Diagnostic Sampling and Therapeutic Techniques

Chapter 20
Diagnostic Sampling and Therapeutic Techniques
Copyright 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Arterial Blood Sample Collection
Purpose

Assess patients ability to ventilate and oxygenate Assess acidbase balance Performed on a pH and blood gas analyzer
Sites

Dorsal metatarsal artery Femoral artery Sublingual artery

Lithium or sodium heparin (1000 units/ml) to coat syringe or specially prepared blood gas syringes Ice water bath and thermometer
Equipment
Urine Collection Female Catheterization
A catheter should not be left indwelling for more than 4-5 days.
Thoracocentesis
Indications
For pleural filling defects lab samples for cell count, total protein, cytology, biochemical analysis, and culture and sensitivity are obtained.
Thoracocentesis
Equipment:
Sterile gloves Over the needle catheter2-5-inch (5.08-12.7 cm) IV extension tubing, three-way stopcock, syringe #15 scalpel blade 2% lidocaine Clippers Antiseptic scrub and solution Lab tubes (EDTA and clot tubes) Culture transport media
Restraint: standing, sternal, or lateral recumbency
Thoracocentesis
Procedure:

Prep an area on thorax dorsally for collection of air and ventrally for fluid Clip the hair over 7th-8th intercostal space several inches in diameter Surgically prep the area Inject lidocaine around the intended insertion site Don sterile gloves
Thoracocentesis
Procedure continued:

Assemble the equipment Attach the stopcock to the syringe Attach the extension tubing to the stopcock
An additional extension tube can be added to the stopcock with the free end placed in a container to collect pleural fluid Add two or three small fenestrations to the catheter with the scalpel blade.
Thoracocentesis
Insert catheter in the caudal aspect of the intercostal space, cranial to the anterior edge of rib Hold the catheter perpendicular to the chest wall Advance the catheter gradually through the chest wall until a flash of fluid is seen in the hub or a pop is felt Change the angle on the catheter so it is parallel to the long axis of the rib
Thoracocentesis
Advance the catheter over the needle a few millimeters so the tip of the needle does not extend beyond the catheter Direct the needle and catheter ventrally Advance the catheter off the needle Quickly attach the catheter to the extension tubing
Ultrasound useful to determine needle or catheter placement
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Thoracocentesis
Cats

A butterfly catheter can be used The needle is inserted in a direction parallel to the long axis of the rib with the bevel facing the thoracic cavity If it is non-productive, it may be necessary to withdraw a few millimeters and redirect the catheter Gently aspirate until you achieve a slight negative pressure or until the patients condition improves
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Thoracocentesis
Complications

Pneumothorax Lung laceration Laceration of blood vessel leading to hypovolemia as a result of hemothorax Respiratory rate measurement Auscultation of lung sounds Oxygen saturation measured with a pulse oximeter Nursing care involves close observation to detect any complications.
Nursing care

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Abdominocentesis
Indications
Aids in diagnosis hemo- or uro-abdomen, peritonitis, or ascites Penetrating abdominal injury Suspected pyometra
Contraindications
Fluid is produced by cells of peritoneum; composition of fluid is determined by condition of organs. Samples are analyzed for cell count, packed cell volume, total protein, cytology, biochemical analysis, and culture and sensitivity.
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Abdominocentesis
Equipment
Sterile gloves 20- to 22-gauge needles Syringe Clippers Antiseptic scrub and solution Lab tubes
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Abdominocentesis
Procedure

Right, mid-abdominal region Clip and surgically prep area several inches in diameter Local block not usually necessary Standing, sternal, or lateral recumbency Introduce needle into peritoneal cavity
The right mid-abdominal region avoids the liver, spleen, and urinary bladder.
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Abdominocentesis
Procedure continued

Gently aspirate or allow fluid to flow Rotation of the needle or placement of second needle can stimulate fluid flow If no fluid is retrieved, the procedure is repeated in other locations
Alternative: can use 18- to 20-gauge overthe-needle catheter.
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Abdominocentesis
Complications

High incidence of false negative If it is negative, peritoneal lavage may be indicated Most common complication is failure to obtain a sample and skin hemorrhage or protrusion of omentum More serious complications include penetration of bowel or spleen, damage to the xyphoid process, and introduction of bacteria
Use of syringe increases likelihood of false-negative because of negative pressure created by aspirating if needle is against tissue. Subcutaneous abscesses and cellulitis are more uncommon complications.
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Peritoneal Lavage
Indications

