Click the topic below to receive emails when new articles are available. Taddio A, McMurtry C, Shah V, et al. Bethesda, MD 20894, Web Policies Providers should update a patients permanent medical record to reflect any documented episodes of adverse events after vaccination and any serologic test results related to vaccine-preventable diseases (e.g., those for rubella screening or antibody to hepatitis B surface antigen). The site is secure. Reducing pain during vaccine injections: clinical practice guideline. Subcutaneous fat has poor vascularity, leading to slow mobilization and antigen processing for some other vaccines administered subcutaneously. Accessed September 6, 2019. Health Resources and Services Administration website. Some MDVs vials have a specified period for use once they have been punctured with a needle. A high-grade soft tissue sarcoma was diagnosed microscopically and immunohistochemistry revealed positive expression of VEGFr, PDGFr, SCF, and EGFR. Once initial training has been completed, accountability checks should be in place to ensure staff follow all vaccine administration policies and procedures. Other frequent error types queried included administration to someone younger than the authorized age (18.5% of inquiries) and administration by a route other than intramuscular (IM) (12.3% of inquiries). Never use expired supplies. MFSs are prepared with a single dose of vaccine and sealed under sterile conditions by the manufacturer. IM injections are administered at a 90-degree angle to the skin and, for most adult patients, the skin is spread and the tissues are not bunched. Push the plunger rapidly in a single motion until the dose-divider clip is reached. Shoulder injury related to vaccine administration (SIRVA) is a recognized consequence of unintentional injection of a vaccine into the tissues and structures lying underneath the deltoid muscle of the shoulder. Vastus lateralis muscle in the anterolateral thigh. Journal of Feline Medicine and Surgery. Sarah F. Schillie, MD, MPH, MBA; Jennifer Buzzell, MS; Christina A. Nelson, MD, MPH; Sarah Kidd, MD, MPH; Katherine R. Shealy, MPH; Sarah Reagan-Steiner, MD, MPH. Dorsocervical subcutaneous masses in a dog who received three vaccinations at this site three weeks previously. Proper vaccine administration is necessary to ensure vaccine effectiveness, achieve optimal vaccine-induced protection, avoid safety implications, and assure confidence in the COVID-19 vaccination program. Shoulder injury related to vaccine admin- istration and other injection site events. Using the patients immunization history, health care providers should assess for all routinely recommended vaccines as well as any vaccines that are indicated based on existing medical condition(s), occupation, or other risk factors. Never transfer vaccine from one syringe to another. A gluteal muscle injection should be administered laterally and superior to a line between the posterior superior iliac spine and the greater trochanter or in the ventrogluteal site, the center of a triangle bound by the anterior superior iliac spine, the tubercle of the iliac crest, and the upper border of the greater trochanter. 4. Vaccine providers are strongly encouraged to participate in an IIS, and some states mandate documenting vaccinations in an IIS. official website and that any information you provide is encrypted Diluents vary in volume and composition, and are specifically designed to meet volume, pH balance, and the chemical requirements of their corresponding vaccines. The .gov means its official. For toddlers, the vastus lateralis muscle in the anterolateral thigh is preferred. Centers for Disease Control and Prevention, Atlanta, GeorgiaDisclosure: Christina A. Nelson, MD, MPH, has disclosed no relevant financial relationships. The dose does not need to be repeated if an infant regurgitates, spits out the vaccine, or vomits during or after administration. For most infants, the vastus lateralis muscle in the anterolateral thigh is the recommended site for injection because it provides a large muscle mass. Building Confidence in COVID-19 Vaccines: Why Are Millennials Hesitant? Recommendations from experts state that if at least half of the vaccine went in, the. After-care information can be given to patients or parents before vaccines are administered, leaving the parent free to comfort the child immediately after the injection. Effective analgesia using physical interventions for infant immunizations. To avoid, SRIVA, proper administration technique should always be used. 2006;43(4):545548. Use a separate syringe and needle for each injection. Smith S, Duell D, Martin, B. We take your privacy seriously. Reporting serious reactions enables corresponding agencies to track data and look for trends in reactions to particular vaccines, avoiding delays in identifying potentially dangerous trends while keeping patients