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?
Sites of Infections:
- Pneumococcal conjugate vaccine: Ears, Brain, Spinal Cord, Blood (Pneumococcal Conjugate Vaccine Information Statement, 2023).
- Pentavalent vaccine: Brain, spinal cord, lungs, blood, joints, and vocal cords (Pentavalent Vaccine Ministry of Health and Family Welfare Government of India 2012 Guide for Health Workers with Answers to Frequently Asked Questions, n.d.)
- Oral Polio Vaccine: Brain and spinal cord (Polio (Poliomyelitis, Infantile Paralysis), 2022)
Target Muscle for Injection:
- When administering IM injections to infants younger than 12 months, the anterolateral thigh (vastus lateralis) is the recommended location. The junction of the upper and middle thirds of the vastus lateralis thigh muscle, the bulkiest area of the muscle, is where medications are injected (Intramuscular Injections for Neonates | Safer Care Victoria, 2013).
- The mouth is the route used for the oral polio vaccine.
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
Location Site:
- Position the patient lying down or in a parent's arms to identify the vastus lateralis. Palpate the muscle above the lateral femoral condyle and beneath the greater trochanter (knee joint). According to the 2017 Clinical Guidelines (Nursing): Intramuscular Injections, divide the muscle into thirds and provide the injection into the middle third of the muscle in the outer anterolateral aspect, lateral to the midway of the thigh.
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?
Preferred site for IM injection for senior citizens:
- These three criteria have led to the deltoid, ventrogluteal, and thigh sites being regarded as safe and often used for IM injections. 2019 (Nakajima et al.). Adults frequently use the deltoid muscle on the upper arm as the site for IM injections. On the outside of the arm, there is a sizable muscle with a triangle shape.
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.
Location Site:
- To make sure the injection site is in the middle of the thickest region of the deltoid muscle, locate several areas of the upper arm. It is situated between the axillary fold (under the armpit) and the acromion process, the bony point at the extremity of the shoulder (Intramuscular Injections Best Practices for Safe Vaccine Administration in Nursing Homes, n.d.).
References:
- Intramuscular Injections Best Practices for Safe Vaccine Administration in Nursing Homes. (n.d.). https://www.ahrq.gov/sites/default/files/wysiwyg/nursing-home/materials/intramuscular-injections.pdf
- Nakajima, Y., Fujii, T., Mukai, K., Ishida, A., Kato, M., Takahashi, M., Tsuda, M., Nanami Hashiba, Mori, N., Yamanaka, A., Ozaki, N., & Nakatani, T. (2019). Anatomically safe sites for intramuscular injections: a cross-sectional study on young adults and cadavers with a focus on the thigh. Human Vaccines & Immunotherapeutics, 16(1), 189–196. https://doi.org/10.1080/21645515.2019.1646576
- Tortora, G. J., & Derrickson, B. (2017). Principles of anatomy and physiology (15th ed.). Wiley Custom Learning Solutions. https://handoutset.com/wp-content/uploads/2022/05/Principles-of-anatomy-and-physiology-Wiley-2017-Derrickson-Bryan-H._-Tortora-Gerard-J..pdf
- Clinical Guidelines (Nursing) : Intramuscular Injections. (2017). Rch.org.au. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Intramuscular_Injections/#:~:text=To%20landmark%20the%20vastus%20lateralis,femoral%20condyle%20(knee%20joint).
- Intramuscular injections for neonates | Safer Care Victoria. (2013). Vic.gov.au. https://www.safercare.vic.gov.au/clinical-guidance/neonatal/intramuscular-injections-for-neonates#:~:text=The%20anterolateral%20thigh%20is%20the%20preferred%20site%20for%20IM%20injection,middle%20thirds%20of%20this%20muscle.
- Polio (Poliomyelitis, Infantile Paralysis). (2022). Ny.gov. https://www.health.ny.gov/diseases/communicable/polio/#:~:text=Polio%20is%20a%20debilitating%20and,cause%20paralysis%20or%20even%20death.
- Pentavalent Vaccine Ministry of Health and Family Welfare Government of India 2012 Guide for Health Workers with Answers to Frequently Asked Questions. (n.d.). https://www.who.int/docs/default-source/searo/india/tobacoo/pentavalent-vaccine-guide-for-hws-with-answers-to-faqs.pdf
- Pneumococcal Conjugate Vaccine Information Statement. (2023). https://www.cdc.gov/vaccines/hcp/vis/vis-statements/pcv.html