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Guide for Primary Health Care Providers: Targeted
Tuberculin Testing and Treatment of Latent Tuberculosis Infection
2005
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Appendix C
Administration and Measurement of the TST*
Administration
The Mantoux test is the recommended TST. It is administered
by injecting 0.1 ml of 5 TU of purified protein derivative (PPD)
solution intradermally into the volar surface of the forearm using
a 27-gauge needle with a tuberculin syringe.
- Obtain results of all previous TST. Ask patient to describe
what the test area looked like 2–3 days after administration;
obtain documentation
- Avoid areas of skin with veins, rashes, or excess hair
- Cleanse the area with alcohol swab, allow area to dry, and inject
all antigen just below the surface of the skin on the volar surface
of the forearm, forming a 6–10 mm wheal (a pale, raised area with
distinct edges; has orange-peel appearance and does not disappear
immediately)
- If no wheal forms, or if a wheal forms that is less than 6 mm,
the test should be repeated immediately, approximately 2 inches
from original site or on the other arm
- If minor bleeding occurs, dab the injection site with a cotton
swab
- Avoid covering the area with a bandage or applying pressure
to the injection site
- Record the date, time, and location of the TST
- Instruct patient not to scratch the site, but to use cool compress
to relieve any itching or swelling
- Inform patient of the importance of returning for a reading
of the TST within 48–72 hours (2–3 days)
- Give written appointment card for TST reading
- Provide written information about TST (pamphlet or brochure)
Measurement
- Measure the induration (hard bump) rather than erythema
- Palpate area with fingertips, measuring the diameter of induration
perpendicular to the long axis of the arm
- Use ballpoint pen to mark edges of induration
- Use a tuberculin skin testing ruler or ruler with millimeters
to measure the distance between the two points
Recording and documentation
- Record date TST was administered
- Record the brand name of the PPD solution, lot number, manufacturer,
and expiration date on the patient record
- Record results in millimeters of induration (0 mm if there is
no induration) rather than as positive or negative
- Record date and time of reading and name of person reading TST
- Provide patient and ordering physician with written documentation
Storage and Handling
- PPD solution must be kept refrigerated at 36°– 46° F
- Avoid fluctuations in temperature; do not store on the refrigerator
door
- Syringes must be filled immediately prior to administration
- Store and transport the tuberculin in the dark as much as possible
and avoid exposure to light.
*Contact the local health department TB program for training
on the Mantoux tuberculin skin test.
Last Reviewed: 05/18/2008 Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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