IM Injections & Z-track

[swee2000]

I am curious if any current or recent students(RN or LPN) were told by their instructors that you did not have to aspirate for blood when giving IM injections, with or w/o using Z-track.

Here's why I ask: while at work today, a student(doing his clinicals on my floor) gave an IM injection to a patient, but DIDN'T aspirate before pushing the med thru. When he was called on it by the staff RN, the student's response was "My instructors have always told us that we don't have to aspirate when using the Z-track method." Personally, I have NEVER heard this, nor was I taught it when I was in school(and I attended the same one as this student)!! As for the instructor's response, unfortunately I never found out what she said. Would've been interesting to hear, though.

So any students ever been told this by an instructor?

[sharona97, BSN, RN]

I've been taught to aspirate before any IM injection, Z-track or not.

[Jilaweez, BSN, MSN, RN]

Same here, we were taught to aspirate or we could cause the patient a great deal of pain.

[vashtee, RN]

I was taught to aspirate (not for pain reasons, though, but to ensure you haven't accidentally hit a vein). I bet if you talkd to that student's instructor, you would find s/he would disagree with the student...

[APBT mom, LPN, RN]

We were told always to aspirate and IM injection and a Z track is a IM injection just done in a different way. It's done so you don't inject the med into a vein which is not the intended absorption route and can cause damage to the tissue. The instructor at the school I'm currently in told me a story about her giving an injection in the military and aspirated got no blood turned around to put the syringe in the sharps counter and when she looked back at the patient he had a bump the size of a golf ball coming out of his arm where she just gave the injection. She called the MD to come and check on the patient and he said that it happened because she was to close to a vein and that the medication was viscous and can cause the vein to rupture which in turn causes the bump.

If you do it worng and something happens to the patient while you're in school you will get kicked out. Do it when you have your license and you may have just kissed it good bye.

[sharona97, BSN, RN]

Z-track method is for your most viscous meds, so that the med itself will be entered deep into the belly of the muscle. I wonder if that nurse shouldn't have given that med in the gluteal, rather than the deltoid. That's why I am always reading package inserts for suggested site. I agree aspiration is to R/O you are in a vein,therefore not having any blood return.

A common Z-Track Method drug is B12. Using Z-track it will also help against seepage after the injection.

[AprilRNhere]

I recently read some studies (unfortuately I don't know where) that debated the validity of aspirating IM's. It showed the risk of hitting a vein is very small..however even with the evidence..they still recommended continueing to aspirate.

[CT Pixie, BSN, RN]

We were taught to aspirate all IM's, Z-track included (especially Z's). I'm still in NS and was taught about injections not too long ago.

Maybe you could question the instructor and see if they are telling the students not to aspirate the Z's. Although I doubt she/he will confirm the students statement.

[PRESLA]

] Always pull back c injections, Z-track no because of some of the medications given this way ie. iron so it will not tattoo the skin at the site.

Lisa

[NursePru]

We just went over this in class and we were told to aspirate all IM injections...including Z-track.

[Daytonite, BSN, RN]

NEVER! Always aspirate before injecting IM. Reason: you don't want to accidentally inject into a capillary which is basically an IV injection.

[Rage, RN]

We were told not to worry about aspirations.........because as April said the studies have shown there is a very small chance of 1) actually hitting a vien and 2) if you do, more than likely the needle will go through it aspirating only the most minute amount of blood.

The way the professor expained it (Phd with 30 years med/surg) unless the tip of the needle actually is situated "in" the vein which is extremely unlikely, you will only draw an occult amount of blood into the syringe with aspiration.......so aspirate if you want to but it's not necessary.

But I would like to hear from experienced nurses what they have actually seen in the field upon aspirating.