PREPARING AND ADMINISTERING INTRADERMAL INJECTION

Purpose:
To provide a medication that the client requires for allergy testing and TB screening.

Equipment / Materials Needed

1. Vial or ampule of the correct medication
2. Distilled Water for Injection
3. Sterile 1 ml syringe (tuberculin) with needle gauge #25 to 27 (1/4 to 5/8 inch
long)
4. Withdrawing needle gauge # 21 0r 22
5. Alcohol swab or cotton with alcohol
6. Clean gloves (according to agency protocol)
7. Medication Card / ticket
8. Kardex
9. Patient’s Chart

EXPECTED BEHAVIOR RATIONALE

ASSESSMENT
1. Assess for previous reaction to skin
testing.
2. Assess for all types of allergies.
Assessment is a prerequisite for every
medication given. Some skin tests, such as
the tuberculin test, should not be repeated
after positive test results.
Intradermal injections are also used for
allergy testing, a client could have an
anaphylactic reaction.

3. Assess the skin at intradermal sites for Site should be free from lesions, rashes,
bruising, swelling, tenderness, and and moles.
other abnormalities.

4. Assess the client’s: To determine if assistance is needed

a) size and build during the actual procedure.
b) physical condition
c) psychological status and the
need for assistance.

PLANNING
5. Determine the appropriate size of
needle and syringe to be used.
6. Determine other equipment needed.
7. Gather needed equipment.
Appropriate needle size and syringe
should be used during skin testing.
For the equipment to be readily accessible
during the actual procedure.
To save time and effort.
IMPLEMENTATION
Preparation of the drug:
8. Check the MAR.
a. Check the label on the To make sure that the correct medication
medication carefully against is being prepared.
the MAR.
Properly identifying medication decreases
risk of inadvertently administering the
wrong medications.
b. Follow the three checks for This is to make sure that the nurse is
administering medications. administering the correct medication to
Read the label of the the patient or the right patient (12 R’s).
medication (1) when it is taken
from the medication cart or
box (2) before withdrawing the
medication and (3) after
withdrawing the medication
9. Organize the equipment To have easy access during drug
preparation.
Performance This is to avoid cross contamination.
10. Perform hand hygiene and observe
other appropriate infection
prevention procedures.

11. Prepare the medication from the To save time and effort.
vial or ampule for drug
withdrawal.
*refer the procedure in preparation of
drug from ampule or vial.

a. Take from medication cart/box
the appropriate drug, check the
label and expiry date.
b. Compare medication label of
the vial or ampule against the
order on the MAR.
c. Prepare a 1cc syringe and
withdrawal needle gauge 21-22
To ensure if the drug is still safe for use.
1st Check. To ensure appropriate
medication is being prepared.
This is the appropriate needle to be used
in skin testing.

