This document provides information about flu clinics and vaccines. It discusses several flu vaccine brands (Sanofi, Novartis, GSK, MedImmune), appropriate age indications, thimerosal contents, and administration methods. Maxim's vaccine policies for different populations like pregnant women and children are outlined. Information is also provided about other vaccines like Tdap, pneumococcal, and proper storage, handling, administration technique, documentation, and waste disposal procedures.

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
• MDV’s 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
» Prefiled syringes
• Adacel : Indications 11- 64 years
» 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°C
(0°F) to 37°C (99°F)
HARD •Accuracy ± 1°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/60/2008–like 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