Day 2 - 1. Peroral, subcutaneous, intramuscular and intravenous drug application; microchip implantation. Flashcards
Application route of choice depends on:
– drug formulation – product labelling – required onset of action – (place of action) – routes available
Peroral medication - Indications
– Usually for long-term medications (owner)
– Drug effect on the GI tract (probiotics, activated charcoal)
– Drugs with systemic effect
Forms of Peroral medications:
– peroral formulated drugs (pills, liquids)
– radiography contrast -gastrointestinal tract studies
– forced feeding
Peroral application - Contraindications
- Head and neck trauma
- Decreased mental state
- Recent surgery
- Known/suspected injury of GI tract
- Vomiting /regurgitation, dysphagia
- Non-cooperative patient (risk of injury)
1.Head and neck trauma
- tissue or bone injury
- damaged innervation
- decreased mental state
2.Decreased mental state, definition:
- shock
- stupor
- coma
- seizure
- inability to swallow (properly)
3.Recent surgery , what are the time limits?
stomach/bowel: <12-24h;
eosophagus: longer
4.Known/suspected injury of GI tract, what kind of injury?
Perforation,
Foreign body/ileus
- Vomiting /regurgitation, dysphagia, what can help?
antiemetics, feeding position
Peroral application - technique, Pilling:
– palatable / hidden in food or pill pockets
– Forced pilling: placement on base of tongue: mouth opening + close right after pill is placed
– induce swallowing (if necessary) flush with some water
Peroral application - technique, liquids
– palatable (((mixed with food??)))
– mouth/muzzle kept rather closed during liquid administration with patient’s nose pointing horizontal or a bit upwards
– use lateral cheek pouch or diastema behind canine teeth to administer
– let the patient swallow during administration!
Cats: very small oral cavity volume! (0.5 ml!)
Agressive dogs: possible with tied muzzle
Peroral application - complications
- Aspiration!
- Injury of patient
- if necrosis (e.g. foreign body ileus) or perforation was present; recent surgery
- Injury of the person treating the patient
- altered mental state of patient; agression; pain
- Inappropriate dosage – vomiting, regurgitation, spitting out the drug
What does the needle size depend on?
(dogs, cats: 18-25 G)
- Patient size
- Admin route
- Injection thickness
- Injection volume
:)
Keep up the good work!!
Subcutaneous application - Indications
– injectable drugs labelled for sc. use – fluids (isotonic crystalloid infusions) – microchip – hormone implants – slower onset of action
Subcutaneous application - Contraindications
- Drugs NOT labelled for sc. use
- oily injections, tissue irritative injections
- Poor s.c. adsorption (enrofloxacin, buprenorphin)
- If faster onset of action required and other admin. route available. (relative CI: bleeding diathesis, dermatitis)
Subcutaneous infusion, general facts:
-Treat mild dehydration
-ONLY isotonic crystalloids!
-NOT: hypertonic, G containing, mannitol, colloids, blood products, lipid or amino acid infusion (tissue necrosis!!!)
-Amount: max. 10(-20) ml/kg per spot
– large dogs: max. 200 ml per spot
-warmed fluids
-Use large bore needle, often directly from infusion bag
Subcutaneous injection - Complications, local:
- Hemorrhage/hematoma
- Granuloma (vaccines)
- Abscess (sterile/non-sterile)
- Tissue irritation, necrosis
- injection site sarcoma (even years later!)
Subcutaneous injection - Complications, systemic reactions:
Allergy - hypersensitivity reactions, urticaria, angioedema, anaphylaxis!
- i.v. application by mistake
Intramuscular drug application, indications
- Labelled for i.m. use
- Oily injections: always i.m.
- Tissue irritative drugs: often labelled to (deep) i.m. use
Intramuscular drug application, contraindications:
– hemorrhagic diathesis
– myositis
Intramuscular injection
• Localisation:
m. supra-, infraspinatus
m. triceps brachii
m. quadriceps femoris
m. semitendinosus/semimembranosus dorsal lumbar epaxial muscles
• drug volume: max. 2-5 ml per patient per muscle! (dep.on weight)
Intramuscular injection - technique
Disinfection!
• Stick perpendicular
• Aspirate
• Slow injection
Intramuscular injection - complications, local reactions
– Hemorrhage/hematoma
– Abscess (sterile / non-sterile)
– Tissue irritation, necrosis
– Peripheral nerve injury!
Intramuscular injection - complications, systemic reactions
– Allergy, hypersensitivity reactions - anaphylaxis!
– i.v. application by mistake • e.g. oil embolism
What do we use for the Intravenous drug application?
i.v. catheters / butterfy needle
Intravenous drug application, appropriate veins:
- v. cephalica antebrachii
- v. saphena lateralis (dog)
- v. femoralis
- V. jugularis
- V. dorsalis pedis
Intravenous injection
• Indications
– injections labelled for i.v. use
– fast onset of action required & i.v. route available
– (tissue irritative drugs: often i.v.)
Intravenous injection, contraindications
oily injections or suspensions NEVER i.v.!!!!!
– (known/suspected hypersensitivity reaction to the drug or product!)
I.v. injection - technique
- Aseptic technique
- Clipping the hair
- Disinfection of the skin
- Vein punction in 15-30- angle
- Aspirate blood prior injection
- Release vein compression
- Inject slowly
Intravenous injection - complications, local reactions
– hemorrhage, hematoma
– phlebitis, thrombophlebitis, thrombosis
– Paravenous injection and necrosis
Intravenous injection - complications, systemic
Systemic reactions
– hypersensitivity reactions anaphylaxis!!!
– septicaemia
– air embolism
– drug side effects are more likely if given too rapidly (e.g. apnea propofol, barbiturates; bradycardia, cardiac arrest potassium, calcium etc.)
Microchipping in hungary:
Dogs: obligatory
Cats: mandatory
Dogs: country database; owner/keeper data, Rabies vaccination data and special remarks available for veterinarians if microchip number is known.
– Rabies vaccination, vaccination book No., pet passport issued: obligatory registration by veterinarian
– microchip insertion process strictly regulated
Process of microchipping
– read patient before the insertion
– read microchip before insertion (and match with badge number)
– prepare site = left side of neck – insert microchip – read microchip – registration: • web database • vaccination book, pet passport, pedigree paper etc. • veterinary facility database • checking microchip before intervention
