T8: Administering Medication and Fluids Flashcards
General clinical equipment is used for consultation and diagnosis.
It includes:
- Thermometer (mercury, digital; rectal or aural): used to measure the animal’s temperature
- Otoscope or Auroscope: used to visually examine the ear canal, nostril, vagina etc.
- Ophthalmoscope: to examine the structures of the eye (e.g. retina, optic disc, blood vessels)
- Stethoscope: used to listen to the heart, lungs and gut sounds
- Laryngoscope: for examination of the back of the throat, larynx and pharynx.
Medical equipment used in the standard administration of drugs and fluids includes
- Syringes of medication and solutions, and needles
- Catheters: stylet or butterfly
- Giving sets
- Fluid bags or bottles
- Infusion pumps
- Paediatric administration sets
Should you use the smallest or largest syringe tgat will comfortably hold volume you wish to inject?
smallest
Always use the smallest and finest needle that will perform the task, except for when using a ….?
catheter; use largest
Things to consider when choosing a needle size are:
- The size of the animal
- Thickness of the skin
- Viscosity or “thickness” of the injected material
- How fast you want to give the injectionThe volume of the drug to be administered
- Veterinary preference: some vets will use one gauge or type of needles for each particular job
Describe a winged needle catheter
Needles have plastic wings on the shaft to facilitate placement.
The needle size ranges from 25 to 19 gauges. Plastic tubing of various lengths extends behind the needle, which allows the operator to connect the syringe to the catheter without disturbing the needle.
These catheters are easy to place but difficult to maintain. They are used for smaller animals, and are best reserved for short term. They are the least stable type of catheter.
Describe a over the needle catheter
Most common type of catheter used in veterinary practice.
They are a form of stylet catheters, and their main use is peripheral vein catheterisation.
These are generally presented as a soft Teflon outer tube reinforced by a steel needle on the inside to penetrate initially the skin and vein wall
Describe a through the needle catheter
Used primarily in the jugular vein. The catheters are protected by a plastic sleeve to prevent contamination.
Once catheter is placed, and the needle withdrawn. most through the needle catheters require a needle guard. The needle guard protects the catheter from sticking the animal and shearing the catheter.
Why give medication?
- Treat disease
- Control disease
- Prevent disease
- Minimise pain
- Restraint
List the 4 basic routes of admin
- Topical (skin, eyes, ears)
- inhalation
- enteric (oral, rectal)
- parenteral injection
Choice of injection route depends on:
- nature of drug
- nature of disease
- size of animal/ability to handle
- V of drug req
- req time of onset of action
- req length of action
- speed of absorption
Describe the two methods for holding a syringe
- Between your thumb on one side of the barrel and the middle three fingers on the other. The little finger is used to press the plunger.
- Place the barrel between the index and middle finger. Use the thumb to press the plunger.
What are the two broad effects a drug has on the body?
- LOCAL EFFECT - where the drug acts directly at the local area where it is administered eg skin creams, local anaesthesia
SYSTEMIC EFFECT - where the drug circulates via the blood stream to affect the body as a whole, including oral, parenteral and rectal routes of administration.
Describe how a drug is absorbed into the blood stream
The drug is absorbed into blood stream.
→ It is then dispersed throughout the blood stream, and reaches a certain concentration evenly through the circulation
→ It is then carried around the body until it reaches the target site, where it leaves the blood stream and enters the target cells
→ At the target cells the drug affects the target cells only if it is at the sufficient concentration
→ There is only continuous action by the drug if the concentration of the drug in the blood stream remains high enough
Drugs are continuously removed from circulation by which methods?
- Inactivation by liver
- Excretion by kidneys
- Volatile drugs breathed out by lungs (e.g. anaesthetics)
- Storage in fatty tissue (This means for some animals, the degree of fat of animal can effect the concentration and duration of activity of some drugs)
- As drug is lost, concentration lowers; the effect of the drug on the cells is lowered.
Describe oral admin and the A/D?
- Drugs administered per os can act locally in GIT or systemically by absorption into BS. Forms of per os medication include tablets, capsules, powder, syrup, solution, suspension and paste.
