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.