Standard Operating Procedure validity on intramuscular vaccine administration in adults: a methodological study

Lima, Elaine Aparecida da Cunha; Caetano, Renata Oliveira; Correia, Marisa Dibbern Lopes; Toledo, Luana Vieira; Faria, Thais Bitencourt; Pereira, Daniela de Almeida; Daskaleas, Luciene Muniz Braga

doi:10.1590/0034-7167-2022-0692

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Revista Brasileira de Enfermagem

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ARTIGO ORIGINAL • Rev. Bras. Enferm. 76 (4) • 2023 • https://doi.org/10.1590/0034-7167-2022-0692 copy

Standard Operating Procedure validity on intramuscular vaccine administration in adults: a methodological study

Validación del Procedimiento Operativo Estándar sobre administración intramuscular de vacunas en adultos: estudio metodológico

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to validate a Standard Operating Procedure on the intramuscular vaccine administration technique in adults using high frequency vibration associated with cryotherapy.

Methods:

a literature review on intramuscular vaccination practice using a vibration device associated with cryotherapy. Then, a form was created to validate the instrument, detailing the items that were assessed by judges following recommendations in the literature. Judges’ answers were assessed using the Content Validity Index, with items whose index was greater than or equal to 0.80 being validated.

Results:

twenty-five nurses participated in validity, identifying judges’ opinion regarding item relevance, clarity and accuracy. Judges validated the instrument, according to the values that remained between 0.88 and 1.0.

Conclusions:

the instrument developed and validated is a tool capable of guaranteeing safety and standardizing immunization practice in vaccine rooms.

Descriptors:
Nursing; Vaccines; Injections; Intramuscular; Validation Study; Process Assessment; Health Care.

Variable	n	%
Sex
Feminine	23	92
Masculine	2	8
State in which they work
MG	24	96
RJ	1	4
Graduation years
5 to 10 years	7	28
10 to 20 years	14	56
20 to 40 years	4	16
Professional experience
Research experience with published articles	20	80
Participation in research groups in the area	9	36
Doctorate in nursing in the area		24
Master’s degree in nursing in the area	6	24
Nursing residency in the area	3	12

Items	Relevance - CVI	Clarity - CVI	Accuracy - CVI
Heading - Procedure: administration of vaccines packaged in a vial with a rubber stopper, intramuscularly, in the deltoid muscle, within the basic health unit, using a portable high-frequency vibration device associated with an ice pack for 30 seconds before and during vaccine administration. Responsible: nursing staff. Supervision: nurses.	1.0	1.0	1.0
Objective - Guide nursing professionals on the technique of administering vaccines intramuscularly in the deltoid region, using a portable high-frequency vibration device associated with an ice pack.	1.0	1.0	1.0
Necessary materials - 01 high frequency vibration external plastic device; 01 frozen gel bag; 03 AAA batteries; 01 stopwatch; 01 pen; 01 “rat-tooth” tweezers or staple extractor; 1.0 ml or 3.0 ml disposable plastic syringes; disposable needles 25x8.0 dec/mm; 25x7.0 dec/mm; 25x6.0 dec/mm; and 20x5.5 dec/mm; cotton; 70% alcohol%; sterile absorbent drape; 01 cutting drill box; 01 stainless steel tray; procedure gloves.	1.0	1.0	1.0
Before administering the vaccine - reception room
1.1 Ensure minimum waiting time for service.	1.0	1.0	1.0
1.2 Assess users’ current state of health.	1.0	1.0	1.0
1.3 Assess users’ vaccination history and ensure the correct vaccine is offered	1.0	1.0	1.0
1.4 Inform about the vaccine administration, the benefits and risks of receiving or not the vaccine.	1.0	1.0	1.0
1.5 Investigate history of severe reaction after receiving vaccine or if they are aware of any allergy to vaccine components.	1.0	1.0	1.0
1.6 Advise on the possible occurrence of post-vaccination local and systemic adverse events such as local pain, redness, swelling, fever, body pain, diarrhea and malaise.	1.0	1.0	1.0
1.7 In cases of local and systemic adverse events after vaccination, advise to : use a cold compress at the vaccine application site to alleviate local pain, redness and swelling; rest at home, in a well-ventilated environment, drink liquids for oral rehydration, and if necessary, use analgesics prescribed by a doctor to alleviate fever, body pain, diarrhea and malaise; seek medical attention if the post-vaccination local and systemic adverse event(s) do not improve or worsen; communicate the symptoms presented to the vaccination service to make the notification.	1.0	1.0	1.0
1.8 Provide an opportunity for users and/or companion/guardian to ask questions and clarify doubts.	1.0	1.0	1.0
1.9 Obtain consent from users or companion/guardian to vaccinate.	0.96	0.96	0.96
1.10 Write down the name of the vaccine in the vaccination booklet, date of administration with day, month and year, batch, validity of the vial, manufacturing laboratory, health unit and leave space for the vaccinator to sign, schedule return of the next dose, if indicated.	1.0	1.0	1.0
1.11 Register the administered dose in the information system in force in the Brazilian National Immunization Program.	1.0	0.96	1.0
Application room: preparation of vaccine administration
2.1 Clean the bench, chairs and stretcher with 70% alcohol.	1.0	1.0	1.0
2.2 Clean the hands with soap and water, according to the institution’s standard operating procedure for hand hygiene.	1.0	1.0	1.0
2.3 Welcome users and close the door to ensure privacy.	1.0	1.0	1.0
2.4 Organize, check the integrity and expiry date of all necessary material.	1.0	1.0	1.0
2.5 Check the notes on the vaccine card, confirming the vaccine to be administered and the data of users who will receive it.	1.0	1.0	1.0
2.6 Place users in a sitting position or in a supine or lateral decubitus position (if necessary).	1.0	1.0	1.0
2.7 Explain the procedure for administering the vaccine and clarify doubts.	1.0	1.0	1.0
2.8 Give users the opportunity to choose the right or left deltoid for administering the vaccine, avoiding places with scars, stains, tattoos and injuries.	1.0	1.0	1.0
2.9 Fully expose the upper limb from the shoulder to the elbow. If necessary, ask to remove the blouse, maintaining privacy.	1.0	1.0	1.0
2.10 Assess skin dirtiness, if necessary, wash the site where the vaccine will be administered with soap and water or use cotton soaked in 70% alcohol for 30 seconds in a single direction. Wait 30 seconds until the alcohol evaporates completely.	1.0	1.0	1.0

