Foundation skills - injection techniques : Page 8

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Foundation skills - injection techniques

Intradermal injection
Anatomy
Intradermal injections are most often used to inltrate local anaesthetic. The site depends on the procedure to be performed. On the whole, the skin is anaesthetised by inltrating into the dermis and subcutaneous tissue just beneath. Regional anaesthesia involves inltrating anaesthetics around the specied nerves to be blocked.

Figure 5

Technique
A standard technique for intradermal injection of local anaesthetic into the skin is shown.

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Procedure
1. Clean the area over this site with an alcohol wipe 2. With a long 25G orange needle attached, expel any remaining air from the syringe 3. Hold the syringe steady with the left hand and insert the needle 2-3 mm into the skin at an angle of less than 30 degrees. 4. Ensure that the bevel of the needle is facing upwards 5. Pull back gently on the plunger with the right hand to ensure that the needle is not lying within a blood vessel 6. If no ashback, inject a small amount of the contents of the syringe to raise a bleb under the skin 7. After raising the intial skin bleb of anaesthetic, the subcutaneous tissues and skin can be inltrated through the numb area of skin. This is done by withdrawing the needle to just below the skin surface, and then re-inserting the needle at a very shallow angle pointing outwards from the initial skin bleb in a radial fashion 8. Pull back on the plunger on each occasion to ensure that the
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9. 10.

11. 12.

needle does not enter a blood vessel Repeat until the desired area is inltrated If the needle must be re-inserted to inltrate further away from the initial bleb, try to insert the needle through an area which has already been anaesthetised Make as few skin punctures as possible When the injection is complete, carefully dispose of the needle and syringe into the nearest sharps bin

Figure 6

Tips
EMLA or Ametop cream may be used to reduce the pain on inserting the needle for children and pH balanced local anaesthetic agents may be available to reduce the stinging on inltrating the agent Be careful to check the maximum recommended dose of local anaesthetic for each individual and avoid agents containing adrenaline in peripheral appendages like the digits, penis, ears, or nose In all cases, it should be ensured that the needle is positioned correctly before injecting the agent, and most importantly that the needle does not stray into the lumen of a blood vessel leading to intra-vascular local anaesthetic injection and toxicity

2013 BMJ Publishing Group Ltd

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