Thread: are U doing Z-track injections ?
06-16-2004, 11:47 AM #1
are U doing Z-track injections ?
I just started doing this techniqu where you displace the top skin and fat layer a half inch off center over the injection muscle by puling on the skin to the side before injecting. Once injected - you release. the idea is to prevent leakage by not having a straight needle path between the layers.
Is everyone else doing this ?
06-16-2004, 11:48 AM #2
Haven't heard of it until now... Sounds interesting... But I usually don't have much, (if any) juice come out after I inject anyway??
06-16-2004, 11:58 AM #3
I use it...
06-16-2004, 11:59 AM #4
sounda kinda painful, your ripping off a layer of skin?
06-16-2004, 12:04 PM #5Originally Posted by LilVito469
lol, way to read into things bro!
06-16-2004, 12:11 PM #6
I've heard of it... It's not needed though IMO...
I've never had much of anything leak out anyway...
This is praticed more in the medical field and I'm
no doctor just a juicer so I stick it straight in...lol
06-16-2004, 12:12 PM #7
I use this method on my delts...i seem to always leak there.
06-16-2004, 12:13 PM #8Originally Posted by Da Bull
I'm going to freeze your acct until I catch up with you in posts! Slow down Skippy!
06-16-2004, 09:48 PM #9Originally Posted by jmp51483
06-16-2004, 09:50 PM #10Originally Posted by jmp51483
06-16-2004, 10:03 PM #11
i use z track on my penis..that **** thing seems to leak out 6-7 times a day wihtout any control.....
06-16-2004, 10:21 PM #12
I've used it, works good. Now I use the air lock method.
06-16-2004, 10:53 PM #13Originally Posted by SV-1
exaplain airlock ?
06-16-2004, 10:59 PM #14Originally Posted by UrbanDawg
I actually do a modified version of the z track...instead of holding the skin tight before shooting...I pull it tight once I pull the needle out....I guess it a reverse z track method then.
The main reason I do it isnt to keep the gear from leaking out, but to trap the little ammount of blood that appears. Just to keep things clean. lol
06-16-2004, 11:01 PM #15Originally Posted by UrbanDawg
Intramuscular (IM) injections, as the name implies, administer drugs directly into the muscle beneath the subcutaneous tissue. This route allows quicker absorption than subcutaneous injections.
In the UK the Z-track method is widely used, advocated by Beyea and Nicoll (1996) as it controls leakage into the surrounding tissues and is generally more comfortable for the patient.
However, a comparative study of depot intramuscular injection techniques has revealed that the air-bubble method widely used in Canada and USA is significantly more effective at controlling seepage than the Z-track (Quartermaine, 1995).
A further study compiled at the Bracton Centre, Specialist Mental Health Service, could provide no advantages to choosing either the air-bubble method or the Z-track method over each other.
Complications of IM injections
Complications can occur at the site of the injection following IM drug administration, such as seepage of the injection solution and/or bleeding from the injection site onto the skin, pain, irritation and even skin lesions. Such complications are widely recognised and have been investigated (Hay 1995, Murphy 1991). One cause of complications noted in these investigations is some degree of fault in the IM injection administration technique itself.
Taylor et al (1993) recommend the rotation of sites if a series of injections is to be administered, in order to reduce the risk of local reaction.
IM injections should be given into the upper outer quadrant of either the thigh or buttock, into the gluteal muscles.
Correctly identify the site
Place patient on their side with their top leg flexed to relax the muscle.
Mark out an imaginary cross thus dividing the area into four quarters.
By injecting into the upper outer quadrant of the buttock, the sciatic nerve will be missed.
Place the ulnar side of your non-dominant hand on the chosen injection site and stretch the skin taut.
Hold the needle at 90 degrees to the skin.
Plunge the needle in quickly, penetrating the muscle and leaving about a third of the needle exposed.
Pull back on the plunger to observe for blood aspiration. If blood is aspirated the procedure should be discontinued.