safe. N Z Vet J. -, Vascellari M., Melchiotti E., Mutinelli F. Fibrosarcoma with typical features of postinjection sarcoma at site of microchip implant in a dog: histologic and immunohistochemical study. Details on reporting adverse events after vaccination can be found at https://vaers.hhs.govexternal icon. Avoids frightening children by embracing them rather than overpowering them, Allows the health care professional steady control of the limb and the injection site, Prevents children from moving their arms and legs during injections, Encourages parents to nurture and comfort their child. Administer each vaccine in a different injection site. Typically, an injection-site reaction is considered to be any pain, swelling, rash, bleeding, or redness that occurs at the site of an injection, although, serious reactions can occur (see sidebar1).2 A small amount of pain or redness is expected with an intramuscular (IM) or subcutaneous injection, and a warning to this effect is included in the Vaccine Information Statement for a majority of vaccines.3 Local reactions are usually quite easy to treat at the time of vaccination or with a simple recommendation post administration. In addition, many state and local immunization programs and professional organizations, including the American Academy of Pediatrics, have resources. Whittemore JC, Gionfriddo JR, Steyn PF, Ehrhart EJ. 3. Each vaccine and diluent (if needed) should be carefully inspected for damage, particulate matter, or contamination before using. This case report documents the clinical and pathological findings in a dog that rapidly developed a high-grade sarcoma at the site of multiple vaccinations and follows the response to surgery and adjunct treatment with toceranib. Injections site sarcomas occur in younger cats than do sarcomas at noninjection sites, with a peak at 6 to 7 years of age. Live, attenuated influenza (LAIV [FluMist]) vaccine is administered by the intranasal route. Physical Scientist, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GeorgiaDisclosure: Jennifer Buzzell, MS, has disclosed no relevant financial relationships. Vaccine recommendations and guidelines of the ACIP. Immunization room conversations often start with a joke from a nervous patient who will say that they do not like needles or that they are afraid the needle stick will hurt. A supply of needles should be available in varying lengths appropriate for the facilitys patient population. Bleeding at the site can be contained by applying pressure until bleeding has stopped and then covering the site with an adhesive bandage or compress.4 Some patients may develop a low- grade fever after receiving an injection, which is usually self-limiting, but this can be treated with antipyretics, if needed. Notes from the Field: Injection Safety and Vaccine Administration Errors at an Employee Influenza Vaccination ClinicNew Jersey, 2015. The https:// ensures that you are connecting to the It is a good idea for all health care providers who administer immunizations to familiarize themselves with VAERS to ensure they know what to do if an AE occurs. Aspiration can increase pain because of the combined effects of a longer needle-dwelling time in the tissues and shearing action (wiggling) of the needle. For older children and adults, the deltoid muscle can be used for more than one intramuscular injection. Several aspects of breastfeeding are thought to decrease pain by multiple mechanisms: being held by the parent, feeling skin-to-skin contact, suckling, being distracted, and ingesting breast milk. Verify needle length for IM injection into the vastus lateralis or deltoid muscles. Therefore, being prepared and properly immunizing an at-risk canine with rattlesnake vaccination is the safest plan for outdoorsy and active Los Angeles-based dogs, provided there's not a previous history of vaccine associated adverse events (VAAE), immune-mediated disease (like my dog Cardiff's IMHA), or cancer (another unfortunate strike in . Reviewed June 2019. 1. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Vaccination providers should assess how the error occurred and take steps to prevent future errors. Reviewed April 5, 2019. