Definition
Intradermal injection is a shallow or superficial injection of a substance into the dermis which is located between the hypodermis and epidermis.
Purposes
- To perform sensitivity test
- To perform tuberculin test.
- To administer vaccination.
Articles
- Medication card.
- Medication in vial/ampoule
- Clean gloves.
- Sterile syringes and needles (Tuberculin syringe or 1 ml. syringe). Needle size 26-30 gauge.
- Alcohol swab.
- Kidney tray.
Procedure
| Nursing action | Rationale | |
| 1. | Before procedure Check physician’s order for medication administration and identify patient. | Eliminates medication error. |
| 2. | Explain procedure to patient, the purpose, the site of injection and how he has to cooperate. | Explanation encourages cooperation and reduces apprehension. |
| 3. | During procedure Wash hands. | Reduces spread of microorganisms. |
| 4. | Prepare medication from ampoule/vial. | |
| 5. | Wash hands and don gloves. | Reduces spread of microorganisms. |
| 6. | Assemble equipment at the bedside. | |
| 7. | Position patient and locate site for intradermal injection (inner aspect of forearm, upper chest or upper back beneath scapulae). | Forearm is the most convenient and easily located and hence the commonly used site. |
| 8. | Cleanse the site with alcohol swab in circular motion moving outward. Allow skin to dry. Keep cotton in the clean tray for reuse when taking out the needle. | Avoids introduction of pathogens into the tissues. |
| 9. | Remove needle cap with the non-dominant hand by pulling it straight off. | Reduces chances of contamination of needle. |
| 10. | Use non-dominant hand to spread skin taut over injection site. | Taut skin provides an easy entrance into skin. |
| 11. | Place needle almost flat against patients’ skin (15°) and insert the needle into the skin so that the point of the needle can be seen through the skin. Insert needle only about 1/8 inch. | Needle position facilitates insertion into intradermal tissue. |
| 12. | Slowly inject the drug (0.01-0.1ml). Watch for a bleb/blister to develop. If not present, withdraw needle slightly and inject medication. | Appearance of a bleb/wheal indicates that needles in intradermal tissue. |
| 13. | Withdraw needle quickly in the same angle as it was inserted. | Reduces tissue damage and discomfort of patient. |
| 14. | Do not massage the area. | Massaging the area will lead to spread of medication to subcutaneous tissue and false results may occur. |
| 15. | Do not recap the needle after injection. Drop the needle after cutting into the needle cutter. Drop the syringe (piston and barrel) into the receptacle with bleach or red color bin as per agency policy. | Reduces risk of accidental puncture with needles. |
| 16. | After procedure Assist patient to comfortable position; | |
| 17. | Remove gloves and wash hands. | Reduces spread of microorganisms. |
| 18. | Record medication administration-the medication administered, amount, dose, site and patient’s response. | Reduces chances of medication errors. |
| 19. | Draw a circle using blue/black pen around injection site. Write date and time of administration of medication and medication name on a piece of adhesive tape and stick near to the site. Check reaction within specified time period. | Helps in identifying exact site for checking reaction to medication. |
Special Considerations
- Ensure that the injection was given using the correct techniques which is evidenced by the appearance of tip of needle directly beneath the skin surface; resistance during injecting the medicine and formation of white wheal of 5-10mm in diameter at the point of the contact of needle and skin.
- In case of test for patient allergy to dust, pollen or similar substance, the reaction will take place after few minutes only.
- In case of Mantoux test evaluation of whether the patient has been exposed to tuberculosis is done after 48-72 hours.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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