Infusion of fluid into the abdominal, then retrieval of the fluid for analysis Indications are the same as abdominocentesis or if abdominocentesis is negative Same as abdominocentesis Not indicated with historical, physical, or radiographic evidence for the need for an exploratory laparotomy
Contraindications

Has a higher diagnostic accuracy than abdominocentesis. Caution should be exercised in patients with respiratory distress because the fluid introduced may impair ventilation.
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Peritoneal Lavage
Equipment
Peritoneal lavage catheter or long over-the-needle catheter IV administration set Isotonic crystalloid Basic surgical set Sterile gloves Lab tubes Lidocaine Surgical prep materials
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Peritoneal Lavage
Procedure

Empty bladder Lateral recumbency Clip and prep skin of the ventral abdomen caudal to the umbilicus Infiltrate skin and abdominal wall with lidocaine Small midline incision just caudal to the umbilicus is made
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Peritoneal Lavage
Procedure continued

Catheter is inserted in incision and directed caudally and dorsally Catheter is gently aspirated; if a diagnostic sample is obtained, no need to perform lavage If not, approximately 20 ml/kg of warmed crystalloid solution is infused into the abdomen Gently rock patient from side to side Allow fluid to flow freely from catheter or gently aspirate If over-the-needle is used, a stab incision is made. If fluid is clear, the catheter is removed, otherwise it is sutured in place for serial evaluations. Nursing care is the same as abdominocentesis.
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Transtracheal Wash
Indications

Aid in the diagnosis of lower airway and lung disease Acute bronchopneumonia Presence of inflammation to detect any microorganisms present Identification of parasite eggs or larvae Identification of infectious agents Identification of neoplastic cells Patients in severe respiratory distress Collection of fluid from the lower respiratory tract for cytologic and microbiologic analysis. This technique bypasses the mouth and oropharynx to prevent contamination of samples with oral flora.
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Transtracheal Wash
Complications
Cellulitis or subcutaneous abscess formation at puncture site Subcutaneous emphysema around the trachea Acute dyspnea Tracheal laceration Minor subcutaneous hemorrhage Iatrogenic infection
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Transtracheal Wash
Three techniques

Two catheter system Through-the-needle catheter Sterile endotracheal tube In each method 10 ml of nonbacteriostatic saline is introduced into the trachea and immediately withdrawn. The procedure is repeated as necessary.
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Arthrocentesis
Indications

Persistent or cyclic fever Generalized stiffness or limb lameness Specific limb lameness Moderate to severe pyoderma or lick granuloma Trauma with or without hemorrhage into joint
Contraindications

Arthrocentesis should not be attempted on an uncooperative animal or one that is not immobilized.
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Arthrocentesis
Procedure
Clip hair and surgical scrub Don sterile gloves Palpate joint space with index finger Introduce the needle attached to syringe Slight negative pressure applied to syringe upon entry into the joint Release suction before withdrawing needle Adequate sample just enough fluid to fill needle hub
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Arthrocentesis
Sites in dogs and cats

Carpus: The joint is held in flexion Tarsus: The hock is held in partial flexion90 degrees with metatarsals and tibia Stifle: The stifle joint is partially flexed during the procedure
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Bone Marrow Aspirate Dogs and Cats
Indications
Evaluate the cells in the bone marrow
Aspirations or biopsies are safe, easy to perform Yield valuable information of etiology or pathogenesis Some of the conditions that can be evaluated by bone marrow aspiration are:

Non-responsive anemia Thrombocytopenia Neutropenia Pancytopenia Suspected hematopoietic malignancies Polycythemia Inappropriate red blood cell response
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Contraindications

Clotting factor abnormalities Severe thrombocytopenia Infection at the aspirate site Damage to soft tissue structures Hematoma
Complications

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Considerations

Ilium, humerus, and femur most commonly used sites in small animals Aged patients bone marrow is less active in long bones CBC and reticulocyte count within 24 hours before or after the aspirate so the peripheral and marrow cell populations can be prepared Very painful procedure Heavy sedation with good analgesics agents (combination of local or general anesthesia) should be used.
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Fine Needle Aspirate
Indications