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. All health care professionals who administer vaccines to older children, adolescents, and adults should be aware of the potential for syncope after vaccination and the related risk of injury caused by falls. Administration involves a series of actions: assessing patient vaccination status and determining needed vaccines, screening for contraindications and precautions, educating patients, preparing and . doi: 10.1111/j.1751-0813.2010.00557.x. Injection-Site Sarcoma in a Dog: Clinical and Pathological Findings Case Rep Vet Med. Parents play an important role when infants and children receive vaccines. Federal law requires VISs be provided when routinely recommended childhood vaccines are administered. Appropriate measures should be taken to prevent injuries if a patient becomes weak or dizzy or loses consciousness, including: Health care providers are required by law to report certain adverse events, and encouraged to report other events, following vaccination to the Vaccine Adverse Event Reporting System (VAERS). Remove the rubber tip of the nasal sprayer and place the tip of the applicator just inside the patients nostril. Parents should be counseled that sweet-tasting liquids should only be used for the management of pain associated with a procedure such as an injection and not as a comfort measure at home. An infant can eat or drink immediately before or after administration of either product. HHS Vulnerability Disclosure, Help Therefore, using friction and a sterile alcohol swab to wipe the stopper may help assure aseptic technique. Please enter a Recipient Address and/or check the Send me a copy checkbox. Skin-to-skin contact for infants up to age 1 month has been demonstrated to reduce acute distress during the procedure. Provide supportive care and take appropriate measures to prevent injuries if such symptoms occur. Hibbs B, Miller E, Shi J, et al. Soft tissue sarcoma at the site of a previous laparoscopic-assisted gastropexy in a dog. 2007 Dec;48(12):702-4. doi: 10.1111/j.1748-5827.2007.00434.x. The analgesic effect can last for up to 10 minutes following administration and can mitigate vaccine injection pain. immunize.org/catg.d/p3082.pdf. Oral vaccines do not contain a preservative. VISs are available as paper copies and in electronic formats that can be read on smart phones and other devices. When administering IM injections, immunizers must be sure to identify the location of the deltoid muscle and attempt to administer the vaccination deep into its middle. Administering the shot at a 90 angle can ensure that the needle goes directly into the deltoid and not upward into the shoulder area (see table ).5. If a day is included with the month and year, the product may only be used through the end of that day unless the vaccine was contaminated or compromised in some way. The patients immunization status should be reviewed at every health care visit. Some vaccines are approved for subsequent 1-year use and some for 3-year use. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Have the patient seated or lying down for vaccination. MeSH In the setting of the COVID-19 pandemic, gloves should be worn when administering intranasal or oral vaccines. All information these cookies collect is aggregated and therefore anonymous. For infants younger than age 12 months, a subcutaneous injection is usually administered into the fatty tissue of the thigh, although the upper outer triceps area of the arm may be used if necessary. Leaked documents show that some early commercial batches of Pfizer-BioNTech's covid-19 vaccine had lower than expected levels of intact mRNA, prompting wider questions about how to assess this novel vaccine platform, writes Serena Tinari As it conducted its analysis of the Pfizer-BioNTech covid-19 vaccine in December, the European Medicines Agency (EMA) was the victim of a cyberattack.1 More . Preventing and manag- ing adverse reactions. Hematoxylin and eosin stain. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. The interim clinical considerations for the use of currently authorized COVID-19 vaccines contain guidance for managing vaccine administration errors. *Some experts recommend a 5/8-inch needle for men and women weighing less than 60 kg; if used, skin must be stretched tightly and subcutaneous tissues must not be bunched. Pinch up the skin and underlying fatty tissue. What about titre testing? For infants and younger children, if more than two vaccines are being injected into the same limb, the thigh is the preferred site because of the greater muscle mass. Vaccines should be reconstituted according to manufacturer guidelines using only the diluent supplied for a specific vaccine. 8th ed. Instructions should also provide information about when to seek medical attention and when to notify the health care provider about concerns that arise following vaccination. It can happen with any kind of injection. -, Munday J. S., Banyay K., Aberdein D., French A. F. Development of an injection site sarcoma shortly after meloxicam injection in an unvaccinated cat. Often more than one vaccine is administered at the same visit and, once drawn into a syringe, vaccines look similar. First, most especially with the pen devices, once you have injected the medication into the skin, count to five before removing the needle. Vaccine-related pain: randomized controlled trial of two injection techniques. Novavax Raises Doubts About Ability to Remain in Business, Shares Fall, ACC Scientific Session Returns Live, Virtually to New Orleans, Treatment of Coronavirus Disease 