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?
Injection site: Anterolateral aspect of mid-thigh
Targeted muscle: Vastus lateralis muscle
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Origin: Greater trochanter and linea aspera of femur.
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Insertion: Patella via quadriceps tendon and then tibial tuberosity via patellar ligament.
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Action: Extend leg at knee joint.
How to locate:
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To landmark the vastus lateralis, position the patient lying down or being held by a parent.
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Make an imaginary box on the upper leg.
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Find the groin. One hand’s width below the groin becomes the upper border of the box.
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Palpate the muscle below the greater trochanter and above the lateral femoral condyle (knee joint).
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Divide the muscle into thirds.
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Stretch the skin to make it tight.
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Administer the injection into the middle third of the muscle, in the outer anterolateral aspect, lateral to the midpoint of the thigh (right angle: 90° straight in).
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?
Injection site: Upper arm
Targeted muscle: Deltoid
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Origin: Acromial extremity of clavicle (anterior fibers), acromion of scapula (lateral fibers), and spine of scapula (posterior fibers).
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Insertion: Deltoid tuberosity of humerus.
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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:
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To locate the landmark for the deltoid muscle, expose the upper arm.
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Identify the shoulder tip (acromion) by palpating the bony prominence.
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Find the deltoid tuberosity.
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Draw an imaginary inverted triangle between the acromion and the deltoid tuberosity.
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The injection site is in the middle of the deltoid muscle, about 2.5 to 5 cm (1 to 2 inches) below the acromion.
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To locate this area, lay three fingers across the deltoid muscle and below the acromion process.
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The injection site is generally three finger widths below, in the middle of the muscle.
References:
Doyle, G. & McCutcheon, J. (2015, November 23). Chapter 7. Parenteral Medication Administration — 7.4 Intramuscular Injections. BCcampus Open Publishing. Retrieved from https://opentextbc.ca/clinicalskills/chapter/6-8-iv-push-medications-and-saline-lock-flush/#:~:text=To%20locate%20the%20landmark%20for,inches
Centers for Disease Control and Prevention. (2022, September 15). Administering Pneumococcal Vaccines. Retrieved from https://www.cdc.gov/vaccines/vpd/pneumo/hcp/administering-vaccine.html#:~:text=Route%2C%20Site%2C%20and%20Needle%20Size,-Administer%20pneumococcal%20polysaccharide&text=The%20preferred%20site%20for%20PCV13,or%20PCV20%20vaccination%20in%20adults.
Cocoman, A. (n.d.). Clinical Practice - IM injections: How’s your technique?. Retrieved from https://www.inmo.ie/MagazineArticle/PrintArticle/5676
Deltoid injection site. (n.d.). Retrieved from https://www.uptodate.com/contents/image?imageKey=PEDS%2F114648
The Royal Children's Hospital Melbourne. (2022, May). Intramuscular Injections. Retrieved from https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Intramuscular_Injections/
UNICEF, Government of India. (2012). Pentavalent Vaccine — Guide for Health Workers with Answers to Frequently Asked Questions. World Health Organization. Retrieved from https://www.who.int/docs/default-source/searo/india/tobacoo/pentavalent-vaccine-guide-for-hws-with-answers-to-faqs.pdf?sfvrsn=903de90_2