Mantoux Tuberculin Skin Testing - Rutgers University



Guidelines and Techniques of Administration

Supplies

* Record keeping forms

* TB syringes and needles (26 gauge steel/27 gauge platinum)

* 5 TU PPD solution - refrigerated at 36-46 degrees (not on refrigerator door to avoid temperature fluctuations)

* Alcohol swabs and cotton balls

* Patient education materials

* Sharps container (needle disposal)

* Appointment cards

* Insulated cool container for mass testing

* Gloves

Preparation

* Determine that you are treating correct patient

* Ask patient if they have any allergies

* Check tuberculin skin testing history

* Select a well-lighted, disturbance-free area for testing

* Explain procedure to patient

* Wash hands

* Obtain skin testing supplies and set up test equipment

Administration of Skin Test (Prepare each syringe prior to each administration)

* Remove vial from refrigerator, read label to insure you have selected correct solution

* Check expiration date and date vial was opened (if you open, date vial)- vial should be discarded after 30 days

* Roll the vial gently back and forth between the palms of both hands to mix antigen - Do not shake vial

* Swab vial top with alcohol

* Check that alcohol-swabbed vial has dried before proceeding

* If using safety needle, twist needle hub into syringe to set needle; remove needle guard

* Pull back on syringe plunger to draw in 0.1cc of air

* Inject air into the empty space, not the solution, in the vial

* Draw in slightly more than 0.1cc of solution into syringe

* Hold syringe upright and gently tap barrel to break up any air bubbles

* Expel all air and excess solution until exactly 0.1cc remains

* Return vial to refrigerator (store in cool container only during mass testing)

* Make patient feel comfortable

* Rest the patient’s arm on a firm, well-lit surface

* Use left arm, if possible, to provide universality and consistency (ask patient if any contraindications to using left arm, e.g., modified radical mastectomy on left side)

* Select injection site on inner aspect of mid-forearm, about 4" below elbow; avoid areas with veins, heavy hair, rashes or other skin surface irregularities

* Put on gloves

* Clean injection site with alcohol, using circular motion beginning in center and working toward the outside

* Allow site to dry thoroughly

* Place needle bevel up

* Stretch skin taut over injection site. This creates a firmer surface for needle insertion.

Do this by either: Stretching skin between your index finger and thumb or by

Grasping the patient’s dorsal forearm and gently pulling it to tighten the ventral skin

* Hold needle almost parallel to the skin

* Making sure the bevel of the needle stays facing upward, insert the needle just below the surface of the skin (you should be able to see the tip of the needle through the top layer of skin)

* Do not aspirate; slowly inject the solution, forming a 6-10mm wheal (if no wheal forms or it is less than 6mm, immediately fill new syringe and place 2 inches away from original site on same arm or use other arm)

* Do not massage the area after injecting tuberculin (this could disperse solution)

* If minor bleeding occurs, use a cotton swab or ball to dab (not press) the injection site; do not use alcohol or bandage

* Record date, time, your name, arm of skin test placement, brand name, lot # and expiration date of PPD solution in patient’s medical record or designated form

Education

* Inform patient about what to expect in the period after injection before the test is read:

- Some people have itching, swelling or irritation on their arms after testing- these

reactions are normal and do not require any treatment and usually subside within a

week or less. Ice usually relieves itching.

- They should not scratch their arms, or put on any cream, ointment, lotion, medication or

bandage.

* Give written information on skin test and answer any questions

* Inform patient about importance of returning within 48-72 hours

* Give written appointment for reading (It’s helpful to schedule appointment between 48 and 56 hours from administration of skin test. This allows 16-26 hours to contact and obtain results on patients who do not show up for their scheduled appointments.)

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