Administering an Intradermal Injection

Goal: Medication is safely injected intradermally causing a wheal to appear at the site of injection.

1. Gather equipment. Check each medication order against the original order in the medical record according to facility policy. Clarify any inconsistencies. Check the patient’s chart for allergies.

2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.

3. Perform hand hygiene.

4. Move the medication cart to the outside of the patient’s room or prepare for administration in the medication area.

5. Unlock the medication cart or drawer. Enter pass code and scan employee identification, if required.

6. Prepare medications for one patient at a time.

7. Read the CMAR/MAR and select the proper medication from the patient’s medication drawer or unit stock.

8. Compare the label with the CMAR/MAR. Check expiration dates and perform calculations, if necessary. Scan the bar code on the package, if required.

9. If necessary, withdraw medication from an ampule or vial as described in Skills 5-3 and 5-4.

10. When all medications for one patient have been prepared, recheck the label with the CMAR/MAR before taking the medications to the patient.

11. Lock the medication cart before leaving it.

12. Transport medications to the patient’s bedside carefully, and keep the medications in sight at all times.

13. Ensure that the patient receives the medications at the correct time.

14. Perform hand hygiene and put on PPE, if indicated.

15. Identify the patient. Usually, the patient should be identified using two methods. Compare information with the CMAR/MAR.
a. Check the name and identification number on the patient’s identification band.
b. Ask the patient to state his or her name and birth date, based on facility policy.
c. If the patient cannot identify him- or herself, verify the patient’s identification with a staff member who knows the patient for the second source.

16. Close the door to the room or pull the bedside curtain.

17. Complete necessary assessments before administering medications. Check allergy bracelet or ask the patient about allergies. Explain the purpose and action of the medication to the patient.

18. Scan the patient’s bar code on the identification band, if required.

19. Put on clean gloves.

20. Select an appropriate administration site. Assist the patient to the appropriate position for the site chosen. Drape as needed to expose only area of site to be used.

21. Cleanse the site with an antimicrobial swab while wiping with a firm, circular motion and moving outward from the injection site. Allow the skin to dry.

22. Remove the needle cap with the nondominant hand by pulling it straight off.

23. Use the nondominant hand to spread the skin taut over the injection site.

24. Hold the syringe in the dominant hand, between the thumb and forefinger with the bevel of the needle up.

25. Hold the 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 the needle into the skin. Insert the needle only about 1⁄8 inch with entire bevel under the skin.

26. Once the needle is in place, steady the lower end of the syringe. Slide your dominant hand to the end of the plunger.

27. Slowly inject the agent while watching for a small wheal or blister to appear.

28. Withdraw the needle quickly at the same angle that it was inserted. Do not recap the used needle. Engage the safety shield or needle guard.

29. Do not massage the area after removing needle. Tell patient not to rub or scratch the site. If necessary, gently blot the site with a dry gauze square. Do not apply pressure or rub the site.

30. Assist the patient to a position of comfort.

31. Discard the needle and syringe in the appropriate receptacle.

32. Remove gloves and additional PPE, if used. Perform hand hygiene.

33. Document the administration of the medication immediately after administration.

34. Evaluate the patient’s response to medication within appropriate time frame.

35. Observe the area for signs of a reaction at determined intervals after administration. Inform the patient of the need for inspection.