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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?
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Preferred site for immunization:
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For infants under 12 months, the preferred intramuscular injection is at the vastus lateralis muscle.
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For the oral polio vaccine, the route used is the mouth.
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Origin:
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The origin of the vastus lateralis muscles is the greater trochanter and linea aspera of the femur.
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Insertion:
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Its insertion is in the patella via the quadriceps tendon and then the tibial tuberosity via the patellar ligament.
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Action:
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The function of the vastus lateralis is to work with the other quad muscles to help extend your knee joint.
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Location site:
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To locate the vastus lateralis muscle, palpate the muscle below the greater trochanter and above the lateral femoral condyle (knee joint). Divide the muscle into thirds and administer the injection into the middle third of the muscle, in the outer anterolateral aspect, lateral to the midpoint of the thigh.
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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?
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Preferred immunization site:
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The deltoid muscle of the arm.
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Origin:
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The acromial extremity of the clavicle (anterior fibers), the acromion of the scapula (lateral fibers), and the spine of scapula (posterior fibers).
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Insertion:
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The deltoid tuberosity of the humerus.
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Action:
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The lateral fibers abduct the arm at shoulder joint, the anterior fibers flex and medially rotate the arm at shoulder joint, the posterior fibers extend and laterally rotate the arm at shoulder joint.
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Location site:
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The deltoid muscle is a rounded triangle shape. To locate this muscle, palpate the acromion (outer edge of the scapula) and outline an imaginary inverted triangle below the shoulder. The injection should be given 3-5 cm below the acromion, in the middle of the triangle.
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Reference:
ACIP Vaccine Administration Guidelines for Immunization. (2019). Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html