Intradermal Injection Checklist

Procedure CD ID
1. Gather appropriate equipment.
• Medication
• Sterile water for injection
• Filter needle or aspirating needle
• 1 cc syringe/tuberculin syringe
• Cotton balls with alcohol
• 1 2x2 sterile gauze or dry cotton balls
• Black ballpen
• Alcohol
• Permanent marker
2. Perform hand hygiene and observe other appropriate infection prevention procedures.
3. Prepare medication from ampule or vial for drug withdrawal.
(Make sure to check expiration and right drug)
• Change the needle of the tuberculin syringe into a filter or aspirating needle.
• Aspirate 0.9 ml of sterile water for injection (make sure to eliminate air before aspirating the
medication).
• Aspirate 0.1 ml of medication.
• Replace the filter or aspirating needle with the original needle
• Put label on the syringe (patient’s name and medication)
4. Select appropriate injection site.
a. Select a site free of hair, blood vessels, skin lesions, tenderness, swelling, hardness, or localized
inflammation.
b. Use alternate sites if injections were frequent.
c. Locate exact site for injection.
5. Perform hand hygiene. (Do alcohol rub to save time)
6. Apply clean gloves.
7. Assist patient in a comfortable position. Have patient extend elbow and support it and forearm on flat
surface.
8. Cleanse site with an antiseptic swab. Apply swab at center of the site and rotate outward in a circular
direction for about 5 cm (2 inches). Let it dry for approximately 30 seconds.
9. Remove needle cap from needle by pulling it in a straight motion.
10. Using non-dominant hand, spread the skin taut over the injection site.
11. Hold the syringe in the dominant hand between the thumb and forefinger, with the bevel of the needle
pointing up.
12. Hold syringe at a 5- to 15-degree angle from the site. Place the needle almost flat against the patient’s
skin, bevel side up, and insert needle into the skin. Insert the needle only about 1/8 in., with the entire
bevel under the skin.
13. Once syringe is in place, anchor the syringe with your non-dominant.
14. Slowly inject the solution. Normally you feel resistance. If not, needle is too deep; remove and begin
again.
15. While injecting medication, note that small bleb or wheal appears on skin surface.
16. Withdraw the needle at the same angle as insertion, engage safety shield or needle guard. Do not recap
used needles. Discard uncapped needle in a puncture-proof and leak-proof receptacle.
17. Do not massage injection site after injection.
18. Circle the area around the injection site using black pen then write the name of the medication and the
time the skin test will be read (30 minutes after injection).
19. Discard remaining supplies, remove gloves, and perform hand hygiene.
20. Document time, date, location, and type of medication injected and notify physician on the time the skin
test will be read.
21. Evaluate patient response to injection within appropriate time frame.
Perfect Score: 54
Passing Score: 43

____________________________
Clinical Instructor’s Signature
 Intramuscular Injection
Procedure CD ID
1. Gather appropriate equipment.
• Medication
• Filter needle or aspirating needle
• 3 cc syringe
• Cotton balls with alcohol
• 1 2x2 sterile gauze or dry cotton balls
• Alcohol
• Band aid
2. Perform hand hygiene and observe other appropriate infection prevention procedures.
3. Prepare medication from ampule or vial for drug withdrawal. (Make sure to check expiration and right
drug)
• Change needle with a filter or aspirating needle
• Aspirate 0.5 ml of the medication (among of medication may vary depending on the case and type
of medication)
• Remove air in the syringe.
• Replace the filter or aspirating needle with the original needle.
4. Provide client privacy.
5. Select appropriate injection site.
a. Select a site free of hair, blood vessels, skin lesions, tenderness, swelling, hardness, or localized
inflammation.
b. Used alternate sites if injections were frequent.
c. Locate exact site for injection.
6. Perform hand hygiene. (Do alcohol rub to save time)
7. Apply clean gloves.
8. Assist patient in a comfortable position. Position patient depending on the chosen site.
9. Cleanse site with an antiseptic swab. Apply swab at center of the site and rotate outward in a circular
direction for about 5 cm (2 inches). Let it dry for approximately 30 seconds.
10. Hold swab or gauze between third and fourth fingers of nondominant hand.
11. Remove needle cap from needle by pulling it in a straight motion.
12. Hold syringe between thumb and forefinger of dominant hand; hold as dart, palm down.
13. Administer injection.
a. Position ulnar side of nondominant hand just below site and pull skin laterally approximately 2.5 to
3.5 cm. Hold position until medication is injected. With dominant hand, inject needle quickly at 90-
degree angle into muscle.
b. Optional: If patient’s muscle mass is small, grasp body of muscle between thumb and forefingers.
c. After needle pierces skin, use thumb and forefinger of nondominant hand to hold syringe barrel
while still pulling on skin. Move dominant hand to end of plunger. Avoid moving syringe.
d. If required by agency policy, pull back on plunger or aspirate 5 to 10 seconds. If no blood appears,
inject medication slowly at a rate of 1 ml/10sec.
e. Wait 10 seconds, then smoothly and steadily withdraw needle, release skin, and apply alcohol swab
or gauze gently over site.
14. Apply gentle pressure to site. Do not massage site. Apply band aid of needed.
15. Discard uncapped needle or needle enclosed with safety shield and attached syringe into a puncture-
proof and leek proof receptacle.
16. Discard supplies, remove gloves, and perform hand hygiene.
17. Document time, date, location, and type of medication injected.
18. Assess patient’s response to the medication after appropriate time frame.
Perfect Score: 54
Passing Score: 43

____________________________
Clinical Instructor’s Signature