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Difficulty: MediumPharmacological and Parenteral Therapies

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

  1. 1Identify the appropriate injection site and cleanse it with an antimicrobial swab.
  2. 2Pull the skin and subcutaneous tissue 1 to 1.5 inches laterally using the nondominant hand.
  3. 3Insert the needle quickly at a 90-degree angle into the muscle.
  4. 4Depress the plunger to inject the medication slowly and steadily.
  5. 5Leave the needle in place for 10 seconds after the medication is fully injected.
  6. 6Withdraw the needle smoothly and immediately release the displaced skin.

Answer

The correct sequence is to first cleanse the site, displace the skin laterally, insert the needle at a 90-degree angle, inject the medication slowly, wait 10 seconds, and finally withdraw the needle while releasing the displaced skin.
The Z-track method is designed to prevent irritating medications, such as iron dextran, from leaking into the subcutaneous tissue. Proper technique requires establishing the track by displacing the skin first, then inserting the needle and injecting. Waiting 10 seconds allows for dispersion within the muscle, and releasing the skin only after the needle is completely withdrawn seals the track.

Step-by-Step Solution

1
Identify and cleanse the injection site.
The skin over the target muscle is disinfected.
This is the foundational step of infection control prior to breaking the skin barrier.
2
Displace the skin and subcutaneous tissue laterally.
The tissue layers are shifted out of their normal alignment.
This sets up the Z-track path, which is required before the needle is introduced.
3
Insert the needle at a 90-degree angle.
The needle penetrates through the displaced skin and subcutaneous tissue into the muscle.
A 90-degree angle ensures the medication is delivered deep into the muscle, not the subcutaneous layer.
4
Inject the medication slowly.
The medication is deposited into the muscle tissue.
Slow injection minimizes tissue distention and discomfort.
5
Wait for 10 seconds with the needle in place.
The medication begins to absorb and disperse.
Waiting prevents the medication from immediately seeking the path of least resistance (the needle track) when the needle is removed.
6
Withdraw the needle and release the skin.
The tissue layers slide back to their normal anatomical position.
This traps the medication in the muscle, preventing it from leaking into subcutaneous tissue and causing irritation.

Key Concept

Z-track Method for Intramuscular Injections
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Topics

Pharmacological and Parenteral Therapies

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