Z track for IM injections? - page 2

by gnursjr2

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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... Read More


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    I've given more long-acting IM's then there are people in Iceland. Each semester I get new students and each semester someone has new methods they have been taught. Some semesters I have two differing methods coming at me from new students in the same class.

    I follow the protocols from where I'm working. I still swab with alcohol (wasn't that supposed to stop like eight years ago), I z-track when possible (been back and forth and back again on that one over the years) I wait with the needle in for as long as the patient (or I) can tolerate it, if it's safe to do so (again, over the years this has went back and forth...usually between five and ten seconds IF possible) and I ALWAYS aspirate. I've drawn up blood only twice with aspiration.

    I have had about four incidences where the pt spurts blood following injection and have seen quite a few injections where the long-acting oozes out if given without z-track. (Been seeing a lot more bleeding with consta). I've also seen blood spurt across the room and onto the face and arms of the nurse....with no noticable "error" in administration.

    As for "flicking" safety needles...it depends on the situation. You, the safety of your co-workers and the safety of the patient are all huge factors. I've see a nurse flick and the liquid flew right into her eye off the needle as she engaged the safety mechanism. I've seen too many needle-stick injuries, both with and without the safety syringes (though most during the transition period with new safety syringes).

    I've done a lot of different methods while in a seclusion room with way too many bodies trying to gain control. In some cases you do what is safest..right or wrong....sometimes that will mean a finger flick, sometimes the bed, sometimes dumping it into the metal prep tray uncapped. It's really hard to do by the book when you have six to ten people in a dog-pile but that is when you have a great chance of an injury.

    I'd be up on what the facility protocol says and follow that. If the policy is clearly outdated, then it may be time to discuss new protocols. Protocols for long-acting injections need to be specific, as they are not the same as injecting other medications or vaccines.

    Good luck and play safe!
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    Quote from LadyLovelilocks
    I find this discussion to be really informative and interesting. In school I was taught that most IM medications are not given via Z-track, only certain irritating ones (compazine was one). They did not recommend using the deltoid for any z-tracks because of the small size of the muscle. Finally, I was taught to leave the needle in the site for 10 seconds after administering a z-track (the rationale was that it would allow the medication to settle, but it seems dangerous in an emergency situation with a volatile patient). At your facilities, do you regularly use z-track for all IMs, including in the deltoid? Also, do you practice the "10 second wait" before removing the needle?
    I can't imagine any patient, other than an unconscious one, being cool with you leaving a needle stuck in them for an extra ten seconds....
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    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.
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    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.
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    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.
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    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
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    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.
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    My facility has been giving Consta in the deltoid. Z track kinda seems impractical for this site. Thoughts?


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