Part of being a good clinician is understanding and practicing techniques properly, so here is a step-by-step skill instruction for giving intradermal injections, which are used to check for allergies and TB (tuberculosis).
Some of the key areas I must highlight/emphasize are:
- Hand-washing: This must be done before and after every contact or activity.
- Gloves should always be used, and changed between every patient.
- Before performing any activity, the patient must be identified by a minimum of two identifiers, such as name and date of birth.
- You should always explain to the patient what you will be doing and what the patient can expect.
- Intradermal injections must be done in the forearm, avoiding scars and moles.
- Needle safety at all times! Never recap a contaminated needle. Place a used needle into a sharps container immediately after use, needle-down to avoid injury.
- Stay focused on one patient/one task to avoid errors.
- Remember and adhere to the five rights of administration to keep patients safe and avoid errors.
Then here are the steps for administering the intradermal injection:
- Assemble equipment and check physician’s order.
- Explain procedure to patient.
- Perform hygiene. Don disposable gloves.
- If necessary, withdraw medication from the ampule or vial.
- Select an area on the inner aspect of the forearm that is not heavily pigmented or covered with hair. The upper chest or upper back beneath the scapulae are also sites for intradermal injections.
- Cleanse the area with an alcohol swab by wiping with a firm circular motion and moving outward from the injection site. Allow skin to dry.
- Use your non-dominant hand to pull skin taut over the injection site.
- Remove needle cap with non-dominant hand by pulling it straight off.
- Place the needle almost flat against the patient’s skin, bevel side up.
- Insert the needle so that the point of the needle can be seen through the skin—only about 1/8 of an inch.
- Slowly inject agent while watching for a small wheal or blister to appear. If none appears, withdraw the needle slightly.
- Withdraw the needle at the same angle it was inserted.
- Do not massage the area after removing the needle.
- Do not recap the used needle. Discard the needle and syringe in the appropriate receptacle.
- Assist the patient into a position of comfort.
- Remove your gloves and dispose of them properly. Perform hand hygiene.
- Chart the administration of medication, as well as the site of the administration. Charting may be documented on MAR, including location. Some agencies recommend circling the injection site with ink.
- Observe the area for signs of reaction at ordered intervals, usually 24- to 72-hour periods.
It’s important to listen to your course instructor and practice these skills often during class lab times so that you’re able to perform an injection with confidence and ease. Before you know it, you’ll have the opportunity to work in a professional setting like a doctor’s office or hospital, and you’ll have the chance to help patients feel better by performing these types of skills.
Carol Lovci is a registered nurse with a MSN and PHN degree. She has worked for California College San Diego for 4+ years, teaching medical specialties and healthcare administration courses. She is also the director of nursing for new and exciting program development in areas such as CNA/CHHA and phlebotomy. She has worked in the field with patients, in administration/management as vice president of a large local hospice, and as an educator over the past 28 years. She enjoys the river, her kids and grandkids, and travel.