Intradermal injection
Definition
An intradermal injection is given into the dermis of the skin
just below the epidermis where the blood supply is
reduced and drug absorption can occur slowly.
The intradermal route provides a local, rather than
systemic effect and is used primarily for administering
small amounts of local anaesthetic and skin testing, for
example allergy or tuberculin testing
Evidence-based approaches
Observation of the skin for an inflammatory reaction is a
priority, so the best sites are those that are lowly
pigmented, thinly keratinized and hairless.
Chosen sites are the inner forearms and the
scapulae.
The injection site most commonly used for skin testing
is the medial forearm area as this allows for easy
inspection.
Volumes of 0.5 mL or less should be used.
Essential equipment
• Needle 25–27 G
• 1 mL syringe containing medication
• Alcohol swab
• Non-sterile gloves
• Apron
.
Pre-procedural considerations
Equipment
The injections are best performed using a 25 or 27 G
needle
inserted at a 10–15° angle, bevel up, just under the
epidermis.
Usually a TB (tuberculosis) or 1 mL syringe is used to
ensure
accuracy of dose
Pre-procedure
Action Rationale
1 Explain and discuss the procedure with the patient. To
ensure that the patient understands the procedure and
gives their valid consent.
Action Rationale
2. Before administering any prescribed drug, look at the
patient’s prescription chart and check the following.
To ensure that the patient is given the correct drug in the
prescribed dose using the appropriate diluent and by the correct route.
To protect the patient from harm.
(a) The correct patient
(b) Drug
(c) Dose
(d) Date and time of administration
(e) Route and method of administration
(f) Diluent as appropriate
(g) Validity of prescription
(h) Signature of prescriber
(i) The prescription is legible
If any of these pieces of information are missing, are
unclear or illegible then the nurse should not proceed
with administration and should consult with the
prescriber.
To prevent any errors occurring.
Prepare medication as described in Procedure
Guidelines.
6. Choose the correct needle size and attach the needle.
To minimize the risk of missing the subcutaneous tissue
and any ensuing pain.
7. Apply gloves and clean the injection site with a swab
saturated with isopropyl alcohol 70% and apply
gloves.
To reduce the number of pathogens introduced into the
skin by the needle at the time of insertion.
8. Remove the needle sheath and hold syringe with the
dominant hand with the bevel of needle pointing up.
To facilitate needle placement.
Procedure
3. Apply apron, close the curtains or door and assist the
patient into the required position.
Wash hands.
To ensure patient privacy and dignity.
To allow access to the appropriate injection site.
4. Remove appropriate garments to expose the injection
site.
To gain access for injection.
5. Assess the injection site for signs of inflammation,
oedema, infection and skin lesions.
To promote effectiveness of administration.
To reduce the risk of infection
To avoid skin lesions and avoid possible trauma to the
patient.
9. With the non-dominant hand, stretch skin over the site
with forefinger and thumb.
To facilitate the needle piercing the skin more easily
10. With the needle almost against the patient’s skin,
insert the needle into the skin at an angle of 10–15°
and advance through the epidermis so the needle tip
can be seen through the skin.-To ensure the needle tip is
in the dermis.
11. Inject medication slowly. It is not necessary to aspirate
as the dermis is relatively avascular.
To minimize the discomfort at site.
12. While injecting medication, a bleb (resembling a
mosquito bite) will form To indicate medication is in
dermis.
13. Withdraw the needle rapidly and apply pressure
gently.
Do not massage the site. To prevent dispersing
medication into underlying tissue layers and altering test
results.
Post-procedure
14. Where appropriate, activate safety device. Ensure
that all sharps and non-sharp waste are disposed of safely
and in accordance with locally approved procedures.
For example: don’t attempt to disassemble a used syringe,
Dispose it along with needles.
To ensure safe disposal and to avoid laceration or other
injury to staff.
15. Record the administration on appropriate sheets.
To maintain accurate records, provide a point of reference
in the event of any queries and prevent any duplication of
treatment.
--Lisa Dougherty and Sara Lister –
The Royal Marsden Manual of Clinical Nursing Procedures
p 729 - 730
--ONLINE RESOURSIS