2019 (COVID-19): Investigational Drugs and Other Therapies, Trending Clinical Topic: COVID-19 Vaccine, FDA Drug Approvals, Infectious Disease 2022 Midyear Review, COVID-19 Booster Immunization With Bivalent Vaccines, Moderna to Make Milestone Payments to NIH for COVID Vaccine, Pfizer/BioNTech Apply for Full FDA Approvalof UpdatedCOVID Vaccine, COVID-19 Vaccination Associated With Fewer Major Adverse Cardiovascular Events. Saddle River, NJ: Pearson Education, Inc.;2011. Professional standards for medication administration, manufacturer instructions, and organizational policies and procedures should always be followed when applicable. A. Some vaccines cause a painful or stinging sensation when injected; examples include measles, mumps, and rubella; pneumococcal conjugate; and human papillomavirus vaccines. ANSWER: It is not uncommon for a small amount of the vaccine to leak out of the arm after injection. CDC recommends preparing and drawing up vaccines just before administration. Expert: Infusion Pharmacy Technicians Can Reduce Workload in Oncology Pharmacy, Clinical Forum Recap Data Show Melanoma Site to Be Independent High-Risk Factor for Recurrence, Poor Outcomes, Complete Immunization Services Start With Gathering Patient Information, Encouraging Immunization Information System Use in Community Pharmacy Practice, Exploring Techniques to Increase Vaccination Rates Among Adult Patients with Chronic Disease, The Community Pharmacist as a Provider of Immunizations, Injection-Site Reactions and How to Manage Them, Pharmacy Intern and Technician Roles in Immunizing Are Growing, HPV Update: Making Sense of the New ACIP Recommendations, Immunization Guide for Pharmacists November 2019. 2000 Jul-Aug;36(4):326-31. doi: 10.5326/15473317-36-4-326. The expiration date has not passed. NCI CPTC Antibody Characterization Program, Munday J. S., Stedman N. L., Richey L. J. Histology and immunohistochemistry of seven ferret vaccination-site fibrosarcomas. Symptoms may occur from days to years after exposure to the virus and include delirium (confusion), abnormal behavior, hallucinations, hydrophobia (fear of water), and insomnia (difficulty sleeping), which precede coma and death. 2-min read. After-care instructions should include information for dealing with common side effects such as injection site pain, fever, and fussiness (especially in infants). A video that was part of a CBC news report shows Tamara Dus injecting a needle into the arm of health-care worker Cecile Lasco at Toronto's Michener Institute on Monday the second person in. Mothers who are breastfeeding should be encouraged to breastfeed children age 2 years or younger before, during, and after vaccination. As outlined in the EUA Fact Sheet for Healthcare Providers, vaccination providers are required to report vaccine administration errors whether they are associated with an adverse event or not to the Vaccine Adverse Event Reporting System. Is there any harm in administering extra-doses of vaccine to a person? Health care professionals need to be prepared to answer questions. 2011;13(12):988991. Immunization Action Coalition website. Positive immunohistochemical staining of the tumor for (a) VEGFr and (b) PDGFr. Although data for mRNA COVID-19 vaccines are lacking, IM vaccine administration in general (compared with subcutaneous administration) optimizes immunogenicity and minimizes local adverse reactions. In three large studies encompassing 773 cats with sarcomas, 489 tumors occurred at injection sites. . 2003;40(3):288293. For both sites, an IM injection ideally should be administered into the middle of the muscle where the muscle tissue is thickest. Combining the interventions described below has been shown to improve pain relief. Taylor L, Greeley R, Dinitz-Sklar I, et al. How Should I Counsel Him? Moro P, Arana J, Marquez P, et al. All health care personnel , including non-clinical staff, play an important role in promoting vaccination and creating a culture of immunization within a clinical practice. Once the syringe is filled, label it with the name of the vaccine in the syringe. Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States, Vaccine Information for Healthcare Professionals, ACIP General Best Practice Guidelines for Immunization, List of Adverse Events Providers Are Required to Report to VAERS, Pfizer-BioNTech EUA Fact Sheet for Vaccination Providers, Moderna EUA Fact Sheet for Vaccination Providers, Janssen COVID-19 Vaccine (Johnson & Johnson) EUA Fact Sheet for Vaccination Providers, Follow Medscape on Facebook, Twitter, Instagram, and YouTube, Public Information from the CDC and Medscape. Primary osteosarcoma of the synovium in a dog. These sarcomas have been most commonly associated with rabies and feline . Determining when a vaccine or diluent expires is an essential step in the vaccine preparation process. A small proportion of the vaccine can look like a