TANILON, Pauline Joy B.
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?
Site of Injection: Anterolateral aspect of the thigh (Pentavalent injections should be administered on the left thigh and PCV injections should be administered on the right thigh.)
Targeted Muscle: Vastus Lateralis
- Origin: Greater trochanter and linea aspera of femur.
- Insertion: Patella via quadriceps tendon and then tibial tuberosity via patellar ligament.
- Action: Extend leg at knee joint
How to Locate
- To find the thigh injection site, create an imaginary box on the upper leg. Locate the groin. The upper boundary of the box is one hand's width below the groin.
- Locate the top of the knee. The lower box boundary is one hand's width above the top of the knee.
- Injections are administered into the middle third (from the imaginary box) of the muscle. The muscle being used has a width that reaches from the middle of the thigh to the middle of the outer 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
Site of Injection: Upper arm
Targeted Muscle: Deltoid
- Origin: Acromial extremity of clavicle (anterior fibers), acromion of scapula (lateral fibers), and spine of scapula (posterior fibers).
- Insertion: Deltoid tuberosity of humerus.
- Action: Lateral fibers abduct arm at shoulder joint; anterior fibers flex and medially rotate arm at shoulder joint; posterior fibers extend and laterally rotate arm at shoulder joint.
How to Locate
The injection site is situated 2.5 to 5 cm (1 to 2 inches) below the acromion process, near the middle of the deltoid muscle. To identify this region, lay three fingers across the deltoid muscle and below the acromion process. In most cases, the injection site is three finger widths below, in the center of the muscle.
References:
Berhane, Y., Worku, A., Demissie, M., Tesfaye, N., Asefa, N., Aniemaw, W., Weldearegawi, B., Kebede, Y., Shiferaw, T., Worku, A., Olijira, L., Merdekios, B., Ashebir, Y., Tadesse, T., Dessie, Y., Meseret, S., & Ayele, G. (2014). Children Who Received PCV-10 Vaccine from a Two-Dose Vial without Preservative Are Not More Likely to Develop Injection Site Abscess Compared with Those Who Received Pentavalent (DPT-HepB-Hib) Vaccine: A Longitudinal Multi-Site Study. PLoS ONE, 9(6), e97376. https://doi.org/10.1371/journal.pone.0097376
Centers for Disease Control and Prevention. (2022a). Administering Pneumococcal Vaccine: For Providers. https://www.cdc.gov/vaccines/vpd/pneumo/hcp/administering-vaccine.html#:~:text=Administer%20pneumococcal%20polysaccharide%20vaccine%20(PPSV23,muscle%20in%20the%20anterolateral%20thigh.
Centers for Disease Control and Prevention. (2022b). Seasonal Influenza Vaccine Dosage & Administration. https://www.cdc.gov/flu/about/qa/vaxadmin.htm
Glynda Rees Doyle, & Jodie Anita McCutcheon. (2015, November 23). 7.4 Intramuscular Injections. Opentextbc.ca; BCcampus. https://opentextbc.ca/clinicalskills/chapter/6-8-iv-push-medications-and-saline-lock-flush/
INMO. (2022). Clinical Practice - IM injections: How’s your technique? Inmo.ie. https://www.inmo.ie/MagazineArticle/PrintArticle/5676
Tortora, G. J., & Derrickson, B. (2014). Principles of Anatomy and Physiology (14th ed.). Wiley.