Acquire sample for tissue cells from a mass Aid in deciphering between inflammation and hyperplasia
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Equipment
25- to 22-gauge needles, lengths determined by depth of mass 3- to 6-ml syringes Clean glass microscope slides Surgical scrub or alcohol
Restrain so mass is accessible
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Procedure

Surgically prep area or wipe with alcohol Secure mass with free hand Introduce needle into the mass, redirecting needle within tissue once or twice; remove needle Syringe containing at least 1 ml of air is attached to the needle Depress the syringe plunger quickly onto a microscope slide Liquid material: a push slide can be made More viscous material: a pull smear is made In large masses direct needle into peripheral parts of the lesion, avoiding necrotic center.
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Alternate technique

Use a 3- to 12-ml syringe attached to the needle Insert needle into mass and apply suction to the syringe plunger Redirect needle once or twice Release negative pressure before withdrawing needle Detach needle from syringe, aspirate 1-2 ml of air into syringe Reattach air-filled syringe to needle Forcefully depress syringe, expelling contents onto microscope slide Use either push or pull technique to make slides
Copyright 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved. 34
Vaginal Cytology
Indications

Determine present stage of estrous cycle for breeding purposes Help determine the cause of vaginal disease Vulva is gently wiped with warm water Labia are separated with a gloved hand A cotton swab is inserted and rolled against the vaginal wall Swab is removed and rolled onto a clean glass microscope slide Female is in standing position with support under her abdomen or in lateral recumbency.
Procedure

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Intravenous Administration
Medications directly into a vein

Used for immediate response Used when drug may be irritating to tissues Used when drug may not be absorbed by other routes of administration Cephalic and lateral saphenous veins
Dogs
Cats
Cephalic, medial saphenous, femoral veins
The jugular vein is used in both large and small animals when a catheter is in place.
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Over-the-needle IV catheter
AKA OTN catheter Most common type of catheter used Used on peripheral veins Catheter is fitted outside a steel needle Needlepoint extends beyond the catheter for entry into vein Needle is withdrawn when catheter is in place
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Through-the-needle IV catheter

Used primarily in the jugular vein Plastic sleeve protects catheter from contamination Allow simultaneous infusions at one catheter site Provides the functions as two or three separately introduced single lumen catheters Placement is percutaneous with a guidewire More expensive than other IV catheters
Multilumen IV catheter

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IV Catheterization
General guidelines
Used for solutions with osmolalities 600 mosm
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IV Catheterization Guidelines
Complications
Phlebitis Thrombophlebitis Local cellulitis Septicemia Collapsed veins or hematomas rendering veins unusable Swelling, heat, pus, thick corded feeling, or appearance of fluid from catheter site are signs to watch for.
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Peripheral Vein Catheterization
With bevel up, insert catheter through skin or relief hole at approximately 15-degree angle
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Jugular IV Catheterization
General procedure Site chosen is shaved and surgically prepped Wipe or spray with betadine solution, left to dry on 2-5 ml of lidocaine given ID over and above insertion site Create sterile field by opening sterile gloves, and laying opened catheter on gloves Other items are either placed on sterile field or in cold sterilization tray Don gloves
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Hold catheter in dominant handother gloved hand occludes jugular Insert catheter into skin at approximately 45-degree angle, toward heart Flash of blood in hub indicates vessel is hit, advance centimeter more Hold needle still, sliding catheter into vessel; remove needle Check to make sure vein is still catheterized by applying digital pressure Attach a PRN or T-port and suture catheter into place Some animals require skin to be cut or pilot hole to be drilled because of thick skin.
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Apply small amount of antibacterial ointment before placing wrap over catheter Wrap neck or apply stents over catheters to stabilize them and to prevent them from getting rubbed out Rotate ointments if catheter will be staying in long termprevents resistant Staphylococcus infections.
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IV Catheterization
Dogs and cats
Cephalic, medial (cat) and lateral (dog) saphenous, caudal auricular veins
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IV Catheterization
Camelid
Adult will require cut down to access jugular, thick skin, and large transverse processes of cervical vertebrae that protect vein
Place catheter in lower third of jugular vein

