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drug leakage, intramuscular injection, pain, randomized controlled study, Z-track technique



  1. Yilmaz, Dilek PhD, RN
  2. Khorshid, Leyla PhD, BSN
  3. Dedeoglu, Yasemin MS, RN


Purpose/Aims: The aim of this study was to investigate the effects of the Z-track technique in the administration of intramuscular diclofenac, a nonsteroidal anti-inflammatory drug, on pain and drug leakage.


Design: This is a semiexperimental and randomized controlled study.


Methods: It was felt necessary to conduct this study to compare the effects on pain and drug leakage of the standard intramuscular injection method and the "Z-track technique," which is claimed to be helpful in this regard. The study was conducted in a government hospital in the Marmara region of Turkey. The research sample consisted of 60 patients, 26 female and 34 male, whose ages varied from 18 to 65 years. Sixty patients were randomly divided into 2 equal groups-the experimental group and the control group. The Z-track technique was used for intramuscular injection with the experimental group, whereas, with the control group, the standard technique of intramuscular injection was used. The patients of both groups were injected with 3-mL diclofenac sodium as prescribed by their doctor. Immediately after the procedure was finished and the needle was withdrawn, a different researcher used a 7 x 7-cm pre-prepared and sterilized standard drying paper to press on the needle entry point. The diameter of leakage was measured with a millimetric ruler and recorded on a data collection form. During this procedure, another nurse who was blind to the injection technique assessed the pain felt during the injection by means of the Visual Analog Scale.


Results: In the experimental group, mean pain severity was found to be 28.30 +/- 23.0, and mean drug leakage was 6.93 +/- 4.62 mm, whereas, in the control group, these values were 36.40 +/- 28.40 and 10.03 +/- 3.69 mm, respectively.


Conclusions: Drug leakage was reduced when administering intramuscular diclofenac sodium by the Z technique, but pain severity was not significantly reduced.