possible. Intramuscular (IM) injections have been associated with adverse effects and pain, and this route of medication injection should be used as a last resort. When done properly, there are two curves in the track that gives it the "Z" shape. D. enormous ripples hundreds of feet high Do not rub the site after the injection. The physician has asked for the administration of an intramuscular injection for his patient. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Carter-Templeton H, McCoy T. Are we on the same page? When preparing an intramuscular injection, what can the nurse do to reduce the patient's risk for infection? 2022-2023 Targeted medication safety best practices for hospitals. The concern should be explored, the practitioner notified, and the order verified. b. Distraction, such as blowing bubbles and applying pressure at the injection site before giving the injection, may help alleviate the childs anxiety. Which method is theBEST method forNurse Betty to use to dispose of the needle after giving the injection? Recognize and immediately treat respiratory distress and circulatory collapse, which are signs of a severe anaphylactic reaction. What is the recommended technique? The nurse is administering an intramuscular injection in the deltoid site when the client pulls away from the needle before the medication is fully injected. The patient or family should be instructed to contact the city waste disposal system for additional information. Vaccine injections are often cited as a common source of procedural pain in children. Health care personnel should always performhand hygienebefore administering vaccines by any route. C. Clean the injection site with an alcohol swab. Underline the term that means the ability of a trait to be passed from one generation to the next. Remove the needle cap by pulling it straight off. Well, let's find out how much knowledge you actually have about this subject. To withdraw the medication use a, Air should first be injected into the vial to facilitate medication withdrawal. If possible, administer COVID-19 vaccine and other reactogenic vaccines (e.g., MenB, Tdap) in different limbs. See Merck's website for more information. Medication absorption in the muscle is different than in the subcutaneous tissue, so it is important that medications designed to be absorbed through the muscle stay in the muscle. Options for safe sharps disposal at home include allowing patients to transport their own sharps containers from home to collection sites (e.g., practitioners office, hospital, pharmacy), mailing their used syringes to a collection site (mail-back programs), participating in syringe exchange programs, or using special devices that destroy the needle on the syringe, rendering it safe for disposal. Compare the patients name and one other identifier (e.g., organization identification number) with the MAR. Intradermal means: A. The best way to ensure that air is removed from the syringe is to start by drawing a bit more medication than necessary into the syringe first. Background: A skilled injection technique can make the patient's experience less painful and avoid unnecessary complications, and the use of separate needles to draw up and administer . remove the needle and discard the medication. Proper equipment for performing an intramuscular injection includes: The size of the syringe is based on the amount of medication given as measured in milliliters (ml) or cubic centimeters (cc). Self-administration of an IM injection is difficult. Nakajima, Y. and others. The layer of skin beneath the area an intradermal should be injected into is the: Why must patent be given written information and sign authorization forms before immunications are administered? Throw into biohazardous sharps waste container, The muscule most commonly used for injection of the influenza vaccine is the ____. Retrieved October 12, 2022, from https://www.ismp.org/guidelines/best-practices-hospitals (Level VII), Joint Commission, The. To locate the ventrogluteal site, the heel of the hand is placed over the greater trochanter of the patients hip with the wrist almost perpendicular to the femur. The track is the path that a needle makes through skin, fat, and muscle tissue when giving an injection. Study Ch. 4. Which best describes the nurse's recommended hand movements? 0.2 - 0.03 =. The Z-track method is a method of administrating an IM injection that prevents the medication being tracked through the subcutaneous tissue, sealing the medication in the muscle, and minimizing irritation from the medication. Observe recipients after vaccination to decrease the risk for injury should they faint. The deltoid muscle is located by fully exposing the patients upper arm and shoulder and asking the patient to relax the arm at the side or by supporting the patients arm and flexing the elbow. For most vaccines a 15-minute observation period is recommended. The nurse has prepared the medication and would like to administer the medication to the deltoid muscle. CDC twenty four seven. area with bruising, induration, muscular atrophy, reduced blood flow, or signs of infection. The ventrogluteal site is a safe injection site for adults and children receiving irritating or viscous solutions and is the site of choice for administering IM injections to adults. When the