Advantages
- Least painful
- Usually easily administered by pet owner
- Strict sterility is not necessary
- Disadvantages
- Cannot give to vomiting/diarrhoeic patient
- Inhalation – possibility of choking, pneumonia
- Variable rate of absorption (gut contents)
- Animal resents administration
- Animal may spit or vomit it out
- Irritation of gut – possibility of vomiting, ulceration
- Difficult to alter doses
Describe ID injection and its A/D?
- Fine needle is injected into skin –forms bleb. Commonly used for ID allergy testing.
- *Advantages**
- Absorption into blood results in good local effect
- Tiny amounts
- Disadvantages
- Technically difficult – easy to go through skin (subcutaneous)
- Can be painful and irritating
Describe SC injection and its A/D?
- Under the skin. Commonly used for vaccinations, sedation, antibiotics and conditions such as vomiting.
- *Advantages**
- Simple procedure
- Least painful
- Relatively large volumes may be administered due to loose attachment of the skin to underlying tissue
- Can administer emulsions and suspensions safely (provided oil can be metabolised) without risk of embolism
- Disadvantages
- Slow speed of action – taking at least 15 minutes for therapeutic effect
- Absorption can vary with location of site, solubility of drug and environmental temperature
- Can get tissue reactions
- Not effective in shocked/dehydrated patients
- Irritant/acidic/alkaline substances will cause pain, inflammation and necrosis
Describe IM injection and its A/D?
- Injected deep into muscle tissue, ensure you draw back to check for blood in hub of needle before injecting.
Advantages
- Faster absorption than SC
- Higher drug concentrations in blood than SC
- Prolonged duration of effect compared with intravenous route due to the slower absorption
- Can use with products unsuitable for intravenous administration – e.g. oil-based drugs
- Good for situations where restraint of animal for intravenous administration is not possible or appropriate – e.g. injured, fractious
- Disadvantages
- Must avoid nerves and bones
- Small volumes only
- Risk of abscess or tissue reaction
- More painful
- Product must be relatively non-irritant, or tissue damage will occur; causing the animal pain and the clinic the embarrassment of a lesion
Describe IV injection and its A/D?
Aka venepuncture, administration of drugs directly into the vein. Used for rapid drug administration, IV fluid admin, blood transfusion and the collection of blood samples. Site depends on the method of animal restraint, but it is vital to find an accessible vein of sufficient size. Equipment used includes hypodermic needles, angiocaths, or butterfly needles.
Advantages
- Rapid rise of drug concentration with rapid systemic effect
- No delay in absorption compared to other routes of administration
- Best method to ensure an accurate dose
- Large quantities can be given over a long period of time (in drip)
- Allows administration of irritant drugs that would damage tissues if given via SC or IM. Care must still be taken to avoid leakage around the vein; catheterisation safeguards against this. If perivascular leakage does occur the areas must be diluted with sterile 0.9% saline solution
- Useful in shocked patient as would not get absorption via other routes
Disadvantages
- Risk of embolism – must not contain any particles (e.g. most penicillins) or oils; must not have air bubbles
- Requires more technical skill and precision to avoid damaging veins – veins are quite delicate and easily damaged and this damage can cause “blown” veins, bruising or the development of a haematoma
- Asepsis vital to prevent infection being carried around the body (septicaemia)
- Must be given slowly
Describe the technique for admin of IV injection
- Safe restraint of animal with correct positioning
- Shave site
- Swab with antiseptic/alcohol
- Remove all air from syringe
- Raise vein – compress it proximally
- can use heat in lab animals
- Insert needle with bevel up
- Draw back for flash of blood to double check you are in the vein
- Release proximal compression
- Inject slowly
- When finished, withdraw needle quickly, apply pressure to site for 1 minute
- Check that no haemorrhage occurs
DEscribe technique for IV catheter placement
- Prepare all equipment prior to procedure
- Safe restraint of animal with correct positioning
- Shave site
- Swab with antiseptic/alcohol
- Raise vein – compress it proximally
- Insert catheter into the skin over the vein at an angle of approx 30 degrees, with stylet bevel up
- Look for flash of blood
- Change angle to be more level with the angle of the vein
- Advance catheter over the stylet along the direction of the vein, while proximal compression is released
- Remove stylet
- Look for flash of blood to double check you are still in the vein
- Place catheter plug (injection port)
- Tape catheter into position
How long can an IV catheter stay in place before removing it?
