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CLINICAL DO'S & DON'TS

Administering medication by the Z-track method

PULLEN, RICHARD L. JR. RN, EDD

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YOU SHOULD USE the Z-track method for all I.M. injections in adults. By leaving a zigzag path that seals the needle track, this technique prevents drug leakage into the subcutaneous tissue, helps seal the drug in the muscle, and minimizes skin irritation.

DO

  • Properly prepare the ordered medication for injection.
  • Confirm the patient's identity, explain the procedure, and provide privacy. Perform hand hygiene and put on clean gloves.
  • Determine the appropriate injection site. The ventrogluteal site is preferred for most I.M. injections in adults because it lacks large nerves and blood vessels.
  • Properly position the patient and identify the injection site by using body landmarks. Make sure the area is intact and free from abnormalities such as infection, bruising, or tenderness.
  • Clean the skin with antiseptic solution according to facility protocol and let it air-dry.
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    Figure
  • Using your nondominant hand, displace the skin and subcutaneous tissue by pulling the skin laterally or downward from the injection site. Holding it taut, quickly and smoothly insert the needle into the muscle at a 90-degree angle.
  • Continue to hold the skin taut with your nondominant hand. With your dominant hand, aspirate for 5 to 10 seconds. If no blood returns with aspiration, slowly inject the medication (10 seconds/ml). If you see blood in the syringe, withdraw the needle, properly discard the medication and syringe, and prepare another dose for injection.
  • Wait 10 seconds to withdraw the needle so the medication can evenly disperse in the muscle tissue. Withdraw it slowly and smoothly at a 90-degree angle.
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    Figure
  • Release the skin to create a zigzag path.
  • Apply gentle pressure at the injection site with a dry sponge. Assess the site for complications and check it again in 2 to 4 hours, if possible.
  • Discard all equipment properly, remove your gloves, and perform hand hygiene. Document the date and time of administration, the drug name and dose, the injection route and site, and the patient's response.

DON'T

  • Don't massage the site after injection. Massaging can irritate the tissue and increase discomfort.
  • Don't administer subsequent injections into the same injection site.

Richard L. Pullen, Jr., is a professor of nursing at Amarillo (Tex.) College. Each month, Clinical Do's & Don'ts illustrates key clinical points for a common nursing procedure. Because of space constraints, it's not comprehensive.

SELECTED REFERENCES

Kozier B, et al. (eds). Kozier & Erb's Techniques in Clinical Nursing: Basic to Intermediate Skills, 5th edition. Upper Saddle River, N.J., Prentice-Hall, Inc., 2004.
    IM injections. In Nursing Procedures, 4th edition. Philadelphia, Pa., Lippincott Williams & Wilkins, 2004.
      Nicoll LH, Hesby A. Intramuscular injection: An integrative research review and guideline for evidence-based practice. Applied Nursing Research. 15(3):149–162, August 2002.
      © 2005 Lippincott Williams & Wilkins, Inc.