Checking Before InjectionGiving Injections

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Questions Received:

  1. Recently a student nurse informed me that she had been told that it is not necessary to withdraw the plunger of the syringe prior to administering an intramuscular injection. Is there any research to support this?

  2. Could you please provide a list of drugs that should be administered via the Z-track method.

Responses:

Recently a student nurse informed me that she had been told that it is not necessary to withdraw the plunger of the syringe prior to administering an intramuscular injection. Is there any research to support this?

6th April 2000

We are not familiar with the suggestion that it is not necessary to partially withdraw the syringe plunger before giving an intramuscular injection. The justification for partially withdrawing the plunger is to make sure that the injection is not made directly into a blood vessel (Mallett and Bailey, 1996; Jamieson et al, 1997; Hayes, 1998). If blood is drawn up into the syringe after a few seconds, the tension on the plunger is released, and the needle and syringe are withdrawn. The syringe, with the needle attached, and the drug, should be disposed of. The procedure is started again after the situation has been explained to the patient. A recent review of intramuscular injection procedures has revealed several conflicting practices in current usage (Rodger and King, 2000). However, they find that the literature is consistent in recommending aspiration for blood.

While on the subject of intramuscular injections, 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 which is standard practice in the UK (Quartermaine and Taylor, 1995).

Thus, so far we have not come across a recommendation for non-withdrawal of the plunger, but we shall continue to look. If your student has seen a reference to this effect, it will be interesting to evaluate it - this is clearly a point of some practical significance.

References

Could you please provide a list of drugs that should be administered via the Z-track method.

18th January 2001

Z-track method of injection - modified from Potter & Perry 1993

We are not able to specify a list of drugs - application of the Z-track injection technique differs from hospital to hospital and country to country. As a general observation, though, the Z-track method is used for intramuscular injections of substances which are known to cause pain to the patient if they seep into the subcutaneous tissues or cause permanent staining of the skin. To reduce the risk of causing irritation along the injection pathway, the needle used to draw up the substance is normally changed before the injection is given. The Z-track technique involves displacing the skin and subcutaneous layer in relation to the underlying muscle so that the needle track is sealed off when the needle is withdrawn, thus minimizing reflux (see diagram above). It is most commonly employed in the administration of parenteral iron solutions such as Iron Dextran (Imferon) and Iron Sorbitex (Jectofer). A drug which is highly coloured in solution may be administered by this method. It is sometimes used in the administration of Heparin into the abdominal subcutaneous tissues. Several studies have been carried out to compare the effectiveness of different injection techniques (eg: Keen, 1986; Quartermaine and Taylor, 1995).

References

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