A police officer brings in a homeless client to the ER. A chest x-ray suggests he has TB. The physician orders an intradermal injection of 5 tuberculin units/0.1 ml of tuberculin purified derivative. Which needle is appropriate for this injection?
A. 5/8” to ½” 25G to 27G needle.
B. 1” to 3” 20G to 25G needle.
C. ½” to 3/8” 26 or 27G needle.
D. 1” 20G needle.
Correct Answer: C. ½” to 3/8” 26 or 27G needle.
Intradermal injections like those used in TN skin tests are administered in small volumes (usually 0.5 ml or less) into the outer skin layers to produce a local effect. A TB syringe with a ½” to 3/8” 26G or 27G needle should be inserted about 1/8” below the epidermis.
Option A: For neonates (first 28 days of life) and preterm infants, a 5/8″ needle is recommended if the skin is stretched flat between the thumb and forefinger and the needle is inserted at a 90-degree angle to the skin.
Option B: The deltoid muscle is most often used as the site for IM injections in adults. Needle length is usually 1″–1½”, 22–25 gauge, but a longer or shorter needle may be needed depending on the patient’s weight. An alternate site for IM injection in adults is the anterolateral thigh muscle. The needle length and gauge are the same as when the deltoid muscle is used, i.e., 1″–1½” length, 22–25 gauge.
Option D: For adults weighing less than 130 lbs (60 kg), use of a 1” needle is recommended. However, a 5/8″ needle may be used for IM injection in the deltoid muscle if the fatty tissue overlying the deltoid muscle is flattened (i.e., not bunched between thumb and fingers during the injection) and the needle is inserted at a 90-degree angle to the skin.
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