8.5: Airlock and Z-Track Techniques
- Page ID
- 89960
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)The airlock and Z-track techniques are used when liquids are irritating or staining. For the airlock technique, measure the amount of drug in the syringe. Next, add 0.2 to 0.5 mL of air into the syringe. When using the airlock technique, the liquid is injected first, followed by the air. The air creates a “lock” preventing the fluid from escaping through the tunnel made by the needle, thus reducing pain.
The Z-track method, recommended for the ventrogluteal site, also prevents liquid from leaking back into tissues but creates a zigzag pattern to keep the irritating fluid in the muscle. Pull the skin laterally with your nondominant hand to perform the Z-track technique before injecting the fluid. After pushing the fluid into the muscle, pull the needle at the same insertion angle and immediately release the skin.
Follow these steps to administer an intramuscular injection safely.
Supplies needed:
- Provider’s order
- Drug reference material
- Patient’s health record
- Alcohol wipes
- Drug vial
- 1 mL or 3 mL syringe with 5/8 inch to 1 1/2-inch, 22–25-gauge safety needle
- Bandage
- Gauze
- Medication tray
- Sharps container
- Marker
- Gloves
- Review the provider’s order and review drug reference material.
- Wash hands and don gloves.
- Select the right medication and check it against the provider’s order.
- Check the expiration date.
- Calculate the dose to be given.
- Assemble the supplies needed.
- Check the medication against the provider’s order.
- Open the syringe and needle; attach the needle to the syringe if packaged separately.
- Use the marker to label the syringe with the drug name.
- Remove the cap from the vial and clean it with an alcohol wipe.
- Using the syringe, pull the plunger down to the amount of drug to be administered.
- Insert the needle into the vial and inject the air.
- Invert the vial and syringe and pull the plunger down to fill it with liquid from the vial.
- Use the plunger to remove any large bubbles.
- Use the plunger to fill the syringe with the correct dose.
- Remove the needle from the vial and use the scoop method to recap the needle.
- Check the provider’s order against the vial and the syringe.
- Place the syringe on the medicine tray and clean the area.
- Remove gloves and wash hands.
- Greet the patient and identify yourself. Verify the patient’s identity by asking for their name and date of birth. Check the patient’s identification bracelet if required.
- Ask the patient if they have any drug allergies.
- Provide patient education. Explain the drug ordered, the indication for the drug, side effects, adverse effects, and the provider who ordered the drug.
- Perform any assessments before administering the drug.
- Allow the patient to ask questions.
- Wash hands and don gloves.
- Assist the patient into the proper position for the IM injection site and expose the area to be injected, protect the patient’s privacy.
- Using landmarks, locate the appropriate IM site.
- Assess the injection site for intact, healthy skin. Palpate the skin for any lumps or bumps under the skin.
- Clean the site with an alcohol wipe and allow it to dry.
- Remove the cap from the syringe. Grasp it with your dominant hand and turn the syringe so the bevel is up.
- Stretch or flatten the skin around the insertion area with your nondominant hand.
- With your dominant hand, quickly inject the needle into the skin in a dart-like motion at a 90-degree angle. Insert the entire needle.
- Aspirate the syringe for 5 seconds and check the barrel for a blood return. If no blood is seen, progress with the procedure. If blood is seen, remove the needle and restart the procedure.
- Push the plunger slowly and smoothly at a rate of 10 seconds per milliliter.
- Wait ten seconds before removing the needle.
- Withdraw the needle at the same insertion angle, activate the safety device, and discard it into the sharps container.
- Apply gentle pressure with gauze to stop any bleeding.
- Place a bandage on the injection area.
- Observe the patient for any reactions.
- Clean the area, remove gloves, and wash hands.
- Document the procedure in the patient’s health record. Include the injection site, patient response, patient assessments, and patient teaching.
Table 8.1 Intramuscular Injections
|
Deltoid |
Vastus Lateralis |
Ventrogluteal |
|
|---|---|---|---|
|
Syringe Size |
1 – 3 ml |
||
|
Needle length Based on patient’s size |
1 – 1 ½ inch |
5/8 inch – 1 ½ inch |
1 – 1 ½ inch Make sure the patient can walk after ½ hour |
|
Needle gauge |
22 – 25 |
||
|
Angle of entry |
90 degrees |
||
|
Maximum volume |
0.5 – 1 mL |
Birth – 1 yr: 1 mL 1 – 11 yr: 2 mL >11 yr: 3 mL |
|
|
Patient position |
Sitting |
Sitting/ supine |
Side-lying |
|
Skin |
pinch |
pinch |
taut |
(Centers for Disease Control and Prevention, 2023; Polania Gutierrez & Munakomi, 2023).