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Difficulty: MediumPharmacological Therapies

A practical nurse (PN) is preparing to administer an intramuscular (IM) injection of iron dextran to an adult client using the Z-track method. Arrange the following steps for this procedure in the correct chronological order.

  1. 1Cleanse the selected injection site with an antimicrobial swab and allow it to dry completely.
  2. 2Displace the skin and subcutaneous tissue laterally about 1 to 1.5 inches (2.5 to 3.8 cm).
  3. 3Insert the needle at a 90-degree angle and inject the medication slowly.
  4. 4Keep the needle in place for 10 seconds after completing the injection.
  5. 5Withdraw the needle smoothly and immediately release the displaced tissue.

Answer

The correct sequence for a Z-track IM injection is: cleanse the site, displace the tissue laterally, insert the needle and inject, wait 10 seconds, and finally withdraw the needle while releasing the tissue.
The Z-track method is designed specifically to prevent highly irritating or staining medications (like iron dextran) from leaking into the subcutaneous tissue. Proper sequence is vital: site preparation must happen first. The skin is then displaced to shift the entry point. While maintaining displacement, the injection is given. Waiting 10 seconds allows the medication to disperse. Finally, withdrawing the needle and releasing the skin simultaneously 'locks' the track, sealing the medication deep inside the muscle.

Step-by-Step Solution

1
Cleanse the injection site and allow it to dry.
Pathogens are removed from the skin surface.
Prevents the introduction of microorganisms deep into the muscle tissue upon needle insertion.
2
Displace the skin and subcutaneous tissue.
The superficial tissues are offset from the underlying muscle.
Creates a non-linear path (a 'Z' track) for the needle to follow, preparing the mechanical lock.
3
Insert the needle at 90 degrees and inject.
Medication is delivered directly into the deep muscle belly.
Ensures the medication reaches the highly vascular muscle tissue for proper absorption.
4
Wait 10 seconds before removing the needle.
Medication diffuses into the surrounding muscle fibers.
Prevents the fluid from being forced back up the needle track due to pressure in the tissue.
5
Withdraw the needle and release the tissue simultaneously.
The displaced tissue slides back over the injection site in the muscle.
Closes off the needle track, preventing irritating medications like iron dextran from leaking into the subcutaneous layer and causing severe staining or pain.

Key Concept

Safe Medication Administration: Z-Track Method
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Topics

Pharmacological Therapies

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