7.4: Intradermal Route
- Page ID
- 89723
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)Intradermal injections are administered just under the epidermis at a 15-degree insertion angle. The maximum dose to be administered is 0.1mL. A tuberculin (1 mL) syringe is used with a 25-27 gauge needle with a length of ¼ to 5/8 inch. This administration method causes stinging and burning that resolves quickly. This administration route is used for Mantoux tuberculin skin testing (TST), intradermal flu vaccines, and allergy testing. Sites for intradermal injections include the anterior forearms, the upper arms, and the upper back. When performing TST administration, the medical assistant should schedule the patient for a follow-up visit within 48–72 hours to assess the injection site for a positive or negative result.
Follow these steps to administer an intradermal injection safely.
Supplies needed:
- Provider’s order
- Drug reference material
- Patient’s health record
- Alcohol wipes
- Medication ordered
- 1 mL syringe with ¼ to 5/8-inch 25-27 gauge safety needle
- Bandage
- Medication tray
- Sharps container
- Marker
- Gloves
- Review the provider’s order and review drug reference material.
- Wash hands and don gloves.
- Select the right medication and check it against the provider’s order.
- Check the expiration date.
- Calculate the dose to be given.
- Assemble the supplies needed.
- Check the medication against the provider’s order.
- Open the syringe and needle; attach the needle to the syringe if packaged separately.
- Use the marker to label the syringe with the drug name.
- Remove the cap from the vial and clean it with an alcohol wipe.
- Using the syringe, pull the plunger down to the amount of drug to be administered.
- Insert the needle into the vial and inject the air.
- Invert the vial and syringe and pull the plunger down to fill it with liquid from the vial.
- Use the plunger to remove any large bubbles.
- Use the plunger to fill the syringe with the correct dose.
- Remove the needle from the vial and use the scoop method to recap the needle.
- Check the provider’s order against the vial and the syringe.
- Place the syringe on the medicine tray and clean the area.
- Remove gloves and wash hands.
- Greet the patient and identify yourself. Verify the patient’s identity by asking for their name and date of birth. Check the patient’s identification bracelet if required.
- Ask the patient if they have any drug allergies.
- Provide patient education. Explain the drug ordered, the indication for the drug, side effects, adverse effects, and the provider who ordered the drug.
- Perform any assessments before administering the drug.
- Allow the patient to ask questions.
- Wash hands and don gloves.
- Instruct the patient to extend their forearm or expose the area to be injected.
- Assess the injection site for intact, healthy skin. Palpate the skin for any lumps or bumps under the skin.
- Clean the site with an alcohol wipe and allow it to dry.
- Remove the cap from the syringe. Grasp it with your dominant hand and turn the syringe so the bevel is up.
- With your nondominant hand, hold the skin taut around the area of insertion.
- With your dominant hand, slowly inject the needle into the skin at a 15-degree angle.
- Slowly move your nondominant hand to the plunger and slowly inject the drug by pressing the plunger. Watch the skin to ensure a 6-10mm wheal appears.
- Withdraw the needle, activate the safety device, and discard into the sharps container.
- Do not massage the area and instruct the patient not to massage the area.
- Place a bandage on the injection area.
- Observe the patient for any reactions.
- Clean the area, remove gloves, and wash hands.
- Document the procedure in the patient’s health record. Include the injection site, patient response, patient assessments, patient teaching, and the patient’s return visit to have the site assessed.