ACTIVITY 3
1) It is immunization day at the health center. The first patient is a 2-month-old well female infant who is scheduled for the following vaccinations: pneumococcal conjugate vaccine (PCV), pentavalent vaccine (Penta) and oral polio vaccine. PCV and Penta are given via intramuscular route. Where are the sites of injection? What muscle is targeted in the injection? Write down its origin, insertion and action. How do you locate this area?
Considering that the patient is a 2-month-old well female infant, the Centers for Disease Control and Prevention (2022) prefer that the PCV and Penta are to be administered intramuscularly in the vastus lateralis (target muscle) in the anterolateral thigh (site of injection). Its origin is the greater trochanter and linea aspera of femur, with insertion in the patella via quadriceps tendon and then tibial tuberosity via patellar ligament, and action through leg extension at knee joint.
To locate the vastus lateralis, the infant should be positioned lying down or being held by a parent. Then, palpate the muscle below the greater trochanter and above the lateral femoral condyle or knee joint. The muscle will then be divided into thirds and the injection will be administered into the middle third of the muscle, in the outer anterolateral aspect, lateral to the midpoint of the thigh.
2) The baby’s 65-year-old grandfather also came to the center because influenza vaccine is being offered to senior citizens. The flu vaccine is given intramuscularly. Which muscle is the preferred site for IM injection in this case? Write down its origin, insertion and action. How do you locate this area?
As for the baby’s 65-year-old grandfather, the flu vaccine may be administered intramuscularly at the deltoid muscle in the outer aspect of the shoulder/s. Its origin are the acromial extremity of clavicle (anterior fibers), acromion of scapula (lateral fibers), and spine of scapula (posterior fibers); with insertion in the deltoid tuberosity of humerus; and the action in which lateral fibers abduct arm at shoulder joint, anterior fibers flex and medially rotate arm at shoulder joint, and posterior fibers extend and laterally rotate arm at shoulder joint.
In the location of this area, the grandfather should be sitting comfortably with his arm visible from the shoulder to the top of the elbow. The acromion (outer edge of the scapula) will be palpated and an imaginary inverted triangle below the shoulder will be traced. The injection should be given 3 to 5 centimeters below the acromion, in the middle of the triangle.
References
Centers for Disease Control and Prevention. (2022). Administering Pneumococcal Vaccine: For Providers. CDC. Retrieved September 23, 2022, from https://www.cdc.gov/vaccines/vpd/pneumo/hcp/administering-vaccine.html
Schneider, M. (2022, May). Intramuscular Injections. The Royal Children’s Hospital Melbourne. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Intramuscular_Injections/
Tortora, G. J., & Derrickson, B. (2014). Principles of Anatomy and Physiology (14th ed.). Wiley.