PPD

[gReeNTwin1, BSN, RN]

Hello nurses!

Quick question: I was taught in nursing school that the left forearm is the standard for PPD, although you may administer in right forearm if for some reason you can't use left for some reason.

Is this true? I'm asking because I said this to an LPN today, and she stated that she never heard/was taught this? Clarification, anyone.?

[Farawyn]

I worked in Employee Health for 5 years and gave multiple PPDs daily, and I've never heard this.

What is the rationale?

[gReeNTwin1, BSN, RN]

Well, from my understanding....

If the left arm is the standard, in the event an individual didn't circle it (like our protocol is at the hospital), then you would automatically check the left forearm, because that is the "standard"...

[Rose_Queen, BSN, MSN, RN]

Never heard of it. When my employer does it, they do like to put it on the same place on everyone (with the exception of us OR peeps who need it on upper arm due to scrubbing) just so that they know where it was done.

[Farawyn]

????

We don't circle it anymore. It's either there or not.

I usually used the non dominant arm, or the arm without the mastectomy, or the arm without the AV fistula, or the arm without the sleeve of tats...

[gReeNTwin1, BSN, RN]

Oh, ok. Gotcha. Just wondering. I've Googled a few things, and it seems to be more of a facility policy thing than anything.

Thanks for you guys quick responses! :)

[Extra Pickles]

I've given lots of them and where I worked we always used the left forearm unless there was a reason not to, like tattoo that covered the entire arm, or the arm wasn't there! History of mastectomy doesn't have anything to do with it, so not a reason to not put it there. Don't think I've ever had to put one on someone with a fistula, but if I did, I'd switch to the other arm! But we did normally place it on the Left arm first only so that it didn't matter who was reading it, we all knew to immediately look at the left arm first, and the documentation form was already pre-filled with Left forearm. We just made a change to the form if we had to change arms. No biggee :)

[CelticGoddess, BSN, RN]

I have had it placed in my right arm and my left arm. As it was documented which arm the PPD was administered, it isn't a problem to figure out which arm to check when due. Honestly it all depended on what side of the room the desk was. If my right arm is resting on the desk, they use the right arm and if my left, well you get the picture.

[Farawyn]

I've given lots of them and where I worked we always used the left forearm unless there was a reason not to, like tattoo that covered the entire arm, or the arm wasn't there! History of mastectomy doesn't have anything to do with it, so not a reason to not put it there. Don't think I've ever had to put one on someone with a fistula, but if I did, I'd switch to the other arm! But we did normally place it on the Left arm first only so that it didn't matter who was reading it, we all knew to immediately look at the left arm first, and the documentation form was already pre-filled with Left forearm. We just made a change to the form if we had to change arms. No biggee :)

No, the mastectomy does not, but I find breast cancer survivors like to avoid the arm anyway.

[Extra Pickles]

Farwyn yes that does make sense :) Maybe it never came up as an issue for me before? I have had people point out a freckle or tiny scratch and tell me that mark isn't where the PPD was placed. LOL I know that! If I can't tell a scratch or freckle from PPD+ I think I should hang it up LOL!

[amoLucia]

Had a pt who had bilateral casts on his arms up to his arm pits. I was asking the same question.

So I called the State Tuberculosis Epidemiology office (or some such title). The guy was rather rude as he snippily commented "skin is skin". I could give it wherever.

I don't remember where I wound up giving it - I'm thinking inner thigh just above his knee.

[xoemmylouox, ASN, RN]

I've never heard of the left arm thing either. I'm guessing it's a facility policy.