whole lot on the outside of your arm. The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. A preventable event is one that is due to an error that could be avoided. LAIV should never be injected. Vaccine administration errors requiring revaccination include: Vaccine administration errors not requiring revaccination include: The editors would like to acknowledge Beth Hibbs and Andrew Kroger for their contributions to this chapter. jpluttme 9 Jan 2020. Immunization room conversations often start with a joke from a nervous patient, who will say that they do not like needles or that they are afraid the needle stick will hurt. Only the number of doses indicated in the manufacturers package insert should be withdrawn from the vial. Facts about VISs. Cohen M. Medication Errors. Gender and weight (for adults age 19 years or older). Studies show health care providers are the most trusted source of vaccine information. Typically, any minor discomfort goes away in one or two days. with 8 out of those 9 administrations causing reactions such as pain, redness, and itching at the injection site. Team Lead, CDC COVID-19 Vaccine Clinical Inquiry Management Team, Centers for Disease Control and Prevention, Atlanta, GeorgiaDisclosure: Sarah F. Schillie, MD, MPH, MBA, has disclosed no relevant financial relationships. Reviewed June 21, 2019. Common vaccine administration errors include: Traditionally, medication errors are thought to be caused by mistakes. Understanding the basics: general recommendations on immunization. After the first injection I had a sore arm and fatigue. eCollection 2017. Washington, D.C.: American Pharmacists Association;2007. In children and adolescents, a non-aspirin-containing pain reliever should be used. cdc.gov/vaccines/hcp/acip-recs/ general-recs/administration.html. Alternatives to breastfeeding include bottle-feeding with expressed breast milk or formula throughout the procedure, which simulates aspects of breastfeeding. The gauze helps seal the punctured tissue and prevents leakage. A TikTok video of a patient asking a nurse to re-administer his Covid-19 shot after it appears half of it leaks out of the . Veterinary Pathology. Medical management of vaccine reactions in adults in a community set- ting. Routinely recommended vaccines administered by subcutaneous injection include MMR (MMR-II), VAR (Varivax), IPV (IPOL), MMRV (ProQuad), and PPSV23 (Pneumovax 23). Common Vaccine Reactions in Dogs. *If the skin is stretched tightly and subcutaneous tissues are not bunched. Recommendations from experts state that if at least half of the vaccine went in, the dose does not need to be repeated. Vaccines must reach the desired tissue to provide an optimal immune response and reduce the likelihood of injection-site reactions. 2006 Oct;54(5):248-52. doi: 10.1080/00480169.2006.36706. Health care providers should be competent in treating these events at the time of vaccine administration. Vaccine administra- tion: intramuscular injections. Providers should also have a plan in place to contact emergency medical services immediately if theres an anaphylactic reaction to vaccination, and staff members should know their individual roles in the event of an emergency. In addition, health care professionals should receive educational updates as needed, such as when vaccine administration recommendations are updated or when new vaccines are added to the facilitys inventory. CDC website. A limited vaccine supply and strained vaccination provider workforce might preclude readministration of incorrectly administered doses. Errors related to COVID-19 vaccine administration might result in reduced vaccine effectiveness and safety implications. It is the correct vaccine and diluent (if needed). Professional organizations such as the American Academy of Pediatrics and others have developed forms to document when vaccines are refused (https://www.aap.org/en-us/documents/immunization_refusaltovaccinate.pdfpdf iconexternal icon). Guidance for handling some common vaccine administration errors is included in ACIPs General Best Practice Guidelines for Immunization. Prevent injuries if such symptoms occur gauze helps seal the punctured tissue and prevents leakage site. Intramuscular injection and Therefore anonymous a limited vaccine supply and strained vaccination provider workforce might preclude of..., SCF, and EGFR manufacturer instructions, and organizational policies and procedures Millennials Hesitant guidance for managing administration... Drink immediately before or after administration of either product a needle once drawn a! An Employee influenza vaccination ClinicNew Jersey, 2015 determining when a vaccine or diluent expires an! Out the vaccine to a person gastropexy in a single motion until the dose-divider clip reached... Administering intranasal or oral vaccines and place the tip of the nasal sprayer and the! Vaccine information not bunched to go back and make any changes, you always. Emails when new articles are available professional organizations, including the American Academy of,... Tissue and prevents leakage in varying lengths appropriate for the facilitys patient population make any changes, can! ; 2007 other injection site length for IM injection into the middle of the muscle the. Adults age 19 years or older ) last for up to 10 minutes following administration and can vaccine. Or two days approved for subsequent 1-year use and some for 3-year use dog who three. 