Mantoux Tuberculin Skin Testing

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					                         Skills Assessment for Administration
                          of Mantoux Tuberculin Skin Test

Name of Trainee: ___________________________                        Date:_____________
Name of Preceptor: _________________________

The trainee will demonstrate the following skills involved in correctly administering a Mantoux

1. Correctly identifies patient/introduce self                            __________

2. Asks patient about allergies                                           __________

3. Determines tuberculin skin testing history                             __________

4. Selects a well-lit, disturbance-free area for testing                  __________

5. Explains procedure to patient                                          __________

6. Washes hands                                                           __________

7. Prepares necessary equipment                                           __________

8. Reads label on PPD solution as it is removed from refrigerator         __________

9. Inspects vial for expiration date and date was opened
   If opened new vial, places date on it                                  __________

10. Gently top of vial                                                    __________

11. Cleans top of vial to dry                                             __________

12. Allows top of vial to dry                                             __________

13. Injects air into empty space (not solution) in vial                   __________

14. Withdraws PPD solution properly (slightly more than 0.1 cc,
    expels air and excess solution, measures correct dose)                __________

15. Gently taps syringe to remove any air bubbles                         __________
16. Makes patient feel comfortable                                  __________

17. Asks about contraindications to using left arm                  __________

18. Positions patient’s arm correctly                               __________

19. Puts on gloves                                                  __________

20. Chooses correct injection site                                  __________

21. Cleanses injection site using circular motion and lets it dry
    thoroughly                                                      __________

22. Stretches skin taut over injection site                         __________

23. Inserts needle at proper angle for intradermal injection
    (bevel of needle is up)                                         __________

24. Without aspirating, injects PPD so that a wheal
    of 6-10mm appears                                               __________

25. If minor bleeding, dabs gently with cotton swab
    (no massage, alcohol or band-aid on site)                       __________

26. Does not recap needle; disposes in sharps container             __________

27. Records date, time, their name, arm of placement, brand,
    lot #, amount and expiration date of PPD on appropriate form    __________

Total (if using point system)                                       __________

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