Administering Multiple Vaccines to a Child During a Single Office Visit

December 2010

Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children’s Hospital of Philadelphia Vaccine Education Center’s (VEC’s) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events.
Administering Multiple Vaccines To A Child During A Single Office Visit
Published December 2010
Information presented in this article may have changed since the original publication date. For the most current immunization recommendations from the Advisory Committee on Immunization Practices, visit ACIP Vaccine Recommendations.
When infants and children need to be vaccinated, they often need to receive three or more injections, particularly if they are behind schedule. To make sure a child is fully protected as early as possible, the CDC and AAP recommend that at the next office visit, the child receive all the vaccines needed, no matter what the number (as long as there are no contraindications or precautions).
When a child needs several doses, it’s sometimes necessary to give more than one intramuscular (IM) injection in a single muscle. The CDC recommends separating these IM injections by one inch or more. When administering subcutaneous (SC) injections separate the doses in the fatty tissue by one inch or more, as well.
When giving a child two injections in the same anatomic area, it is important to document in the medical record the anatomic site where each vaccine was given. For example, when you give two vaccines in the same muscle, you might simply record which vaccine you gave in the “upper” portion of the injection area, and which in the “lower.” In this instance, your note in the patient chart might state, “DTaP: right thigh, upper; and Hib: right thigh, lower.”


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