MISAMIS UNIVERSITY

Ozamiz City 7200, Philippines

Tel No. +63 88 521-0367 / Telefax No. +63 88 521-2917
E-mail Address: mu@mu.edu.ph
CERTIFIED: ISO 9001:2015 Risk Management – Det Norske Veritas, The Netherlands
ACCREDITED: Philippine Association of Colleges and Universities Commission On Accreditation
(PACUCOA)

INTRADERMAL INJECTION

DEFINITION:
An intradermal (ID) injection is the administration of a drug into the dermal layer of the skin just
beneath the epidermis. Usually only a small amount of liquid is used (e.g. 0.1 mL). This method
of administration is frequently used for allergy testing and tuberculosis (TB) screening.

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

MATERIALS:
• Chart/Medication Record
• Vial or ampule of the correct medication
• Sterile 1-mL syringe calibrated into hundredths of a milliliter (i.e., tuberculin syringe) and a
#25- to #27-gauge safety needle that is 1/4 to 5/8 inch long
• Alcohol swabs
• 2×2 sterile gauze square (optional)
• Clean gloves (according to agency protocol)
• Epinephrine on hand in case of allergic anaphylactic reaction

PROCEDURE RATIONALE
Preparation
1. Check physician’s order. Check patient’s name, The order sheet is the most reliable source
medication name, dosage, route, and time of and the only legal record of medications
administration. that the patient is to receive. Ensures that
the patient receives the correct
medications.

2. Prepares all materials needed for the procedure Enhances time management and efficiency
aseptically
3. Perform hand hygiene and observe other Reduces transmission of the microorganisms
appropriate infection prevention procedures.

4. Prepare the medication from the vial or ampule for Injectable medications can be prepared by
drug withdrawal. withdrawing the medication from an ampule or vial
• Replace the needle of the sterile tuberculin into a sterile syringe and diluting the concentration
syringe with aspirating needle. of the medication with the use of sterile water.
• Aspirate 0.9 ml of distilled water/sterile
water and 0.1ml of the drug using the
tuberculin syringe with aspirating needle.
Mix the drug and sterile water in the syringe.
• Replace the aspirating needle with the
original needle of the tuberculin syringe
 MISAMIS UNIVERSITY
Ozamiz City 7200, Philippines
Tel No. +63 88 521-0367 / Telefax No. +63 88 521-2917
E-mail Address: mu@mu.edu.ph
CERTIFIED: ISO 9001:2015 Risk Management – Det Norske Veritas, The Netherlands
ACCREDITED: Philippine Association of Colleges and Universities Commission On Accreditation
(PACUCOA)

PROCEDURE RATIONALE
5. Prepare the client This ensures that the right client receives the
• Prior to performing the procedure, medication.
introduce self and verify the client’s
identity using agency protocol.
6. Explain to the client that the medication will Explaining procedures can facilitate acceptance
produce a small wheal, sometimes called a bleb. and compliance with the therapy.
A wheal is a small, raised area, like a blister.
The client will feel a slight prick as the needle
enters the skin.
7. Have the client extend the elbow and support
it and the forearm flat on a surface.
8. Select and clean the site. Reduce the risk of contamination from the
• Apply gloves as indicated by agency patient’s skin flora
policy.
• Select a site (e.g., the forearm about a
hand’s width above the wrist and three
or four finger widths below the
antecubital space).
• Avoid using sites that are tender,
inflamed, or swollen and those that have
lesions.
• Cleanse the skin at the site using a firm
circular motion starting at the center and
widening the circle outward. Allow the
area to dry thoroughly.
9. Prepare the syringe for the injection.
• Remove the needle cap while waiting for
the antiseptic to dry.
• Expel any air bubbles from the syringe. • A small amount of air will not harm the
Small bubbles that adhere to the plunger tissues.
are of no consequence.
• Grasp the syringe in your dominant • The possibility of the medication
hand, close to the hub, holding it entering the subcutaneous tissue
between thumb and forefinger. Hold the increases when using an angle greater
needle almost parallel to the skin than 15°.
surface, with the bevel of the needle
pointing up.
10. Inject the fluid.
• With the non-dominant hand, pull the • Taut skin allows for easier entry of the
skin at the site until it is taut. For needle and less discomfort for the client.
example, if using the ventral forearm,
grasp the client’s dorsal forearm and
gently pull it to tighten the ventral skin.
 MISAMIS UNIVERSITY
Ozamiz City 7200, Philippines
Tel No. +63 88 521-0367 / Telefax No. +63 88 521-2917
E-mail Address: mu@mu.edu.ph
CERTIFIED: ISO 9001:2015 Risk Management – Det Norske Veritas, The Netherlands
ACCREDITED: Philippine Association of Colleges and Universities Commission On Accreditation
• (PACUCOA)
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.
• Stabilize the syringe and needle. Inject • This verifies that the medication entered
the medication carefully and slowly so the dermis.
that it produces a small wheal on the
skin.
• Withdraw the needle quickly at the same
angle at which it was inserted. Activate
the needle safety device.
• Do not massage the area.
• Massage can disperse the medication
• Circle the injection site with ink to
into the tissue or out through the needle
observe for redness or induration
insertion site.
(hardening), per agency policy.
• Do not recap the needle in order to
• Do not recap the needle in order to
prevent needlestick injuries
prevent needlestick injuries
11. Remove and discard gloves and perform Reduces transmission of the microorganisms
hand hygiene.

