A nurse administers an intramuscular (IM) injection using the Z-track technique. Place the steps in chronological order. All options must be used. A)Apply gentle pressure at the injection site but do not massage B)Inject medication slowly with dominant hand while maintaining traction C)Hold the skin taut with non-dominant hand and insert needle at a 90-degree angle D)Pull the skin 1-1 ½" (2.5-3.5 cm) laterally and away from the injection site E)Release the hold on the skin, allowing the layers to slide back to their original position F)Wait 10 seconds after injecting the medication and withdraw the needle

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11ecbb05_cb3d_ac69_b433_0968b5336314_MD0009_00 The Z-track technique prevents tracking (leakage) of the medication into the subcutaneous tissue and is universally recommended for the administration of IM injections. Displacing the skin while injecting the medication, and then releasing the skin back to its normal position after removing the needle creates a zigzag track. The procedure for administering an IM injection using the Z-track technique includes these steps: Pull the skin 1-1 ½" (2.5-3.5 cm) laterally away from the injection site (Option D). Hold the skin taut with the nondominant hand, and insert the needle at a 90-degree angle - taut skin facilitates entry of the needle and this angle ensures that the needle will reach the muscle (Option C). Inject the medication slowly into the muscle while maintaining traction - slow injection promotes comfort and allows time for tissue expansion to facilitate absorption of the medication (Option B). Wait 10 seconds after injecting the medication and withdraw the needle while maintaining traction on the skin; this allows the medication to diffuse before needle removal and helps to prevent tracking (Option F). Release the hold on the skin - this allows the tissue layers to slide back to their original position, sealing off the needle track (Option E). Apply gentle pressure at the injection site, but do not massage as this can cause the medication to seep back up to the skin surface and cause local tissue irritation (Option A). There is no clear evidence to support the need for aspiration prior to IM injection. Aspiration may be indicated if the dorsogluteal site (last resort) is used for IM injection due to its proximity to the gluteal artery. The preferred areas for IM injection are the ventrogluteal site in adults and the vastus lateralis site in children. Educational objective: The Z-track technique for administering IM injections prevents tracking (leakage) of the medication into the subcutaneous tissue.

A Nurse Administers an Intramuscular (IM) Injection Using the Z-Track