Intradermal injections (ID) in pediatrics are used primarily for diagnostic purposes—such as tuberculin skin testing or allergy testing—by delivering a small volume of medication into the dermal layer of the skin. This route allows for slow absorption and easy visualization of local reactions.
Key Features of Pediatric Intradermal Injections
| Aspect | Details |
|---|---|
| Common Sites | Inner forearm (most common), upper chest, upper back below scapula |
| Needle & Syringe | 26–27 gauge, ¼–½ inch needle; use a tuberculin syringe (1 mL) |
| Angle of Insertion | 10–15° with bevel up |
| Volume | Typically 0.1 mL or less |
| Expected Result | Formation of a small bleb or wheal (like a mosquito bite) |
Preferred Sites for Intradermal Injections
- The most common site for this type of injection is the forearm.
- Other sites include the upper chest and the back beneath the shoulder blade, upper arm, buttock, or upper thigh.
Equipment Needed
A tray containing:
- Disposable syringe with needle
- Prescribed medication
- Alcohol wipes
- Medication card
- Paper bag
- Pen to mark the site
Preparation
- Check the name of the patient.
- Tell the parents and the child (older enough) that the injection will cause a small lump, such as a bite or small blister, but it will disappear quickly.
Procedure
- Wash your hands.
- Select a site that has no discoloration or rash or broken skin.
- Clean the site with alcohol swab using circular motion.
- Load the medicine from the vial and remove the air.
- Pull the patient’s skin flat.
- Hold the syringe at about a 15° angle and insert the needle through the epidermis into the dermis.
- Inject the fluid slowly until a lump appears. This indicates that the fluid is in the dermis.
- Take the needle out quickly and lightly wipe the site with cotton ball.
- In tuberculin/allergy test, the area should be circled with pen (5-10 cm). Date, time, and name of injection should be written.
Clinical alert: Do not massage the injection site because that might make the medication absorbed into the tissue or out of the injection site.
Post-Injection Care
- Mark the site with a pen (especially for TB or allergy testing).
- Instruct caregivers not to apply creams or scratch the area.
- For TB testing, advise return in 48–72 hours for reading.
- Document site, dose, time, and child’s response.
Documentation Essentials
- Date and time of injection
- Site used (e.g., left forearm)
- Medication name and dose (e.g., PPD 0.1 mL)
- Appearance of bleb (e.g., 6 mm wheal formed)
- Child’s response (e.g., tolerated well, mild discomfort)
- Instructions given to caregiver (e.g., return in 48–72 hours)
Special Considerations
- Use distraction techniques or comfort holds to reduce anxiety.
- Document site, medication, dose, and child’s response.
- Monitor for delayed hypersensitivity reactions (e.g., 48–72 hours for TB test).
- Educate caregivers on what to observe and when to return for reading.
- For tuberculin skin testing, avoid sites with tattoos or scars—they can obscure results.
- Use a pen to circle the bleb and label with date/time for easy follow-up.
- Do not cover the site with a bandage unless necessary—it may irritate the skin or alter results.
- For allergy testing, multiple ID injections may be placed in a grid pattern on the back or forearm.
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
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- 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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