72 hours
What is phlebitis?
inflammation of the vessel wall as a result of damage to the endothelial lining of the vein. Phlebitis is characterised by swelling, tenderness upon palpation, and erythema of the skin over the vessel
What is thrombosis?
Formation of a clot from fibrin and platelets. Thrombosis can result from endothelial trauma at the points between the catheter and the vessel wall.
Thrombosis is characterised by a vein the stands up without being held off and a thick cord-like feeling to the vein
What is catheter embolism?
occurs when a fragment of catheter becomes free and enters the circulation and lodges in the heart or lungs.
The catheter fragment results from a severing of the catheter
What is fluid infiltration?
diffusion of fluids into the surrounding tissues of the vein.
Signs of infiltration are swelling and tenderness proximal to the vein.
The skin may feel cool
What is the functions of blood?
- carry oxygen to the tissues and remove carbon dioxide from the tissues delivering it to the lungs to be exhaled
- carry nutrients (the result of digestion) such as glucose, fatty acids and amino acids to the tissues
- supply water to the tissues
- carry wastes (urea, acids and alkalis) away from the cells to the kidneys for excretion
- help regulate body temperature through vasodilation, vasoconstriction which allow the exchange of heat from the body, as the blood is warm it also carries heat around the body
- Stops haemorrhage by blood clotting mechanisms
- transports hormones and enzymes throughout the body
- protects the body against infection by transporting immune system cells, antitoxins and antibodies
Describe IP injections and its A/D?
iven around the umbilical area into the peritoneal cavity.
Advantages
- Simple procedure
- Can give large volumes
- Rapid absorption
- Useful when difficult to get a vein e.g. shock
Disadvantages
- Risk of peritonitis especially if poor asepsis
- Risk of puncturing organs – damage, haemorrhage, leakage of organ contents, infection and peritonitis
- Do not use irritant or oil-based drugs
- Drugs are absorbed via portal system and go to the liver where they may be inactivated
Describe IC injection and its A/D?
- administration of drugs directly into the heart through the chest wall, using a long-shafted needle.
- The animal should be in a state of unconsciousness for this method of administration.
- It is used to administer adrenaline in cases of emergency, to administer pentobarbital (lethabarb) for rapid euthanasia, or for blood collection in very small animals
- Advantages
Rapid action – good for euthanasia or emergency drug administration
Large volume of blood for collection from tiny animals
- Disadvantages
Painful, dangerous procedure
Must be extremely careful to minimise heart damage
Must be performed under general anaesthesia or a state of unconsciousness
What is an epidural injection?
drug is placed directly into the dural space around the lumbar spinal cord.
It is used to administer analgesia or anaesthesia.
Consequences of poor technique range from pain, infection/inflammation or haemorrhage, to damage to spinal cord and potential paralysis.
What are the A/D of topical meds?
Advantages
Simple to apply
Acts directly on target area
Non painful, non stressful
Disadvantages
Animal may lick medication or rub/wash it off
equipment needed for the administration of fluids and blood includes:
- Fluid bottle or bag
- Blood or plasma expander
- Administration set
- Infusion pump
- Paediatric administration set
- Catheter: either stylet or butterfly
- Tape (e.g. elastoplasts, vetwrap, transpore, leukoplast tape)
The veterinary nurse should be able to (in terms of setting up fluid therapy):
- Set up the drip line in an aseptic manner
- Calculate fluid rate
- Set the fluid drip rate
- Correctly add fluid additives
- Label the fluids
- Monitor and troubleshoot the fluid delivery system
- Regularly reassess the patient and adjust the fluid therapy plan accordingly
- Assess skin turgor, body weight, PCV/TPP, and USG
- Know how to maintain and setup fluid pumps, burettes and other delivery systems
Suggested fluid rates for cats and dogs for different fluids ******
List the levels of dehydration and the corresponding clinical signs
