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Intradermal injections are administered into the dermis, which it just below the epidermis. This injection is the most superficial and has the longest absorption time. Intradermal injections may be used for sensitivity tests (such as allergy testing or tuberculin skin test) or for local anaesthesia.
Introduction
Wash hands; Introduce self; Patient’s name, DOB and wrist band; Explain procedure and obtain consent
Allergy check: check for allergies with patient and on drug chart
Prescription check: check the prescription drug and dose, and confirm the name and DOB are correct (check with patient and their wristband)
Look up drug in Injectable Medicines book to determine volume of sterile water/saline required to reconstitute drug (if it is in powder form)
Preparation
Wash hands
Clean tray
Gather equipment around tray (think through what you need in order)
Equipment list
Gloves (+ extra pair and apron if you need to draw up drug)
Drug – CHECK DATE, DOSE, PRESCRIPTION AND ALLERGIES
+ if drug is in liquid form: blunt fill 18G drawing-up needle and syringe for drawing-up
+ if drug is in powder form: blunt fill 18G drawing-up needle, syringe and vial of sterile water/saline for reconstituting drug and drawing-up – CHECK DATE
Orange 16mm 25G needle or brown 26G needlefor injection
Sterile gauze
Tape
Wash hands
Open packets and place neatly in tray, keeping items in plastic parts of packets (without touching the instruments themselves)
If the drug is in powder form:
Wash hands, put on apron and extra pair of gloves
Snap top off sterile water/saline vial
Put drawing-up needle on syringe, hold sterile water/saline vial upside-down and draw up required amount for reconstitution (plus a bit extra)
Expel air and some water to leave the exact amount needed for reconstitution
Flick top off drug vial
Insert needle and inject the sterile water/saline. Twist the vial back and forth on end of needle until drug powder is fully dissolved.
Draw up drug solution while the vial is upside-down
Remove and dispose of drawing-up needle in sharps bin and replace with injection needle (leave sheath on)
Expel air from syringe and place back into syringe packet in tray
Discard waste; then discard gloves and apron; wash hands
If the drug is in liquid form:
Wash hands, put on apron and extra pair of gloves
Put drawing-up needle on syringe and fill with approximately the same volume of air as in the drug vial if drug vial contains a vacuum
Flick/snap top off drug vial
Insert the needle into the vial, and inject the air into the airspace if drug vial contains a vacuum
Draw up drug solution while the vial is upside-down
Remove and dispose of drawing-up needle in sharps bin and replace with injection needle (leave sheath on)
Expel air from syringe and place back into syringe packet in tray
Discard waste; then discard gloves and apron; wash hands
Walk to patient (with tray and sharps bin)
Procedure
Exposure
Wash hands
Expose injection site
Support the limb with pillows if necessary
Injection
Wash hands
Put on gloves
Sterilise area using skin-cleansing wipe (clean for 30 seconds, then allow to air-dry for 30 seconds) – optional
With the thumb and index finger of your non-dominant, stretch the skin at the injection site
Holding the syringe (like a dart) between the thumb, index and middle fingers of your dominant hand, insert the needle into the dermis at an acute angle (10-15˚)
Using your dominant hand to securely hold the syringe in place (resting against the patient), use your non-dominant hand to slowly inject the drug, watching a wheal form (no need to aspirate prior to injecting)
Gently but briskly remove the needle and immediately dispose of it (with syringe) in the sharps bin
Wipe the injection site gently with gauze (don’t rub or apply pressure because medication will disperse)
