Intradermal injections are injections given to a patient in which the goal is to empty the contents of the syringe between the layers of the skin.
This is a painful procedure and is used only with small amounts of solution. The nurse should ensure that the needle is inserted into the epidermis, not subcutaneously, as absorption would be reduced. It is imperative that the following information is reviewed prior to administration of any medication: the right patient, the right medicine, the right route, the right dose, the right site, and the right time. Because this method of injection is often used in allergy testing, it is important that latex-free syringes are used.
With the intradermal injection, a small thin needle of 25 or 27 gauge and 3/8 to 3/4 inch (1-2 cm) is inserted into the skin parallel with the forearm, with the bevel facing upward. These injections are normally given in the inner palm-side surface of the forearm, with the exception of the human diploid cell rabies vaccine, which is given in the deltoid muscle.
After washing his or her hands, the nurse should put on latex-free gloves to complete the procedure. A sterile syringe and a needle should be prepared. If a sterile multiple-dose vial is used, the rubber-capped bottle should be rubbed with an antiseptic swab. The needle is then inserted through the center of the cap, and some air from the syringe inserted to equalize the pressure in the container. Slightly more of the required amount of drug is should then be removed. The syringe should be held vertically at eye level, then the syringe piston should be pushed carefully to the exact measurement line.
If a small individual vial containing the correct amount of drug is used, the outside should be wiped with an antiseptic swab and held in the swab while the top is snapped off. The needle is then inserted into the vial, taking
care that the tip of the needle does not scratch against the sides of the vial, thereby becoming blunt.
The syringe and needle containing the drug should be placed on a tray with sterile cotton swabs and cleaning disinfectant. If the patient is unfamiliar with the procedure, the nurse should explain what he or she is about to do, and let the patient know that the medication was prescribed by the doctor. As with all drugs prescribed for a patient, the dose on the patient's prescription sheet should be checked prior to administration.
A screen should be drawn around the patient to ensure privacy. The injection site is then rubbed vigorously with a swab, and disinfectant applied to cleanse the area and increase the blood supply. With the bevel of the needle facing upwards, the needle is inserted into the skin, parallel with the forearm. The syringe piston should then be pushed in steadily and slowly, releasing the solution into the layers of the skin. This will cause the layers of the skin to rise slightly.
Monitor the patient's reaction and provide reassurance, if required. Dispose of all waste products carefully and place the syringe and needle in a puncture-resistant receptacle.
If the circulation is depleted, absorption of the drug administered may be slow.
Check for any adverse reactions if the drug is being administered for the first time.
Health care team roles
As this procedure is often used as a diagnostic tool, the process should be explained fully to the patient.
The health care team should record any side effects or negative reactions to the drug that has been injected; medical staff should be notified.
Bevel—The flat aperture on one side of a needle at the tip.
Deltoid muscle—A large muscle covering the shoulders.
Sterile—Free from living microorganisms.
Subcutaneous—Beneath the skin.
Advisory Committee on Immunization Practices. Recommendation of Advisory Committee on Immunization Practices. (January 28, 1994): 43 (RRO1); 1-38.
Guide to Good Prescribing, Annex 4: The Use of Injections. World Health Organization.
American Academy of Nurse Practitioners, AANP, PO Box 12846, Austin, Texas, 78711. (512) 442 4262. E-mail: firstname.lastname@example.org.
American College of Allergy, Asthma, and Immunology. Latex Allergy Home Page. <http://allergy.mcg.edu/advice/latex.html>.
"Guidance on the content of premarket notification [510(K)] submissions for piston syringes." <http://www.fda.gov/cdrh/ode/odegr821.html>.
"How to protect yourself from needlestick injuries." DHHS 9NIOSH) publication No. 2000-135. NIOSH <http://www.cdc.gov/niosh/homepage.html>.
Margaret A Stockley, R.G.N.