Z track for IM injections?

  1. 0
    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.
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  3. 17 Comments so far...

  4. 0
    Always aspirate, only takes a second or 2 and if you inject into a blood vessel you're going to be dealing with bigger problems than an agitated patient. Z track doesn't take any extra time and is helpful for keeping the injection in place for absorption.
    Our safety needles auto retract or engage by sliding a lever from the side so I can't be of help there but I would think a technique that keeps stick risk low is the one to use.
  5. 0
    I'm a student but have given many injections and we were told not to aspirate anymore. We also were taught the z-track method but that because of new research they are not teaching to aspirate anymore.
  6. 0
    On our unit we try to do Z-track if appropriate and accessible. If it is not, and it is an emergency, we can use our judgement as to where to put the needle. While buttock is always the preferred site at our facility, if it can't be done by Z-track then we can still get it in in another buttock location. I've also seen them done on the thigh and deltoid.

    Also, our facility we were taught not to aspirate because the newest evidence shows that aspiration of the needle is not necessary in IM injections.. because the location of the IM injections rarely has a blood vessel running through it. So, we don't.

    Last, insanely, our facility does not always have safety needles!!! I think it's insane.. I once refused to give an IM to a screaming flailing patient on the floor for this reason. The nursing director gave it instead. I am sorry, but I am not risking getting stuck because the facility doesn't want to pay extra for them! Since that incident we have seen a rise in safety needles at our facility, and when I do use them, I try to flick them back by rubbing it on something (safer!) unless there is nothing there to flick it back with then I'll use my finger.
  7. 0
    hmm, I'm interested in the research. All I can find is info about immunizations and deltoid aspiration. Completely anecdotal but I once saw a charge nurse have blood return during a vastus lateralis injection. Dorsogluteal is my site of choice and I've often thought the risk would be low but that event always stuck with me. Of course I want to use evidence based practice though! Anyone have any further info on aspiration at gluteal sites?
    Thanks for the update guys! We're always learning!
  8. 1
    Quote from 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.
    You should ALWAYS aspirate and Z-track. It only takes an extra second or two, gets the medication to where it needs to be--and keeps it there--and can save a patient from harm. I've done it even in the worst of codes where I've had to administer multiple shots. I also do it regardless of injection site (my preferred site is the vastus lateralis)

    As far as activating safety covers, I prefer to keep my fingers as far away from the needle as possible...especially given that in psych there seems to be quite a bit more than usual of Hep B/Hep C/HIV in our patient population. I would use the side of the bed/table/anything not my finger.
    Cmenurse likes this.
  9. 0
    Quote from iluvpatho
    I'm a student but have given many injections and we were told not to aspirate anymore. We also were taught the z-track method but that because of new research they are not teaching to aspirate anymore.
    That doesn't sound correct. It's rare to hit a vessel but it DOES happen. You definitely don't want to be injecting a long acting antipsychotic into someone's blood stream.
  10. 1
    Quote from rotary
    That doesn't sound correct. It's rare to hit a vessel but it DOES happen. You definitely don't want to be injecting a long acting antipsychotic into someone's blood stream.
    Actually.. according to the Centers for Disease Control/US Dept. Health and Human Services "Because there are no large blood vessels in the recommended sites, aspiration before injection of vaccines (i.e., pulling back on the syringe plunger after needle insertion but before injection) is not necessary" (p. D-10).

    Link: http://www.cdc.gov/vaccines/pubs/pin...pdx-full-d.pdf

    Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Wolfe S, Hamborsky J, eds. 12th ed. Washington DC: Public Health Foundation, 2011.
    grownuprosie likes this.
  11. 0
    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?

    As far as aspiration, I know the CDC no longer recommends aspiration when providing vaccinations, but I have not heard anything definitive about non-vaccination IMs. I wouldn't be surprised if the aspiration policy changes in the future, though (I've heard rumors that SQ shots used to require aspiration, and I've seen a few older nurses aspirate for SQ injections).
  12. 0
    I was just discussing this topic with some of my coworkers. Some nurses have observed new nurses giving IMs without z track and you could literally see the medication running out of their body as the needle retracted.


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