Z Track Injection Technique

Indications

1. Technique for injecting dark-colored med solns that can stain subcutaneous
tissue or skin
2. IM injection of meds that are irritating to tissue such as haloperidol or vistaril
3. Contraindications/Cautions
o Disabled limbs or other cause of poor circulation to limb used for
injection

Procedure

1. Prepare pt by providing necessary background info

o Provide necessary written instructions w/pictures if possible to
reinforce
o Review inj procedure in detail first; explain use of equip
o Offer reassurance and support
2. Use at least two pt identifiers when providing care, tx, or services:
o Check pts ID band and ask name
o Check pts ID band for date of birth
3. Check for pts allergies
4. Check med vial against med record/order
5. Gather equip needed
o Long needle 2-3 inches, (5-7.5 cm) and 21 or 22 gauge (G) to inject
med deeply into muscle tissue
 Note: Needle length will depend on
 Site being used and pts size
 Larger needle gauge can be used for more viscous solns
o 3-5mL syringe
o Vial of med to be admin
o Alcohol swabs
o Non-sterile gloves
o 2x2 gauze
6. Inspect med for appropriate appearance
7. Explain technique and provide privacy
8. Implementation
o Confirm pts name by checking wrist band or other identification
o Confirm allergies
o Wash hands and put on clean gloves
o Use syringe and needle to draw up med into syringe and incl an
addition 0.3-0.5 mL of air
o Select inj site choosing a site that is free from
 Irritation
 Inflammation
 Lesions
o Common inj sites
 Gluteus minimus
 Gluteus medius
o Clean inj site w/alcohol swab
o Uncap needle
o Using non-dominant hand to move and hold skin and subcutaneous
tissue about 1-1.5 in (2.5-3.75 cm) laterally from inj site
 o Ask pt to relax muscle to be injected to reduce resistance
o While continuing to displace skin, inject needle rapidly at a 90° angle

o Aspirate syringe to check for blood return to ensure that a blood vessel
was not penetrated
 If blood return is seen, remove needle and and discard dose
 Draw up new dose for inj
o If no blood return, inj med and air slowly into muscle
o W/draw syringe and immed release displaced skin and subcutaneous
tissue
o Use a 2x2 gauze pad to apply gentle pressure if site bleeds
o After a short rest period, encourage pt to walk to enhance absorption
of med
o Do not rub inj site
o Do not recap needle and discard in appropriate sharps container
o Discard all other trash in appropriate trash container
o Wash hands
o Instruct pt that burning or bruising at inj site is common
o Notify physician if severe pain or abscess form at inj site
o Discard single use vials
o Label multi use vials w/
 Pts name
 Date and time it was first accessed
 Store any unused portion of med according to mfr instructions
9. Document assessment, actions and pts response/education per institutional
guidelines and nursing standards

Complications

1. Cellulitis
2. Tissue irritation
3. Bacteremia
4. Hematoma

Nursing Considerations

1. Pt should relax muscle to reduce pain and risk of bleeding

2. For repeated inj rotate sites
3. Never inject into gluteal muscle of a child who has not been walking for more
than a yr
4. IM inj may damage muscle tissue and cause false elevations in CK levels
o Use diagnostics to differentiate between tissue damage and MI
5. Esp w/irritating meds
o Inspect past inj sites post-admin for cellulitis or other signs of
persistent irritation