What Is Z Track Method for Injection?

Use, Procedure, and Side Effects

The Z track method is a procedure for intramuscular injections that helps to keep the medication in the muscle. It is one method used to perform intramuscular (IM) injections. Learn more about the purpose of the test as well as what to expect before, during, and after the procedure.

Purpose of Test

The idea behind the Z track method of IM injections is to put medications into the muscle tissue and not allow them to leak (track) back into the subcutaneous tissue layer over the muscle. Circulation in the muscle is different than in the subcutaneous tissue, so it is important that medications designed to be absorbed in muscle stay in the muscle.

The only indication for using the Z Track Method is an intramuscular injection. The type and amount of medication given will help determine the length and gauge of the needle as well as the proper location of the injection.

Patients who are learning to give injections for home-based treatment should ask their doctor or nurse to explain the best method for their specific medication and situation.

How the Z Track Method Works

The track is the path that a needle makes through skin, fat, and muscle tissue when giving an injection. Any kind of injection creates a track. When the needle is removed, medication and bodily fluids—such as blood—can sometimes wick up through the track and leak out of the body. That leaking is also called tracking.

The Z track method helps to prevent leaking by making a bend in the track created by the needle. When done properly, there are two bends in the track that gives it the "Z" shape. You can't see the track in the actual patient, so your only indication that the method worked is that no medication leaks out.

In addition to helping to prevent leaking, there is some evidence indicating that the Z track method reduces pain from an intramuscular injection.

Risks and Contraindications

There are no known risks or contraindications for using the Z track method for intramuscular injections. The Z track method will not be appropriate for all types of medications if those medications are given via subcutaneous injection or intravascularly. Your doctor will advise you on which medications can be used with this method.

Before the Test

For patients, caregivers, or family members who are administering medications at home, be sure to ask a healthcare provider to instruct on the proper technique for administering an intramuscular injection. You should feel confident administering the injection prior to performing it.

Equipment

Proper equipment for performing an intramuscular injection using the Z track method includes:

The size of the syringe is based on the amount of medication given as measured in milliliters (ml) or cubic centimeters (cc). A milliliter is the same as a cubic centimeter and volume can be expressed using either measurement. The smallest syringe available for the volume of liquid administered is best for proper control and dosing. To administer .5 ml of medication, it is best to use a 1 ml syringe. To administer 2 ml of liquid, it is usually best to use a 3 cc syringe.

If the size of the syringe is too large, medication errors are more likely. Using a 10 ml syringe for an injection of less than 3 ml of medication could result in accidentally drawing up too much or too little medication.

The size of the needle is expressed in both length and gauge (diameter). The lower the gauge number, the larger the diameter of the needle.

For example, a 22 gauge needle is smaller than an 18 gauge needle. Thicker and more viscus medications require a larger gauge needle.

The length of a needle is expressed in centimeters (cm). Longer needles are needed for patients with more adipose (fat) tissue over their muscle tissue.

Preparing for the Injection

Once all of the equipment is gathered, the caregiver should wash his or her hands thoroughly for at least 60 seconds. Dry hands and use clean exam gloves that are not made of latex.

Timing

It shouldn't take more than a minute or two to perform an injection using the Z track method. The method itself does not add any appreciable time to the process of an intramuscular injection.

Injection Sites

The patient's physician or caregiver should determine the proper injection site based on the volume and type of medication being administered, the patient's age, and the patient's size. The best sites for intramuscular injection include the deltoid, the ventrogluteal, and the vastis lateralis.

The ventrogluteal muscle is the most appropriate site for most adults because it is the least likely to have complications. All intramuscular injections can be administered there. The deltoid should only be used for medication volumes of 1ml or less. In most pediatric patients, the vastis lateralis is preferred.

Prepare the Medication

Follow the instructions provided by the physician or caregiver for preparing the medication. Some medications are provided ready for injection directly out of the vial. Other medications require mixing of either two or more liquids, or by reconstituting a dry powder into a liquid solution.

Draw the medication into the syringe by following the instructions provided by the caregiver or physician. Make sure there is no air in the syringe that can be injected into the patient. Air that is injected into the patient may result in irritation, inflammation, and in severe cases, an aneurysm.

