The choice of which of the parenteral routes to use is determined by
the prescriber based on the nature of the medication, the desired onset of the
therapeutic effect, and the patient’s needs. For example, the test for TB is per-
formed by injecting the purified protein derivative intradermally, which is
under the skin. Insulin is injected subcutaneously, although regular insulin
can also be administered intravenous. Medications administered intravenously
have a faster onset of therapeutic effect than other parenteral routes. Vacci-
nations, some antibiotics, and other medications are injected intramuscularly.
INTRADERMAL
Intradermal injections are given in hairless areas of the body that are lightly pig-
mented and thinly keratinized so that the nurse can observe any reaction to the
medication. These are:
- Inner aspect of forearm or scapular area of back.
- Upper chest.
- Medial thigh sites.
Medication injected intradermally has a localized effect because it does
not enter the bloodstream. It usually causes a wheal (blister) to appear at the
injection site. Injections are given using a 26–27 gauge needle and a 1 mL
syringecalibrated in 0.01 mL increments. The typical injection is between 0.01
to 0.1 mL.
Here’s how to administer medication intradermally:
- Check the prescriber’s medication order.
- Wash hands and then put on clean gloves.
- Properly identify the patient.
- Cleanse the area of the site in a circular motion using alcohol or betadine,
depending on the medication and agency policy. - Hold the skin taut.
- Position the bevel up and insert the needle at a 10- to 15-degree angle. You
should be able to see the outline of the needle through the skin. - Inject slowly to form a wheal.
- Slowly remove the needle.
- Don’t massage the area.
- Mark the site with a pen.
- Tell the patient not to wash the mark until a healthcare provider assesses
the site for a reaction between 24 to 72 hours after the injection.
CHAPTER 6 Route of Administration^105