14 gauge, 5-inch catheters for adults, 16- to 20gauge, 3-inch for crias Cephalic vein can be used, but difficult to place and maintain because they lie down in sternal recumbency
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IV Catheterization
Ovine and caprine
Jugular vein is most suitable but cephalic vein also used
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IV Catheterization
Porcine
Ear vein 19- to 22-gauge butterfly catheter or 18- to 22gauge, 1- to 2-inch over-the-needle catheter recommended Occluded base of ear with digital pressure Insert catheter toward base of ear into vein Cap and secure to ear using glue or plastic tape Support pinna with roll of gauze or tape inside pinna, fold margins under, and secure with strips of adhesive tape
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IV Catheterization
Equine

Vein of choice is jugular vein Catheter options are based on length of time catheter will be in place and number of ports necessary 2 ml of lidocaine is injected over site If jugular is not accessible, use cephalic vein or lateral thoracic vein. Occasionally carotid artery is catheterized, bright red blood will forcibly pulses out catheter; remove catheter and apply digital pressure.
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IV Catheterization
Bovine
Restraint is critical for safety of animal and staff Cut down using scalpel blade, or puncture with same size needle Adults chute or stanchion with head haltered Calves standing or in recumbency
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IV Catheter Maintenance
If any of these things occur, remove catheter and place a new one in a different location:
Phlebitis Infection Thrombosis Leaking at insertion site by itself or during a flush Pain upon injection Any portion of the catheter is exposed
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Performed every 48 hours or on an as-needed basis Dressing should be removed and site inspected twice daily. Phlebitis may include erythema, swelling, tenderness upon palpation, and an apparent increase in skin temperature over vein. Infection is characterized by redness, local increase in temperature; may include a purulent discharge Thrombosis is characterized by vein that stands up without being held off and thick cord-like feeling to vein.
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If catheter site looks good, then clean with iodophor or chlorhexidine solution
Allow site to dry then cover as described previously
Recommended not to leave a catheter in place longer than 72 hours If bandage gets wet, reason should be identified and bandage changed Swelling distal to catheter usually indicative of tight bandage. Swelling proximal to the catheter may be due to infiltration.
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Catheters not continuously used should be flushed with 4 U/ml of heparinized saline (1000 units/ 250 ml normal saline) every 4 hours Bags of heparinized saline are discarded every 12-24 hours to minimize risk of contamination Catheters not used for prolonged period of time should be fitted with heparin lock NEVER flush concentrated heparin solution into patient. Clearly label catheter to avoid inadvertent flushing of concentrated heparin into patient.
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Subcutaneous Administration
Not recommended in severely dehydrated or critically ill patients
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Subcutaneous Administration

Dorsolateral region from neck to hips Dorsal region of neck and back avoided Intrascapular region avoided for feline vaccinations
Incidence of vaccine-induced tumors
Insulin injections are not administered in the intrascapular region Feline vaccinations given as distally on the extremity as possible
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Difficulty treating abscesses or masses on the dorsal region of the neck and back Insulin injections are not administered in the intrascapular region because of poor absorption and the possibility of brosis formation from repeated injections. Feline vaccinations
Right front leg, rhinotracheitis-calici-panleukopenia Right rear leg, rabies Left rear leg, feline leukemia
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Intramuscular Administration
Appropriate for injection of small volumes of medication Sites
Lumbosacral musculature lateral to dorsal spinous processes Semimembranosus or semitendinosus muscles Semimembranosus or semitendinosus muscles: enter lateral aspect of muscle, directed caudally to avoid sciatic nerve. Using lumbosacral muscles not recommended in very thin animals. Deep lumbar injections in the third to fth lumbar region are used to administer heartworm treatment Triceps muscles on caudal aspect of front legs Neck is never used for intramuscular injection
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Intradermal Administration
Used for allergy testing or to desensitize skin with local anesthetic Procedure

Shave hair on lateral aspect of trunk Gently wipe skin with a water-moistened gauze sponge Lift fold of skin Insert 25- to 27-gauge needle attached 1-ml syringe into dermis Inject 0.1 ml of allergen or local anesthesia per site A small lump will form if done correctly Vigorous scrubbing or use of antimicrobial cleaning solution is contraindicated. DO NOT massage area!
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Intranasal Administration
Certain vaccines are formulated for intranasal administration

Feline infectious peritonitis Feline viral rhinotracheitis-calici-panleukopenia Bordetella bronchiseptica
Diazepam for treatment of status epilepticus if IV inaccessible
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Intratracheal Administration

