Chapter 15: Medicines optimization: ensuring quality and safety
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Intradermal injection
Definition
An intradermal injection is given into the dermis of the skin just below the epidermis, where the blood supply is reduced and drug absorption can occur slowly (Chernecky et al. [39]). The intradermal route provides a local rather than systemic effect and is used primarily for administering small amounts of local anaesthetic and skin testing, for example allergy or tuberculin testing (Perry [281]).
Evidence‐based approaches
Observation of the skin for an inflammatory reaction is a priority, so the best sites are those that are lowly pigmented, thinly keratinized and hairless. The inner forearms and the scapulae are commonly chosen. The injection site most commonly used for skin testing is the medial forearm area, as this allows for easy inspection (Downie et al. [82]). Volumes of 0.5 mL or less should be used (Chernecky et al. [39]).
Pre‐procedural considerations
Equipment
These injections are best performed using a 25 or 27 G needle inserted at a 10–15° angle, bevel up, just under the epidermis. Usually a tuberculosis or 1 mL syringe is used to ensure accuracy of the dose.
Procedure guideline 15.16