If no blood is aspirated, slowly and continuously inject the drug.
After a couple of seconds withdraw the needle at the same angle at which it went in.
Release the skin. This has the effect of breaking the needle track as the skin and subcutaneous layers move back over the muscle. The drug is therefore locked within the muscle. (Belanger, 1985)
Air bubble technique
The procedure for the air bubble technique differs from the Z-track in only one way. When drawing up the medication, a small bubble of air is also drawn up. This is injected into the muscle with the drug, thus forming an air lock in the muscle depot preventing the medication from seeping out along the needle track into other subcutaneous tissue or onto the skin. (Pritchard and Mallett 1992, Taylor et al 1993)
Keen, (1986) suggests that the Z-track technique produces more pain at the injection site and this is further supported by MacGabhann (1996).
Does experience improve IM technique?
MacGabhann goes on to suggest that "The period of training for staff during the study highlighted disparate knowledge and practice of injection techniques. There was no working policy or procedure on administering injections to which staff could refer". This implies a potential discrepancy between ongoing training and improving techniques.
Katsma and Smith (1997) suggest that the potential for pain experience in IM injections is due to the kinematics of injections, ie. the movement of the needle through muscle and tissue. He goes on to say "Minimizing of this effect is accomplished by controlling the needle trajectory during penetration along a linear path from point of contact to end point."
The study invloved 35 RGNs and 21 3rd year student nurses. Student nurse characteristics differed from experienced nurses primarily in syringe angular positioning. They tended to be closer to the "textbook" style (which they had been recently taught) with angle at contact closer to vertical. However, kinematic characteristics describing the non-linear characteristics during needle penetration were not significantly different from those of experienced nurses.
While it is fair to assume that the more experience a nurse has the more likely she will be to optimize a technique for IM administration, this study suggests the wide variability of the nurse kinematic characteristics argues against this optimization occurrence.
There are arguments for and against both the Z-track method and the air bubble method of IM injection techniques and currently in the UK the most commonly used is different variants of the Z-track method (MacGabhann, 1996). This said, nurses should not become complacent in their abilities to administer injections. As the study by Katsma and Smith showed, some experienced nurses have a much poorer technique than those less experienced than them. To understand the rationale, supported by effective research, behind good injection technique can only serve as a benefit to the profession as a whole, our patients and the nurses of the future.
Belanger MC (1985) Long acting neuroleptics: technique for intramuscular injection. Canadian Nurse. 81, 8, 41-44.
Beyea, S., Nicoll, L.M. (1996) Back to basics. Administering Intramuscular Injections the right way. American Journal of Nursing 96:1, 34-35
Hay J (1995) Complications at site of injection of depot neuroleptics. British Medical Journal. 311, 421.
Katsma, D., Smith, G. Intramuscular injection mechanics: Does experience improve technique?Nursing Research, 46, 288-292, 1997.
Mac Gabhann L (1996) A comparison of two depot injection techniques. Nursing Standard. 12, 37, 39-41
Murphy JI (1991) Reducing the pain of intramuscular (IM) injections. Clinical Care. July/August, 35.
Quartermaine S (1995) A comparative study of depot injection techniques. Nursing Times. 91, 30, 36-39.
Pritchard AP, Mallett J (1992) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Third edition. London, Blackwell Scientific.
Taylor C, Lillis C, Le Mone P (1993) Fundamentals of Nursing: The Art and Science of Nursing Care. Second edition. Philadelphia PA, JB Lippincott.
06-17-2004, 12:01 AM #16
Real good info SV-1.
I use this method on my delts...i seem to always leak there.
Same here DB, my delts leak more fluid and more often than any other site.
06-17-2004, 01:46 AM #17
yep airlock is the way to go...i leave about 1/4cc of air in the syringe and shoot...works well...all ive ever leaked when doing that is when i hit a vein or some thing and i get a gusher and some blood and oil comes out...but then i have a swab real handy for that so its ok
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