BCG, measles and yellow fever vaccines must be reconstituted before they can be used. Reconstitution means mixing the dry powder form of a vaccine with a fluid called a diluent so that the vaccine can be injected.
Follow the steps indicated below to reconstitute vaccines.
Do not begin this process until clients have arrived and you are ready to immunize.
Reconstituted vaccine lasts only six hours.
8.1 Wash your hands
Wash your hands with clean water and soap before reconstituting vaccines.
8.2 Open diluent ampoule
The diluent for reconstituting BCG, measles and yellow fever vaccines is usually held in ampoules, which are glass bottles that you open by breaking off their pointed glass tops.
Figure 7-I: Ampoules and metal file
Read the label on the ampoule to be sure that (1) it is the diluent the manufacturer sent with the vaccine you are reconstituting and (2) the expiry date has not passed. Inspect the ampoule for cracks.
Use ONLY the diluent that the manufacturer sends with the vaccine.
• BCG diluent with BCG vaccine;
• measles diluent with measles vaccine;
• yellow fever diluent with yellow fever vaccine.
Proceed as follows to open an ampoule.
1) Hold it between your thumb and middle finger.
2) Use your index finger to support the top.
3) Take the metal file that is packed with the ampoules and scratch hard around the neck of the ampoule you wish to open.
Figure 7-J: "Scratching" the neck of the ampoule
4) Wipe the outside of the ampoule with cotton wool and clean water. This removes pieces of glass produced by filing and prevents them from getting into the vaccine.
5) Hold the ampoule in a piece of clean cloth and gently break off the top. It breaks where you made the scratch.
Figure 7-K: Breaking off the neck of an ampoule
8.3 Draw diluent into syringe
1) Choose a sterile mixing (5 ml) syringe and a sterile mixing (76 mm, 18 gauge) needle and mark the syringe "BCG", "measles" or "YF" so that you use it only for reconstituting one kind of vaccine.
2) Put the needle in the open top of the ampoule and pull back the plunger to draw all the diluent from the ampoule into the syringe.
Figure 7-L: Taking fluid from an ampoule
8.4 Open vaccine vial or ampoule
Most vaccines come in vials, except for BCG vaccine, which comes in ampoules.
A vial is a glass bottle with a rubber stopper held in place by a metal cap. The centre of the metal cap is pre-cut so that it can easily be removed.
Figure 7-M: Vials
1) Before opening a vial, check the VVM. Read the expiry date on the label to make sure that you can still use the vaccine.
2) Flick the vial to make sure that all the vaccine powder is at the bottom.
Figure 7-N: Flicking a vaccine ampoule
3) Lift the centre of the metal cap and bend it back, using the same metal file as for opening ampoules.
Figure 7-O: Lifting the metal cap
1) Insert the mixing needle into the vaccine vial or ampoule.
2) Hold the plunger end of the mixing syringe between your index and middle fingers and push the plunger in with your thumb. This empties the diluent into the vaccine.
Figure 7-P: Emptying a syringe
3) To mix the diluent and vaccine, draw them slowly up into the syringe and inject them slowly back into the ampoule. Repeat this several times.
4) If you think you may need to reconstitute more of the same kind of vaccine during the session.
You can put the mixing syringe and needle on the sterilizer rack lid for use later in the session.
5) Wrap the reconstituted vaccine in foil to protect it from dirt and sunlight. Keep it in the shade.
Put the vaccine on the foam pad of your vaccine carrier.
Figure 7-Q: Keeping vaccine cold on a foam pad
6) When you no longer need an empty diluent ampoule, dispose of it in a safety box.
Destroy all reconstituted vaccine after six hours.