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Administering an intradermal injection

LOVE, GAYLA H. RN, CCM, BSN

CLINICAL DO'S & DON'TS
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Gayla H. Love is a practical-nursing instructor at Griffin (Ga.) Technical College, and she's also a nurse for Medical Staffing Network in Atlanta, Ga.

Richard L. Pullen, Jr., RN, EdD, coordinates Clinical Do's & Don'ts, which illustrates key clinical points for a common nursing procedure. Because of space constraints, it's not comprehensive.

AN INTRADERMAL injection may be given for diagnostic purposes, such as allergy or tuberculosis testing. Medication injected into the dermis is absorbed slowly because of this skin layer's limited blood supply.

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DO

  • Gather equipment, including the ordered medication and a tuberculin syringe with a 26- or 27-gauge, ½″ to 3/8″ needle.
  • Verify the order. Check the medication expiration date and assess the patient for contraindications, including allergies. Ask her if she's ever had an injection reaction.
  • Draw up the correct medication dose aseptically in a syringe.
  • Perform hand hygiene, explain the procedure to the patient, and put on gloves.
  • Select an appropriate injection site, rotating the site if necessary. The first choice is usually the ventral aspect of the forearm because it's relatively hairless. If you can't use the forearm, consider the upper back or a subcutaneous injection site.
  • Instruct your patient to extend her arm if you use the ventral aspect of the forearm. Support her elbow and forearm on a flat surface and clean the injection site.
  • ◂Pull the skin taut with your nondominant hand and slowly insert the needle, bevel up, at a 5- to 15-degree angle, until the bevel is just under the epidermis.
  • ◂Inject the medication slowly. You'll immediately see a wheal or bubblelike area on the skin's surface.
  • Remove the needle and apply gentle pressure to the site with an alcohol swab or 2×2 gauze pad. Using a skin marker, draw a circle around the injection site.
  • Assess the injection site and observe the patient for adverse drug events (ADEs), such as difficulty breathing.
  • Discard equipment properly, remove your gloves, and perform hand hygiene.
  • Document the medication administration and the patient's response according to facility policy. Note any ADEs and actions taken.
  • Reassess the reaction at the site according to facility policy; for example, 48 to 72 hours after injection.
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DON'T

  • Don't choose an injection site that's inflamed, burned, or hairy, or that has a lesion or traumatic injury.
  • Don't administer more than 0.1 ml intradermally without questioning and confirming the order.
  • Don't massage the site after giving the injection because doing so can cause a false-positive result.
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SELECTED REFERENCES

Rice J. Medications and Mathematics for the Nurse, 9th edition. Clifton Park, N.Y., Thomson Delmar Learning, 2002.
    White L. Foundations of Nursing, 2nd edition. Clifton Park, N.Y., Thomson Delmar Learning, 2005.
      © 2006 Lippincott Williams & Wilkins, Inc.