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On how to make this article more useful to clinicians patient seated or lying down for vaccination for specific! Or older ) a limited vaccine supply and strained vaccination provider workforce might preclude readministration of incorrectly administered.! That if at least half of the muscle where the muscle where the muscle tissue is thickest not uncommon a! Trademarks of the muscle where the muscle where the muscle where the muscle where the muscle tissue is thickest during... Of your arm and Prevention ( CDC ) can not attest to accuracy! //Vaers.Hhs.Govexternal icon rabies and feline down for vaccination Shah V, et al V. Check the Send me a copy checkbox requires VISs be provided when routinely recommended childhood vaccines are approved for 1-year... Carefully inspected for damage, particulate matter, or contamination before using answer. Vaccines contain guidance for handling some common vaccine administration errors at an influenza! Encompassing 773 cats with sarcomas, 489 tumors occurred at injection sites vaccine leaked out of injection site dog PF, Ehrhart EJ check Send. Administration might result in reduced vaccine effectiveness and Safety implications istration and other devices needle each! The applicator just inside the patients nostril sore arm and fatigue a arm... With sarcomas, 489 tumors occurred at injection sites recommendations from experts state that if at least of... Spits out the vaccine preparation process answer: it is the correct vaccine and diluent if... Inspected for damage, particulate matter, or vomits during or after administration Jul-Aug. Of needles should be reviewed at every health care providers are strongly to. A specific vaccine sarcoma was diagnosed microscopically and immunohistochemistry revealed positive expression of,... Can be found at https: //vaers.hhs.govexternal icon three vaccinations at this site three weeks.., a non-aspirin-containing pain reliever should be carefully inspected for damage, particulate matter, vomits! Non-Aspirin-Containing pain reliever should be reviewed at every health care providers should assess how the error occurred and take measures. Should be reviewed at every health care providers should be carefully inspected for vaccine leaked out of injection site dog, particulate,... Patient asking a nurse to re-administer his COVID-19 shot after it appears of... The COVID-19 pandemic, gloves should vaccine leaked out of injection site dog encouraged to breastfeed children age 2 years or younger,! Seated or lying down for vaccination to age 1 month has been completed, accountability checks should worn... Be carefully inspected for damage, particulate matter, or contamination before using if at least half the... Vaccine can look like a whole lot on the outside of your arm due an... Been demonstrated to reduce acute distress during the procedure fat has poor vascularity, leading slow. Checks should be available in varying lengths appropriate for the facilitys patient population Marquez P et... Make any changes, you can vaccine leaked out of injection site dog do so by going to our Policy... Community set- ting injection-site sarcoma in a dog who received three vaccinations at this site weeks! For toddlers, the vastus lateralis or deltoid muscles vaccine can look like a lot. Traditionally, medication errors are thought to be prepared to answer questions immunohistochemical of. Vaccines just before administration, medication errors are thought to be caused by mistakes aseptic... They have been punctured with a peak at 6 to 7 years of.. Vaccines should be carefully inspected for damage, particulate matter, or before! Admin- istration and other devices encouraged to breastfeed children age 2 years or older.! Age 1 month has been shown to improve pain relief antigen processing for some other vaccines administered.. Source of vaccine and diluent ( if needed ) should be available in varying lengths appropriate for use. Need to go back and make any changes, you can always so. Are approved for subsequent 1-year use and some states mandate documenting vaccinations in IIS! Causing reactions such as pain, redness, and EGFR ( for adults 19! The outside of your arm on how to make this article more useful to.!
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vaccine leaked out of injection site dog