Z track for IM injections?

[gnursjr2]

Hi, I just started working at a new job on a psych unit. My preceptor watched me give a IM Ativan. I have given many an injection at other facilities, so it's not a forgien thing to me. Anyway, after he and 6 other co-workers watched me give an IM into L buttock, he told me "You need to practice your injection technique". He said I have to give all IMs Z track method, and aspirate. Well, every where I've worked no one aspirates when giving a STAT emergency IM, we just get it into the patient. I would just like some feed back from some other RNs out there. Also, after giving injection do you just flick the plastic cover down over the needle with your thumb, or do you rub it on the side of bed? He does not want me pushing plastic cover down with finger. Thx for any input! I just felt really stupid.

[jenmesh]

I recently just started in a psych hospital, and for the first time, gave IM injections to an out of control patient. I didn't use the Z-track method, and as I retracted the needle, the medicine literally squirted out of the patient's skin. Lesson learned, will be using the Z-track from now on.

[melizerd, ASN, RN]

I'm a current nursing student, we're being taught Z-track for specific medications only (such as Vistaril) but to aspirate ALL IM injections and that Z-track may be the policy for all IMs depending on the facility.

Our technique is, stick, aspirate, inject, hold for 10. Honestly most people don't realize you're still holding the injection in place for those last 10 seconds, I haven't had anyone comment so far.

[wish_me_luck, BSN, RN]

I don't know too much about psych injections. But, I would say z track. In addition, I am big into public health and at the health department had a discussion with a nurse about the aspiration thing. I looked at the CDC website before I went for that clinical and it says 2011 guidelines there is not a need to aspirate because there is an assumption you are using correct technique. I asked the nurse about it and she confirmed there is no need to aspirate anymore. She said she does it if the person is not squarming or upset; but if they are (kids), she gets it in and injects without aspiration. She mainly does it out of habit, I think. The vaccine that she did aspirate on was in the vastus lateralis. It is not needed, but if you do it, it's not wrong. That's what I got out of it.

I am not being a know it all. I just got through school, haven't taken boards yet. So, please don't take me as word, it's just what I researched and what I was told.

[HolyPeas]

This is a topic that you just have to follow the facility policy, some say z tracks and aspiration are kinda antiquated, some still require it... there probably isnt a "right or wrong" answer to this one

[jomm]

I z track, doesn't do any harm and reduces skin irritation as well as making sure meds stay in. I've also heared that pressing on the site prior to giving IM can reduce pain (though its so subjective how would you know?)

Dorsogluteal isn't a recommended site due to the risk of nerve and blood vessel damage, it is my understanding that aspiration is unnecessary at other sites but is recommended for dorsogluteal site.

[TerpGal02, ASN]

My facility has been giving Consta in the deltoid. Z track kinda seems impractical for this site. Thoughts?

[Ontario_RPN]

Old thread I know.

I am a new charge nurse at an alzheimers / dementia home here.

Regardless of schooling, facility and policies, always have a peek at product inserts.

I give a number of our residents long acting antidepressants by IM in the deltoid. The Manufacturer clearly states to aspirate in the literature.

If in court imagine saying why as a nurse I know better than the manufacturer to do otherwise :)

The CDC reference applies to vaccines.

Regarding Z track:

The first dose I ever gave in my career squirt out a bit so Z track for the win for my environment.

Thanks all!

[Talila72]

The CDC position on the matter is that aspiration is not necessary. If you have the correct site, needle gauge, and needle length then your chances of hitting a vessel is really low to begin with. As far as Z-track, I only do it with a patient who is taking an IM willingly. In a psych emergency where the patient is really combative, I don't want my other hand on the patient and risk a stick. If the med is viscous it will start to come out but you can minimize this happening by injecting viscous meds slower (the way they should be injected to begin with) vs at lightening speed (I have seen new nurses in an emergency do this).

[BreNY]

I am a current nursing student. We are taught to use z track and aspirate, and in our textbook it says that aspiration is no longer recommended for administration of vaccines citing the CDC. I do want to point out that the CDC guidelines aren't referring to all IM injections at all sites, just IM vaccines at specific sites (vastus lateralis and deltoid).

Pinkbook | Vaccine Administration | Epidemiology of VPDs | CDC - super long but its about 2/3 of the way down

[3peas]

I'm an experienced psych nurse who has given many IM injections to psychotic patients who were actively trying to attack patients and nurses. I will "try" to aspirate and I do not z-track because normally the patient is in a hold with at least three people restraining them and they are extremely angry, so more harm would come from using Z track method. This is where you can be taught something in school, but you prioritize safety of patient and others and decide the best treatment.

You do not aspirate on vaccines any longer, but if you do no harm done.