Intradermal injection- Introduction, procedure,complications

Presented by Ganga Tiwari, BSc. Nursing Fourth Year, TU,IOM,MNC, Kathmandu, Nepal

1. INTRADERMAL INJECTION Presented by: Ganga Tiwari Bsc . Nsg 4 th year, Teaching Learning TU, IOM, MNC, Kathmandu, Nepal

2. Contents Introduction of intradermal injection Purposes Common sites Article required Procedure C omplications

3. Contents.. Introduction of intravenous injection Purposes Types of intravenous administration Articles required Procedure for intravenous bolus administration .

4. Intradermal injection The intradermal injections are administered into the dermis, just below epidermis. Intradermal routes has longest absorption time of all parenteral route.

5. Intradermal injection.

6. Dose: Less than 0.5 ml Mantoux test 0.1 ml BCG 0.05 ml Angle of injection: 5 to 15 degrees.

7. Common sites Inner surface of the fore arm. Upper arm Upper back under the scapula. Upper chest just below the clavicle.

8. Common sites

9. Articles required: Medication tray containing cardex Medicine (ampule or vial) syringe( tuberculin syringe/ BCG syringe) and needle(26-27 gauge) sprit swab Disposable gloves Kidney tray Ampule cutter or opener

10. P rocedure Check the physician’s instructions and identify the patient. Explain the procedure to the patient. Wash hands Arrange necessary articles. Check medication against the cardex before preparing the medication. Prepare the medication from ampule or vial.

11. Procedure.. Maintain privacy Position the patient comfortably and locate the sites for intradermal injection . Asses the area for any scars, tenderness, tattoo , lesions, abscess etc. Assemble the necessary articles at patient’s bed site . Wear disposable gloves.

12. Procedure.. Clean the site with spirit swab in a firm circular motion (about 5 cm) and moving outward from the injection site Allow skin to dry. In case of live vaccine (BCG Vaccine) do not clean the area with spirit swab, it may interfere with the viability of the vaccine. So clean the area with sterile water swab.

13. Procedure.. Remove the cap with non-dominant hand to spread skin taut over injection site. Grasp the syringe in dominant hand holding in between thumb and fore finger. Place the needle almost against the patient skin at 5 -15 degree angles and insert the needle into the skin with the bevel site up so that needle can be seen through the skin. Insert 1/8 inch of the needle.

14. Procedure.. Slowly inject the drug, watching for a bleb / wheal or blister to develop. If not present withdraw the needle slightly and inject the medication. Withdraw needle quickly in the same angle as it was inserted. Don’t massage . Don’t recap the needle. Discard the needle and syringe in puncture proof container.

15. Procedure.. Assist patient in comfortable position. Draw a circle using blue or black pen in injection area. Remove gloves and dispose them properly. Wash hands. Record and report the medication administration.

16. Health teaching Do not massage or scratch the injection site. Do not put anything on injection site oil, soap, powder etc. Keep the area clean and dry.

17. Health teaching.. Avoid putting bandage, lotions and cream to the injection site . If water spills in the injection site it is not harmful but do not wipe or scrub the area. I nform patient about the reading of mantoux and sensitivity test.

18. C omplications Abscess Tenderness Itching Irritation Severe immediate allergic reactions. Redness Keloid scar formation in case of BCG vaccination

19. Redness

20. A bscess

21. Keloid Scar

22. References Health learning material center. Institute of medicine of medicine , Tribhuwan University.Fundamentals of nursing ( second edition reprint ,2010). Kathmandu:Heidal Press , Dillibazar . Basvanthappa,B.T . (2004 ). Fundamentals of Nursing. New Delhi : Jaypee Brothers. Perry, A.G. and Potter, P.A. (2007).Basic Nursing Essentials For Practice .(sixth edition): Mosby Giri , M. and Sharma,P . (2013). Essential Fundamental Of Nursing.(first edition).Kathmandu: Medhavi Publication .

23. References Pathak , S.and Devkota ,R.(2011).A Textbook of Fundamentals of Nursing.(second edition). Kathmandu:Vidyarthi Prakashan . Taylor,C.R . and Lillis,C .(2008). Fundamental of Nursing.(Volume1):Lippincott William and Willikins Skidmere ,L . Nursing Drug Reference(2009): Mosby

24. THANK YOU!!