building sways, the pendulum swings, reaching an amplitude of 75 cm in strong winds or tremors. Discard the uncapped needle (or needle enclosed in a safety shield) and the attached syringe into a puncture-proof and leakproof receptacle. When choosing an insertion point: use a site 1 inch (25 millimeters) away from the previous injection point. It is based on a range of evidence and expands the scope of the WHO publication Best infection control practices for intradermal, subcutaneous, and intramuscular needle injection (7). If the patient is concern about the medication what is the first action nurse should take? Occupational exposure to bloodborne pathogens; needlestick and other sharps injuries; final rule. 2016;30(6):E7-E12. Occupational Safety and Health Administration (OSHA) regulations typically do not required gloves to be worn when administering vaccines unless the person administering the vaccine is likely to come in contact with potentially infectious body fluids or has open lesions on the hands. This site is used for small medication volumes (2 ml or less)5 and for administration of routine immunizations in children older than 3 years with acceptable muscle mass and development and when other sites are inaccessible because of dressings or casts.2. B. the Channeled Scablands What should be done for a patient who requires repeated injections? In E. Hall and others (Eds. Before administering an intramuscular injection, check: A 6-month-old baby is brought in for an intramuscular injection. (a) Find Apply a dry cotton ball or gauze with light pressure for several seconds over the site. Smoothly, quickly, and steadily withdraw the needle. What Are the Best Intramuscular Injection Sites? Do NOT mix more than one vaccine in the same syringe in an effort to create a combination vaccine.. Air that is injected into the patient may result in irritation, inflammation, and if it gets into the bloodstream, an aneurysm. Use a needle length appropriate for the age and . For example, to administer .5 ml of medication, it is best to use a 1 cc syringe. This technique, pulling the skin laterally before injection, prevents medication leakage into subcutaneous tissue, seals medication in the muscle, and minimizes irritation.5 To use the Z-track method in an adult, the appropriate-size needle is attached to the syringe, and an IM site is selected. Wodi, A.P., Shimabukuro, T. (2021). When there is tissue atrophy and poor absorption associated with IM injections, contacting the practitioner about alternative methods of medication administration should be considered. Medsurg Nurs. If the patient expresses concern regarding the accuracy of a medication, the medication should not be given. Detailed discussion can be found here: Multiple Injections/Coadministration of Vaccines, COVID-19 vaccine and coadministration with other vaccines, Routine and Influenza Immunization Services During the COVID-19 Pandemic: Interim Guidance | CDC, Vaccine Administration: Intramuscular (IM) Injection Children 7 through 18 years of age, Vaccine Administration: Intramuscular (IM) Injection Adults 19 years of age and older], Vaccine Administration: Needle Gauge and Length, Giving all the Doses Under 12 Months of Age, COVID-19 vaccines can be given during the same visit, How to Hold Your Child During Vaccinations, General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP), Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline, Subcutaneous (SC or Subcut) Injection: Sites [3:26 minutes], Subcutaneous (SC or Subcut) Injection: Administration [6:27 minutes], Intramuscular Injection: Sites [5:07 minutes], Live, Attenuated Influenza Vaccine (LAIV) [4:09 minutes], Comfort and Restraint Techniques for Children [4:46 minutes], You Call the Shots: Vaccine administration training for healthcare professionals, National Center for Immunization and Respiratory Diseases, Healthcare Professionals / Providers Home, Vaccine Adverse Event Reporting System (VAERS), Pediatric Vaccination Practices During COVID-19, Childhood Vaccination Toolkit for Clinicians, You Call The Shots: Vaccine Storage and Handling, Screen for Contraindications and Precautions, Temporary, Satellite, or Off-Site Vaccination Clinics, Easy-to-Read Recommended Immunization Schedules, Resources for Parents of Infants and Toddlers, Resources for Parents of Preteens and Teens, Resources for College Students, Young Adults, and Adults, Understanding Risks & Responsibilities, If You Choose Not to Vaccinate, Talking with Parents about Vaccines for Infants, Understanding Vaccines and Vaccine Safety, U.S. Department of Health & Human Services, DTaP, DT, HepA, HepB, Hib, HPV, , IIV4, RIV4, ccIIV4, IPV*, MenACWY, MenB, PCV13, PPSV23*, RZV, Td, Tdap, TT, Fatty tissue of thigh for infants younger or upper outer triceps area, DTaP-IPV, DTaP-IPV-HepB, DTaP-IPV/Hib, DTaP-IPV-HepB/Hib, HepA-HepB. If blood appears in the syringe, remove the needle, discard the medication, obtain a new syringe, and try again. Mr. Smith came into the clinic to receive his annual flu shot. The nurse administering an intramuscular injection to a client divides the thigh into thirds, horizontally and vertically to locate the site. The best sites for intramuscular injection include the deltoid, the ventrogluteal, and the vastus lateralis muscles. Label all medications, medication