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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.

Procedure guideline 13.17 Medication: intradermal injection

Essential equipment

Needle 25–27 G

1 mL syringe containing medication

Alcohol swab

Non-sterile gloves

Preprocedure

Action Rationale

1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their valid consent (Griffith and Jordan 2003, E; NMC 2008b, C; NMC 2008c, C).

2 Consult the patient’s prescription chart and ascertain the following:

Drug

Dose

Date and time of administration

Route and method of administration

Diluent as appropriate

Validity of prescription

Signature of doctor.

To ensure that the patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (NMC 2008a, C; NPSA 2007d, C).

Procedure

3 Close the curtains or door and assist the patient into the required position. To ensure patient privacy and dignity. E

To allow access to the appropriate injection site (Workman 1999, E).

4 Remove appropriate garments to expose the injection site. To gain access for injection (Workman 1999, E).

5 Assess the injection site for signs of inflammation, oedema, infection and skin lesions. To promote effectiveness of administration (Workman 1999, E).

To reduce the risk of infection (Fraise and Bradley 2009, E; Workman 1999, E).

To avoid skin lesions and avoid possible trauma to the patient (Workman 1999, E).

6 Choose the correct needle size and attach the needle. To minimize the risk of missing the subcutaneous tissue and any ensuing pain (Workman 1999, E).

7 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. E (For further information on this action see Skin preparation.)

8 Remove the needle sheath and hold syringe with the dominant hand with the bevel of needle pointing up. To facilitate needle placement (Perry 2007, E).

9 With the non-dominant hand, stretch skin over the site with forefinger and thumb. To facilitate the needle piercing the skin more easily (Perry 2007, E).

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 (Perry 2007, E).

11 Inject medication slowly. It is not necessary to aspirate as the dermis is relatively avascular. To minimize the discomfort at site (Perry 2007, E).

12 While injecting medication, a bleb (resembling a mosquito bite) will form (see Action Figure 12). To indicate medication is in dermis (Perry 2007, E).

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 (Chernecky et al. 2002, Perry 2007, E).

Postprocedure

14 Ensure that all sharps and non-sharp waste are disposed of safely and in accordance with locally approved procedures. For example, sharps into sharps bin and syringes into an orange clinical waste bag. To ensure safe disposal and to avoid laceration or other injury to staff (DH 2005, C; MHRA 2004, C).

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 (NMC 2008a, C; NMC 2009, C; NPSA 2007d, C).

Action Figure 12 Intradermal bleb. After Springhouse (2005).

Reproduced with permission of Lippincott Williams and Wilkins.

Subcutaneous injection

Definition

These are given beneath the epidermis into the loose fat and connective tissue underlying the dermis and are used for administering small doses of non-irritating water-soluble substances for example insulin, heparin (Downie et al. 2003).