12. Determine and prepare accurate This procedure is done to ensure the
volume (While preparing, recheck correct dilution of the medication is
again for the drug label. being made.
(2nd check)
In one syringe withdraw first
0.9ml of distilled water then 0.1
 ml of medication to be tested.
13. Mix the solution
14. Replace the withdrawing needle to This is to avoid irritating the skin and the
the appropriate gauge of needle for subcutaneous tissues due to the
skin testing.
15. After preparing correct amount of
medication, recheck the
medication label and compare it to
MAR. -3rd check.
16. Place the prepared solution
together with the MAR on the
medication tray.
17. Wash hands.
Intradermal Injection
18. Compare MAR to patient
wristband and verify this is the
correct patient.
19. Explain to the client that the
testing / medication will produce a
small wheal/bleb. The client will
feel a slight prick as the needle
enters the skin.
20. Close the door or pull the bedside
curtains and position the client
properly and securely.
21. Select a site. Usually inner
forearm about a hand’s width
above the wrist and 3-4 fingers
below the antecubital space (avoid
using site with lesions, inflamed or
tender) is preferable.
22. Put on right size clean gloves.
23. Cleanse the site using firm and
circular motion starting at the
center and widening the circle
outward with antiseptic swab. But
don’t rub the skin when
disinfecting. Allow the area to dry
thoroughly.
24. While waiting for the antiseptic to
dry, remove needle from cap by
To ensure that an even mixture is being
produced.
medication, as well as to transfer the
debris of glasses from the ampule.
This is to make sure that the right
medication was withdrawn, if not, an error
would occur.
To prepare for the actual administration of
medication.
To prevent cross contamination.
This ensures that the right client receives
the medication.
Explaining rationale increases the
patient’s knowledge and reduces their
anxiety.
Information can facilitate acceptance of
and compliance with the therapy.
This provides patient privacy. Proper
positioning relaxes the client.
Selecting the correct site allows for
accurate reading of the test site at the
appropriate time.
To prevent accidental exposure to
bloodborne pathogens.
Pathogens from the skin can be forced
into the tissues by the needle. Allowing
the skin to dry prevents introducing
alcohol into the tissue, which can be
irritating and uncomfortable.
This decreases risk of accidental needle-
stick injury.
 pulling it off in a straight motion.
25. Expel any air bubbles (small
bubbles that adhere to the plunger
are of no consequence, a small
amount of air will not harm the
tissues).
26. Grasp the syringe in your
dominant hand, close to the hub,
holding it between thumb and
forefinger. Hold the needle almost
parallel to the skin surface, with
the bevel of the needle up.
27. With the nondominant hand, pull
the skin at the site until it is taut.
28. Insert the tip of the needle far
enough to place the bevel through
the epidermis into the dermis. The
outline of the bevel should be
visible under the skin surface.
29. Stabilize the syringe and needle.
Inject the medication carefully and
slowly so that it produces a small
wheal on the skin.
30. Withdraw the needle quickly at the
same angle at which it was
inserted.
31. Do not massage the area.
32. Circle the wheal with ballpoint ink
to observe redness or induration
(hardening) within 30 mins. Label
the encircled area with date, time
due and name of medication.
33. Reposition the client comfortably.
34. Dispose the syringe and needle
into the sharps container. Do not
recap the needle to prevent needle
stick injuries.
35. Remove and discard gloves.
To prevent air from entering into the skin
tissues.
The possibility of the medication entering
the subcutaneous tissue increases when
using an angle greater than 150.
Keeping the bevel side up allows for
smooth piercing of the skin and induction
of the medication into the dermis.
Taut skin allows easier entry of the needle
and less discomfort for the client.
This is to ensure that the medication is
injected in to the skin, not into the
subcutaneous tissues
This verifies that the medication entered
the dermis.
Withdrawing at the same angle as
insertion minimizes discomfort to the
patient and damage to the tissue.
Massage can disperse the medication into
the tissue or out through the needle
insertion site.
This is done for the evaluation of the skin
testing.
To promote client’s comfort.
Do not recap the needle.Proper needle
disposal prevents needle-stick injuries.
This prevents the spread of
microorganisms.
 36. Do after care. To maintain cleanliness of the area.
37. Perform hand hygiene. For infection control.
EVALUATION

38. Reassess the client 5 and 15 The patient will need to be evaluated for
minutes after administration, therapeutic and adverse effects of the
because reaction may subsequently medication or solution.
occur.
39. Read the site within 30 minutes, To determine if patient is allergy to the
depending on the test. medication.
DOCUMENTATION
40. Some medications require Proper documentation helps ensure patient
documentation of lot numbers per safety.
agency policy
41. Chart when the test is to be read.
42. Chart the medication, time, dose
and route given, preadministration
assessments, and your signature.
43. Do not document before giving the
drug; do not document for anyone
else; do not ask another nurse to
document a drug you have given.
44. Chart any therapeutic or adverse
effects of the medication.
45. If the client is unable or refuses to
take the medication, document on
the MAR that the medication was
not administered, along with the
reason, and inform the physician.
 RETURN DEMONSTRATION EVALUATION TOOL FOR:
INTRADERMAL INJECTION

Name: _____________________________________ Grade: _____________

Time started:____________ Time ended:________Date of RD:________________________

RATING COMMENTS
AREA FOR EVALUATION
5 4 3 2 1 0
SKILLS (35%)
ASSESSMENT
1. Assesses for previous reaction to
skin testing.
2. Assesses all types of allergies.

3. Assesses the skin at intradermal sites

for bruising, swelling, tenderness, and
other abnormalities.

4. Assesses the client’s:

a) size and build
b) physical condition
c) psychological status and the
need for assistance.

PLANNING
5. Determines the appropriate size of
needle and syringe to be used.
6. Determines other equipment needed.
7. Gathers needed equipment.

