Administering

Intramuscular
Injection in
Z-Track Technique

Prepared by:
Charril Pabular-Araneta RN, MN
 Z-Track Technique
 The Z-track method is a method of administrating an IM
injection that prevents the medication being tracked
through the subcutaneous tissue, sealing the medication in
the muscle, and minimizing irritation from the medication.
 Using the Z-track technique, the skin is pulled laterally,
away from the injection site, before the injection; then the
medication is injected, the needle is withdrawn, and the
skin is released.
 PURPOSE
 Delivers irritating or caustic medications deep into muscle tissue to prevent
seepage.
EQUIPMENTS:
 ASSESSMENT
Should focus on the following:
 Complete medication order  Client’s response to previous injections
 Intended injection site and condition of the  Factors affecting size and gauge of needle
site ( .g., bruising, tenderness, skin breaks, (e.g client’s size and age, site of injection,
nodules, or edema) viscosity and residual effects of medication)
 Site of last injection  Client’s knowledge about medication and
reason for use
 Allergies
Different Injection Sites
Video Presentation
 PROCEDURE
STEPS
 Perform Hand Hygiene
 Prepare syringe with medication, adhering to
the ten rights of drug administration
 Change needle after drug has been fully
drawn up
 Pull plunger back another 0.1 ml
RATIONALE
 Reduces microorganism transfer
 Prepares drug properly, decreases chance of
drug error
 Prevents staining and irritation of skin and
subcutaneous tissue when needle is inserted
into skin
 Makes air lock in syringe
 PROCEDURE
STEPS
 Identify client by reading identification
bracelet and addressing client by name
 Explain procedure and purpose of drug
 Verify allergies listed on medication record or
electronic medication record
 Provide privacy
 Don gloves
RATIONALE
 Confirms identity of the client
 Decreases anxiety; promotes cooperation
 Alerts nurse to possibility of allergic reaction
 Decreases embarrassment
 Prevents direct contact with body secretions
 PROCEDURE
STEPS RATIONALE
 Assist client into prone position with toes  Promotes comfort by relaxing gluteal muscles
pointed inward  Prevents sciatic nerve damage
 Outline dorsogluteal site by identifying  Maintains asepsis
landmarks appropriately; alternatively use
ventrogluteal or vastus lateralis area.
 Clean site with alcohol and allow site to dry.
 Remove needle cap
 PROCEDURE
STEPS
 Hold syringe with needle pointed down and
observe for air bubble to rise to top (away
from the needle)
 Using fingers of non-dominant hand, pull
skin laterally (away from midline) about 1
inch and down
 While maintaining skin retraction, rest heel of
non-dominant hand on skin below fingers
RATIONALE
 Ensure that air clears needle after drug is
administered so that drug can be sealed into
muscle tissue
 Retracts skin and subcutaneous tissue from
muscle
 Allows nurse to maintain retraction and
stability of needle while aspirating or if client
suddenly moves
 PROCEDURE
STEPS
 Talk to client and warn of impending
needlestick
 With dominant hand, quickly insert needle at
a 90 degree-angle (as if throwing a dart)
while maintaining traction on site with heel of
non-dominant hand
 Pull plunger back and aspirate for blood
return
RATIONALE
 Provides distraction; prevents jerking
response
 Minimizes pain from insertion; ensures that
needle enters muscle mass
 Determines if accidental insertion into blood
vessel has occurred
 PROCEDURE
STEPS RATIONALE
 If blood returns, remove needle, clean site
with antiseptic swab, assess site, apply  Prevents leakage into subcutaneous tissue;
adhesive bandage and begin injection allows adequate absorption time
procedure again
 Prevents tearing of tissue avoids direct track
 If no blood returns, inject drug slowly, between muscle and surface of skin
holding needle in place for 10 seconds
 Remove needle at same angle of insertion
while releasing skin at the same time
 PROCEDURE
STEPS RATIONALE
 Place alcohol swab over insertion area but do  Avoids displacing drug into tissues, which
not massage would cause irritation and pain
 Place needle on tray; do not recap  Prevents needlestick
 PROCEDURE
STEPS
 Reposition client, raise side rails and lower
bed to lowest position; place call light within
reach.
 Dispose of equipment properly
 Remove gloves and perform hand hygiene
 Document administration on medication
record
 Check site 15 to 30 minutes later for pain,
bleeding, fluid, drainage, or bruising.
RATIONALE
 Maintains safety and comfort; allows
communication
 Prevents injury and spread of infection
 Reduces microorganism transfer
 Serves as legal record of administration;
prevents accidental re-medication
 Verifies that no seepage of medication has
occurred