Z- tracking: A technique used to prevent medication leakage, particularly for oily injections. 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.
THE Z-TRACK METHOD of I.M. injection prevents leakage of irritating and discoloring medications (such as iron dextran) into the subcutaneous tissue. It also may be used in elderly patients who have decreased muscle mass. Lateral displacement of the skin during the injection helps seal the drug in the muscle.
It's pretty simple: The Z-track is a better injection technique. It's been shown to reduce leakage of medication through subcutaneous tissue and decrease skin lesions at the injection site. Plus, it doesn't hurt patients quite as much as a regular I.M. injection.
The Z-track IM injection is particularly useful with medication that must be absorbed by the muscle to work in order to ensure a full dosage, when using a dark-colored drug that can cause staining of the skin and /or when administering irritating medications such as Iron Dextran and Inferon as it is less likely that ...
In general, medical providers prefer to use the Z-track injection technique for all intramuscular injections in adults. As a result, most medications given through intramuscular injection are also Z-track method medications.
Z-track Method for IM injections
Evidence-based practice supports using the Z-track method for administration of intramuscular injections. This method prevents the medication from leaking into the subcutaneous tissue, allows the medication to stay in the muscles, and can minimize irritation.
The Z-track technique is used for intramuscular injections to prevent leakage of medication into the needle track, thus minimizing discomfort.
Z-track also reduces pain and irritation at the injection site. The Z-track method should continue to be implemented in nursing practice.
Insert needle at an 45o angle to the skin. Pinch up on SQ tissue to prevent injecting into muscle. Aspiration before injection is not required.
A ventrogluteal site is the most commonly used and recommended site for IM injections in adults and children of walking age because of the large muscle mass. This site is located away from the superior and inferior gluteal arteries as well as the sciatic and superior gluteal nerves,9 and is also the least painful.
The the Z-track method is only used is for intramuscular injections, and not other types of injections.
For adults
The needle length and gauge are the same as when the deltoid muscle is used, i.e., 1"–1½” length, 22–25 gauge. You should choose needle length based on the weight of your adult patients, as follows: Adults weighing less than 130 lbs (60 kg): Use of a 1” needle is recommended.
Testosterone injections are typically intramuscular – that is, given directly into a muscle. Two relatively easy and accessible sites for intramuscular injection are the deltoid (upper arm) or the glut (upper back portion of the thigh, ie, the butt cheek).
This traps the drug inside the subcutaneous tissue and prevents any leakage. To prevent leakage, an injection should be performed with the Z-track insertion technique with a thin needle in the cutaneous tissues.
One commonly known and well discussed event, which may occur after an injection, is the leakage of fluid out of the skin at the injection site, commonly referred to as either leakage or backflow. Studies indicate that the amount of detected leakage is not of clinical significance.
Leakage will be minimized using a thin needle, using 90° needle insertion in the abdomen, injecting maximum 800 µL at a time, and waiting at least 3 seconds after the injection until the needle is withdrawn from the skin.
The Z-track method of intra-muscular (I.M.) injection is used primarily when giving dark-colored medication solutions, such as iron solutions, that can stain the subcutaneous tissue or skin.
There are timely situations, and then there are critical, life-or-death situations where a second can't be wasted, such as when someone is suffering a heart attack or an anaphylactic allergic reaction. These are circumstances that call for an IV push.
Replace the needle with a new one after preparing the drug so that no drug remains outside the needle shaft. This prevents tracking the drug into the subcutaneous tissue during injection.
My nurse colleagues would demonstrate a technique of landmarking just before injecting then sliding the hand toward the side of the injection site to apply light pressure for distraction. Pressure on the injection site with a cotton ball immediately after removing the needle also lessens the perception of pain.
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. This method can be used if the overlying tissue can be displaced (Lynn, 2011).
Generally, rubbing or massaging the injection site area should be avoided through the time the drug is expected to reach peak levels to avoid intended absorption patterns.
Because intravascular injection of vaccines is formally contraindicated, the justification for aspiration would be based on the theoretical assumption that it can be seen as a test with the “needle out of the vessel”.