Emergency drugs can be injected directly into the trachea Absorption is extremely rapid Procedure
Polypropylene urinary catheter or rubber feeding tube is inserted into trachea either directly or through an endotracheal tube Drug contained in a syringe is forcefully injected through the tube Approximately 10 ml of air or 3-10 ml of sterile saline solution follows immediately to disperse the drug Intratracheal dosage is usually twice the intravenous dosage Use acronym ALE (Atropine, Lidocaine, or Epinephrine) to remember which drugs can be administered via endotracheal tube.
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Intraosseous Administration
Contraindications

Patients with sepsis Bones that are fractured or infected Skin over insertion site is not free of infection Bone cortex is punctured multiple times
Needles are removed as soon as intravenous access can be established.
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Sites
Tibia, femur, humerus, occasionally iliac wing or ischium Intraosseous catheter or needle should have a stylet Needles sizes 15-18 gauge Bone marrow needles in adults 18- to 22-gauge hypodermic needle for neonates
Equipment
If hypodermic needle plugs with core of bone, it can be flushed with saline. 22-gauge 3.75-cm needle can be nested inside 18gauge 2.5-cm needle to serve as stylet.
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Same needle placement as for bone marrow aspiration Secure needle by wrapping a butterfly tab of tape around it as it exits skin Suture tape to skin Povidone-iodine ointment-treated gauze pad is applied to entry site Bulky, gauze bandage is placed around needle for further stabilization Patency of intraosseous needle is maintained by flushing every 6 hours with 1-2 ml of heparinized 0.9% saline solution Needle may remain in place for up to 3 days.
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Intraperitoneal Administration

Involves placement of substances directly into abdominal cavity Fluids are absorbed more rapidly than subcutaneous route, but more slowly than by intravascular or intraosseous routes Chemotherapy drugs can be given IP Lavage of the abdomen for peritonitis or pancreatitis Warm or cool fluid lavage used to treat severe hypothermia or hyperthermia May be used in neonates when intravascular or intraosseous access is difficult to obtain. Occasionally used for noncaustic fluids, blood products, or medications. Fluids must be at body temperature.
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Intraperitoneal Administration

Ventral abdomen between the umbilicus and bladder is shaved and surgically prepared 18- to 22-gauge needle or catheter is inserted into abdominal cavity on ventral midline, a few centimeters caudal to umbilicus Syringe is attached and aspirated If needle is in proper location and no blood or fluid is aspirated, the substance is injected If syringe remains empty when negative pressure is applied, the medication or fluids have been injected If blood or fluid enters syringe tip, needle may have punctured a vessel or abdominal organ. Remove needle, and a new needle is inserted in a different site.
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Topical Ophthalmic Administration

If patient requires multiple medications in the same eye, apply 3-5 minutes apart. If both solution and ointment are prescribed, solution is applied 3-5 minutes before ointment.
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Transdermal Administration
Sprays or liquids
Either sprayed on hair over entire body or applied to skin between shoulder blades For control of mites, fleas, ticks, heartworm, intestinal parasites
Creams

Manufactured to be applied directly on skin Treated area is lightly covered so its not accidentally touched Some creams containing lidocaine or prilocaine desensitize skin to provide local anesthesia for venipuncture Ideally creams should be in contact with skin for 30-60 minutes to reach maximum effectiveness.
When treating hospitalized animals, place a note on the front of the patients cage specifying:

Medication used Site the medication was applied
Duration of time that must pass before the site can be safely touched.
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Intrarectal Administration
Mucosa of large intestine capable of absorbing medications

Have both local and systemic effects Absorption is most effective when free of fecal material Antiemetic tablets or suppositories can be administered to vomiting patients
Procedure
Gloved, lubricated nger inserts tablet into rectum at least 5 cm Lubricated short rubber feeding tube or urinary catheter is inserted 8-10 cm into rectum Medication is placed into a syringe and injected through catheter Several milliliters of warm water are flushed into catheter

