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. How do you locate this area
Where are the sites of injection?
- Anterolateral aspect of the thigh
What muscle is targeted in the injection?
- Vastus Lateralis
Write down its origin, insertion and action.
- Origin: originates via a broad aponeurosis from various sites on the femur, such as the proximal half of the intertrochanteric line, anterior and inferior borders of the greater trochanter, lateral lip of the gluteal tuberosity and proximal half of the lateral lip of linea aspera.
- Insertion: inserts to the base of patella via the quadriceps tendon.
- Action: work with the other quad muscles to help extend the knee joint.
How do you locate this area?
- Standing at the individual's side facing the thigh, locate the greater trochanter with your palm. Slide your palm distally onto the lateral thigh. Palpate the oblique fibers of the vastus lateralis anterior and posterior to the iliotibial band.
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?
- Deltoid Muscle
Write down its origin, insertion and action.
- Origin: lateral part of the clavicle (collarbone), as well as the spine and acromion process of the scapula (shoulder blade)
- Insertion: Deltoid tuberosity of humerus
- Action: Flexion and internal rotation of the arm (clavicular part), abduction of the arm beyond 15 degrees (acromial part), extension and external rotation of the arm (spinal part)
How do you locate the area?
- To locate the landmark for the deltoid muscle, expose the upper arm and find the acromion process by palpating the bony prominence. 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.
References:
Vastus Lateralis. (2016). Abmp.com. https://www.abmp.com/textonlymags/article.php?article=1594#:~:text=Palpating%20the%20Vastus%20Lateralis&text=Standing%20at%20the%20client's%20side,posterior%20to%20the%20iliotibial%20band.
ACIP Vaccine Administration Guidelines for Immunization. (2023). https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html#:~:text=For%20adults%2C%20the%20deltoid%20muscle,thigh%20also%20can%20be%20used.
Deltoid muscle. (2023). Kenhub. https://www.kenhub.com/en/library/anatomy/the-deltoid-muscle
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/#:~:text=To%20locate%20the%20landmark%20for,inches)%20below%20the%20acromion%20process.