Overview
This lecture reviews proper techniques and considerations for administering intradermal, subcutaneous, and intramuscular injections, including the Z-track method.
Intradermal Injections
- Use a small gauge needle, bevel up, usually on the forearm.
- Clean the site from center outward with an antiseptic swab.
- Hold syringe high with fingers on top; do not grip like a dart.
- Pull skin taut and insert needle at a 5- to 15-degree angle.
- Inject with bevel just under the skin to form a bleb (bubble/wheal).
- Withdraw needle at same angle; do not massage the site afterward.
Subcutaneous Injections
- Choose sites with fatty tissue: abdomen, backs of arms, or lateral thighs.
- Clean site in a circular motion from center outward.
- Pinch up subcutaneous tissue; if at least 1 inch of fat, insert at 90 degrees, otherwise at 45 degrees.
- Insert needle, let go of pinch, inject medication, and withdraw at same angle.
- Dispose of needle in sharps box immediately; do not massage the site after injection.
Intramuscular Injections (IM)
- Locate site (e.g., vastus lateralis) using anatomical landmarks: greater trochanter, iliac crest, and groin.
- Clean the site in concentric circles.
- Pull skin taut and insert needle at a 90-degree angle, holding syringe like a dart.
- Anchor syringe with fingers to prevent movement, inject medication slowly, and withdraw at same angle.
- Dispose of needle in sharps box immediately.
Z-track Method for IM Injections
- Displace upper tissue layers laterally with side of non-dominant hand at site.
- Inject at 90-degree angle, withdraw needle, then release displaced skin.
- This method creates a zig-zag wound path, reducing medication leakage into other tissues.
- Always engage needle safety features if available and discard in sharps box.
Key Terms & Definitions
- Intradermal injection — Injection into the skin's first layer, usually to create a bleb.
- Subcutaneous injection — Injection into fatty tissue beneath the skin.
- Intramuscular injection (IM) — Injection into muscle tissue.
- Bleb/Wheal — Small bubble formed after intradermal injection.
- Z-track method — IM technique that displaces tissue to prevent medication leakage.
- Bevel up — Needle tip angled upward during insertion.
Action Items / Next Steps
- Review Clinical Nursing Skills deck for detailed steps.
- Practice all injection types on simulation models if available.
- Always follow proper safety and hygiene protocols.