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?
Patient: 2-month old healthy female infant
Sight of PCV and Penta injection:
Anterolateral part of the thigh
Muscle targeted in the injection:
Vastus lateralis
Origin: Greater trochanter and linea aspera of femur.
Insertion: Patella via quadriceps tendon and then tibial tuberosity via patellar ligament.
Action: All four heads extend leg at knee joint; rectus femoris muscle acting alone also flexes thigh at hip joint.
How to locate the Vastilus lateralis muscle:
Lie the patient down or have a parent hold them. 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?
Patient: 65-year old male
Sight of flu vaccine injection:
Scapular Muscles
Muscle targeted in the injection:
Deltoid
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.
How to locate the Deltoid muscle:
The patient's arm should be visible from the shoulder to the top of the elbow while sitting comfortably. Palpate the acromion (outer edge of the scapula) and trace an imaginary inverted triangle below the shoulder. The center of the triangle, 3-5 cm below the acromion, should be the location of the injection.
References:
Clinical guidelines (Nursing) : Intramuscular injections. (n.d.). The Royal Children's Hospital : The Royal Children's Hospital. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Intramuscular_Injections/
Tortora, G. J., & Derrickson, B. H. (2017). Principles of Anatomy and Physiology (15th ed.). Wiley. Retrieved from https://handoutset.com/wp-content/uploads/2022/05/Principles-of-anatomy-and-physiology-Wiley-2017-Derrickson-Bryan-H._-Tortora-Gerard-J..pdf.