Student: _________________________________

Instructor: _______________________________
Instructor’s Signature: _____________________ Date:

INTRADERMAL INJECTION
Performance Checklist
STEPS S U REMARKS
1. Secure medication card and check this carefully
against the doctor’s order.
2. Calculate dosage prn.
3. Wash hands thoroughly.
4. Place needed equipment and supplies of
medication cart and bring to client’s bedside.
5. Prepare medication:
● Ampule with liquid medication
● Vial with medication
● Ampule/vial with medication that needs to be
reconstituted.
6. (If medication was prepared at Nurse’s station,
bring equipment and supplies to bedside).
Identify client; explain procedure.
7. Provide appropriate environment.
8. Put on gloves.
9. Assist client to assume a comfortable position.
10. Locate site of choice.
11. Clean area with technique; allow site to dry.
12. Keep swab between fingers of non-dominant
hand.
13. Take syringe form hypo tray, maintain asepsis.
Remove needle cap.
14. Hold syringe with dominant hand, use other
hand to grasp tissue.
15. With needle almost against client’s skin. Insert
it slowly at 5°-15° angle until resistance is felt.
16. Advance needle through epidermis to
approximately 3 mm (1/8 inch) below surface.
17. Inject medication slowly.
18. Observe site for the formation of bleb
(approximately ½ inch in diameter).
19. Withdraw needle while applying alcoholized
cotton
gently over injected site. Do not massage area.
20. Without recapping or after using one-handed
recapping technique, place used syringe in sharp

2
 disposal container.
21. Run medication card face down.
AFTERCARE:
Patient:
22. Use pen to draw circle at perimeter of bleb.
23. Assist patient assume a comfortable position,
then remove gloves.
24. Check on client 10-30 minutes after injection.
(If it is a skin test, make sure it is read 30
minutes after injection).
Equipment:
25. Throw disposable materials into their proper
containers.
26. Return the hypo tray to its proper place.
27. Do handwashing.
CHARTING:
28. Do recording accurately.

3
Student: _________________________________
Instructor: _______________________________
Instructor’s Signature: _____________________ Date:

SUBCUTANEOUS INJECTION
Performance Checklist
STEPS S U REMARKS
1. Secure medication card and check this carefully
against the doctor’s order.
2. Calculate dosage prn.
3. Wash hands thoroughly.
4. Place needed equipment and supplies of
medication cart and bring to client’s bedside.
5. Prepare medication:
● Ampule with liquid medication
● Vial with medication
● Ampule/vial with medication that needs to
be reconstituted.
6. (If medication was prepared at Nurse’s station,
bring equipment and supplies to bedside).
Identify client; explain procedure.
7. Provide appropriate environment.
8. Put on gloves.
9. Assist client to assume a comfortable position.
10. Locate site of choice.
11. Clean area with technique; allow site to dry.
12. Keep swab between fingers of non-dominant
hand.
13. Take syringe from hypo tray, maintain asepsis.
Remove needle cap.

4
14. Hold syringe with dominant hand, use other
hand to grasp tissue.
15. Insert needle at 45º-90º angle.
16. When needle is in place, aspirate the plunger
and inject the medication slowly.
17. If no blood is aspirated, hold syringe steady and
inject the medication slowly.
18. After injecting drug, remove needle quickly
while applying pressure on the injection site
with the alcoholized cotton.
19. Massage area with alcoholized cotton
(EXCEPT
WHEN INJECTING HEPARIN/INSULIN).
20. Without recapping or after using one-handed
recapping technique, place used syringe in
sharp
disposal container.
21. Run medication card face down.
AFTERCARE:
Patient:
22. Assist patient assume a comfortable position,
then remove gloves.
23. Check on client 10-30 minutes after injection.
Equipment:
24. Throw disposable materials into their proper
containers.
25. Return the hypo tray to its proper place.
26. Do handwashing.
CHARTING:
27. Do recording accurately.