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?
Since the patient is a 2-month old infant, the site of injection for PCV and Penta, which are given via intramuscular route, must be in the leg. Specifically, the vastus lateralis.
To locate this site for injection, first, position the patient lying down. Next, palpate the muscle below the greater trochanter and above the lateral femoral condyle. Third, divide the muscle into thirds and inject into the middle third in the outer anterolateral aspect, which is lateral to the midpoint of the thigh (The Royal Children's Hospital, n.d.).
The following origin, insertion, and action are based on an article by Hafeez (n.d.) on Physiopedia.
Origin. The vastus lateralis has multiple origins.
- Upper intertrochanteric line
- Base of greater trochanter
- Lateral linea aspera
- Lateral supracondylar ridge
- Lateral intermuscular septum
Insertion:
- Lateral quadriceps tendon attached onto the tibial tubercle
Action:
- Extends the knee
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?
The deltoid muscle is the preferred site in this case. To find the deltoid muscle injection site, locate the acromion process of the patient who is sitting upright. The correct injection site is 2.5 cm below the acromion process (ECG Webmaster, 2021).
The following information is from Loyola University Medical Education Network.
Origin. The deltoid muscle also has multiple origins.
- Lateral third of clavicle
- Acromion
- Spine of scapula to deltoid tubercle
Insertion:
- Middle of lateral surface of humerus / deltoid tuberosity
Action:
- Abducts the arm
- Anterior fibers flex
- Medial fibers rotate
- Posterior fibers extend
- Lateral fibers rotate
References
ECG Webmaster. (2021, March 19). Locating the correct position on the deltoid for an IM injection. ECG. https://ecgtraining.co.uk/locating-the-correct-position-on-the-deltoid-for-an-im-injection/
Hafeez, A. (n.d.). Vastus Lateralis. Physiopedia. https://www.physio-pedia.com/Vastus_Lateralis#cite_note-:0-2
Loyola University Medical Education Network. (n.d.). Deltoid. Master Muscle List. https://www.lumen.luc.edu/lumen/meded/grossanatomy/dissector/mml/delt.htm
The Royal Children's Hospital. (n.d.). Clinical guidelines (Nursing) : Intramuscular injections. The Royal Children's Hospital Melbourne. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Intramuscular_Injections/