Intradermal Injection: Procedure and Uses

Intradermal Injection

• Intradermal (ID) injections are administered into the dermis, just below the epidermis.
• The ID injection route has the longest absorption time of all parenteral routes.
• These injection types are used for sensitivity tests (TB allergy) and local anesthesia tests.
• The advantage of these tests is that body reaction is easy to visualize, and the degree of reaction can be assessed.
• Common injection sites: inner surface of forearm and upper back, under the scapula.

Equipment

• Tuberculin syringe, 1 mL
• Antiseptic or alcohol swabs
• Medication ampoule or vial
• Medication card or medication administration record (MAR)
• Disposable gloves

Preparation - Nursing Action

• Nurse washes hands and puts on clean gloves to reduce transmission of microorganisms.
• Prepare needed equipment to save time and effort.
• Identify the client, explain procedure, position client comfortably to ensure correct patient and gain cooperation.
• For forearm site, relax the arm with elbow and forearm extended on a flat surface.
• Distract client by talking about an interesting subject for relaxation and to reduce anxiety.
• Close the door or curtains around bed to keep privacy, expose only the injection site.

Assessment - Nursing Action

• Select injection site, free from lesions.
• Inspect skin for bruises, inflammation, edema, masses, tenderness, and sites of previous injections.
• Repeated daily injections should be rotated.
• Forearm site should be 3-4 finger widths below antecubital space and one hand width above wrists on inner aspect of forearm.

Implementation - Nursing Action

• Withdraw medication from ampoule or vial as described in the IM injection procedure.
• To correctly dilute Cefotax 500mg: Dilute in 5ml sterile water, aspirate 10 units with insulin syringe, dilute the tenth unit with sterile water to complete the insulin syringe (to 100 units), and administer 10 units (0.1%).
• Use an antiseptic swab in a circular motion to clean skin at the site to remove secretions.
• With nondominant hand, stretch skin over site with forefinger and thumb.
• Insert needle slowly at a 10-15 degree angle, bevel up; the needle tip should be seen through the skin.
• Ensures needle tip is in the dermis.
• Dermal layer is tight and does not expand easily when fluid is injected.
• Indicates the medication was deposited in the dermis.
• Slowly inject the medication.
• Resistance will be felt.
• Note a small bleb forming under the skin surface like a mosquito bite.
• Encircle the site correctly and write the time.

Post-Injection - Nursing Action

• Withdraw the needle while applying gentle pressure with an antiseptic swab.
• Supporting tissue around injection site minimizes discomfort.
• Do not massage the site.
• Prevents medication from being dispersed into the tissue.
• Assist the client to a comfortable position.
• Promote comfort.
• Discard the uncapped needle and syringe in a safe receptacle to decrease risk of needle stick.
• Remove gloves; wash hands/hand hygiene to reduce transmission of microorganisms.

Evaluation/Documentation - Nursing Action

• Check the site for drug reaction after 30 minutes.
• Document the procedure.