ACTIVITY 3
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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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Where are the sites of injection?
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For PCV and Penta: vastus lateralis muscle in the anterolateral thigh.
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For oral polio vaccine: Children receive doses of the vaccine by drops in the mouth.
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What muscle is targeted in the injection?
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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: All four heads extend the leg at knee joint; rectus femoris muscle acting alone also flexes thigh at hip joint.
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How do you locate this area?
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The greater trochanter and the lateral femoral condyle are markers that can be found halfway down the vastus lateralis, the muscle on the outside of the thigh so the injection site can be located around halfway between these two levels.
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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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Which muscle is the preferred site for IM injection in this case?
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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.
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How do you locate this area?
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On top of the humerus, clavicle, and scapula, the deltoid is a large, rounded triangular structure on the exterior part of the upper arm. Behind the deltoid and descend from the muscle are the brachial artery and radial nerve so the injection site is a smaller triangle-shaped area located above the deltoid tuberosity and is also in the middle of the deltoid.
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References
Centers for Disease Control and Prevention. (2022, October 12). Polio vaccination: What everyone should know. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/polio/public/index.html#:~:text=Oral%20poliovirus%20vaccine%20(OPV)&text=Children%20receive%20doses%20of%20the%20vaccine%20by%20drops%20in%20the%20mouth.
Department of Health and Aged Care of Australia. (2021, July 22). Figure. anatomical markers used to identify the vastus lateralis injection site on the anterolateral thigh. The Australian Immunisation Handbook. https://immunisationhandbook.health.gov.au/resources/figures/figure-anatomical-markers-used-to-identify-the-vastus-lateralis-injection-site-on-the-anterolateral-thigh
Department of Health and Aged Care of Australia. (2023, June 30). Administration of Vaccines. The Australian Immunisation Handbook. https://immunisationhandbook.health.gov.au/contents/vaccination-procedures/administration-of-vaccines#:~:text=The%20vastus%20lateralis%20muscle%20in,be%20harmed%20by%20vaccine%20administration.
Department of Health and Aged Care of Australia. (2023b, July 6). Figure. anatomical markers used to identify the deltoid injection site. The Australian Immunisation Handbook. https://immunisationhandbook.health.gov.au/resources/figures/figure-anatomical-markers-used-to-identify-the-deltoid-injection-site
Tortora, G. J., & Derrickson, B. (2017). Principles of anatomy and physiology. Wiley Custom Learning Solutions.