Intradermal Injections

• Intradermal injections (ID)

  Injections administered into the dermis, just below the epidermis
• Intradermal injections


  • Have the longest absorption time of all parenteral routes
  • Used for sensitivity tests (TB, allergy, local anesthesia)
  • Used for administering insulin or heparin drugs
• Advantage of intradermal injections

  Body reaction is easy to visualize, and the degree of reaction can be assessed
• Common sites for intradermal injections

  • Inner surface of the forearm
  • Upper back, under the scapula
• Choose an injection site that is free from lesions, rashes, moles, or scars, which may alter the visual inspection of the test results
• Equipment for ID injections

  • Tuberculin syringe calibrated in tenths and hundredths of a millilitre
  • 1/4 to 1/2 in., 26 or 27 gauge needle

  
• Dosage of an ID injection

  Usually under 0.5 ml
• Angle of administration for an ID injection

  5 to 15 degrees
• Once the ID injection is completed, a bleb (small blister) should appear under the skin
• Steps to administer an intradermal injection

  1. Check accuracy and completeness of medication administration record (MAR) with prescriber's medication order

  2. Review pertinent information related to medication

  3. Assess patient's medical and medication history and history of allergies

  4. Check date of expiration for medication

  5. Assess patient symptoms or condition for which medication has been prescribed
• Steps to administer an intradermal injection (continued)

  1. Prepare the materials needed

  2. Obtain the appropriate medication

  3. Compare the label of the medication against the order on the patient's MAR/ CMAR

  4. Bring medications to patient's bedside and keep in sight at all times
• Steps to administer an intradermal injection (continued)

  1. Wash hands

  2. Identify the patient using two identifiers

  3. Explain the procedure and purpose to the patient and family

  4. Provide privacy

  5. Re-check again the medication against the MAR at the patient's bedside
• Steps to administer an intradermal injection (continued)

  1. Explain to the client that the medication will produce a small wheal/ bleb

  2. Select the injection site

  3. Assist patient to appropriate position
• Steps to administer an intradermal injection (continued)

  1. Cleanse the skin using a firm circular motion

  2. Uncap the needle with non-dominant hand

  3. Using non-dominant hand, spread the skin and taut over the injection site

  4. Using the dominant hand, hold the syringe between thumb and forefinger with bevel up

  
• Steps to administer an intradermal injection (continued)

  1. Insert needle with bevel up at 5- 15 degree angle

  2. Inject medication slowly

  3. Withdraw needle quickly at the same angle that it was inserted
• Steps to administer an intradermal injection (continued)

  1. Blot the site with dry gauze if necessary

  2. Assist patient to comfortable position

  3. Discard uncapped needle or needle enclosed in safety shield and attached syringe into puncture-proof and leak-proof receptacle

  4. Draw a perimeter circle around the wheal/ bleb using black ink pen carefully

  5. Remove gloves and perform hand hygiene. Care for equipment
• Steps to administer an intradermal injection (continued)

  1. Document the administration of medication

  2. Evaluate the patient's response to the medication/ testing substance within an appropriate time frame

  3. Evaluate the condition of the site depending on the test done

  4. Read site within appropriate amount of time, designated by type of medication or skin test administered together with physician
• Rationale of: Explain to the client that the medication will produce a small wheal/ bleb. The client will feel a

  slight sting as the medicine enters dermis.

  To allay fear/anxiety through correct information
• Rationale of: Select the injection site:

  Site can be: forearm about a hand’s width above the wrist and three or four finger widths below the antecubital space.

  Refrain from using sites that are hairy, tender, inflamed or swollen and with lesions

  To utilize correct technique applicable to the patient. Correct site allows for accurate reding
• Rationale of: Using non-dominant hand, spread the skin and taut over the injection site.

  To expose site better; Taut skin provides easy entrance for the needle
• Rationale of: Using the dominant hand, hold the syringe between thumb and forefinger with bevel up.

  This allows for easy handling of the syringe.
• Rationale of: Insert needle with bevel up at 5- 15 degree angle.

  Place the needle flat almost against patient’s skin.

  Advance needle through epidermis to approximately 3 mm (1/8 inch) below skin surface. Once needle is in place steady the lower end of the syringe and slide hand to plunger.

  Keeping the bevel side up allows for smooth piercing of the skin and induction of the medication into the dermis.
• Stabilize the hub of needle with thumb of non-dominant hand.
• Inject medication slowly. Normally you feel resistance. If there is no resistance, this indicates that needle is too deep; remove and begin again.
• Rationale of: While injecting medication, notice that small bleb approximately 6 mm (1/4 inch) in diameter (resembling mosquito bite) appears on surface of skin. Instruct patient that this is a normal finding.


  The presence of the wheal or bleb indicates drug is in the dermis
• Rationale of: Withdraw needle quickly at the same angle that it was inserted. Do not recap and engage safety shield.

  Withdrawing at the same angle as insertion minimizes discomfort to the patient and damage to the tissue.
• The ID injection route has the longest

  absorption time of all parenteral routes. These types of injections are used for sensitivity tests, such as TB, allergy, and local anesthesia tests. Also, it is used for administering insulin or heparin drugs.
• The advantage of these tests is that the body reaction is easy to visualize, and the degree of reaction can be assessed.
• The most common sites used are: ▪ the inner surface of the forearm and ▪ the upper back, under the scapula.
• Choose an injection site that is free from lesions, rashes, moles, or scars, which may alter the visual inspection of the test results