When administering an im injection using the Z track method which action is appropriate?

J Diabetes Sci Technol. 2018 Mar; 12(2): 537–538.

Correct technique in insulin delivery is an important aspect of a successful insulin therapy.1 Observed anomalies at injection sites are insulin leakage, pain, bleeding, inflammation, bruising, lipoatrophy, and lipohypertrophy.2 Possible concerns regarding incorrect insulin application technique include greater insulin leakage and back flow. Reflux from the injection site is by far the most frequently reported type of leaking patients report. Incidence is variable and etiology is unclear.3 Leakage influences patients’ perception of insulin administration because patients are concerned whether they have received the correct dosage.

The 10-second waiting and Z-track techniques can be supplied to prevent any leakage of liquid in patients receiving subcutaneous injections. It’s necessary to prevent medication leakage and to get the full dose.4,5 The 10-second waiting technique is recommended to prevent any leakage of liquid in patients receiving subcutaneous insulin injections. For the 10-second waiting technique, a 90° needle is directly inserted into the subcutaneous tissue and patients wait at least 10 seconds after the injection before the needle is withdrawn from the skin.1

For the Z-track technique, the cutaneous tissues are pulled 2 cm caudad before inserting a 90° needle into the subcutaneous tissue after the button has been fully depressed, and then the needle is removed from the skin. When using the Z-track technique, you displace the tissue before you insert the needle. Once the needle is withdrawn, the tissue is restored to its normal position. This traps the drug inside the subcutaneous tissue and prevents any leakage.6

To prevent leakage, an injection should be performed with the Z-track insertion technique with a thin needle in the cutaneous tissues. It was felt necessary to conduct this study to compare the effects on drug leakage of the 10-second waiting technique and the Z-track technique, which is claimed to be helpful in this regard.4,5

Recent studies have indicated that leakage of liquid from the skin did not occur when administering subcutaneous tissue lateral to vertical lines drawn 5 cm away from the umbilicus 30 units/mL distilled water with shorter 4 mm prefilled pens needles by the Z technique. Studies have included both healthy volunteers and persons with diabetes, and their results have been consistent.4,5 Demirhan et al4 found that in the healthy volunteers group with the Z technique, mean Schirmer liquid leakage was 0.0 ± 0.0 mm, whereas with the 10-second waiting technique these values were 0.1 ± 0.7 mm, respectively. In their other works,5 the authors found that in the persons with diabetes group with the Z technique mean Schirmer liquid leakage was 0.0 ± 0.0 mm, whereas with the standard 10-second waiting group these values were 0.4 ± 0.5 mm, respectively. When compared to the 10-second waiting technique, the Z-track insertion technique did not have leakage of liquid from the skin with subcutaneous injections. This suggests that Z-tracking may be an alternative to the 10-second hold time. This is necessary to prevent medication leakage and to get the full dose.

Footnotes

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

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5. Demirhan Y, Altun İ., Peker A, Çetinarslan B. Comparison of the “10 seconds waiting” and the “Z-track” injection techniques in subcutaneous insulin administration. Paper presented at: 53rd National Diabetes Congress, 19th National Diabetes Nursing Symposium; 2017;Girne, Cyprus. [Google Scholar]

6. Pullen RL., Jr. Administering medication by the Z-track method. Nursing. 2005;35(7):24. [PubMed] [Google Scholar]

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