Can Phosphatidylcholine Injectable Be Given on the Same Day as Anti-Tetanus Shot and Tuberculosis Test?
Yes, phosphatidylcholine injections (TGL Slim), tetanus vaccination, and tuberculin skin testing can all be safely administered on the same day, provided each is given at separate anatomic sites using different syringes. 1, 2
Evidence-Based Administration Guidelines
Simultaneous Administration is Permitted
Inactivated vaccines (including tetanus toxoid) may be administered at any time before or after different inactivated vaccines or other medical procedures unless a specific contraindication exists. 1, 2
The Advisory Committee on Immunization Practices (ACIP) explicitly states that when two or more vaccines or procedures are indicated, they should be administered during the same visit using separate syringes at different anatomic sites. 1, 2
No waiting period is required between these procedures when performed on the same day. 2
Proper Injection Site Selection
Tetanus vaccine should be administered intramuscularly in the deltoid muscle (0.5 mL dose). 2
Tuberculin skin test (PPD) should be placed intradermally on the volar surface of the forearm. 1, 2
Phosphatidylcholine should be injected subcutaneously at the treatment site (typically areas of localized fat). 3
Maintain at least one inch (2.5 cm) separation between any injections in the same general area. 1
Critical Safety Considerations
When both tetanus vaccine and tetanus immune globulin (TIG) are indicated, each product must be administered using a separate syringe at different anatomic sites. 1 This principle extends to all simultaneous injections.
Important Contraindications to Monitor
The only scenario requiring caution would be a patient with a history of Arthus reaction to previous tetanus vaccination, which would contraindicate tetanus vaccine administration but would not affect phosphatidylcholine or tuberculin testing. 1, 2
Severe adverse reactions to tuberculin skin testing are rare but include ulceration, necrosis, vesiculation, or anaphylactic shock—these are the only contraindications to tuberculin testing. 1
Minor concurrent illness is not a contraindication to any of these procedures. 2
Common Pitfall to Avoid
Do not confuse tuberculin antigen (PPD) with tetanus toxoid vaccine. Physical separation of refrigerated products, careful visual inspection and reading of labels, and preparation of PPD only at time of testing are essential to prevent inadvertent misadministration. 1 This is a documented source of medical errors.
Expected Adverse Effects
Phosphatidylcholine injections typically cause localized swelling, erythema, burning/stinging, pain, tenderness and bruising, described by most patients as "very mild" (18.4%) or "mild" (39.2%). 3
Tuberculin skin testing produces a wheal that is normal and will remain about 15 minutes; patients should avoid touching, scratching, or applying pressure to the injection site. 1
Tetanus vaccination may cause local reactions (erythema and induration with or without tenderness), with fever and systemic symptoms being less common. 1