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Z-track Injection

A technique for IM injection to prevent medication leakage

Definition

The Z-track technique is a method of intramuscular injection used to prevent medication from leaking into subcutaneous tissue and irritating or staining skin. It is required for irritating medications like iron dextran (Imferon).

Technique

  1. Select ventrogluteal or vastus lateralis site
  2. Prepare medication (draw up plus 0.2 to 0.3 mL air for iron dextran)
  3. Clean site
  4. Pull skin 1 to 1.5 inches laterally with non-dominant hand
  5. Hold skin while inserting needle at 90°
  6. Aspirate (if institutional policy)
  7. Inject medication slowly
  8. Wait 10 seconds before withdrawing needle
  9. Release skin immediately after withdrawing needle. Creates a zigzag path sealing medication in muscle
  10. Do NOT massage

Common Medications Requiring Z-track

Iron dextran (Imferon), hydroxyzine IM (deep), vistaril, haloperidol decanoate, certain oil-based medications.

NCLEX Relevance

Z-track technique: pull skin first, inject, release skin after needle withdrawn. Do not massage.