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 thigh (for PCV and Penta); oral drops in the mouth (for OPV)
- Target Muscle: Vastus lateralis
- Origin: greater trochanter, intertrochanteric line, linea aspera of the femur; upper part of the femoral shaft
- Insertion: patella via the quadriceps tendon and tibial tuberosity via the patellar ligament
- Action: extension of leg at knee joint
- How to Locate: To locate this, palpate the muscle above the lateral femoral condyle (knee joint) and beneath the greater trochanter. Divide the muscle into thirds, and then inject the substance lateral to the midpoint of the thigh into the middle third of the muscle in the outer anterolateral aspect.
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?
- Target Muscle: Deltoid Muscle of the Upper Arm
-
Origin: acromial extremity of clavicle, acromion of scapula, and spine of scapula
-
Insertion: deltoid tuberosity of humerus
-
Action: anterior head (flexes and internally rotates arm), middle head (abducts arm), posterior head (laterally rotates arm and extends it)
-
How to locate the area: The bone (acromion process) located at the top of your upper arm should be first identified. The injection site is two finger widths below the acromion process. An upside down triangle should be felt at the bottom of the two fingers which is the deltoid. Injection is given at the center of the triangle.
References:
Tortora, G. J., & Derrickson, B. (2017). Principles of Anatomy and Physiology (15th ed.) [Online]. https://handoutset.com/wp-content/uploads/2022/05/Principles-of-anatomy-and-physiology-Wiley-2017-Derrickson-Bryan-H._-Tortora-Gerard-J..pdf