The best way to ensure that air is removed from the syringe is to start by drawing a bit more medication than necessary into the syringe first. Follow that by drawing a small amount of air into the syringe. Point the needle up and gently flick the syringe to cause all air bubbles to coalesce at the tip of the syringe where the needle attaches. Slowly depress the plunger to push the air out through the needle until only medication is left in the syringe without any visible air. Continue to push until a drop of medication is visible at the tip of the syringe.

Prepare the Injection Site

Using the alcohol swab, wipe clean the site of the injection in progressively larger concentric circles, moving away from the site at the center. If additional cleaning is necessary, perform that first and make the alcohol swab the final preparation. If needed, an iodine solution may be used to help clean the site prior to using the alcohol swab. Be sure to consult with your physician or caregiver before using iodine as it might interact with some medications.

During the Injection

To perform an injection using the Z track method, follow these steps:

  1. Gently but firmly use your non-dominant hand to pull the skin taut at the site of the injection.
  2. With the exact amount of prepared medication already drawn into a syringe, insert the needle directly into the injection site at a 90-degree angle.
  3. Depress the plunger of the syringe to inject the medication into the patient's muscle.
  4. Once the plunger is completely depressed and unable to move further, remove the needle by pulling the entire syringe straight out of the muscle at a 90-degree angle.
  5. Release the skin to allow it to return to its original position. This step is what causes the track to close up and prevent leaking.

Throughout the Test

It is important for the patient not to move during the procedure. Movement can lead to injury at the injection site, which could cause bleeding or result in abnormally rapid absorption of the medication into the bloodstream.

There is no need to pull back on the plunger during the procedure. Older injection methods advocated this step as a way to ensure that the medication was not being injected directly into a vein. However, this method is only nominally successful in identifying the presence of a vein at the site of injection and can increase the chance of irritation or damage to the surrounding tissues.

Post-Test

Do not rub the site after the injection. That can force medication to leak out of the injection site.

After the Test

Once you have completed an intramuscular injection using the Z track method, cover the site of the injection with an adhesive bandage. Keep any injection site clean and covered. Look for signs of irritation or infection such as swelling, an injection site that is hot to the touch, and redness. If any signs of irritation are noted, be sure to contact your physician or healthcare provider for guidance.

A Word From Verywell

This guide is intended to be a reference and to support the instruction you received from your nurse or physician. It is not intended to replace proper instruction. The Z track method is a quick and useful procedure for successfully administering intramuscular injections with as little pain and complications as possible. But be sure to thoroughly discuss the injection process whether you are administering the injection yourself or you are receiving an injection from a loved one or healthcare professional.

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Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Kara D, Yapucu güneş Ü. The effect on pain of three different methods of intramuscular injection: A randomized controlled trial. Int J Nurs Pract. 2016;22(2):152-9. doi:10.1111/ijn.12358

  2. Arslan GG, Özden D. Creating a change in the use of ventrogluteal site for intramuscular injection. Patient Prefer Adherence. 2018;12:1749-1756. doi:10.2147/PPA.S168885

  3. Gordy S, Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013;3(1):73-6. doi:10.4103/2229-5151.109428

  4. Sepah Y, Samad L, Altaf A, Halim MS, Rajagopalan N, Javed khan A. Aspiration in injections: should we continue or abandon the practice?. F1000Res. 2014;3:157. doi:10.12688/f1000research.1113.3

Additional Reading

  • Carter-Templeton H, McCoy T. Are we on the same page?: a comparison of intramuscular injection explanations in nursing fundamental texts. Medsurg Nurs. 2008 Aug;17(4):237-40. Review.

  • Kara, D., & Yapucu Güneş, Ü. (2014). The effect on pain of three different methods of intramuscular injection: A randomized controlled trial. International Journal Of Nursing Practice22(2), 152-159. DOI:10.1111/ijn.12358

  • Yilmaz, D., Khorshid, L., & Dedeoğlu, Y. (2016). The Effect of the Z-Track Technique on Pain and Drug Leakage in Intramuscular Injections. Clinical Nurse Specialist30(6), E7-E12. DOI:10.1097/nur.0000000000000245