OSCE: Intradermal Injection (ID)

Intradermal injection

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Objectives and Key Competencies:

• Demonstrate correct intradermal injection technique.

• Identify potential errors in the procedure.

• Address the "Rights of Medication Administration."

Steps for Intradermal Injection:

1. Patient Preparation:

   • Right Client: Introduce yourself, verify patient identity (name and date of birth).

   • Right Drug: Check and confirm the drug name.

   • Right Dose: Verify the correct dosage.

   • Right Route: Confirm the route (intradermal injection).

   • Right Time: Ensure the injection is administered at the prescribed time.

   • Right to Refuse: Respect the patient's right to refuse and explain potential consequences of refusal.

   • Right Documentation: Record the administration details accurately.

2. Indications for Procedure:

   • Skin allergy testing.

   • Tuberculin skin testing.

   • Xylocaine sensitivity testing.

   • Local anesthesia administration.

   • Specific vaccinations.

3. Contraindications:

   • Active skin infections.

   • Erythema or swelling at the site.

4. Complications:

   • Immediate severe allergic reactions.

   • Abscess formation.

   • Keloid scars (e.g., BCG vaccination).

5. Precautions:

   • Follow universal precautions, including hand hygiene.

   • Ensure sterile technique throughout the procedure.

Procedure:

1. Site Selection:

   • Preferred areas include:

     • Anterior forearm.

     • Upper back below the scapula.

     • Posterior arm.

     • Upper chest just below the clavicle.

   • Ensure the site is free of infection or irritation.

2. Positioning:

   • Position the patient comfortably in a sitting or supine position.

3. Preparation of Equipment:

   • Use a 26-gauge, half-inch needle.

   • Prepare the drug as per protocol.

4. Site Cleaning:

   • Clean the site with alcohol in a circular motion, starting at the center and moving outward.

5. Injection Technique:

   • Stretch the skin taut.

   • Insert the needle at a 5-15° angle into the dermis.

   • Slowly inject the solution, ensuring a raised wheal forms, indicating proper intradermal placement.

6. Post-Injection Care:

   • Remove the needle in the same angle of insertion.

   • Avoid pressing or massaging the site.

   • Observe the patient for adverse reactions.
     

Evaluation Criteria:

Step	Correct	Partially Correct	Not Performed
Patient Identification	✅	⚠️	❌
Drug Verification	✅	⚠️	❌
Skin Preparation	✅	⚠️	❌
Injection Technique	✅	⚠️	❌
Documentation	✅	⚠️	❌

Important Reminders:

• Accurate technique is validated when a wheal forms after injection.

• Avoid areas with swelling, redness, or irritation.

• Monitor for immediate allergic reactions, providing emergency care if necessary.