How to give a intradermal injection correctly?

Some blood vessel disruption happens with subcutaneous (intradermal) injections from time to time.

That said,.. practice makes perfect. This is why you are doing this. Some people will 'get' it faster than others.. some students are just born naturals with subcutaneous injections, intramuscular, and more fascinating to me venipuncture for injection or draw.

I remember learning this myself and initially I had some self-doubt with my proficiency with venipuncture (I know you are specifically discussing intradermal.. but the theory applies). Other fellow students would be able to find veins practically anywhere in others arms, hands, legs, etc -- on the first try, every time, and I could not see what they were seeing. I could not understand how some of these people were able to instantly able to angle a needle smoothly into all of these veins that on some people you visually just couldn't. While I , initially, felt a little bad because I were making some of my 'friends' virtual pincushions in practice. I had my anatomy at the time visualized very well but it still baffled me.

Others were like me.. and some worse of course. Point is, some people just have a natural knack (for lack of a better word) for such visualization and hand/eye coordination and technique. Bottom line, however, is with practice I (and everyone else) quickly became very adept in all injections of any type. The hardest to me was obviously venipuncture -- after a while once the confidence built up after X successes that confidence and memory just clicked and it was second nature. It really is all up to practice.

There are VERY few people I have ever witnessed who were unable to become proficient in all needle execution given enough time and encouragement. (Yes, we would practice on each other in sterile environments outside of labs, at our dorms/rooms etc. Though of course it isn't encouraged,.. it is ultimately how many of us became proficient. I'm not suggesting this, just interjecting (no pun intended) the personal experience.)

An intradermal injection has but a few key things that really need to be worked on to prevent bleeding. As the vascular nature of this superficial layer of the skin is made up of very fine capillaries and thus is why your instructor is demanding this type of injection without much if any blood after injection.

First.. relax. Blood vessels are very easy to sheer and cause unnecessary bleeding. So just relax first.. and remember we ALL have a fine tremor to our bodies which is very pronounced in our hands. It is exacerbated by anxiety, nervousness , etc.. but don't expect your hand to be like a robot.

Try not to be too over aggressive with the alcohol swab (pressure wise).

You want to make the skin taut (tight) with your opposing hand at the injection site -- but again you may be overdoing this (or you may not be tightening enough) -- further you may be pushing too far inward, inadvertently, with your opposing hand.

You want to place the needle virtually flat against the patients (or friend, etc) skin, bevel side up.

The key here is you want to insert the needle (of proper gauge) so you can SEE the point of the needle through the skin (generally about an 1/8th of an inch).

While injecting you do want to see a wheal (blister) appear.

Withdraw the needle at the same angle at which it was inserted -- again as flat as you can.

Do NOT massage the area after an intradermal injection.

I'm fairly sure all of these tips you have read and know by heart -- but it bears repeating the things that make the difference in vessel laceration/sheering that is causing the bleeding.

There can only be three reasons there is bleeding after this (in a normal subject)

1) The insertion of the needle (you inserted too quickly.. too slowly.. at an improper angle.. or you are shifting angles while inserting.)

2) After inserting you shift the syringe and as consequence the needle and this causes vascular disruption.

3) Upon removal you remove it too quickly (sometimes too slowly),.. at a different angle than insertion, or as insertion issues you are slightly shifting angles as you remove.)

Generally the shifting of angles (which is slight, and often unnoticeable to the eye) is an action of instability of the hand. Try to focus on getting yourself properly braced where you can make use of your dominant hand (hand with the needle) with precision. There is no 'perfect' technique that makes everyone comfortable with the rest of their body before injection.. so experiment with how the rest of your body is positioned , be mindful of it.

Remember, going to slowly on insertion, or withdrawal can actually be a detriment as fine motor movements like this become less stable if one is TOO slow.

References

• It is a fine motor skill that your brain will eventually adjust to something you do without thinking about it (this is when you actually become the most proficient) -- as with anything like this whether swinging a golf club, or an injection is infinitely harder if you are occupying your conscious mind with a million different things 'not to do' .. and 'things to do'. I hope that makes sense..
• Just be confident you will get it in time,.. and a little tip, your teacher may be great -- but often we can get some things out of our peers that we just don't pick up from our professors. So don't hesitate asking others in your lab/class about it.
• There is also a great deal of psychological workings going on as you are initially trying to figure it out. You will understand just how much confidence and self-assured (ness) help you in the long run.
• Good luck,