ZTrack Technique
The Z-track method of IM injection is used when a drug is highly irritating to SC tissues or has the ability to permanently stain the skin. The nurse should adhere to the following procedure when using the Z-track technique (Fig. 2-8):
• Draw the drug up into the syringe.
• Discard the needle and place a new needle on the syringe. This prevents any solution that may remain in the needle (that was used to draw the drug into the syringe) from contacting tissues as the needle is put into the muscle.
• Pull the plunger down to draw approximately 0.1 to 0.2 mL of air into the syringe. The air bubble in the syringe follows the drug into the tissues and seals off the area where the drug was injected, thereby preventing oozing of the drug up through the extremely small pathway created by the needle.
• Place the patient in the correct position for administration of an IM injection.
• Pull the skin, SC tissues, and fat (that are over the injection site) laterally, displacing the tissue to the side.
• While holding the tissues in the lateral position, insert the needle and inject the drug.
- Anterior superior
A. Vastus Lateralis Site
B. Ventrogluteal Site
A. Vastus Lateralis Site
B. Ventrogluteal Site
Gluteus medius
Greater trochanter
Gluteus medius
Greater trochanter
C. Dorsogluteal Site D. Deltoid Site
Figure 2-7. Sites for intramuscular administration. (A) Vastus lateralis site: the patient is supine or sitting. (B) Ventrogluteal site: the nurse's palm is placed on the greater trochanter and the index finger is placed on the anterior superior iliac spine; the injection is made into the middle of the triangle formed by the nurse's fingers and the iliac crest. (C) Dorsogluteal site: to avoid the sciatic nerve and accompanying blood vessels, an injection site is chosen above and lateral to a line drawn from the greater trochanter to the posterior superior iliac spine. (D) Deltoid site: the mid-deltoid area is located by forming a rectangle, the top of which is at the level of the lower edge of the acromion, and the bottom of which is at the level of the axilla; the sides are one third and two thirds of the way around the outer aspect of the patient's arm.
Deltoid muscle Scapula
Humerus
C. Dorsogluteal Site D. Deltoid Site
Figure 2-7. Sites for intramuscular administration. (A) Vastus lateralis site: the patient is supine or sitting. (B) Ventrogluteal site: the nurse's palm is placed on the greater trochanter and the index finger is placed on the anterior superior iliac spine; the injection is made into the middle of the triangle formed by the nurse's fingers and the iliac crest. (C) Dorsogluteal site: to avoid the sciatic nerve and accompanying blood vessels, an injection site is chosen above and lateral to a line drawn from the greater trochanter to the posterior superior iliac spine. (D) Deltoid site: the mid-deltoid area is located by forming a rectangle, the top of which is at the level of the lower edge of the acromion, and the bottom of which is at the level of the axilla; the sides are one third and two thirds of the way around the outer aspect of the patient's arm.
• After the drug is injected, release the tissues and withdraw the needle. This technique prevents the backflow of drug into the SC tissue.
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