Medication Administration in Cats and Dogs CTVT pages

Medication Administration in Cats and Dogs CTVT pages 586 -599 *Skip section regarding IV catheters

Objectives � Understand how to safely and accurately administer medications to cats and dogs � Understand the equipment needed to administer medications � Understand potential complications from medication administration � To perform an intramuscular injection � To perform an intravenous injection

Routes of Medication Administration � � Oral (PO) Via feeding tube › Esophagostomy › Gastrostomy › Jejunostomy � � � Orogastric intubation Nasogastric intubation Rectal (PR) � � � � › Nebulized or volatilized � � Aural Topical ophthalmic Transdermal Transmucosal Sublingual Intranasal Inhalation Intratracheal

Parenteral Routes: Needle Required o Intradermal (ID) o Subcutaneous (SC or SQ) o Intramuscular (IM) o Intravenous (IV) o Intraosseous (IO) o Intraperitoneal (IP) o Epidural/subdural o Intracardiac (IC)

How Do We Decide Which Route is Best? Patient Factors � Health conditions Drug Factors � Formulation of drug › Symptoms � Absorption rate of drug required � Systemic vs. local effect desired � Temperament � Ease of administration for client � Cost

Other Factors to Consider � Does the medication require any special precautions to be followed during administration? › Examples: � Potential side effects of drug? › Examples: �Pain at injection site �Vomiting/GI upset/constipation � Can it be combined with other prescribed meds?

Supplies Needed 1. 2. 3.

Accurate Dosing Based on Syringe Size

Needles � Needle gauge is determined by: › Route of administration › Amount of drug › Consistency of drug � Two needles are required: › One to draw up the medication › One to administer the medication Why is this? _______________

Process for Changing Needle � Draw up exact amount of drug › Use the same gauge needle as administration � Aspirate all drug into the syringe (out of needle) › This prevents _________ � Remove needle and replace with new needle � Carefully ensure all air is out of the syringe by slowly depressing the plunger › Medication should fill the hub � Ensure accurate amount of medication

Injectable Drugs � Supplied as: 1. Sterilized solutions 2. Sterilized suspensions 3. Powders that must be mixed, or ________ with sterile solution � May be stored in: › Vials (single or multi-dose) › Ampules

Angle of Syringe is Important

Intradermal Injections � Indications for: 1. Local nerve block 2. Allergy skin testing � Skin is usually shaved before this injection � Animals � Drug are usually sedated does not go _______

Intradermal Administration

ID Injection Procedure � Skin is pulled taught and a _____ gauge needle is attached to a syringe and inserted with the bevel up into the _____. › If allergy testing: A ____ volume of allergen is injected. › If locally anesthetizing skin: dose of drug based on weight �Two most common local anesthetics: � The injection site will look like a translucent lump if the injection is performed correctly › Referred to as a _____

Intramuscular Injections � Indications for IM injections: › Anesthetics/sedatives �Convenient route of administration for ______ animals › Pain medications › Heartworm treatment � Appropriate route for injection of _______ volumes of medication � Generally, more painful for animals than SC or IV. › Why?

IM Injection Sites Lumbosacral region 1. Epaxial muscles: ______ to the dorsal spinous processes Hind limb 1. 2. Quadriceps muscle

Epaxial Injections � Inject deep into the third to fifth lumbar region of the epaxial muscles › 2 -3 fingers lateral to the spine � Used to administer _______ heartworm treatment Drug name: _________ Brand Name: Immiticide®

Hind Limb Injections � Quadriceps: most cranial aspect of limb � Semimembranosus/ semitendinosus: small straps of muscle belly on the caudal aspect of limb *Needle should always be directed away from the ____________.

IM Injection Procedure Isolate the muscle between the fingers and thumb of nondominant hand. � Hold the syringe so you do not have to take your hand off of it to aspirate. � A ______ gauge needle attached to a syringe is embedded into the muscle at a ______ angle. � Once in the muscle completely, aspirate. � › What should you feel? _____________________ › What do you do if you see blood in needle hub? Inject the medication. � Massage the site for a few seconds after the injection to help distribute the liquid. � › Exception:

While You’re Injecting… � How do you know how deep to go? � Watch needle closely! › If we move in or out, OR if the animal moves, we should _______. � If the animal moves drastically, we must remove our needle!

Possible Complications from IM Injection � Tissue trauma � Nerve damage *This is a painful injection route- be ready for the animal to react/move upon injection (have good restraint) **Sometimes they do not react to the needle, but to the liquid being injected!

Intravenous Administration � Drugs a vein and/or fluids may be injected directly into � IV route produces an immediate, ______ response to the drug � Supplies needed: › Syringe › 2 needles of the same gauge › Alcohol cotton › Drug

Indications for IV Administration › › › Inducing anesthesia Chemotherapeutic agents Anti-convulsant drugs Vesicants Antibiotic therapy Emergency/resuscitation drugs

IV Injection Sites � Cephalic is most common › Saphenous may be used if needed � Jugular is not used unless a ________ catheter is placed

IV Injection Instructions � � Pull up the drug (same as for IM injection) Expel all air bubbles from the syringe prior inserting into the vein. to › Prevents ___________ � Restrainer should occlude the vessel � Swab the skin with an alcohol cotton ball � Insert a 20 - to 25 - gauge needle, bevel up into the vein. › Only go in until a flash is seen › Confirm placement by gentle aspiration

IV Injection Instructions � Venipuncturist: communicate to restrainer “I’m in” or “ready to inject” � Restrainer: release pressure from the vein › Why is this important? � Inject the medication into the vein � Once complete, communicate with restrainer and remove the needle � Apply firm digital pressure to the injection site until hemostasis/coagulation occurs

IV Injection Tips � If injecting a large volume of drug or have movement of needle: Re-aspirate to confirm placement in vein �Restrainer must _______ again! � If multiple drugs are prescribed or repeated access is needed, an intravenous catheter should be placed

Possible Complications with IV Injections � Air-embolus � Septicemia � Hematoma/Perivascular injection of drug › Incorrect absorption rate › Skin sloughing if a _______ is given DRG page 497