Antiseizure drugs, such as diazepam, can be administered intrarectally. Diazepam can also be injected directly into rectum with needleless syringe.
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Intrarectal Administration
Enemas
Lubricate syringe or bottle tip containing enema solution and insert into rectum; allow animal to defecate Warm-water enemas are given via a lubricated tubing inserted past rectum and into large intestine Water is funneled or injected into end of tube Move tube back and forth, slowly advancing up intestinal tract as fecal material is expelled
Medicated enemas
Medication, such as lactulose, added to enema solutions, must be retained in large intestine After the allotted time has passed, the catheter is removed and intestine is allowed to evacuate

Place animal in an area where it can defecate. If solution must be retained in the rectum, the solution is injected into urinary or feeding catheter and crimped shut or the rectum is held closed with a gloved hand to prevent the enema from exiting.
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Oral Administration

Placement of medication into oral cavity Come in a liquid, capsule, or tablet form Liquids
Administered with dropper or syringe Pulverized tablets and contents from capsules can be mixed with small volume of food, water, or flavored liquid
Technicians should be adept at administering oral medications. Technicians should be capable of demonstrating techniques to pet owners.
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Oral Administration
Procedure for administering liquids

Patients lower lip is pulled out at the commissure Tip of the syringe or dropper is placed between cheek and gums Small volumes of liquid are injected while muzzle is held at a neutral angle and not elevated Hyperextension of neck or movement may result in fluid aspiration
Allow patient to rest if it struggles or coughs or the fluid spills out of mouth.
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Oral Administration
Tablets and capsules

Can be hidden in meat, cheese, or a chunk of canned pet food Must be sure the animal has eaten the medication
Procedure

Restrain animal in a sitting position Hold pill between index and thumb of dominant hand Tilt the head back Roll the lips over the molars on top jaw Pry open lower jaw with middle finger hand holding the pill Place or toss pill far back on base of tongue Hold the muzzle closed Stimulate animal to swallow Cats will eat the food surrounding the pill and leave the pill. If patient has diminished appetite, it may not eat all of the medication-laced food. Tablet will be expelled if not placed far enough back. Stimulate animal to swallow by gently massaging throat area.
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Oral Administration
Pilling syringe

Used to administer tablets to fractious cats and dogs Tablet is secured in tip Tip is inserted into back of mouth The plunger is depressed, and pill is propelled down esophagus
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Orogastric Intubation
Administer medication, food, or fluids through a tube passed through the mouth directly into the stomach OGT = orogastric tube Orphan or weak neonates can be fed milk replacer OGT may be passed in an attempt to decompress a patient with gastric dilatation
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Correct placement of tube must be verified
See placement of NGTs
Fluid is administered via 60-ml syringe, drench pump, or funnel After fluid has been administered, the tube is bent to occlude it and then withdrawn in a downward direction Occluding the tube before removal prevents backflow of fluid from entering the trachea.
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Enteral Feeding Tubes
General guidelines

Indications for critically ill and chronic disorders such as renal impairment Excellent method for maintaining normal nutritional status when oral intake is not possible Tubes placed directly into esophagus, stomach, duodenum, or jejunum Must be capable of digestion and absorption of food slurries, fluid, or medication Selection of feeding tube depends on duration of enteral support, aspiration risk, and animals temperament
Maintenance

All enteral feeding tubes are flushed before and after use Small volume of warm water is injected slowly to dispel lumen obstructions Aspirate with syringe to check gastrostomy tubes before giving next meal or medications Tube insertion site and position are inspected daily for shifting and inflammation and discharge
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Nasoesophageal tubes

Occasionally used for short-term feeding and administration of medications Nutritional support is required beyond 10 days, placement of an esophagostomy or gastrostomy tube is preferred Easy and inexpensive to place Contraindicated in vomiting patients or patients without a gag reflex
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Nasoesophageal tubes

5- to 8-Fr pediatric feeding tube premeasured on outside of body 0.5-1 ml, 2% lidocaine is infused into one nostril on dog, and 5 drops of 0.5% proparacaine in one nostril of cat Restraint is same as previously described Tube is lubricated and started in nostril dorsomedial to alar fold then advanced down the nostril and directed ventrally
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Nasoesophageal tubes continued

