Explain the procedure and obtain consent from the patient
3
Wash your hands and wear protective gloves
4
Choose a suitable site, usually the forearm
5
Clean the injection site with an alcohol swab
6
Prepare the Tuberculin Syringe with PPD solution
7
Inject 0.1 ml of purified protein derivative (PPD) intradermally
8
Make sure the injection has resulted in a wheal or blister
9
Dispose used syringe and gloves in a safe manner
10
Instruct patient to keep the site clean and to avoid scratching the area
11
Schedule a follow-up visit for the patient in 48 to 72 hours
12
Approval: Nursing Supervisor to verify the execution of steps
13
Document the procedure in patient's medical record
14
Review the patient’s forearm after 48 to 72 hours
15
Measure the induration, not redness, in millimeters
16
Interpret the measurement according to the patient’s risk factors
17
Document the result in patient's medical record
18
Inform the patient about the test results
19
Approval: Physician to review induration measurement and interpretation
Verify the patient's identity
Confirm the patient's identity by checking their identification credentials or asking for their personal information. This task is crucial to ensure that the correct individual is receiving the PPD test. Verify their full name, date of birth, and any other identifying details mentioned in their medical record.
Explain the procedure and obtain consent from the patient
Provide a detailed explanation of the PPD test procedure to the patient, including its purpose, potential side effects, and any discomfort they may experience. Obtain informed consent from the patient to proceed with the test. Address any concerns or questions they may have to ensure they fully understand and consent to the procedure.
Wash your hands and wear protective gloves
Thoroughly wash your hands using soap and water for at least 20 seconds. Dry your hands properly and put on a pair of disposable protective gloves. This step is crucial to maintain a high level of hygiene and prevent the spread of infection during the PPD test procedure.
Choose a suitable site, usually the forearm
Select an appropriate site on the patient's body for the PPD injection. The usual location is the forearm, as it provides a flat and easily accessible area for administration. Ensure the chosen site is free from any rashes, open wounds, or other skin conditions that could interfere with the test results.
1
Forearm
2
Upper arm
3
Thigh
4
Upper back
5
Lower back
Clean the injection site with an alcohol swab
Take an alcohol swab and clean the chosen site for PPD injection. Rub the swab in circular motions over the area for at least 10 seconds to ensure proper disinfection. This step helps reduce the risk of introducing any contaminants or bacteria into the injection site.
Prepare the Tuberculin Syringe with PPD solution
Assemble the Tuberculin Syringe by attaching the appropriate needle. Draw 0.1 ml of purified protein derivative (PPD) solution into the syringe, ensuring accurate measurement. Take precautions to prevent any air bubbles in the syringe, as it may affect the accuracy of the injection.
Inject 0.1 ml of purified protein derivative (PPD) intradermally
Using the prepared Tuberculin Syringe, administer the 0.1 ml PPD solution intradermally at the chosen site. Insert the needle at a shallow angle, just beneath the surface of the skin, and slowly inject the solution. Take care to avoid piercing any blood vessels or causing excessive pain to the patient.
Make sure the injection has resulted in a wheal or blister
Observe the injection site for the appearance of a raised wheal or blister, which indicates a proper intradermal injection. The formation of a small raised area is an expected response and signifies the correct administration of the PPD solution. Note any abnormalities or unexpected reactions in the form field below.
1
Wheal
2
Blister
3
Redness
4
No reaction
5
Other
Dispose used syringe and gloves in a safe manner
Properly dispose of the used Tuberculin Syringe and protective gloves to ensure safe disposal and prevent cross-contamination. Dispose of the syringe in a designated sharps container and discard the gloves in a biohazard waste bin. Follow the established protocols for medical waste management.
Instruct patient to keep the site clean and to avoid scratching the area
Advise the patient to keep the injection site clean and dry to prevent infection or complications. Instruct them to refrain from scratching, touching, or irritating the site unnecessarily. Provide any necessary additional instructions regarding wound care, hygiene, or potential side effects.
1
Clean the site with mild soap and water daily
2
Avoid applying any creams or lotions to the site
3
Do not scratch or pick at the injection site
4
Avoid excessive sweating or water exposure to the site
5
Contact healthcare provider if any unusual symptoms occur
Schedule a follow-up visit for the patient in 48 to 72 hours
Schedule a follow-up appointment for the patient to review the PPD test results. Ideally, this appointment should be within 48 to 72 hours after the test administration. Provide the patient with the necessary information regarding the date, time, and location of the follow-up visit.
Approval: Nursing Supervisor to verify the execution of steps
Will be submitted for approval:
Verify the patient's identity
Will be submitted
Explain the procedure and obtain consent from the patient
Will be submitted
Wash your hands and wear protective gloves
Will be submitted
Choose a suitable site, usually the forearm
Will be submitted
Clean the injection site with an alcohol swab
Will be submitted
Prepare the Tuberculin Syringe with PPD solution
Will be submitted
Inject 0.1 ml of purified protein derivative (PPD) intradermally
Will be submitted
Make sure the injection has resulted in a wheal or blister
Will be submitted
Dispose used syringe and gloves in a safe manner
Will be submitted
Instruct patient to keep the site clean and to avoid scratching the area
Will be submitted
Schedule a follow-up visit for the patient in 48 to 72 hours
Will be submitted
Document the procedure in patient's medical record
Record the details and specifics of the PPD test procedure in the patient's medical record for future reference and documentation purposes. Include information such as the date and time of the procedure, the patient's vital signs, any complications or unusual observations, and other relevant data as required by the medical institution's protocols.
Review the patient’s forearm after 48 to 72 hours
Examine the patient's forearm, specifically the PPD injection site, after the recommended 48 to 72 hour waiting period. Look for any changes or reactions, such as redness, swelling, or discomfort. Ensure appropriate lighting and documentation tools are available to accurately assess and document the results.
Measure the induration, not redness, in millimeters
Using a millimeter ruler or caliper, measure the area of induration, which is the raised and hardened skin around the injection site. Measure only the induration and avoid including redness or swelling in the measurement. Record the measurement accurately in millimeters.
Interpret the measurement according to the patient’s risk factors
Consider the patient's risk factors, such as age, previous exposure to tuberculosis, and immune status, to interpret the induration measurement accurately. Review guidelines or reference materials to determine the significance of the measured induration based on the patient's specific risk factors. Record the interpretation in the form field below.
1
Positive
2
Negative
3
Borderline
4
Requires further evaluation
5
Inconclusive
Document the result in patient's medical record
Record the interpretation of the induration measurement and the overall result of the PPD test in the patient's medical record. Include the measurement value, the interpretation, and any relevant clinical notes or recommendations. Ensure accuracy and clarity in documenting the result for future reference and continuity of care.
Inform the patient about the test results
Communicate the PPD test results to the patient in a clear and compassionate manner. Explain the interpretation of the result, provide any necessary education on tuberculosis, and discuss the implications or next steps based on the result. Address any questions or concerns the patient may have regarding the test outcome.
Approval: Physician to review induration measurement and interpretation
Will be submitted for approval:
Review the patient’s forearm after 48 to 72 hours
Will be submitted
Measure the induration, not redness, in millimeters
Will be submitted
Interpret the measurement according to the patient’s risk factors
