Intradermal injection

Authors: Rednenko V.V., Rednenko L.I., Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• Workplace for injections and intravenous infusions (see PS1 - Preparing of the workplace for injections and intravenous infusions)
• Medication in ampule or vial
• needle size 0.8x 40 mm for medication withdrawal;
• 1 ml syringe with a needle of 0.33-0.4x10-15 mm;
• medical records

Clinical situation:

• You are a nurse at a hospital’s therapeutic department. Give an allergy test for tolerance to antibiotic

Order of the skill performance:

Preparatory stage:

• inform the patient about the injection, get verbal consent to giving it, ask him to take the required position
• withdraw the required medication into a syringe from an ampule (vial) in an amount of 0.2 ml and change the needle (see PS5 - Withdrawing of medicine from an ampule  into a syringe) or (PS6 - Withdrawing of medicine from a vial into a syringe)
• discard the air and excessive amount of medication from the syringe to 0.1 ml of the drug without removing a cap from the needle
• place the syringe with the medicine into the opened syringe package 

Maine stage:

• select, examine and palpate a injection site with your dominant hand (middle third of the inner surface of the forearm)
• take two swabs with your dominant hand, wet it with alcohol 70°;
• treat the skin at the injection site 2-3 times in one direction:
  
  • with one swab a “large field” (10x10 cm in size);
  • wtithe second one the "small field" (size 5x5 cm) ;
• place the used swabs in the container “Disinfection of dressings, PPE”;
• wait until the alcohol has completely evaporated from the surface of the skin;
• take the syringe with a medication from the opened package with your dominant hand, place the second finger on the needle hilt, grasp the syringe barrel with others fingers;
• place the package in the "Package" container;
• remove a cap from the needle with your non dominant hand, holding the needle hilt with the index finger of your dominant hand, place the cap in the "Plastic" container
• grasp the outer surface of the forearm with the fingers of your non dominant hand, stretch the skin at the injection site;
• holding the needle with the bevel up, insert it into the skin to the length of the bevel of the needle (the needle is inserted parallel to the skin);
• 
• fix the position of the needle by holding the needle hilt with the first finger of your left hand, loosening the skin tension;
• place the second and third fingers of the dominant hand on the flange of the syringe barrel, move the first finger  to the plunger;
• administer the medication by pressing on the syringe plunger with the first finger of the dominant hand (if the injection is done correctly, you should form a papule in the form of a "lemon peel");
• remove the needle with a quick movement

Final stage:

• disinfect syringe and injection needle (see PS3 - Disinfection of disposable syringes and injection needles);
• take off the gloves, place it in the container “Disinfection of dressings, PPE” (see Removal contaminated gloves); 
• wash your hands (see Hygienic hand washing)
  
• register the medication administration in medical records;
• observe the patient for 5-7 minutes to detect an allergic reaction