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?
- The injection site would be in the anterolateral thigh because this is the preferred site for intramuscular injection in infants under the age of 12 months. The vastus lateralis is the muscle targeted in the injection. The vaccines will be injected into the vastus lateralis thigh muscle's bulkiest part, which is the junction of the upper and middle thirds of this muscle.
- Vastus lateralis
- Origin: Greater trochanter and linea aspera of femur
- Insertion: Patella via quadriceps tendon and then tibial tuberosity via patellar ligament
- Action: Extends leg at knee joint
- Locating the Injection Site:
- Perform hand hygiene.
- Don non-sterile gloves and prepare the patient in the correct position. Ensure a sharps disposal container is close by for disposal of needle after administration.
- To find the thigh injection site, make an imaginary box on the upper leg. Find the groin. One hand’s width below the groin becomes the upper border of the box
- Find the top of knee. One hand’s width above the top of the knee becomes the lower border of the box.
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?
- For adults, the deltoid muscle is the preferred site for IM injection.
- Deltoid muscle
- 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
- Locating the Injection Site:
- Allow the patient to relax his/her arm. The patient may stand, sit, or lie down.
- Expose the upper arm and find the acromion process by palpating the bony prominence to locate the landmark for the deltoid muscle. The injection site is in the middle of the deltoid muscle, about 2.5 to 5 cm (1 to 2 inches) below the acromion process.
- Lay three fingers across the deltoid muscle and below the acromion process to locate this area. The injection site is generally three finger widths below, in the middle of the muscle.