INTRADERMAL INJECTIONS
An intradermal injection is the introduction of a hypodermic needle into the dermis
Intradermal medicine when introduced into the dermis (under the epidermis)
Purpose
- To obtain a local effect at the site of injection of local anesthesia such as xylocaine and novocaine
- Diagnostic purpose as in sick test, tuberculin test, etc
- To test for allergic reaction of a drug, e.g. penicillin serum, etc
Selection of Syringe and Needle
- Size of syringe used for intradermal injections are 1 ml calibrated in 0.01 ml units (tuberculin syringe)
- Size of needle used for intradermal injections are 26 to 27 gauge diameter and 3/8 to 5/8 inch length
Equipment
A tray containing
- Syringe and needles of various sizes according to the need in a covered tray (sterile)
- Sterile cotton swabs and gauge piece in sterile containers
- Methylated spirit in a container
- Kidney tray and paper bag
- Drug order sheet
- Small covered tray (sterile) to carry the prepared injections (syringes and needles with medication) to the bed side
Preparation of the Patient and Equipment
Identify the patient correctly:
- Explain the procedure to the patient
- Provide privacy
- Place the patient in comfortable and relaxed position suitable for the type of injection
- Select a site suitable for the route of administration, quantity of medication to given to the characteristics of medication
Procedure
- Read the doctor’s order and select the medication
- Wash hands
- Select appropriate syringe and needle and check whether they are in good working order
- Recheck the order, medicine card with the label of the medicine, expiry date, etc
- Mix well and take out the required amount of solution in the syringe
- Carry medication to the patient and identify the correct patient
Method of Administration
- This method is also used for skin tests to detect the allergies
- Hold the skin tight by grasping it
- With the bevel of the needle facing up insert the needle at an angle of 10-15 degree to the skin
- The needle enters between the two layers of the skin. The bevel should be practically visible through the skin
- Inject the medication slowly to produce wheel on the skin
- 0.01 to 0.1 ml of medication injected intradermal
- Take out the needle quickly do not clean or massage the area
After Care
- Inspect the area but do no massage
- Help the patient to dress up
- Watch for the sign and symptoms of any allergic reaction
- Replace the equipment used for injection
- Clean all other articles and replace them in their proper place
- Wash hands
- Record the procedure on the nurse’s record and drug sheet
General Instructions
- As skin contains sensory nerve ending only a small amount of solution can be injected into the skin as it is painful
- The skin should be healthy, free of any skin infection such as edema or irritation, the cloths should not irritate the skin
- Separate syringe and needles should be used for giving injections
Observations of the Site after Intradermal Injection
Tuberculin Test
- If tuberculin test is done, ask the patient to report after 48 hours
- Reddened raised area at the site of injection shows a positive reaction
- If the area is not discolored or raised it is a negative reaction
Penicillin Test
If the test dose is given for penicillin observes the area for reactionary changes after 20 minutes to 1 hour
The area will be reddened the wheel will be increase in case of reactionary changes
If the patient is sensitive to penicillin he may develop the signs and symptoms of anaphylactic shock within few minutes after the injection
