Saturday, 20 March 2021

Air bubbles in syringes

Back in December 2014, I wrote a blog about this subject as guidance had been put in the Vaccine Update for November/December 2014, which was the first official guidance I'd seen on the subject.  At that time it said "You shouldn’t get rid of the air bubble. To try to expel it risks accidently expelling some of the vaccine and therefore not giving the patient the full dose. The air bubble is also there for a reason – the air injected into the muscle forms an airlock preventing the medication seeping out along the needle tract into subcutaneous tissue and onto the skin. The small bolus of air injected following administration of medication clears the needle and prevents a localised reaction from the vaccination". However things have moved on since then so please read on!  

This subject has come up recently within training ongoing for the COVID-19 vaccine. The COVID-19 vaccination programme document from Public Health England, Information for healthcare practitioners, was last updated on 26 February 2021.  Within this document it says 'any air bubbles should be removed before removing the needle from the vial in order to avoid losing any of the vaccine dose'.  This is stated on pages 41, 44 and 48 referring to all three brands of COVID-19 vaccine we're currently using in the UK.  

Guidance is also provided on a very useful webinar training by Sarah Lang who is well known in the world of travel medicine but also within immunisation for the national programme especially for children.  Sarah delivered a series of webinars on behalf of PHE London.  The session on Vaccine administration - best practice is excellent in its content and delivery and is provided on a video (which you can download as an MP4) but the slides are also given in a PDF (in which the sound of the presentation is provided within the document).  On slide 16 (just after 14 minutes) Sarah discussed air bubbles and then also goes on to explain injection sites as well.  The whole presentation is very worth watching, including issues such as timing you may have for an appointment, pain reduction etc.   Click HERE to access the whole series.  For the session on Vaccine administration - best practice click HERE or on the image below.  (Tip, the links provided can be accessed via the PDF document which also gives the best resolution to the presentation although the slides don't move along in time to the spoken content).  

  • Leave air bubbles in pre filled syringes (PFS)
  • For a non pre filled syringe, prime the syringe up to the hub of the needle and any air bubbles should be removed before removing the needle from the vial in order to avoid losing any of the vaccine dose.

Friday, 27 November 2020

COVID-19 Vaccination e-learning programme

Health Education England e-Learning for Healthcare has worked in partnership with Public Health England and NHS England and NHS Improvement to develop the COVID-19 Vaccination e-learning programme.  The e-learning programme is designed to provide the health and care workforce involved in the national COVID-19 vaccination programme with the knowledge they need to confidently promote high uptake of the vaccine and deliver the vaccine programme effectively.

The programme currently consists of one core knowledge session, which covers subjects including vaccine eligibility and legal aspects, and an accompanying multiple-choice assessment session.  All those undertaking this e-learning should complete the core knowledge session as this is designed to provide essential knowledge about COVID-19 and the key principles of vaccination needed to deliver the vaccine.


The e-learning sessions describe the national COVID-19 vaccination programme for England. Most of the information in the sessions will be relevant for those involved in the programme throughout the UK and Crown Dependencies. However, those undertaking the programme in Northern Ireland, Scotland, Wales and the Crown Dependencies should be aware that some details as to how the programme will be delivered may be different. Vaccinators should therefore ensure that they refer to any country-specific information available, so they are familiar with the details of the programme for the country they are practising in.

This e-learning programme provides theoretical training.  Practical training in vaccine administration, and assessment and sign-off competency is also required before administering the COVID-19 vaccine.

Learners should also complete the vaccine specific session(s), when available, which will provide more detailed information about the vaccine(s). The assessment sessions should be completed after each knowledge session.  More vaccine-specific sessions will be added as and when more COVID-19 vaccines become available.

Additional, complementary, e-learning sessions including Basic Life Support, anaphylaxis and statutory and mandatory training are available to support vaccinators’ training and education.

For more information about the COVID-19 Vaccination programme, including details on how to access, visit the e-LfH website. (or click on the image above). 

