UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: ADMINISTERING A Z-TRACK INTRAMUSCULAR INJECTION
Effective Date: February, 2002 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed October, 2003 March, 2005 Nov., 2007 May,2010 October 2011
PURPOSE: To provide guidelines for the administration of a Z-Track intramuscular injection at UWMF
POLICY: Clinical staff will utilize the following guidelines to administer a Z-Track intramuscular injection to
UWMF patients. The preparation and administration of a medication should be completed by the same person.
DEFINITION: The Z track method of IM injection prevents leakage, or tracking, into the subcutaneous tissue.
It’s typically used to administer drugs that irritate and discolor subcutaneous tissue. It may also be used in
elderly patients who have decreased muscle mass. Lateral displacement of the skin during injection helps seal
the drug into the muscle.
SUPPLIES: 3 ml syringe, two- 20 or 22 gauge needles 1 ¼”- to 2 “, small gauze pad, alcohol pads, gloves,
bandage, provider’s order, medication record, correct medication
* Make sure the needle you are using in long enough to reach the muscle
1. Check medication against provider’s order and clarify any inconsistencies in the dose against the
2. Identify the patient: include date of birth and verify allergies.
3. Know medication’s actions, special considerations, safe-dose ranges, purpose of administration, and adverse
4. Provide patient education:
Explain medication(s), reason(s) for the medication(s), and administration technique to patient
Explain sensations to expect during administration (pain/discomfort during injection, burning/stinging at
5. Wash hands and assemble equipment.
6. Prepare medication:
a. Adhere to the five rights of drug administration.
Right – drug, dose, time, route, patient
b. Check the expiration date of the medication
c. Draw up 0.2 cc of air into the syringe using the airlock method. (See diagram)
(If medication comes from pharmacy in prepared syringe, airlock may already be added)
7. Remove the first needle and attach the second needle. This prevents tracking the medication through the
subcutaneous tissue as the needle is inserted.
8. Provide good light and privacy by closing curtains or door.
9. Locate site of choice and ensure that the area is not tender and is free of lumps or nodules.(see diagram)
NOTE: Do not use deltoid muscle
Dorsogluteal - Patient may lie prone with toes pointing inward or on side with upper leg flexed and placed
in front of lower leg.
9. Put on disposable gloves.
10. Cleanse area thoroughly with alcohol swab, using friction, and allow alcohol to dry.
12. Remove needle cap by pulling it straight off.
13. Place your fingers on the skin surface, and pull the skin and subcutaneous layers out of alignment with the
underlying muscle, about ½ -1“ laterally.(See diagram).
14. Hold syringe in dominant hand between thumb and forefinger.
15. Quickly insert (dart) needle into the tissue at a 90° angle.
16. Aspirate by slowly (about 2 seconds) pulling back on plunger to determine whether or not needle is in a
blood vessel. If blood is aspirated, discard needle, syringe, and medication. Prepare a new sterile setup and
inject in another site.
17. If no blood is aspirated, inject solution slowly.
18. Wait 10 seconds and then remove needle slowly and steadily, straight out from the site. This ensures
dispersion of medication.
19. Release displaced tissue.
20. Apply gentle pressure at site with a small, dry sponge. Do not massage the injection site or allow patient to
wear tight fitting garment over the site as this could force the medication into the subcutaneous tissue.
21. Discard needle and syringe in sharps container.
22. Assist patient to a position of comfort, and encourage patient to exercise leg.
23. Remove gloves, dispose of them properly, and wash hands.
24. Documentation (HealthLink)
Manufacture, Lot #, Expiration date (as indicated)
VIS# (if applicable)
Name, dosage, route of medication, site of injection, and time given
Progress Notes utilizing SmartPhrases: .npinjectstart and .npinjectend
Assessment and laboratory results relevant to purpose of the medication
Effects of the medication on patient
Teaching about the drug or injection technique
How patient tolerated procedure, i.e., desired effect, adverse reactions
25. Evaluate patient response to medication within an appropriate time frame.
26. Assess site. Observe closely for adverse reactions to the medication.
WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support
REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator
REVIEWED BY: LaVay Morrison, RN, BSN, Clinical Staff Educator
Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.
Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St. Louis, MO: Mosby
Medical Director Date: