Reading TB skin test

JaceyRN, BSN · Feb 21, 2005

i think they are the ones that are confused. most positive tb skin tests should have some induration. even redness doesn't necessarily count. they should feeling for any hardness or swelling. are they feeling or just looking?when i have gotten them, i usually have some redness that goes away. if you are concerned, what about going to your local health dept and getting them to do it. good luck :)

jacey

SharonH, RN · Feb 21, 2005

If there's no induration, there is nothing to record. A bruise or redness doesn't count. And to tag on to what Jacey said, why are they reading it positive at 4mm? Obviously I don't know your husband's entire health history but most people are not read as positive until they are 5mm anyway and that's if you have a lot of additional risk factors. Someone like myself would not be read as positive until I was 15mm. I would take him to the health dept before I let them do anything more.

ICUsleep · Feb 21, 2005

I agree...have your hubby go elsewhere. Once he has a negative PPD reading (sounds like he will be neg.), bring that paperwork back to your MD's office and explain that they may need to train or re-train some of the people reading PPDs there. :rolleyes:

CoffeeRTC, BSN, RN · Feb 21, 2005

We just went thru this at work. :uhoh3:

YOu should feel first, then look. On the back of our forms it clearly spells out a positve and negative reaction.. I think it has to be over 10 mm with other conditions...Make them have a doctor read it.

TMPaul · Feb 21, 2005

I am very very frustrated with my husband's "nurse" at the MDs office right now. We are trying to get him on Remicade for Crohn's, and that involves having the PPD done.
First PPD they said was 4mm. I had already been watching it at home--it has a small blue bruise around the insertion site, but there was no redness, no hardness, no swelling. They recorded it at a positive PPD.
Second PPD (today) was completely flat, no bruise, just a tiny dot where the needle had gone in. They read this one as 2mm. WTH? They are going to prevent him from being able to get Remicade because they can't read a PPD properly.
Or am I just an idiot and I don't know how to read one?

I'd go to the local Health Department and have it re done by people who know how to plant them as well as read them. :) I work Occupational Medicine as a Nurse Practitioner and can't tell you how many times I've seen that happen. It just causes a lot of unnecessary worry. :angryfire

CCL"Babe", BSN, RN · Feb 21, 2005

If there was a bruise, it needs to be redone. There should be no bruising, that means that the test was not done correctly and the results are invalid.

tatt25 · Feb 6, 2006

I agree with you totally. I had a Tb done last Wed. and when I went back for my reading, I pulled my sleeve up and the nurse said " It's Positive", she didn't feel it until we went in the back, it was a little red like a rash but no visible bump, lump, nothing. Then she took a pen and marked the red area and measured the rash looking area. I have a lot of friends at the place and 4 of her co workers looked @ it and said it was negative, my friend who is a LPN said it was negative, I went back today to see if I could get another one done because of all the others opionions and she said no, I work with children in Headstart and need some advice on steps to take. I know she was wrong and I would hate for this to happen to someone else.

TazziRN, RN · Feb 6, 2006

I agree with you totally. I had a Tb done last Wed. and when I went back for my reading, I pulled my sleeve up and the nurse said " It's Positive", she didn't feel it until we went in the back, it was a little red like a rash but no visible bump, lump, nothing. Then she took a pen and marked the red area and measured the rash looking area. I have a lot of friends at the place and 4 of her co workers looked @ it and said it was negative, my friend who is a LPN said it was negative, I went back today to see if I could get another one done because of all the others opionions and she said no, I work with children in Headstart and need some advice on steps to take. I know she was wrong and I would hate for this to happen to someone else.

You can go elsewhere and request another one...a clinic, urgent care, or better yet, the public health dept. If you truly are positive you need to report to public health anyway, so they would understand your desire to have it redone by the ones who really know how to plant one.

GooeyRN, ADN, BSN, CNA, LPN, RN · Feb 6, 2006

That is a negative result. I had a positive result. Believe me, you would know it if it were positive! She shouldn't be looking at the redness at all. That means nothing! It's positive when there is induration of 10+.

MajorAl · Feb 6, 2006

You absolutely need to have it redone by someone who knows what they are doing. I converted several years ago and the induration was more than 10 mm. Since I work with people who have been found not guilty of a crime by reason of mental disease, I come under the stricter guidelines for those working with prisoners. 4 mm of induration is negative in everyone, at least in the state of Wisconsin. I had a friend whose whole arm turned red from the shot, but he was negative. Good Luck.

Larry77, RN · Feb 6, 2006

At the hospital I work in the reading of our PPD tests are sort of a joke for us nurses because we as RN's are not allowed to read these tests on employees we are required to go to a clinic and have it read by the secretary (it's possible that she is a MA but certainly not an LPN or RN).

I would tell them fine you think it's positive let's do a chest x ray to make sure that he doesn't have TB and lets start the Remicade thank you.

I looked into the drug a little bit and the recommendations are to use it "cautiously" in pt's with a hx of TB or exposure to TB. This tells me that it's up to the MD's discretion if he wants to use Remicade with your husband.

I like the idea of going to the health department and having another nurse read another PPD test. BTW if the first PPD was truly positive they should NOT have done a second one. Once you have a positive PPD you should never have another PPD again because the reaction gets worse each time.