Please note, this information was copied directly from the e mail sent by the Directorate of Innovation and Transformation, Technology Enhanced Learning, e-Learning for Healthcare.

Sunday, 25 October 2020

Good Practice Guidance for a Travel Health Service


For travel health or travel medicine - my area of specialist practice, the impact of COVID-19 has been devastating for different reasons for those working in this field full time.  In the main people have stopped travelling so there are very few travellers to see who would have previously required advice and where there is demand, this is currently largely for COVID testing for travel.  Even if you undertake travel health as a small part of your daily workload, as many will in General Practice, there is little demand.  Jobs are at risk in many related areas for travel health (e.g. the specialist private travel clinics, staff in vaccine divisions of pharmaceutical companies).  Vast stocks of vaccines approaching their 'expire by date' will be wasted, a huge economic loss, and I've heard of no real solution to this and certainly no compensation unless the owner has specific valid insurance.  Specialist travel services operating in the private sector have the skills to immunise with all the required knowledge and yet to date, I've seen little co-ordination to consider using this taskforce to assist in the massive operation needed to administer the NHS flu vaccination campaign or to help in the future campaign to vaccinate the millions of people when a COVID-19 vaccine hopefully becomes available. 

What is the Faculty of Travel Medicine?

The Royal College of Physicians and Surgeons of Glasgow are the only College in the Northern Hemisphere to have a Faculty of Travel Medicine (FTM).  We are a small group of subject experts in travel medicine. The mission of the FTM surrounds concern for education and standards.  More details can be found here. If you become a Fellow, Member or Associate of the Faculty you are awarded a post nominal qualification, signifying your level of expertise, but entry must be demonstrated to allow this.  We also have another category of Affiliate, which is open to anyone interested in the subject.  The fee for this is far smaller but allows the individual to benefit from the educational opportunities the Faculty provides.  

This was our stand at the RCN/NaTHNaC conference in February 2020

I referred in the last paragraph to the FTM as 'we'.  This is because I was involved in the development of this body in 2011 - the Faculty came into existence in 2012.  I am the fifth Dean (the Leader of the group) but I held many other positions before this and I am the first nurse and first female to become the Dean, which spans a term of three years.  We all work in our roles unpaid, but this is standard practice in any body such as a medical Royal College because the work is about having a passion to utilise one's experience to develop the subject, support other practitioners and improve standards of care for our patients.  I'm immensely proud to hold this role and since COVID-19 resulted in losing all my face to face teaching work, I've focussed on FTM work full time.  The FTM comprises doctors, pharmacists and there are many nurses who belong and have qualifications in the subject.  On International Nurses Day this year, I put a photo together with images of some of them - I'm so proud to be part of this group and many of them are active in the FTM work!  

NEWS !  Good Practice Guidance for Providing a Travel Health Service

So it was with immense pleasure that I announced a document at our AGM last Friday, 'GOOD PRACTICE GUIDANCE FOR PROVIDING A TRAVEL HEALTH SERVICE'.  It may seem a strange time to launch such a publication but this has actually been in development for two years before any of us had any idea what was around the corner!  Standards of care for travel health in the UK are variable.  In the introduction of the document it states 'The FTM considers the most important aspect of delivering travel health care is not which professional group delivers the care, but that each person doing so exceeds the minimum standard of practice and meets the health needs of the traveller'

Click on the image above to access the document. or here

Overview of content 

The document sets out expected standards of practice in four key areas

  1. Service Delivery
  2. Operating/Facility Requirements for a Travel Service
  3. Assurance and Governance of Travel Health Services
  4. Recomendations for the Practice of Travel Medicine 
The fourth section is supported by two appendices to further enhance standards and training 

  • Appendix B provides an example of a practitioner assessment tool for competency in travel health
  • Appendix C lists the training requirements in travel medicine. 

Other helpful reources.  
At the end of the document is a 12 page 'booklet' of really useful resources followed by a patient leaflet to help the traveller understand WHAT they should expect to experience within a travel health consultation.  This patient leaflet  is also available as a single downloadable item.  