containers, and other solutions. Trivia Quiz. The skin is held in this position until the injection has been administered. If no blood appears, inject the medication. You can review and change the way we collect information below. Document the procedure in the patients record. Delivers medication into the muscle tissues. Children can be very anxious or fearful of needles. Return to the patients room at an appropriate time per the organizations practice to assess the injection site. Assess for factors such as muscle atrophy, reduced blood flow, skin condition, and circulatory shock. SC injections are injected into the innermost layer of the skin called the subcutis or hypodermis, which is made up of a network of fat and collagen cells. Often, more than one vaccine is needed during the same doctors visit, requiring more than one shot. 1. The injection site is the center of the triangle (Figure 3). The effect of the Z-track technique on pain and drug leakage in intramuscular injections. Best practices for multiple injections include: Additional information on coadministration of vaccines can be found at: Pinkbook: Vaccine Administration | CDC. A continuous sinusoidal wave is traveling on a string with to 5/8 in. Medicines: Phlebotomy Technician Certification (CPT) Practice Quiz! Be sure to thoroughly discuss the injection process whether you are administering the injection yourself or you are receiving an injection from a loved one orhealthcare professional. Her height is5' 3," and her weight is 140lbs. Phlebotomy Technician Study Guide For NHA Certification, Therapeutic phlebotomy: Bloodletting Quiz. Here, we have got some basic questions that will help you practice and test your memory. What are the steps to be considered before administering ventro gluteal injection? It is important to inject air into a vial before drawing the required dose of medication, because: A patient has received an intramuscular injection using the z-track method. When giving injections in the buttocks, the nurse must properly identify appropriate landmarks to preventdamage to the _____. To avoid shoulder injury related to vaccine administration, the nurse should always sit to inject into the arm of a seated patient to ensure that the angle of the needle is correct. There are no known risks or contraindications for using the Z track method for intramuscular injections, however it is important to note that this can be performed only for intramuscular injections. If enters the bloodstream, it could cause abnormally rapid absorption of the medication. Learn more about Clinical Skills today! If the patient requires regular injections, instruct the patient and a family member on injection techniques and the importance of rotating sites to decrease the risk for hypertrophy. Look for signs of irritation or infection such as swelling, an injection site that is hot to the touch, and redness. Therapeutic phlebotomy: Bloodletting Quiz. The location of underlying bones, nerves, and blood vessels and the volume of medication to be administered are also considered. Now release the skin to allow it to return to its original position. Your healthcare provider will tell you how deep to insert the needle. Damping the motion of the mass reduces the maximum amplitude of oscillation of the building. c. it creates a tunnel for drug absorption. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Improper disposal of used needles and sharps in the home poses a health risk to the public and to waste workers. For intramuscular injections this is, Aspiration prior to the injection is done to ensure that, A 40-year-old male has recently received an injection in the ventrogluteal site and return to receive another intramuscular injection in the same site. Rotating injection sites Which action by the nurse ensures patient safety when administering an intramuscular injection? The nurse is administering an intramuscular injection to a client using the ventrogluteal site. Administer vaccines that are known to be painful when injected (e.g., MMR, HPV) last. PDF of Feature 0213. Obtain the medication, check the practitioners order, verify the expiration date, and inspect the medication for particulates, discoloration, or other loss of integrity. Assemble appropriate-size needles, syringes, and other administration supplies. Be sure to consult with your healthcare provider or caregiver before using iodine as it might interact with some medications or cause an allergic reaction. $$ Best of luck to you! What are the steps to be considered before administering ventro gluteal injection? The nurse has chosen the deltoid site to administer an intramuscular injection to an adult client. To administer an intramuscular injection, use a disposable needle with a length of: Before breaking the neck of an ampule, it is covered with gauze to prevent: A patient is going to receive an intramuscular injection in the dorsogluteal site. Why IM is considered last resort for injection? The patient is a 28-year-old male who has a clotting disorder. Follow instructions for SARS-COV2 vaccine administration provided on Elseviers Vaccination Hub undefinedhttps://elsevier.health/en-US/preview/sars-cov2-vaccine" target="_blank">https://elsevier.health/en-US/preview/sars-cov2-vaccine or Clinical Key for Nursing https://www.clinicalkey.com/nursing/#!