Z-track method of intramuscular injection is used to administer drug in a large muscle that prevents the leakage of the medication into the layers of subcutaneous tissues. It is named Z-track because after the techniques of this medication administration are implemented a zigzag path is responsible for sealing the drug in the muscles.
Irritating medications and those that cause discoloration such as Iron Dextran and Inferon preparations are administered intramuscularly using this method. Tissue irritation is minimized by the lateral displacement of the skin during injection that seals the drug into the muscle tissue, thereby, inhibiting the escape of drug injected into the subcutaneous layer of the skin.
The procedure requires a thorough concentration to the technique because leakage of the injected drug causes permanent staining of some tissues and patient uneasiness. A large and deep muscle must be used in this procedure. Preferably, the ventrogluteal muscle is usually selected as the site of IM injection.
- Verify doctor’s order on the patient’s chart.
- Hand washing.
- Use a proper needle. Rule of thumb in needle selection for IM injection are as follows:
200 lb (90.7 kg) – 2” needle
100 lb (45 kg) – 1 1/4” to 1 ½” needle
- Aspirate the prescribed medication into the syringe. Draw 0.2-0.5 cc of air (depending on the hospital policy) to create an air lock. (Air-lock technique is used with this procedure.)
- Replace the needle with a new one after preparing the drug so that no drug remains outside the needle shaft. This prevents tracking the drug into the subcutaneous tissue during injection.
- Identify the patient. Explain the procedure.
- Provide privacy by closing the doors and providing drapes.
- Position the client in either his abdomen (prone) or his side (lateral).
- Expose the gluteal muscle. Ventrogluteal muscle is usually used.
- Prepare the site with an antiseptic swab. The principle of this method is to start from the inner to the outer surface.
- Don gloves.
- Perform the Z-track technique.
- Place gloved fingers on the skin surface and pull the overlying skin and subcutaneous tissue approximately 2.5-3.5 cm (1 to 1 ½ inches) laterally to the side. (See Figure A)
- Holding the skin taut with the nondominant hand, insert the needle at a 90 degree angle at the spot where the finger was initially placed before displacing the skin laterally. (See Figure B)
- Aspirate for blood return with the dominant hand only (practice of nurse makes this step easy). If there is no blood return on aspiration, inject the drug slowly, followed by the air. Air clears the clears the needle of the medication and prevents tracking of the medication through the subcutaneous layers upon needle withdrawal. (Air-lock technique)
- Wait for 10 seconds before withdrawing the needle to allow the medication to disperse evenly.
- Slowly remove the needle.
- Release the skin taut. A zigzag needle track is created (by sliding of the tissue planes across each other) preventing the escape of medication from the muscle tissue. (See Figure C)
- Instruct the patient never to wear tight or constricting clothing because it can force out the injected medication to the subcutaneous layers. Do not massage the site.
- Encourage the patient to mobilize (walk or move in bed) to facilitate the absorption of medication.
- Discard the needles and syringe in an appropriate sharps container. Always remember, never to recap the syringe to avoid needle-stick accidents.
- Remove gloves.
- Document medication, dosage, date, time and site of injection on the patient’s chart.
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