Other helpful tips

If you download the document, many features have been added to help you navigate the 52 pages. All the links in the index both on page 5 and on page 39 have been hyperlinked to the sections within the publication to make it easy to get to the sections without having to scroll down all the time.  And if you click on any resource that has a weblink, if you press Ctrl then click the link, the page should open in a separate tab if you're using browsers such as Google Chrome or Internet Explorer.  

The competency tool is also available as an editable Word document so that you can keep a 'living' and 'virtual' record of the competencies you develop.  This is especially important for new learners but also useful to use as you develop your skills and determine the further training and learning skills you need.    


Despite the current Global Pandemic, many similar situations have happened in the past and in due course travel will be very popular again, indeed it may be busier than ever and I hope then travellers will be increasingly more aware of the advice they need to take to protect their health.  So to prepare for that situation, it is important that practitioners are properly trained and prepared.  This document supports this aim, to ensure the future safety of our travellers is catered for and practitioners practice safely within their professional codes of conduct.  

Friday, 4 September 2020

31st National Immunisation Conference

The 31st National Immunisation Conference for Healthcare Workers has been led by Dr David Baxter over many years and has always been held on the first Friday of December in Manchester.  However, this year it's going virtual and is provided free of charge.  It always attracts excellent and well known speakers.  

The meeting is advertised on the Clinical Vaccinology website HERE or ALTERNATIVELY and to save time, you could download the application form HERE and then e mail it directly to 

The meeting also has a poster competition element to it. To download a copy of this information click HERE

I intend to register so see you there virtually on Zoom!  

Saturday, 25 July 2020


As we start to return to a new type of normal in our lives, there has been an increased interest in travel medicine education so I thought I would lay out in this blog some activities I've been up to over the last few months - mostly within my role as Dean of the Faculty of Travel Medicine (FTM) of the Royal College of Physicians and Surgeons of Glasgow.  Much of this is for those practising the subject, but if you're new, you may also find it very interesting to explore!

TRAVEL HEALTH UPDATES - this will be a series of one hour webinars (plus extra time for questions) that I'll be chairing and speaking at along with some travel health specialist nurse colleagues and friends on four consecutive Tuesdays in November (17th and 24th) and December (1st and 8th) but all events will be available afterwards to catch up on if you miss one.  Each session will cover different topics and resources will also be provided.  Cost for the entire series £25 for FTM members and £40 for non members.  See HERE.
Please note: If you think your organisation may be interested in a block booking there are also corporate rates so please contact me

ONLINE CONFERENCE - Future Travel Medicine Practice in the Wake of COVID-19 on 6th November 2020 from the FTM.  This event has an amazing line up of speakers and the delegate rates are very low at £25 for FTM members and £35 for non members.  Please check out the programme HERE  or you could download it directly from here 

TIP - to become an Affiliate member of the FTM costs £30 and there are many benefits.  If you decided to attend the conference and the travel health updates, having joined as a member, it would mean the whole package would cost a total of £80.  To read more about joining see HERE

EMPORIATRICS is an education hub of resources that comes out 6 monthly from the FTM as a membership benefit.  I create this, supported by College staff, some great authors and a very supportive editorial team.  This is usually a membership benefit but due to COVID-19 the College made this open access for the current edition - explore HERE

My own two day training course which is held face to face at the UCH Education Centre in London has been cancelled because the centre has closed to all outside trainer bookings until April 2021.  However I am developing the course into a digital format with some follow up real time training online after the e learning has been undertaken.  This is taking time to create the high standards and quality I always want to maintain and I anticipate it will be ready later this year.  Please check out the new to travel course webpage in due course - accessed here and for further information you are welcome to contact me here.  

Thursday, 23 April 2020

Happy St George's Day!

I decided to post a blog that's been fun to create because I've had a good 24 hours - need a bit of light relief in these hard times.  Travel medicine was the first thing in my career that came near to the excitement my time as a ward sister of a female medical ward (Ogle) at St. George's Hospital in Tooting evoked.