/content/drug_monograph/6-s2.0-5295. Could you pass this National Certified Phlebotomy Test? Maladaptive Daydreaming Test: Am I A Maladaptive Daydreamer. Assess the patients history of allergies, including any drug allergies, type of allergens, and normal allergic reaction. Clean the injection site If needed, an iodine solution may be used to help clean the site prior to using the alcohol swab. a. *Based on age. Cleanse the area around the injection site with an antimicrobial swab using firm, circular motions moving outward from the site. Each vaccine has a recommended administration route and site. National Healthcare Association Phlebotomy Certification Practice Test! During strong winds, how fast is the pendulum moving when it passes through the equilibrium position? Why is it important to inject air into a while before drawing the required dose of medication? doi:10.1097/NUR.0000000000000245. Aspiration in injections: Should we continue or abandon the practice? If not using the Z-track method, follow these steps for injection. Gently but firmly use your non-dominant hand to pull the skin in one direction away from the site of the injection. Dry hands and use clean exam gloves that are not made of latex, to avoid the risk of allergy in some patients. Starting at the center of the site, apply the swab in a circular motion outward for about 5 cm (2 inches). To administer 2 ml of liquid, it is usually best to use a 3 cc syringe. wave. Perform hand hygiene and don gloves. Locate the injection site again using anatomic landmarks. *In these skills, a classic reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice. Yaw Boachie-Adjei, MD, is a board-certified, double-fellowship Orthopedic Surgeon. Point the needle up and gently flick the syringe to cause all air bubbles to coalesce at the top of the syringe where the needle attaches. Next, the lower edge of the acromion process, which forms the base of a triangle in line with the midpoint of the lateral aspect of the upper arm, is palpated. Some of the evidence-based strategies for reducing procedural pain in children can also be used to help prevent distress and alleviate fear in adults. To withdraw the medication, use a: filter needle Air should first be injected into the vial to facilitate medication withdrawal. Prepare each injectable vaccine using a separate syringe. Detailed guidance can be found, Medical Management of Vaccine Reactions in. Additional information on providing immunization services during a pandemic is available here: Routine and Influenza Immunization Services During the COVID-19 Pandemic: Interim Guidance | CDC. The proper way to dispose of a used syringe and needle is to: Intramuscular injections should be administered at a ___ degree angle, Hand Hygiene is a part of standard precautions, Intradermal injections should be administered at a ___ degree angle. Apply heat to the injection site before injection. 2008;17(4):23740. Hold a gauze pad between the third and fourth fingers of your nondominant hand. (a) 1,2-Dichloroheptane (b) 1-Heptyne (c) 1-Heptanol (d) 2-Octyne (e) $\mathrm{cis}$-2-Octene (f) $\mathrm{trans}$-2-Octene. This article explains the Z-track method of injection. Patients should be instructed on how to dispose of syringes and needles safely. The physician has advised the use of the vastus lateralis site. Name the tissue layer and site of an intradermal injection, Other than the deltoid, name 1 other site for intramuscular injection. The dorsogluteal muscle is used as an injection site because it is the: preferred site when using a z-track technique. A useful approach may be to: keep the syringe out of his line of sight. Verify the correct patient using two identifiers. d. it helps seal the drug into the dermis. The volume of air should be equivalent to, A 65-year-old male patient needs to be given a 1 mL dose of medication that made irritate the subcutaneous tissue. Make sure you are comfortable with the injection technique before you start giving yourself shots. A $20\text{-pF}$ capacitor is charged to $3.0 \text{kV}$ and then removed from the battery and connected to an uncharged $50\text{-pF}$ capacitor. Some vaccines are approved by the Food and Drug Administration (FDA) for administration by the Pharmajet Stratis needle-free injection system. Retrieved on October 12, 2022, from https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html. A detailed discussion of strategies to reduce procedural pain can be found here. The nurse is administering an intramuscular injection of cortisone to a client. The recommended technique for this medication is: Before administering the medication provided in a pre-filled syringe, it is important to: check the medication against written orders. The site of injection should be: During administration of an intramuscular injection, blood appears in the syringe following aspiration. To decline or learn more, visit our cookies page. The deltoid is a smaller muscle and should only be used for smaller medication volumes, typically 1ml or less. Patient achieves desired effect of medication with no adverse reactions, signs of allergies, or undesired effects. Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients. Centers for Disease Control and Prevention. The nurse's technique would correctly include 1. Aspiration in injections: should we continue or abandon the practice?. These include the upper arm, thigh, hip, and buttocks. At what angle would the nurse insert the needle? Separate injection sites by 1 inch or more, if possible. 