Rest of steps are same as those previously described for orogastric tubes This tube is sutured or glued to patient Remainder of tube should be taped to dorsum of neck and tted with an Elizabethan collar End is capped to prevent reflux
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Esophagostomy and gastrostomy devices
Preferred over pharyngostomy tubeshave less laryngeal irritation and obstruction and less likely to induce vomiting and become dislodged Can remain long-term (weeks to months) Inserted under a light general anesthesia Occasional replacement may be necessary depending on construction and wear of tube Specially designed percutaneous kits available
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Method using right-angled forceps and a 14-20 Fr red rubber-feeling tube Placed in midcervical esophagus on left side of neck Animal in right lateral recumbency, left cervical region is shaved and surgically prepared Point of shoulder and angle of mandible are used as guides to measure tube to the seventh rib Pair of extra long curved forceps such as a carmalt is advanced down throat to left midcervical region of esophagus
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A stab incision is made through skin over tips Hemostat tips are put through hole and opened enough to grasp fenestrated end of feeding tube, which is drawn through oral cavity Once end of tube reaches mouth, tube is bent and redirected back down esophagus to pre-measured mark Retention sutures are used to secure distal end of tube to skin Povidone-iodinetreated gauze sponge is placed around skin-tube interface and bandage is applied Exposed tube end is capped
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Gastrostomy tube feeding

Recommended for long-term nutritional support Especially suited for patients suffering from dysphagia, megaesophagus, and head/laryngeal/esophageal trauma Tubes generally larger in diameter18-24 Fr Contradicted in patients that vomit frequently, have gastrointestinal obstruction, or are obtunded Some animals require life-long gastrostomy tube feedings Can be placed percutaneously or during laparotomy
Blood Sample Collection Large Animals
Venipuncture Sites

Horses: jugular, cephalic, transverse facial, and lateral thoracic vein Cattle: jugular and coccygeal Camelids: jugular, saphenous, auricular, coccygeal, and cephalic Sheep and goats: jugular, cephalic, and saphenous Pigs: cranial vena cava, jugular, auricular, peripheral leg veins, coccygeal, and orbital sinus
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Blood Sample Collection Large Animals
Restraint

Cattle in chutes or stanchions, halter or nose lead Horse halter and stocks Camelidssternal recumbency Sheep and goats backed into a corner and straddled Pigshog snare for big to medium-sized pigs
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Assess blood gases Assess oxygen and carbon dioxide content, pH, base deficit, and bicarbonate Used to evaluate respiratory status Performed on a pH and blood gas analyzer
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Equipment

1- or 3-ml syringe with 25-gauge needle Lithium or sodium heparin (1000 U/ml) to coat syringe or specially prepared blood gas syringes Vacutainer tube cork Alcohol swab and surgical scrub Ice water bath and thermometer
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Equine arteries
Facial artery, transverse facial, carotid, and metatarsal Auricular artery Transverse facial, carotid, auricular, dorsal, and metatarsal
Camelid arteries
Bovine, ovine, and caprine arteries
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Urine Collection Voluntary
Horses

Freshly bedded stall Running water on cement Tickling the prepucevulva Recumbent neonates when stood up Lead to communal dung piles Attach collection cup to end of broom to collect without causing distraction Urinate in caudal direction while squatting
Camelids

Cattle

Lightly stroking the vulva tip and skin Prepuce massaged and splashed with warm water
Sheep and goats
Immediately after rising from recumbency Ewes by occluding the nostrils for up to 45 seconds Fresh pen or stall
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Swine

Common for adults to urinate 2-3 times per day Males encourage urination by stroking prepuce Females may respond by gently stroking vulva
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Urine Collection Catheterization
Equine males

Sedation to make the horse easier to handle and to facilitate extension of the penis Retract the prepuce, grasp the penis gently, and wash the penis with dilute antibacterial soap Rinse with water Put on sterile glovesapply sterile lubricant to the tip of catheter Hold penis with one hand and gently advance catheter up urethra with other hand Slight resistance will occur at the curvature of the ischial arch Position yourself cranially to avoid being kicked.
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Equine females
Restrain haltered and tied standing in stocks Wrap the tail and tie it out of the way Thoroughly clean the vulva and perineum Apply sterile lubricate to gloves Slide hand into vulva to locate urethral orifice on the ventral aspect of the vaginal vault Lubricate the catheter and slide catheter in and down the urethral orifice
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Llama and alpaca females

Clean and dry vulva Don gloves, lubricate finger Insert finger into vulva, locate external urethral orifice Withdraw finger slightly and slide catheter along finger into the orifice Slowly advance catheter Collect a free-flowing sample or gently aspirate with syringe
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Cattle