Application room: technique	Relevance - CVI	Clarity - CVI	Accuracy - CVI
3.1 Clean hands with 70% alcohol-based antiseptic, when there is no visible dirt, or wash with soap and water, in cases of dirt. If necessary, put on procedure gloves (presence of open lesions on the hands or risk of contact with body fluids), changing and cleaning hands between users.	1.0	1.0	1.0
3.2 Choose syringe size according to the volume of the vaccine to be administered and choose needle length and gauge according to users’ biotype.	1.0	1.0	1.0
3.3 Check vaccine name, liquid integrity and expiration date.	1.0	1.0	1.0
3.4 Show users the vial and read along with them the name of the vaccine to be administered and the expiration date.	1.0	1.0	1.0
3.5 Remove the seal from the vaccine vial with the aid of rat-tooth forceps or the staple extractor and clean the rubber of the vial with dry cotton.	1.0	1.0	1.0
3.6 Attach a 25x7.0 dec/mm, 25x8.0 dec/mm needle to the syringe and introduce it into the vial.	1.0	1.0	1.0
3.7 Homogenize the liquid, rotating the flask in one direction and without producing foam, until a uniform suspension is obtained.	1.0	1.0	1.0
3.8 Place the syringe in a vertical position, at eye level, aspirate the liquid corresponding to the dose to be administered and eliminate the air with the needle still inside the vial, immediately before its application.	1.0	1.0	1.0
3.9 Replace the 25x7.0 dec/mm or 25x8 dec/mm needle with a 25x6.0 dec/mm or 20x5.5 dec/mm needle, according to users’ biotype and keep it protected.	0.96	0.96	0.96
3.10 Pack the syringe in the thermal box.	0.96	0.96	0.96
3.11 Position the upper limb aligned with the body with the shoulder relaxed and the forearm on the abdomen.	1.0	1.0	1.0
3.12 Locate the deltoid muscle by identifying the acromion, mark 3 cm below the acromion and draw an imaginary triangle with the base facing upwards.	1.0	1.0	1.0
3.13 Take the ice pack from the freezer, attach it to the back of the portable high-frequency vibration device and place it in contact with the skin, in the center of the imaginary triangle, where the vaccine will be administered. Fix the vibration device associated with the ice pack with the tourniquet that comes with said device, turn on the vibration button and time 30 seconds. After that time, with the device still on, slide the device about 2 cm above the vaccine administration site.	1.0	1.0	1.0
3.14 Administer the vaccine using the Z technique.	0.96	0.96	0.96
3.15 Introduce the needle into the deltoid muscle in the center of the imaginary triangle, at a right angle (90º) with lateral bevel.	1.0	1.0	1.0
3.16 Do not vacuum.	0.96	0.96	0.96
3.17 Maintain Z technique while administering the vaccine rapidly.	0.88	0.88	0.88
3.18 Withdraw the needle with a quick, firm movement and undo the Z technique.	0.88	0.88	0.88
3.19 Activate the safety system on the needle, if applicable.	1.0	1.0	1.0
3.20 Place dry cotton and maintain light pressure on the vaccine administration site.	1.0	1.0	1.0
3.21 Disconnect and remove the vibration device associated with the ice pack.	1.0	1.0	1.0
3.22 Do not rub the vaccine administration site.	1.0	1.0	1.0
3.23 Observe if there is bleeding at the vaccine administration site, if necessary, maintain compression until the bleeding stops.	1.0	1.0	1.0
3.24 Observe user reactions, be aware of immediate adverse events.	1.0	1.0	1.0
3.25 Dispose of the syringe with the needle in the sharp puncture box.	1.0	1.0	1.0
3.26 Remove the cotton and dispose of it in the infectious waste.	1.0	1.0	1.0
3.27 Apply absorbent covering over the vaccine administration site.	1.0	1.0	1.0
Application room: post-vaccination
4.1 Dispose of the syringe and needle packaging in the common trash.	1.0	1.0	1.0
4.2 Dispose of the bottle in an appropriate place, in accordance with legislation.	1.0	1.0	1.0
4.3 Clean the hands with soap and water, according to the institution’s standard operating procedure for hand hygiene.	1.0	1.0	1.0
4.4 Sign the name in full, legibly, on the vaccination card and return it to users.	1.0	1.0	1.0
4.5 Instruct users to remain seated in the unit’s premises for 15 minutes for observation.	1.0	1.0	1.0
4.6 Clarify doubts.	1.0	1.0	1.0
4.7 Dismiss users.	1.0	1.0	1.0
4.8 Disinfect the portable high-frequency vibration device with 70% alcohol.	1.0	1.0	1.0
4.9 Disinfect the gel bag with 70% alcohol and return it to the freezer.	0.92	0.92	0.92
4.10 Clean the hands with soap and water, according to the institution’s standard operating procedure for hand hygiene.	0.96	0.96	0.96

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Marisa Dibbern Lopes Correia, E-mail: marisa.lopes@ufv.br