ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque, Extension, Roxas City 5800, Capiz, Philippines
Member, DC-SLMES, DC-SLMHS Philippines
INTRADERMAL OR INTRACUTANEOUS INJECTION
Name: _____________________________________________ Date: ___________ Score: ________
Year and Section: ______________________ Time Started: ___________ Time Ended: _________
Scoring for Graded Return Demonstration
SCORE INTERPRETATION CRITERIA FOR SCORING
5 DONE ALL CRITERIA Performed the procedures correctly.
4 DONE AT LEAST 4 CRITERIA Performed the procedures in a systematic & organized
3 DONE AT LEAST 3 CRITERIA manner.
2 DONE AT LEAST 2 CRITERIA States rationales/principles correctly.
1 DONE AT LEAST 1 CRITERIA States the definition, purposes & special considerations
0 NOT DONE of the activity/procedure.
Finished within specified time.
PROCEDURE 5 4 3 2 1 0 REMARKS
1. Verify physician’s order.
2. Identify the client, explain the procedure and note for
allergies.
3. Select appropriate syringe, needle and prepare other
needed materials.
4. Perform hand hygiene and put on clean gloves.
5. Remove the protective cap, or clean the rubber cap of a
previously opened vial with an aseptic wipe by rubbing in
a circular motion.
6. Attach a withdrawing needle to the syringe and ensure that
it is firmly attached to the syringe.
7. Remove the cap from the needle then draw up into syringe
the amount of air equal to the volume of the NSS to be
withdrawn.
8. Carefully insert the needle into the upright NSS vial
through the center of the rubber cap, maintaining the
sterility of the needle.
9. Inject the air into the NSS vial, keeping the bevel of the
needle above the surface of the NSS solution.
10. Withdraw the prescribed amount of NSS by inverting the
vial, ensuring the needle tip is below the fluid level, and
gradually withdrawing the NSS.
11. Hold the syringe and the vial at eye level to determine that
the correct dosage of drug is drawn into the syringe.
12. When the correct volume of medication is obtained,
withdraw the needle from the NSS vial, and replace the
cap over the needle using the scoop method, thus
maintaining the sterility.
13. Flick the upper stem of the ampule several times with a
fingernail.
14. Place a piece of sterile gauze between your thumb and the
ampule neck or around the ampule neck, and break off the
top by bending it toward you to ensure the ampule is
broken away from yourself and away from others.
15. Dispose the top of the ampule in the container from
disposal.
16. Place the ampule in a flat surface.
17. Remove the cap from the withdrawing needle and insert
the needle into the center of the ampule. Do not touch the
rim of the ampule with the needle tip or shaft.
18. Withdraw the amount of drug required for the dosage by
inverting the ampule.
19. Withdraw the needle from the ampule and replace the cap
over the needle using the scoop method, thus maintaining
the sterility.
20. Mix the solution by rotating the syringe between the palms
of the hands.
21. Change the needle on the syringe with the appropriate
gauge.
22. Invert the syringe with needle uppermost and expel excess
air.
23. Position the patient in maximum comfort, and provide
privacy.
24. Select the correct injection site and expose the skin of the
puncture site.
25. Disinfect the infection site with antiseptic wipe using
circular motion working from inner to outer to about 5cm
(2”). Allow the site to dry thoroughly.
26. Position the syringe at 10-15 degree angle with the bevel
of the needle facing up.
27. Insert the tip of the needle through epidermis into the
dermis. The outline of the needle should be visible under
the skin surface.
28. Stabilize the syringe and needle with your non-dominant
hand by holding the needle hub and inject the medication
carefully and slowly until a small wheal on the skin is
formed.
29. Remove the needle gently at the same angle it was
inserted.
30. If blood appear at the puncture site, pat it with dry cotton
balls.
31. Trace the wheal using black ink and indicate the time
when it will be due for reading and evaluation.
32. Discard uncapped needle and syringe into its appropriate
receptacle and clean work area.
33. Ensure patient’s safety and comfort.
34. Remove gloves and wash hands.
35. Document the date, time, route and site of injection and
the name and dosage of medication.
36. Observe the patient for local and systemic reaction and
refer accordingly.
COMMENTS:
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Student’s Signature Clinical Instructor’s Name and Signature