12. Document all relevant information. Proper documentation helps ensure patient
• Record the medication is given, the time, safety.
dosage, route, site, and nursing
assessments.
13. Evaluate the client’s response to the Allows the nurse to anticipate the effects of the
testing substance. drug and observe patients’ responses.
• Checks the site within 15-30 minutes •
time frame and evaluates the condition
of the site. Measure the area of redness
and induration in millimeters at the
largest diameter and document findings.
• If an injection is a TB skin test evaluate
the site within 48 to 72 hours
 CERTIFIED: ISO 9001:2015 Risk Management – Det Norske Veritas, The Netherlands
ACCREDITED: Philippine Association of Colleges and Universities Commission On Accreditation
(PACUCOA)
MISAMIS UNIVERSITY
Ozamiz City 7200, Philippines
Tel No. +63 88 521-0367 / Telefax No. +63 88 521-2917
E-mail Address: mu@mu.edu.ph

Performance Checklist on Intradermal Injection

Name of Student: Date:

INTRADERMAL INJECTION PROCEDURE

Able to Able to Unable to

Perform Perform with Perform
Procedure Competen Supervision (0 Point)
tly (1 Point)
(2
Points)
. 1. Verify physician’s order

2. Prepares all equipment needed for the procedure aseptically.

3. Perform hand hygiene and observe other appropriate infection

prevention procedures.
4. Introduce self and identify patient.
5. Explain the steps of the procedure.
7. Prepare the medication to be used for skin testing (e.g ampule
or vial).
Aspirate 0.9 ml of distilled water/sterile water and 0.1ml of the
drug using the tuberculin syringe with aspirating needle. Mixing
the drug and sterile water in the syringe.

8. Have client extend elbow and support it and

forearm flat on surface
9. Apply clean gloves
11. Select and clean the site. (e.g., the forearm about a hand’s
width above the wrist and three or four finger widths below the
antecubital space).
12. Prepare the syringe for the injection:
Remove the needle cap while waiting for the antiseptic to dry.
13. Expel any air bubbles from the syringe. Small bubbles that
adhere to the plunger are of no consequence.
14. Using non-dominant hand, spread the skin taut over the c
injection site.
15. 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.
 MISAMIS UNIVERSITY
Ozamiz City 7200, Philippines
Tel No. +63 88 521-0367 / Telefax No. +63 88 521-2917
E-mail Address: mu@mu.edu.ph
CERTIFIED: ISO 9001:2015 Risk Management – Det Norske Veritas, The Netherlands
ACCREDITED: Philippine Association of Colleges and Universities Commission On Accreditation
(PACUCOA)
Able to Able to Unable to
Procedure Perform Perform with Perform
Competently Supervision (0 Point)
(2 Points) (1 Point)
Administer injection:
16. Place needle almost flat against patient’s skin, insert it
slowly with bevel up at a 5- to 15-degree. Advance it through
epidermis to approximately 3 mm (1/8 inch) below skin
surface.
17. Inject the medication carefully and slowly until it
produces a small wheal or bleb on the skin and use
nondominant hand to stabilize the syringe and needle
during the injection.
18. Withdraw the needle quickly and gently at the same
angle at which it was inserted.

19. Do not massage site. Wipe the site with alcohol swab or
gauze and apply gentle pressure if necessary.

20. Do not recap and dispose of the syringe and needle into the
sharps container.

21. Encircle the injection site with ink and write the time
when to check the site to observe for drug reaction.
22.Checks the site within appropriate time frame and
evaluate the client’s response to the testing substance
23. Remove and dispose gloves

24. Perform hand hygiene

25. Document all relevant information.

Total Score:
Highest Possible Score: 50 Points

Remarks:
 MISAMIS UNIVERSITY
Ozamiz City 7200, Philippines
Tel No. +63 88 521-0367 / Telefax No. +63 88 521-2917
E-mail Address: mu@mu.edu.ph
CERTIFIED: ISO 9001:2015 Risk Management – Det Norske Veritas, The Netherlands
ACCREDITED: Philippine Association of Colleges and Universities Commission On Accreditation
(PACUCOA)
Signature of Student Name & Signature of Clinical Instructor

References:

Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of nursing (9th ed.).
Mosby.
Kozier & Erb's Fundamentals of Nursing : Concepts, Process, and Practice. Upper Saddle River,
N.J. :Pearson Prentice Hall, 2008.
BCcampus Open Publishing. Clinical Procedures for Safer Patient Care. Accessed at
https://opentextbc.ca/clinicalskills/chapter/3-7-transfers-and- ambulation/ on February 9,
2022.
 MISAMIS UNIVERSITY
Ozamiz City 7200, Philippines
Tel No. +63 88 521-0367 / Telefax No. +63 88 521-2917
E-mail Address: mu@mu.edu.ph
CERTIFIED: ISO 9001:2015 Risk Management – Det Norske Veritas, The Netherlands
ACCREDITED: Philippine Association of Colleges and Universities Commission On Accreditation
(PACUCOA)