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UWHC,UWMF,

Policies,Clinical,UWMF Clinical,UWMF-wide,Clinical Policies and Procedures,Medication Administration, Route of

Administering an Intradermal Injection (102.065)

Administering an Intradermal Injection (102.065) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Medication Administration, Route of

102.065

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UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: ADMINISTERING AN INTRADERMAL INJECTION

Effective Date: February, 2002 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed October, 2003 March, 2005 Nov, 2007 May, 2010
October, 2011 November, 2014
PURPOSE: To provide guidelines for the administration of an intradermal injection at the University of
Wisconsin Medical Foundation (UWMF) and Department of Family Medicine (DFM) clinics.

POLICY: Clinical staff will utilize the following guidelines to administer an intradermal injection to UWMF
patients. The preparation and administration of a medication should be completed by the same person.

DEFINITION: An intradermal injection allows for small amounts of medication to be deposited under the skin
and is primarily used to produce a local effect.

SUPPLIES:
ξ 1-ml syringe with 1/4 to 3/4-inch safety needle (25, 26, 27, or 28 gauge needle)
ξ small gauze pads
ξ alcohol pad
ξ gloves
ξ bandage (unless doing a PPD)
ξ provider’s order
ξ correct medication

PROCEDURE:

1. Check medication against provider’s order and clarify any inconsistencies.

2. Wash hands and assemble equipment.

3. Identify patient, including date of birth. Verify allergies.

4. Provide privacy for the injection.

5. Wash hands and put on disposable gloves.

6. Draw up medication, adhering to the five rights of drug administration.
ξ Right – drug, dose, time, route, patient
ξ Check the expiration date of the medication
ξ Check date vial was opened (vials must be discarded 28 days after being opened regardless of
expiration date unless the manufacturer specifies a different date).

7. Give medication intradermally.
ξ TB tests are to be given in the left forearm, unless there is scarring, rash or lack of appendage on that
side, then the right forearm can be used.

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ξ Do not perform intradermal injections or TB skin tests in areas with excess hair, acne, tattoos, redness,
swelling, visible veins, or insufficient subcutaneous tissue
ξ Upper chest or upper back beneath the scapulae also are sites for intradermal injections, if unable to use
patient’s forearm. (See diagram).

8. Cleanse area with alcohol swab by wiping with a firm, circular motion and moving outward from the
injection site.

9. Allow skin to dry. If skin is oily, cleanse area with gauze pad moistened with acetone.

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

11. Use nondominant hand to spread skin taut over injection site.

12. Hold the needle at 5-15 degree angle to patient’s arm
with bevel up



13. Insert needle (about 1/8 inch) into skin so the point of needle can be seen through skin.

14. Slowly inject agent while watching for a small wheal to appear. If none appears, withdraw needle slightly
and continue to inject medication.

15. Withdraw needle quickly at the same angle it was inserted.

16. Do not massage area after removing needle, and avoid bandage. DO NOT apply bandage if giving PPD and
instruct patient not to do so.

17. Discard needle and syringe in the sharps receptacle.

18. Assist patient into a position of comfort.


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19. Remove gloves, dispose of gloves properly, and wash hands.

20. Documentation (HealthLink)
 IMM/INJ
ξ Manufacture, Lot #, Expiration date (as indicated)
ξ NDC#
ξ VIS# (if applicable)
ξ Name, dosage, route of medication, site of injection, and time given
 Progress Notes utilizing SmartPhrases: .npinjectstart and .npinjectend
ξ Assessment and laboratory results relevant to purpose of the medication
ξ Effects of the medication on patient
ξ Teaching about the drug or injection technique
ξ How patient tolerated procedure, i.e., desired effect, adverse reactions.

25. Assess site observing closely for skin reactions and other adverse reactions.

WRITTEN BY: Ronnie Peterson, R.N., MS, Manager of Clinical Support

REVISED BY: Eve Christoffersen, BSN, RN, Clinical Staff Educator

REVIEWED BY: Bridget Statz, BSN, RN, Team Lead UW Allergy
Stacy Hewitt, RN, UW Health Dermatology
Lisa Hilker, MA, Supervisor UW Health Dermatology

REFERENCES:
1. Becton, Dickinson and Company. (2012). Intradermal injection guidelines for needle length and
gauge selection. Retrieved from
http://www.bd.com/hypodermic/pdf/Intradermal_Injection_Guidelines.pdf
2. CDC NCHHSTP Division of Tuberculosis Elimination. (2004). The Mantoux tuberculin skin test wall
chart. Retrieved from
http://www.cdc.gov/tb/publications/Posters/images/Mantoux_wallchart.pdf
3. Centers for Disease Control and Prevention: Division of Tuberculosis Elimination. (2012, September).
Mantoux tuberculosis skin test facilitator guide. Retrieved from
http://www.cdc.gov/tb/education/Mantoux/part1.htm
4. Centers for Disease Control and Prevention. (2011, February). Questions about multi-dose vials.
Retrieved from http://www.cdc.gov/injectionsafety/providers/provider_faqs_multivials.html
5. Keystone, J. S., Freedman, D. O., Koz arsky, P. E., Connor, B. A., & Nothdurft, H. D. (Eds.) (2013).
Travel medicine (3rd ed.). Retrieved from https://www-clinicalkey-
com.ezproxy.library.wisc.edu/#!/ContentPlayerCtrl/doPlayContent/3-s2.0-
B9781455710768000090/{"sectionId":"3-s2.0-B9781455710768000090-f009-008-
9781455710768","scope":"all","query":"Injections, Intradermal needle length"}
6. Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures. (5th ed.). Ambler, PA: Lippincott
Williams & Wilkins.
7. Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO:
Mosby.
8. Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.).
St. Louis, MO: Mosby Elsevier.



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AUTHORIZED BY: Richard Welnick, MD, Medical Director, Ambulatory Clinic Operations, UWMF
Sandra A. Kamnetz M.D., Vice Chair, Department of Family Medicine


__________________________________________________________________________________________
Medical Director, UWMF Date


__________________________________________________________________________________________
Vice Chair, Department of Family Medicine Date