Intradermal injection

1.	Goal: Appearance of a wheal at the site of injection. Gather equipment. Check each medication order against the original physician’s order according to agency 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.
6.	Prepare medications for one patient at a time.
7.	Read the Medication order and select the proper medication from the patient’s medication drawer or unit stock.
8.	Compare the label with the Medication order. Check expiration dates and perform calculations, if necessary.
9.	If necessary, withdraw medication from an ampule or vial.
10.	Recheck the label with the Medication order before taking them 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.	Identify the patient. Usually, the patient should be identified using two methods. Compare information with the patient’s chart- a. Check the name and identification number on the patient’s identification band. b. Ask the patient to state his or her name. 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.
15.	Close the door to the room or pull the bedside curtain.
16.	Complete necessary assessments before administering medications. Check allergy bracelet or ask patient about allergies. Explain the purpose and action of the medication to the patient.
17.	Perform hand hygiene and put on clean gloves.
18.	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.
19.	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
20.	Remove the needle cap with the non-dominant hand by pulling it straight off.
21.	Use the non-dominant hand to spread the skin taut over the injection site.
22.	Hold the syringe in the dominant hand, between the thumb and forefinger with the bevel of the needle up. .
23.	Hold the syringe at a 10- 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 so that the point of the needle can be seen through the skin. Insert the needle only about 1/8″ with entire bevel under the skin.
25.	Once the needle is in place, steady the lower end of the syringe, and slide your dominant hand to the end of the plunger.
26.	Slowly inject the agent while watching for a small wheal or blister to appear.
27.	Withdraw the needle quickly at the same angle that it was inserted.
28.	Do not massage area after removing needle. Tell the 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.
29.	Do not recap the used needle. Engage the safety shield or needle guard, if present. Discard the needle and syringe in the appropriate receptacle.
30.	Assist the patient to a position of comfort.
31.	Remove gloves and dispose of them properly. Perform hand hygiene.
32.	Observe the area for signs of a reaction at determined intervals after administration. Inform the patient of the need for inspection