Intradermal injection, pediatric (Skills Checklist)
Lippincott Procedure, accessed via XU eLearn
Objective: To administer an intradermal injection in a child according to the standard of care.
__ Avoid distractions and interruptions when preparing
and administering the medication.
__ Verify the practitioner's order.
__ Reconcile the child's medications when the practitioner
prescribes a new medication.
__ Perform hand hygiene.
__ Gather and prepare the necessary equipment and
supplies.
__ Compare the medication label to the order in the
child's medication record.
__ Check the child's medical record for the last dose of
the medication, allergies, and other contraindications to
the procedure. If an allergy or contraindications exist,
don't administer the medication and notify the practitioner.
__ Check the expiration date on the medication. If the
medication is expired, return it to the pharmacy and
obtain new medication.
__ Visually inspect the prescribed medication for
particles, discoloration, or other loss of integrity; don't
administer the medication if integrity is compromised.
__ Discuss any unresolved concerns with the child's
practitioner.
__ Perform hand hygiene.
__ Calculate the dosage and draw up the medication
using sterile, no-touch technique. Be sure to disinfect the
rubber stopper of the medication vial with an alcohol pad
before inserting the needle.
__ Assess the child's level of anxiety with needles. Obtain
the assistance of a child life specialist, if needed.
__ Perform hand hygiene.
__ Confirm the child's identity using least two patient
identifiers.
__ Provide privacy.
__ Explain the procedure to the child and the parents or
guardians according to their individual communication
and learning needs.
__ If the child is receiving the medication or antigen for
the first time, teach the child (if appropriate) and the
parents or guardians about potential adverse reactions
and other concerns related to the medication.
__ Verify that the medication is being administered at the
proper time, in the prescribed dose, and by the correct
route.
__ If your facility uses bar-code technology, use it as
directed by your facility.
__ Assess the child's condition.
__ Assess the child for a rash, pruritus, cough, and other
signs of an adverse reaction to a previously administered
drug.
__ Position the child with the arm extended and
supported on a flat surface with the ventral forearm
exposed.
__ Perform hand hygiene.
__ Put on gloves if contact with blood or body fluids is
likely or if your skin or the child's skin isn't intact. Note that
gloves aren't necessary for routine intradermal injection.
__ Select an injection site on the ventral forearm that is
free from hair and blemishes.
__ Clean the injection site with an alcohol pad. Allow it to
dry.
__ While holding the child's forearm in your hand, stretch
the skin taut with your thumb.
__ With your free hand, hold the needle at a 5- to
15-degree angle to the child's arm with the needle's bevel
up.
__ Insert the needle about ⅛" (0.3 cm) below the
epidermis. Stop when the needle's bevel tip is under the
skin, and inject the medication or antigen slowly. Expect
to feel some resistance, and watch for a wheal to form.
__ Remove the needle quickly, being careful to maintain
the injection angle. Don't rub the site, and instruct the
child (if appropriate) and the parents or guardians to
avoid rubbing the area.
__ Don't recap the needle; discard it in a leakproof,
puncture-resistant container.
__ If you're administering multiple injections, administer
them at least 2" (5 cm) apart. Circle each test site with a
marking pen and label each site according to the recall
antigen given. Instruct the child (if appropriate) and the
parents or guardians to refrain from washing off the
circles until the test is completed.
__ Remove and discard your gloves, if worn.
__ Perform hand hygiene.
__ Offer the child praise and developmentally appropriate
rewards.
__ Document the procedure.