Administering Intramuscular Injections by the Z-Track Method

• To contain irritating medication in the muscle and prevent seepage to the surrounding subcutaneous tissues.

• Appropriate injection sites for this method of medication administration include dorsogluteal, ventrogluteal, and vastus lateralis areas.
• Needle length should be 2 inches to prevent medication delivery to subcutaneous tissue.
• Viscosity of the solution should be considered when selecting gauge of needle.
• Consider consulting physician to obtain an alternative route in the patient who is emaciated or has muscle atrophy

Special Considerations

• Incorrect administration of iron preparations can cause skin staining.
• Incorrect administration of other medications may cause irritation to subcutaneous tissue.

Relevant Nursing Diagnoses

• Risk for injury related to IM injection and irritating medications

• Patient is without extreme pain after medication delivery via Z-track method
• Skin surrounding injection site should be intact without bruising or hematoma
• Mild burning or irritation upon injection; extreme pain is an unexpected outcome

• Syringe
• 2 needles (one 2-inch needle)
• Alcohol pads
• Medication

• Wash hands.
• Prevents transmission of microorganisms.
• Prepare syringe with ordered medication adhering to the five rights of drug administration.
• Reduces risk of drug error.
• Proper preparation of drug.
• Change needle after medication has been drawn up, and pull plunger back 0.3 mL.
• Prevents irritation and staining of skin and subcutaneous tissues when needle is inserted into skin; airlock prevents back seepage of medication through the tissues.
• Identify patient by reading identification bracelet and addressing patient by name.
• Confirms identity of the patient.
• Explain procedure and purpose of medication to be given.
• Decreases anxiety and promotes cooperation.
• Verify allergies listed on medication record.
• Alerts nurse to possible allergic reactions.
• Provide privacy.
• Reduces embarrassment.
• Don gloves.
• Prevents contact with body fluids.
• Assist patient into the prone position.
• Prone position facilitates identification of anatomic landmarks and promotes relaxation of gluteal muscles.
• Outline injection site by identification of anatomical landmarks of dorsogluteal site (See Fig. 6.2C Locating the Dorsogluteal Injection Site for important factors for acceptable sites), and information on locating anatomical landmarks.
• Prevents nerve injury.
• Clean skin with alcohol, and remove needle cap.
• Prevents transfer of microorganisms.
• Pull skin 1 to ½ inches laterally away from midline with nondominant hand, and rest the heel of the hand on the skin while maintaining traction.
• Retracts the skin and subcutaneous tissue from muscle, forming a tract that prevents back seepage of medication into subcutaneous tissues. Allows fingers to support syringe barrel to provide stability of needle while aspirating.

  See Fig. 6.3A Applying Traction

• Observe for the rise of the air bubble to the top of syringe and quickly insert needle at 90-degree angle.
• Minimizes pain upon needle insertion, facilitates needle entering muscle mass, and ensures that air clears the needle to seal drug in muscle tissue.
• Pull plunger back to aspirate for blood return.
• Determines if inadvertent insertion into blood vessel has occurred.
• If blood returns, remove the needle, assess and clean site with alcohol pad, apply Band-Aid, and discard medication. Repeat steps 1–14. If no blood, return slowly inject medication, and hold needle in place for 10 seconds.
• Blood return indicates intravascular injection.
• Medication contaminated with blood must be discarded.
• Provides adequate absorption time, and prevents leakage of medication back into subcutaneous tissues.
• Release the skin while removing needle at the same angle of insertion.
• Avoids a direct track between muscle and subcutaneous tissue and skin that would allow the drug to be displaced causing irritation and pain.

  See Fig. 6.3B Medication is Sealed in the Muscle

• Dispose of needle in sharps container; do not recap.
• Prevents accidental needle stick.
• Do not massage the insertion area; may place alcohol pad or Band-Aid over the site.
• Massage will increase the possibility of drug displacement into the tissues.
• Reposition patient, raise side rails, and lower bed. Place call bell within reach.
• Maintains safety, comfort, and communication.
• Wash hands
• Prevents transfer of microorganisms.
• Document administration on medication record.
• Prevents accidental re-medication, and serves as a legal record.
• Re-check site in 15 to 30 minutes.
• Verifies that no seepage of drug has occurred.

Evaluation and Follow-Up Activities

• Reassessment of site after injection is important to ascertain whether seepage has occurred
• Notify physician if subcutaneous seepage is suspected

Key Points for Reporting and Recording

• Reporting should include all the information under IM injections with the following additions: method (Z-track), pain after injection, and presence of skin stain.
• Extreme pain upon injection.
• Skin stain.
• Physician notification.