Peroral, subcutaneous, intramuscular and intravenous drug application; microchipping

Question 1

What are the different drug application methods?

Answer 1

• peros
• subcutaneous
• intramuscular
• intravenous
• intradermal, intraauricular, intraocular, intraosseal, intraarticular, intraperitoneal, rectal…

Question 2

What is the application route of choice depending on?

Answer 2

– drug formulation
– product labelling
– required onset of action
– (place of action)
– routes available

Question 3

Peroral (drug) application
What are the Indications?

Answer 3

– peroral formulated drugs (pills, liquids)
– radiography contrast
– gastrointestinal tract studies
– forced feeding

Question 4

Peroral (drug) application
What are the Contraindications

Answer 4

1– head and neck trauma
* tissue or bone injury, damaged innervation, decreased mental state
2– decreased mental state or coma * inability to swallow (properly)
3– recent surgery
* stomach/bowels:<12-24h; esophagus: longer
4– known/suspected injury of GI tract (perforation, foreign body/ileus)
5– aggressive patient (risk of injury) (?)
6– vomiting/regurgitation, dysphagia
* antiemetics?, feeding position? e.g. megaesophagus patients

Question 5

Peroral (drug) application
What are the techniques?

Answer 5

1– pilling

• palatable / hidden in food or pill pockets (((mixed with food??)))
• not palatable: placement on the base of tongue: mouth opening + close right after pill is placed
• induce swallowing (if necessary)
• (tied mouth necessary: pill might be crushed and mixed with fluid)
  2 – liquids

Question 6

Peroral (drug) application
What are the possible complications:

Answer 6

1– Aspiration! (→asp. pneumonia /-itis)
2– injury of the patient
* e.g. soft tissue laceration via forceps used * further injury of GI tract
3– if necrosis (e.g. foreign body ileus) or perforation was present; recent surgery
4– injury of the person treating the patient
* altered mental state of patient; agression; pain
5– inappropriate dosage
* vomiting, regurgitation, spitting out the drug

Question 7

Subcutaneous (drug) application
What are the indications?

Answer 7

– injectable drugs labelled for sc. use
– fluids (isotonic crystalloid infusions)
– microchip
– hormone implants
– (slower onset of action – sc. fluids and drugs)

Question 8

Subcutaneous (drug) application
What are the contraindications?

Answer 8

– Drugs NOT labelled for sc. use
* Oily injections, tissue irritative injections (necrosis)
– Poor s.c. absorption
(enrofloxacin, tramadol, buprenorphine)
– (if faster onset of action required and another admin. route available)
– (relative CI: bleeding diathesis, dermatitis)

Question 9

S.c., i.m., i.v. – needle and syringe
–> Needle length and Diameter
–> Suitable diameter in dogs and cats?

Answer 9

size: length and diameter
* diameter: Gauge (G)
(larger gauge – smaller diameter)
* (dogs, cats: 18-25 G)

Question 10

S.c., i.m., i.v. – needle and syringe
Size of choice depending on

Answer 10

• patient size
  (lenght: deep im or sc.?, diameter)
• administration route
  (skin thickness, vein size…)
• injection thickness
  (thicker suspensions or oily: smaller Gauge)
• injection volume
  (e.g. sc infusion: smaller gauge)

Question 11

S.c., i.m., i.v. – needle and syringe
Choice of syringe depending on?

Answer 11

– 1-10 (50) ml
(sc infusion: often directly from inf. bag)
– accurate dosage
– (i.v.: slower administration)
– special:
insulin syringe (and needle): scale: I.U.

Question 12

Subcutaneous injection site

Answer 12

Question 13

The process of subcutaneous drug application –> Special considerations?

Answer 13

• If immunocompromised, then clean skin
• Always aspirate, bubbles = whent through

Question 14

Subcutaneous (drug) application
- Importance of Subcutaneous fluids!?

Indication, type of solution, amount, temperature, limitations, Not route of choice in case of

Answer 14

• For (chronic) dehydration
  (e.g. chronic kidney patients)
• only isotonic crystalloids!
• NOT: hypertonic, G containing, osmotic diuretics, 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
• (with larger bore needle, often directly from infusion bag)
• (limitation: patient tolerance)
• (not the route of choice for patient in hypovolaemia! )

Question 15

Subcutaneous (drug) application
Complications

Answer 15

– hemorrhage
– hematoma
– granuloma
– abscess (sterile / non-sterile)
– tissue irritation, necrosis
– allergy
* hypersensitivity reactions – urticaria, angioedema, anaphylaxis!
– i.v. application by mistake
– injection site sarcoma (even years later!)

Question 16

Intramuscular drug application
- Indications

Answer 16

– injectable drugs labeled for i.m. use
– oily injections: always i.m.
– irritative tissue drugs: often labeled to (deep) i.m. use
* (imidocarb, melarsomine)

Question 17

Intramuscular drug application
What are the contraindications for IM application?

Answer 17

– hemorrhagic diathesis! (thrombocytopenia, -pathia, coagulopathy) – (myositis; muscle stiffness e.g. tetanus)

Question 18

Intramuscular drug application
Which muscles are used as injection sites?
IMPORTAINT

Answer 18

1. m. supra-, infraspinatus
2. m. triceps brachii
3. m. quadriceps femoris
4. m. semitendinosus/semimembranosus (hamstring muscles)
5. dorsal lumbar epaxial muscles

Question 19

Intramuscular drug application
Drug volume?

Answer 19

Drug volume:
max. 2-5 ml per patient per muscle! (dep.on weight)