Quick question about a Mantoux plant....

[42pines]

I'm about to do a Mantoux plant, and the last one I did was on a hot dog back in nursing school in 2002.

Now I've done thousands of IM and SubQ's so I'm not fearful...and know the procedure and well, the hot dogs never complained so...

The quick question:

The up bevel needle enters the upper skin layer at 5-15 degree angle, ok. But how far does the needle penetrate? (Note I'm not asking how deep, I know that) But do you insert the bevel + 1mm or perhaps 5 or 6 mm?

I'd hate to insert it too short and have it ooze back out requiring a second plant.

[Esme12, ASN, BSN, RN]

From the CDC website.......

The Mantoux tuberculin skin test is an intradermal injection.

With the needle bevel against the patient’s skin, insert it slowly at a 5- to 15-degree angle.

The 5- to 15-degree angle is very important because this layer of skin is very thin.

For an intradermal injection, the needle bevel is advanced through the epidermis, the superficial layer of skin, approximately 3 mm so that the entire bevel is covered and lies just under the skin.

The injection will produce inadequate results if the needle angle is too deep or too shallow.

When the needle is inserted at the correct angle you can see the bevel of the needle just below the skin surface. Next, release the stretched skin and hold the syringe in place on the forearm.

Grip the flange of the syringe between your first and middle fingers. Use your thumb to press on the plunger.

Now, slowly inject the tuberculin solution. You should feel fairly firm resistance as the tuberculin enters the skin. A tense, pale wheal that’s 6 to 10 mm in diameter appears over the needle bevel. Remove the needle without pressing or massaging the area.

Next, discard the used syringe immediately in the designated puncture-resistant container.

If you’re using a safety needle, engage the safety-needle mechanism before discarding.

To prevent needlestick injuries, used needles should not be recapped, purposely bent or broken, removed from disposable syringes, or otherwise manipulated by hand.

It’s not unusual for a drop of blood to appear at the injection site, even when the needle is inserted properly.

Should this happen, lightly blot the blood away with a 2x2 gauze pad or cotton ball. Do not cover the site with an adhesive bandage because the adhesive could cause irritation and interfere with the test. Properly dispose of the contaminated gauze pad. To determine if the skin test was administered properly, use the millimeter ruler to immediately measure the wheal at its maximum size.

The wheal should be at least 6 mm in diameter.

If the wheal is less than 6 mm in diameter, then the test should be administered again.

The needle bevel may have been inserted too deeply or an inadequate dose administered.

If leakage occurs at the insertion site, the needle bevel may not have been inserted far enough for the bevel to be covered by the skin.

If the tuberculin test must be repeated, use another site at least 2 inches, or 50 mm, from the original site. Or use the standard alternate placement site. You will need to indicate this alternate site when you fill out the record keeping forms.

The final step in administering the Mantoux tuberculin skin test includes washing your hands, recording information, reminding the patient about the return visit, providing patient education, and returning the vial to the refrigerator.

In this step, immediately and thoroughly wash your hands.

This step also includes recording information on the patient’s chart and other record-keeping forms. Write the date and the time the test was administered, the name and manufacturer of the injected solution, the lot number, the tuberculin dose administered, the expiration date, the forearm or alternative site in which the injection was given, the site location if you repeat the test, the name of the person who administered the test, and the reason for giving the skin test.

CDC | TB | Mantoux TB Skin Test Faciliator Guide - Part 1: Administering