IMPLEMENTATION
Preparation of the drug:
8. Check the MAR.
a. Checks the label on the
medication carefully against
the MAR.
b. Follows the three checks for
administering medications.
Read the label of the
medication (1) when it is
taken from the medication cart
or box (2) before withdrawing
the medication and (3) after
 withdrawing the medication
9. Organize the equipment
Performance
10. Performs hand hygiene and
observe other appropriate
infection prevention procedures.

11. Prepares the medication from the

vial or ampule for drug
withdrawal.
a. Takes from medication
cart/box the appropriate
drug, check the label and
expiry date.
b. Compares medication
label of the vial or ampule
against the order on the
MAR.
c. Prepares a 1cc syringe and
withdrawal needle gauge
21-22
12. Determines and prepares accurate
volume (While preparing, recheck
again for the drug label.
(2nd check)
In one syringe withdraw first
0.9ml of distilled water then 0.1
ml of medication to be tested.
13. Mixes the solution
14. Replaces the withdrawing needle
to the appropriate gauge of needle
for skin testing.

15. Rechecks the medication label

and compare it to MAR. -3rd
check.
16. Places the prepared solution
together with the MAR on the
medication tray.
17. Washes hands.
Intradermal Injection
18. Compares MAR to patient
wristband and verifies the correct
patient.
19. Explains to the client that the
testing / medication will produce
 a small wheal/bleb. The client will
feel a slight prick as the needle
enters the skin.
20. Closees the door or pull the
bedside curtains and position the
client properly and securely.
21. Selects a site. Usually inner
forearm about a hand’s width
above the wrist and 3-4 fingers
below the antecubital space (avoid
using site with lesions, inflamed
or tender) is preferable.
22. Put on right size clean gloves.
23. Cleanses the site using firm and
circular motion starting at the
center and widening the circle
outward with antiseptic swab. But
don’t rub the skin when
disinfecting. Allow the area to dry
thoroughly.
24. Removes needle from cap by
pulling it off in a straight motion.
25. Expel any air bubbles (small
bubbles that adhere to the plunger
are of no consequence, a small
amount of air will not harm the
tissues).
26. Grasps the syringe in your
dominant hand, close to the hub,
holding it between thumb and
forefinger. Holds the needle
almost parallel to the skin surface,
with the bevel of the needle up.
27. With the nondominant hand, pulls
the skin at the site until it is taut.
28. Inserts the tip of the needle far
enough to place the bevel through
the epidermis into the dermis. The
outline of the bevel should be
visible under the skin surface.
29. Stabilizes the syringe and needle.
Inject the medication carefully
and slowly so that it produces a
small wheal on the skin.
30. Withdraws the needle quickly at
the same angle at which it was
 inserted.
31. Did not massage the area.
32. Circles the wheal with ballpoint
ink to observe redness or
induration (hardening) within 30
mins. Label the encircled area
with date, time due and name of
medication.
33. Reposition the client comfortably.
34. Dispose the syringe and needle
into the sharps container. Do not
recap the needle to prevent needle
stick injuries.
35. Remove and discard gloves.
36. Do after care.
37. Perform hand hygiene.
EVALUATION
38. Reassess the client 5 and 15
minutes after administration,
because reaction may
subsequently occur.
39. Read the site within 30 minutes,
depending on the test.
DOCUMENTATION
40. Some medications require
documentation of lot numbers per
agency policy
41. Chart when the test is to be read.
42. Chart the medication, time, dose
and route given, preadministration
assessments, and your signature.
43. Do not document before giving
the drug; do not document for
anyone else; do not ask another
nurse to document a drug you
have given.
44. Chart any therapeutic or adverse
effects of the medication.
45. If the client is unable or refuses to
take the medication, document on
the MAR that the medication was
not administered, along with the
reason, and inform the physician.
KNOWLEDGE (15%)
1. Gives rationale of the procedure.
 2. Explains the elements and
mechanics of the procedure.
3. Knows the elements of nursing
process as applied
4. States Principles applied in the
procedure.

ATTITUDE: (10%)
1. Is well groomed.
2. Wears prescribed, neat, and clean
uniform.
3. Arrives on time for the RD.
4. Speaks to CI and client tactfully.
5. Minimizes use of energy, time, and
effort
6. Utilizes supplies efficiently.
7. Considers client’s safety, privacy, and
comfort.
8. Is well organized.
9. Keeps working area clean at all times.
10. Gives high value for aesthetics.

Comments: _______________________________________________________________

Clinical Instructor’s signature: ____________________________________