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Definition of Terms
Respiratory Syncytial Virus (RSV) is one of the most common causes of lower respiratory tract infections in children at high risk of respiratory disease. It is associated with increased morbidity amongst preterm infants and babies born with chronic health conditions such as respiratory and/or cardiac complications. Palivizumab, provides passive immunity against RSV infection and has been shown to decrease hospitalisation for RSV related illness. For patients who have been admitted to hospital for RSV infection, the incidence of an ICU admission related to RSV infection is decreased in patients receiving 4 weekly Palivizumab. The Royal Children’s Hospital (RCH) funds Palivizumab for selected cardiology patients and other at risk groups and administration is coordinated by the RCH Immunisation Service. Palivizumab is given as a course of up to 5 intramuscular injections at 1 month intervals throughout the RSV season. The RSV program at RCH begins in May each year and concludes at the end of September.This guideline is intended for use by Medical and Pharmacy staff and nurse immunisers working in the Immunisation Drop in Centre (DIC) at RCH. The guideline applies to neonate/infants inpatient or outpatients attending RCH and can be administered by approved nurse immunisers in the DIC with a Drug Usage Committee (DUC) approved order on EMR. Palivizumab can be given from birth. (Usually given in first year of life)
The aims of this guideline are:
Eligibility for Palivizumab is considered by the Drug Usage Committee (DUC) on a case by case basis. Criteria for use is established following consultation with relevant clinicians, and examples of approved patients include:
Note: Dose 2 is given 3 weeks after dose 1 and then 4 weekly for the remainder of RSV season.
Palivizumab for injection is available as:
following steps are taken:
Note: RSV does not contain a preservative and should be
administered immediately after drawing up the dose
See also RCH Procedure
document Multi-use of Pharmaceutical
injection products, sealed vials and bags available at http://www.rch.org.au/policy/policies/Multi-use_of_pharmaceutical_injection_products,_sealed_vials_and_bags/
Intramuscular injection technique
Photo courtesy Lloyd Ellis, The Royal Children’s Hospital, Victoria (pg. 80 of Australian Immunisation Handbook, 10th ed. 2013)
Position for infants < 12 months
Position the infant in a semi-recumbent position on the lap of the parent/carer (see figure below) this position is also suitable for young children.
Photo courtesy Dr Joanne Molloy, Victoria (pg 75 of Australian Immunisation handbook, 10th ed. 2013)
Injections can result in distress and anxiety for infants, children and their parents. It is important that effective pain management strategies are used during injection procedures. Some strategies that are recommended during administration of the Injection include:
See also RCH nursing clinical guideline document available at http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Procedural_Pain_Management/
The evidence table for this guideline can be found here.
Please remember to read the disclaimer.
development of this nursing guideline was coordinated by Nadine Henare, Nurse Coordinator Immunisation,
and approved by the Nursing Clinical Effectiveness Committee. Updated August 2018.