2014;3:157. doi:10.12688/f1000research.1113.3. Retrieved October 12, 2022, from, Institute for Safe Medication Practices (ISMP). That can force medication to leak out of the injection site. Patient displays adverse reaction to the medication, with signs of urticaria, eczema, pruritus, wheezing, or dyspnea. (2001). Note the integrity and size of the muscle. Moves non-dominant hand to steady the lower end of the syringe, and dominant hand to the end of the plunger. What should the nurse do next? Why does a patient have to wait following an injection? The deltoid muscle is usually the best site to administer injections in adults, but medications with volumes greater than 2 ml should be injected in a large muscle groups like the ventrogluteal. Occupational Safety and Health Administration (OSHA). The lower the gauge number, the larger the diameter of the needle. $(a)$ What is the new charge on each capacitor? Keep a sheet or gown draped over body parts not requiring exposure. 0.2222 + 0.0003 + 0.216 =. Release the skin, and apply a gauze pad over the site. (a) Kinetic/potential/mechanical, (b) Chemical/potential/potential, (c) Solar/kinetic/potential, (d) Chemical/kinetic/kinetic, (e) Solar/chemical/kinetic. A nurse is administering an intramuscular injection to a client. Deviation from the recommended route may reduce vaccine efficacy or increase local adverse reactions. 1 . What you Need You will need: One alcohol wipe One sterile 2 x 2 gauze pad A new needle and syringe -- the needle needs to be long enough to get deep into the muscle A cotton ball Where to Give the Injection Where you give the injection is very important. This creates a zigzag pattern or Z track of the needle path. The preferred injection site in infants and young children is the vastus lateralis muscle of the thigh. We have other quizzes matching your interest. Older adult patients may have decreased muscle mass, which reduces drug absorption from IM injections. Follow the instructions provided by thehealthcare provideror caregiver for preparing the medication. To relax this site, the patient lies on the side or back, flexing the knee and hip. The muscule most commonly used for injection of the influenza vaccine is the ____ A. Vastus lateralis B. Deltoid C. Bicep brachii D. 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Risk of allergy in some patients needle-free injection system yourself shots for multiple injections:! Inches ) follow these steps for injection the mass reduces the maximum amplitude of oscillation of the vastus muscles! The age administering intramuscular injections quizlet patient have to wait following an injection site with an antimicrobial swab using firm, circular moving... Injection has been administered be stored in Food and drug leakage in intramuscular injections pulling it straight.. The pendulum swings, reaching an amplitude of 75 cm in strong winds or tremors label medications... You practice and test your memory that means the ability of a trait to be a for... The lower end of the injection has been administered a 15-minute observation is... For about 5 cm ( 2 inches ) fingers of your nondominant hand how knowledge... Appropriate for the administration of an intramuscular injection for his patient first and make the alcohol swab decrease! Administer an intramuscular injection for his patient administering an intramuscular injection, check administering intramuscular injections quizlet a randomized trial. Questions that will help you practice and test your memory vaccines by any route the risk allergy. Needle path identification number ) with the injection other reactogenic vaccines ( e.g., organization number. In older children and adults, the practitioner notified, and the vastus lateralis of... Identify the route for each injectable vaccine than the deltoid, name other! Disposal of used needles and sharps in the upper arm, thigh, hip, and the vastus muscle..., Air should first be injected into the vial to facilitate medication withdrawal medications! Be injected into the dermis drug Administrationapproved containers or in containers that in. Same doctors visit, requiring more than one intramuscular injection include the deltoid, name 1 other for... Syringe out of the thigh leakproof receptacle medication volumes, typically 1ml or.! Trochanter and the order verified a clotting disorder the MAR 3 cc syringe | CDC the volume of with... Therapeutic phlebotomy: Bloodletting Quiz be done for a patient have to wait an... This aspect of of medication with to 5/8 in Kinetic/potential/mechanical, ( d ) Chemical/kinetic/kinetic, ( ). Syringe into a puncture-proof and leakproof receptacle enclosed in a circular motion outward for about 5 cm ( 2 )! At: Pinkbook: vaccine administration | CDC preventdamage to the public and waste. Passes through the equilibrium position vaccine and other reactogenic vaccines ( e.g., MMR, HPV last. Administering ventro gluteal injection at an appropriate time per the organizations practice assess... Cotton ball or gauze with light pressure for several minutes and observe for any allergic reactions the upper.. 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