But yesterday I received an e mail from Mandy Galloway, the Editor of Practice Nurse Journal.  She had received an e mail from Practice Nurse Manager Oonagh Atkinson who wrote to say that she had subscribed to the journal since 1993 and she wanted to give thanks as she recognised the journal as a superb resource which had helped her to keep up to date with current practice nursing issues and learn about new areas.  She also said the following!  I have particularly enjoyed reading Jane Chiodini's Travel Health Updates. I worked as a student nurse on Ogle Ward at St George's Hospital in 1983 where Jane was the ward sister. She was a wonderful ward sister and mentor then and I have found her articles and resources excellent.  And I remember Oonagh so well too, I saw her in a Holiday Inn near Surrey University where I was delivering a study day in 2010.  I also have a photo of her in Il Carretto's in Streatham where we went for a leaving meal for one of the Staff Nurses who was leaving, the memory of that event is strong and the amazing 'chicken kievs' served up as well at the restaurant, sadly no longer trading!

Ogle was a 25 bedded Nightingale Ward, it was very busy and the work heavy but I loved it so much.  Well that then set up an e mail exchange with Beverley Bostock who is the Editor in Chief of Practice Nurse Journal who had also trained at St George's and it turned out we had many people we know in common, including Ruth Amartey (nee Holgate) who is an Advanced Nurse Practitioner and Clinical Lead for Nursing  in the Waltham Forrest Training Hub (CEPN) and with whom I've provided travel health study days for a number of years now!  That led me to contact two friends on FaceBook who were staff nurses on Ogle and a little chat then pursued with them.  And all this discussion happening on St. George's Day!  So if you knew me in the past (and I've met a few on study days) or you trained at St George's and have anything to share then perhaps e mail me via my website - I'd love to compile some historical memories together.

 In the nurses office of Ogle Ward writing up the Kardex!  

I was featured in a careers magazine - right hand pictue, middle row! My twin nephews picked the mazine up in the school library and were excited to see their Aunt on the cover - they are now 40! 

After a year working at St George's as a Staff Nurse one was awarded with a 'red belt' and a St George's buckle as a reward.  It was oval with George and the dragon in solid silver, mine had the Queen's Silver Jubiliee hallmark on it.  Loved the uniforms of those days although the hats were a nightmare to make.  I happened to have a 'flair' for them unfortunately - they had to have five pleats and three crowns on the top, with a very specific bow completing the work at the back!  I often got 'landed' with requests to make them for lots of other friends and colleagues - of course I did, but many would use them for weeks on end because they were so tricky to make - not sure infection control was a term we knew 'on our heads' but my hair was washed daily! We used to have some Royal Masonic nurses living in the nurses home, now their hats were even more complex!  I used to sing in the London Choirs for the Malcolm Sargeant Cancer Fund for Children at the Royal Festival Hall each Christmas - all the hats were on display there. The Bart's hats were my favourite!  

and lastly, my husband always buys me a rose on St George's Day - 
here's an image I shared earlier on Instagram!  


Tuesday, 31 March 2020

What a March

COVID-19 has moved at such a fast pace, travel medicine seems a very low priority and I struggle to find much news to put on my FaceBook page about it really.  I also realise that this is the only subject I've blogged about this year.  I've now created a webpage of resources to take you to key sites for information, but to be honest, it's very hard to keep up with it all and I've reduced the time I listen to the news - I was finding it detrimental to sleeping well and coping with day to day work. 

So although I'm fully aware of the situation, my usual news sources have changed.  I wake to the headlines on Radio 4 at 6.30am each day, continue to refer to the Government resources, watch the daily Goverment briefings if possible and if not, catch a summary on the 6pm news. 

I'm still blogging every two weeks for the Royal College of Physicians and Surgeons of Glasgow in my role as Dean of the Faculty of Travel Medicine.  They have a great COVID-19 landing page of resources here and my blogs can be found as follows:  31st January 202014th February 202028th February 2020, 13th March 2020  27th March 2020    10th April 2020

Click the image below ot access the COVID-19 resources page on my website or here.