Intradermal Injections

Gather required materials, supplies, or equipment: exam gloves, alcohol/antiseptic swab, needle (twenty-nine or thirty gauge, one half inch), one milliliter syringe, medication vial, and gauze and bandage if needed. Verify the Six Rights of Medication Administration: patient, drug, dose, time, route, documentation. Check the medication order in the EHR. Note: Check the medication label three times for safety when it is taken from the medication drawer, comparing it to the EHR/MAR and comparing it with the EHR/MAR when ready to leave the medication preparation area or when in the patient's room. Calculate the correct dose of medication that you will be administering. Verbalize the dose milligram per milliliter. Introduce yourself to the patient. First name is appropriate.

Hi, my name is Madison. I'll be your nurse for today, okay?

Provide patient privacy. Note: If the patient has family present, ask the patient if family may stay while discussing HIPAA protected information. Identify the patient with at least two identifiers. Ask the patient if they have any known allergies (food, medication, seasonal, other). Inform the patient of the purpose of your visit. Discuss intradermal medication, its action, uses, and common side effects and list them. In addition, let the patient know that they may feel a slight burning or stinging sensation while administering the injection. Instruct the patient to report any adverse effects and list them. Allow the patient to ask any questions. Note: research adverse effects of the medication, potential adverse effects, and how long after administration it may occur. Perform hand hygiene and apply clean gloves. Draw up medication using aseptic technique. Select the correct gauge and length of the needle and the size of the syringe. If this is the first time using this medicine vial, start by removing the cap. Wipe the rubber top clean with an alcohol swab. Filling the syringe with medication: hold the syringe like a pencil with the needle pointed up. With the cap still on, pull back the plunger to the line on the syringe for the prescribed dose, filling the syringe with air. Insert the needle into the rubber top. Do not touch or bend the needle. Push the air into the vial. Turn the vial upside down and hold it up in the air. Keep the needle tip in the medicine. Pull back the plunger to the line on your syringe for your dose. To remove air bubbles from the syringe, keep the syringe tip in the medicine vial. Tap the syringe with your finger to move air bubbles to the top, then push gently on the plunger to push the air bubbles back into the vial. If there are a lot of bubbles, push the plunger to push all the medicine back into the vial. Draw medicine out again slowly and tap air bubbles out. Double check that the dose is still correct. Remove the syringe from the vial and keep the needle clean. If you plan to put the syringe down, put the cover back on the needle using the one handed scoop method. Verbalize the correct medication dose again and show in your video the correct dose and the correct syringe. Note: If a blunt/filter needle was being used to drop the medication, this must be changed prior to administration. Select an appropriate site. Note and verbalize any lesions, skin discoloration, and palpate for tenderness. If noted, select another site for injection. Clean the site with an antiseptic alcohol swab. Apply the swab at the center of the site and rotate the swab outward in a circular direction for about five centimeters (two inches). Allow the area to dry completely on its own. Do not blow on it or wave your hand to dry the area. Note: Do not touch the site once cleansed. While administering the injection, verbalize all steps and ensure the camera is angled to make each step visible. Hold the syringe between the thumb and forefinger of your dominant hand with the bevel of the needle pointing up. With your non-dominant hand, stretch skin over the site with your forefinger or thumb with the needle almost against the patient's skin. Insert it slowly at a five to fifteen degree angle. Ensure that resistance is felt. Advance the needle through the epidermis to a depth of about three millimeters (one eighth inch) skin surface. You will see the bulge from the needle tip below the skin. Inject medication slowly. Note: Normally you feel resistance. If not, the needle may be too deep. Remove and begin again. While injecting medication, note a small bleb/wheal approximately six millimeters to ten millimeters resembling a mosquito bite to appear on skin surface. Withdraw the needle while placing an alcohol swab or gauze pad gently over the site. Do not massage the site. Apply a bandage if needed. Note: Adhesive bandage might cause irritation to the skin. Ask the patient if this is a known issue. Do not recap the used needle. Discard the needle and syringe in a sharps or puncture proof container. Remove gloves, perform hand hygiene, and verbalize that you would document.