Running Header: TO Z OR NOT TO Z

Rachel Funk
Nursing Pharmacology
Keiser University
Cohort 39
November 29, 2016

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To Z or Not to Z
Z-track injections
The Z track technique is the preferred method for administering intramuscular injections.
Intramuscular injections can be administered in one of three anatomical places: the deltoid,
gluteus maximus, and vastus lateralis. The Z track method is implemented to prevent the seeping
of medicine to the subcutaneous tissue. Some injections, such as Iron, can stain the skin and
irritate skin so this method prevents potential harm or irritation to the patient (Lynn, 2015). This
method differs from other injections because when the nurse is ready to administer the does, he
or she takes their non-dominant hand and displaces the skin before injecting the needle with their
dominant hand like a dart at a ninety-degree angle. The nurse then grabs the needs with their
non-dominant hand while still holding the skin away from the injection. The needle must be
aspirated and if no blood is seen, then the needle was injected into the correct area. The presence
of blood can indicate that the needle has been injected into the wrong area, such as a vein. After
confirming the needle has been injected into the correct area, the dose should then be injected
slowly, about one milliliter per ten seconds (Lynn, 2015). After the entire dose, has been
administered, the nurse should remove the needle from the skin at the same angle that it was
administered, while also removing their non-dominant hand at the same time. When applying
pressure or a bandage, it is important that the nurse knows to never massage the site of the
injection. Massaging the site could potentially cause the medication to seep back through to the
subcutaneous tissue causing irritation.
The nursing process would begin with assessing the patient. Verify that the patient does
not have any known allergies to the drug being administered, ask for two forms of identification,
and then assess the site of injection. Assess that the arm, leg, or glute is free of lesions, bruised

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and tenderness (Lynn, 2015). Depending on the medication given, taking vital signs may be
necessary prior to administering medication. According to Lippincotts Photo Atlas of
Medication Administration, some possible nursing diagnoses are Acute Pain, Anxiety, and Risk
for Injury. The desired goal when using the Z-track method is to reduce pain during the
injection and to prevent the medication from leaking into the subcutaneous tissue, which may
cause skin irritation. It is important that the nurse is aware of landmarks while giving the
injection. The nurse needs to be sure that they will be administering the dose at the accurate site
intramuscularly. They must be precise when locating the site by palpating the bone and
measuring correctly using their hand as a measurement guide. The potential pain for the patient
is greatly decreased when the nurse implements a successful Z-track injection. A skilled nurse is
the best way to prevent complications due to medical error. If the nurse does not follow the
proper protocol, some possible adverse effects may be bleeding, bruising, abscesses, nodules or
other skin conditions (Berman, Snyder & Frandsen, 2016, pg. 797). Uncommonly, sciatic nerve
damage is possible if the nurse does not find the correct landmark with the gluteal injection
(Intramuscular Injection Technique, 2014). The nursing process ends with evaluating the
injection site, the patients anxiety if relevant, and the pain that the injection may have caused.
Documenting any adverse reactions in the patient charts would be necessary. Client teaching
would include advising the patient to not massage the injection site and to call their primary care
provider if they experience any side effects such as severe skin irritation.

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References

Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erbs Fundamentals of Nursing (10th
ed.). Julie Levin Alexander.
Ogston-Tuck, S. (2014). Intramuscular injection technique: An evidence-based
approach. Nursing Standard (2014+), 29(4), 52. doi:http://dx.doi.org.prxkeiser.lirn.net/10.7748/ns.29.4.52.e9183
Lynn, P. (2015). Lippincott Photo Atlas of Medication Administration. Philadelphia: Wolters
Kluwer.