Republic of the Philippines

Laguna State Polytechnic University

Province of Laguna

College of Nursing and Allied Health

Name: __________________________________________ Date: ______________________________

Year & Section: _______________________________ Score: _____________________________

Z-TRACK METHOD: INJECTING MAGNESIUM SULFATE AND PARENTERAL IRON

Steps Rationale Performed Mastered Comments
1. Wash hands  Reduces Yes No
thoroughly before transmission of
preparing infection.
medication. Prepare  Hospitals must
medication for adopt
administration as medication
ordered. Observe administration
the 5 R's: right policy and
drug/medicine, procedure for
right dose, right timing of
time, right route of medication
administration, and administration
right patient. that considers
nature of
prescribed
medication,
specific clinical
application, and
patient needs
(DHHS, 2011;
ISMP, 2011)

2. Draw medication
into the syringe
using an aspirating
needle. Remove
needle.

3. Apply a new needle

to the syringe. The
injection needle
should be
appropriate for the
 size of the woman:
gauge 19 to 23, 1to
1.5 in. On the
average, the large,
edematous,
preeclamptic
woman uses a gauge
21 needle that is 1.5
inches long.

4. Draw up to 0.2 to 0.3

mL of air to create an
air lock that
prevents tracking
medication into the
subcutaneous tissue
that favors its escape
onto the surface,
causing tissue
irritation (in the
case of magnesium
sulfate) and
tattooing of the skin
(in the case of iron).

5. Bring medication to
the bedside.

6. Provide essential  Injection into

explanations, select correct
an intramuscular anatomical site
site, preferably the prevents injury
gluteal muscles to nerves, bone,
(dorsal gluteal or and blood
ventrogluteal). vessels

7. Prepare the site  Mechanical

with an antiseptic action of swab
swab. removes
secretions
containing
microorganisms

8. Pull the skin and

subcutaneous
 tissues 1 to 1.5
inches laterally.

9. Using the non-  Z-track creates

dominant hand, hold zigzag path
the skin taut; then, through tissues
with the dominant that seals
hand, inject the needle track to
needle at a 90- avoid tracking
degree angle deep medication. A
into muscle tissue. quick dartlike
injection
reduces
discomfort. Use
Z-track for all
IM injections
(Hopkins and
Arias, 2013;
Nicoll and
Hesby, 2002;
Ogston-Tuck,
2014b).

10. Aspirate on syringe  Aspiration of

to make sure the blood into
needle is not in a syringe
blood vessel. indicates
possible
placement into
a vein.
Aspiration of
blood into
syringe
indicates
intravenous
(IV) placement
of needle. Slow
injection rate
reduces pain
and tissue
trauma and
reduces chance
of leakage of
medication
back through
 needle track
(Hockenberry
and Wilson,
2015; Nicoll and
Hesby, 2002).
The CDC (2015)

11. Inject the

medication if no
blood return is
noted. Remove the
needle and locate
another site if blood
return is noted,
which means that a
blood vessel is hit.
Use a fresh syringe
and needle for re-
injection.

12. Withdraw the  Allows time for

needle, then medication to
release the skin absorb into
immediately to muscle before
leave a zigzag path removing
that seals the syringe. Dry
medication within gauze
the muscle tissue. minimizes
discomfort
associated with
alcohol on non-
intact skin

13. Do not massage the

injection site and
have no tight
clothing over it to
prevent escaping of
the medication
from the
muscle
tissue. Just apply
pressure for a few
minutes.
14. For parenteral iron  This is because
preparation, use two parenteral iron
needles, one for the tattoos the skin.
aspiration of the
drug from the vial
and other one for
injection.