Intradermal Injections: Techniques, Sites, and Tips

For many clients, the sight of a needle can bring on a wave of anxiety.

As a nursing student, you’ll encounter clients who tense up or even wince at the thought of an injection. Your ability to handle these situations confidently and with compassion can make all the difference.

Mastering an intradermal injection isn’t just about technique. It’s about creating trust and ensuring comfort, even when a client is nervous.

This guide will give you the knowledge and tips to deliver intradermal injections smoothly and confidently, helping you and your clients feel at ease.

What is an Intradermal Injection?

An intradermal injection is a method used to deliver a small volume of medication or substance directly into the dermis, the layer of skin beneath the surface.

This technique typically allows for slow absorption.

Here’s the thing to remember about intradermal administration. It’s all about precision!

The goal is to form a small wheal (or bubble) just under the surface, which confirms that your injection technique is on point.

Types of Injections That Require Intradermal Administration

Nurses often use intradermal injections for:

• Tuberculosis (TB) skin test: Health care providers use this method, also known as the Mantoux tuberculin skin test (TST), to diagnose a TB infection.

• Allergy testing: This involves delivering tiny amounts of potential allergens under the skin to evaluate reactions.

• Certain vaccines: Nurses may administer some flu and rabies vaccines intradermally for specific populations or protocols.

These situations demand accuracy and understanding of intradermal procedure basics.

Steps for Intradermal Injection Administration

Want repeatable success with intradermal injections?

Follow these steps!

1. Gather supplies.

The list includes gloves, medication, a syringe, an alcohol prep pad, and gauze.

2. Perform hand hygiene and put on gloves.

Wash your hands and put on a pair of gloves before handling any supplies or coming into contact with the injection site.

3. Recall the six rights of medication administration.

Before administering the injection, follow the six rights of medication administration by double-checking the medication, client’s name, route, dose, time, and documentation.

4. Choose the site.

Select a flat, hairless area (commonly the inner forearm).

5. Clean the area.

Clean the injection area with an alcohol pad and allow it to air dry.

6. Position the needle at the proper intradermal injection angle.

Hold the syringe at a 5-to 15-degree angle with the bevel facing up. Then, remove the needle cap.

7. Insert the needle.

Slowly insert just the bevel into the skin until it’s fully covered.

8. Inject the medication.

Administer the solution slowly, forming a small bleb or wheal under the skin that will decrease over time.

9. Withdraw the needle.

After you fully inject the medication, gently remove the needle at the same angle, engage the safety shield, and dispose of it safely in a sharps container.

Important reminders:

• Never recap the needle! It’s a high risk for an accidental needle stick.
• Don’t massage the injection site, as this may disperse the medication and potentially alter test results.

10. Remove the glove, perform hand hygiene, and document.

Remove your gloves and dispose of them in a proper waste receptacle.

Then, wash your hands thoroughly with soap and water or use alcohol-based hand sanitizer. Finally, document the injection in the client’s chart.

11. Observe the client and educate them on post-injection care.

Monitor for any immediate reactions, especially during allergy testing.

Educate the client on proper post-injection care, such as avoiding rubbing or scratching the injection site and applying a cold compress for swelling or discomfort. Remind them to report any adverse reactions or changes in their health status.

Common Intradermal Injection Sites

When it comes to intradermal injection sites, you’ve got a few reliable options.

Nurses choose this area for their accessibility and thin dermal layers:

• Inner forearm (inner aspect): The most used site for TB tests and often used for allergy testing.
• Upper back: A preferred site for allergy tests, the testing area may involve the entire back depending on the number of allergens tested and the size of the client’s back.

Intradermal Injection vs Subcutaneous Injection

Do you know the difference between intradermal vs subcutaneous injection?

Here’s a quick breakdown:

Intradermal Injection Needle Size

Using the right needle size is essential for accurate intradermal administration. For most procedures:

• Gauge: 25 to 27
• Length: 1/4 to 1/2 inch

The finer and shorter the needle, the easier it is to precisely deliver the medication into the dermis without causing unnecessary discomfort.

Safety Considerations and Tips

Safety first! Here are some tips to ensure your intradermal injection is error-free:

• Check for allergies: Confirm the client is not sensitive to any test agents or medications.

• Sterile technique is key: Always handle needles and syringes with sterile gloves to avoid introducing infection.

• Bevel-up always: This technique helps form the desired wheal.

• Avoid overpenetration: Insert only the bevel to prevent deeper injection.

• Monitor for allergic reactions: Especially important during allergy testing.

• Dispose of needles properly: Follow sharps disposal guidelines.

• Communicate with the client: Explain each step to reduce anxiety and build trust.

Stick the Landing with SimpleNursing

Now that you know the steps in administering an intradermal injection, you’re on your way to mastering this skill.

If you’re looking for a quick and easy way to review nursing concepts and skills like this, check out SimpleNursing. Our video tutorials, cheat sheets, and practice questions can help you ace your exams by learning what you need to know to provide quality care to clients.

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