INTRADERMAL ROUTE

• Intradermal injections are made into the dermal layer

of skin just below the epidermis. Small volumes,
usually 0.1 mL, are injected. The absorption from
intradermal sites is slow, thereby making it the route
of choice for allergy sensitivity tests, desensitization
injections, local anesthetics, and vaccinations.
EQUIPMENT
• Medication to be injection
• Tuberculin syringe with 26-gauge, ¼ inch, or 28 gauge, ½ inch
needle, or a special needle and syringe for allergens
• Metric ruler, if performing skin testing procedure
• Gloves
• Antiseptic alcohol wipe
• Prescriber’s order
 SITES
• Intradermal injections may be made on any skin surface,
but the site should be hairless and receive little friction
from clothing. The upper chest, the scapular areas of the
back, and the inner aspect of the forearms are the most
commonly used areas.
TECHNIQUE
1. Follow the procedure protocol
2. Verify the identity of the patient using two identifiers. Check with the patient before
starting the test to ensure that he or she has not taken any antihistamines.
3. Provide for patient privacy. Cleans the selected for testing thoroughly
4. Two methods can be used to administer the allergenic testing. One method requires
the intradermal injection of the allergens, the other is completed by using the skin
prick method.
 INTRADERMAL INJECTION METHOD
1.Perform hand hygiene, and apply clean gloves.
2.Prepare the designated solutions for injection using the
aseptic technique.
3.Insert the needle at a 15-degree angle with the needle
bevel upward
4.Do not reuse the needles.
 SKIN PRICK TEST METHOD

1. Perform hand hygiene, apply clean gloves.

2. Make a grid, at least four squares.
3. Place a drop of each allergen in one of the grid squares of the testing site.
4. Using a lancet with a 1-mm point, prick the skin through the allergen drop.
5. Gently blot the excess allergen off of the site.
6. The skin prick test can be read 10 to 20 minutes after the administration
7. Remove the gloves and dispose it
8. Chart the times, agents, concentrations, and amounts administered.
9. Follow the directions regarding the time of the reading of the skin testing being performed.
DOCUMENTATION
Provide the right documentation of the medication
administration and the patient’s responses to the drug.
1.Chart the date, time, and drug name.
2.Perform a reading of each site after the application
3.Chart and report any signs and symptoms.
4.Perform and validate essential patient education.
• The following is a list of commonly used reading of reactions and their appropriate
symbols:
•
• + (1+) No wheal, 3-mm
• ++ (2+) 2 to 3-mm wheal
• +++(3+) 3 to 5-mm wheal
• ++++(4+) >5-mm
•
• Generally, a positive reaction to delayed hypersensitivity skin testing requires an
induration of at least 5-mm in diameter.
SUBCUTANEOUS ROUTE
• Subcutaneous injections are made into
loose connective tissue between the
dermis and muscular layer. Absorption is
slower and drug action is generally longer.
EQUIPMENT
• Medication to be injected
• Syringe size= corresponds with the volume of the drug to
be injected.
• Needle Length
• Needle Gauge
SITES

• Common sites used for the subcut

injections are upper arms, anterior thigs,
and the abdomen. The less common are
the buttocks and the upper back or
scapular region.
 TECHNIQUE
1. Follow the procedure protocol
2. Verify the identity of the patient using 2 identifiers.
3. Check the drug accuracy
4. Consult the master rotation schedule for the patient so that the drug is administered at the correct site.
5. Explain carefully to the patient what to expect.
6. Provide for client privacy.
7. Apply clean gloves
8. Expose the selected site
9. Cleans the skin surface
10. Allow the area to air-dry
11. View the site of injection and length of the needle.
METHOD

1.Insert the needle quickly at 45 to 90-degree angle

2.Withdraw the needle
3.Do not recap any needles that have been used
4.Remove and dispose the gloves.
PATIENT TEACHING

• Perform appropriate patient teaching as described

in the related drug monographs.
DOCUMENTATION

Provide the right documentation of the medication

administration and the patient’s responses to the drug.
1. Chart the date, time, and drug name.
2. Perform and record regular patient assessments for the
evaluation
3. Chart and report any signs and symptoms.
4. Perform and validate essential patient education.
INTRAMUSCULAR ROUTE
• Intramuscular injections are made by
penetrating a needle through the epidermis,
dermis and the subcutaneous tissue into the
muscle layer. The injection deposits the
medication deep within the muscle mass.
EQUIPMENT

• Medication to be injected
• Syringe size= corresponds with the volume of the
drug to be injected.
• Needle Length
• Needle Gauge
SITES

• Vastus Lateralis Muscle

• Rectus Femoris Muscle
• Gluteal Area
• Ventrogluteal area
• Dorsogluteal area
• Deltoid muscle
SITE ROTATION

• A master plan for site rotation should

be developed and used for all patients
who require repeated injections.
 TECHNIQUES
1.Follow the protocol
2.Verify client identity
3.Check the drug accuracy
4.Check the institutional policy
5.Consult the master rotation schedule
6.Explain the procedure carefully to the client.
7.Provide for the patient’s privacy.
8.Apply clean gloves
1. Cleanse the skin surface
2. Allow the area to air-dry
3. Using the nondominant hand, spread the skin and hold down the subcut tissue away
and allow the greater needle penetration.
4. Insert the needle at a 90 degree angle
5. Inject the medication using gentle and steady pressure
6. After removing the needle, apply gentle pressure to the site.
7. Do not recap any needles that have been used.
8. Apply a small bandage to the site.
9. Provide emotional support to the patient.
10.Remove gloves and perform hand hygiene.
PATIENT TEACHING

•Perform appropriate patient

teaching as described in related
drug monographs.
DOCUMENTATION

Provide the right documentation of the medication

• Chart the date, time, and drug name.
• Perform and record regular patient assessments for the
evaluation
• Chart and report any signs and symptoms.
• Perform and validate essential patient education.
 Z-TRACK METHOD
1. Provide client privacy
2. Apply clean gloves
3. Expose the ventrogluteal site
4. Calculate and draw up the medication
5. Position the patient
6. Stretch the patient’s skin approximately 1 inch to one side
7. Insert the needle
8. Gently inject the medication
9. Remove the needle and allow the skin to return to its normal position
10. Do not massage the injection site
11. If further injection are to be made, alternate among sites.
12. Do not recap any needles.
13. Remove gloves and dispose them
14. Walking will help with the medication’s absorption.