Males have anatomic obstacles making catheterization extremely difficult Females use a 0.5-cm catheter using similar techniques as used for mares 5-12 Fr catheter Restrain standing with tail tied or held out of the way Similar procedure as cattle, urethra is found midline on the ventral surface within 5-10 cm
Sheep and goat females:

Sheep and goat males similar to cattle, making catheterization of the bladder extremely difficult. Catheterization of the urethra is commonly performed on blocked goats.
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Milk Sample Collection

Collected to test for presence of mastitis Inflammation may be present if teat or udder has received a traumatic injury Colostrum frequently collected and tested from mares to determine quality
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Sterile milk samples

Wash and dry hands Clean teat end with alcohol until cotton or gauze comes away clean and allow to air dry Using clean dry hands, remove top of a culture tube Collect milk from all 4 quarters Open new container for each quarter Hold tube so no dirt or debris falls into tube and do not allow anything to touch opening of tube Discard first few squirts of milk, then squirt a stream of milk directly into collection tube and recap Putting a sample from each quarter in a separate container prevents contamination of the samples. Can refrigerate sample up to 24 hours before lab processing.
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Nonsterile milk samples can be milked directly into collection tube or container California Mastitis Test (CMT)

Test involves use of a white plastic test paddle with four cups labeled A to D and a reagent fluid Teats are cleaned and dried A small amount of milk is stripped from one teat into one well of the paddle and repeated for all four quarters An equal volume of CMT reagent solution is added to each well The paddle is gently moved to swirl the milk and observe the resultant solution that is graded on gel formation
Mastitis is an inflammation of the mammary gland commonly caused by bacteria. Clinical mastitis signs include hard, hot udder; abnormal appearance; or smell of milk and pain Subclinical mastitis must be determined by testing the milk.
100
CMT results:

0 = no gel Trace = Precipitate disappears with continued movement of sample 1 = First visible precipitate doesnt disappear 2 = First visible gel-mixture moves toward center of cup, leaving bottom outer edge of cup exposed 3 = Egg yolk type clot that sticks to bottom of plate The higher the number, the greater the severity.
101
Colostrum sample collection

Sterile samples are not required Mares udder should be washed with gentle soap and warm water and soft cotton, then rinsed before milking after foaling Usually need 5-10 ml for the colostrometer Colostrometers provide specific gravity assessment of
the sample. May also be submitted for laboratory analysis including immunoglobulin (IGg) content and antierythrocyte alloantibody determination.
102
Rumen Fluid Collection
Collected for analysis to aid in diagnosis of diseases of forestomachs in large and small ruminants Characteristics of interest include color, pH, odor, identification and assessment of microbial organisms and numbers, and electrolyte levels May also be collected for therapeutic purposes Therapeutically it can be collected from a healthy animal and used for inoculation into sick animals rumen to aid digestion.
103
Equipment

Stomach tube Water-based lubricant Frick speculum (cattle) PVC pipe speculum Block of wood with hole cut in center Roll of tape (sheep, goats) Dose syringe Sample collection container
Adult cattle: medium to large diameter; internal diameter no less than 1.5 cm Calves, sheep, and goats: small and medium foal stomach tubes can be used.
104
Bovine rumen fluid collection

Estimate length of tube needed to reach Standing to side of animal, insert speculum over root of tongue in center of mouth Lubricate tip of tube with a water-soluble lubricant or with water Insert tube through speculum and down esophagus Allow animal to swallow then advance tube; if not going easily, withdraw and rotate tube Blowing into tube dilates esophagus and eases passage of tube
Restrain in chute or stanchion. Do not overly elevate head; may regurgitate fluid around tube, increasing likelihood of aspiration. Resistance usually felt as tube reaches back of pharynx.
105
Confirm placement of tube

Palpate trachea, tube may be felt as two distinct tubular structures Visualizing tube in esophagus Blow into tube and listen for gurgling from end of tube Blow into tube with an assistant auscultating abdomen with stethoscope over rumen listening for gurgles Smell exposed end for distinctive odor of fermented gas
Aspirate rumen fluid using a dose syringe Discard initial fluid because it often contains an excessive amount of saliva Coughing and feeling air pass out of tube may indicate that tube is in trachea.
106
When finished kink tube and withdrawn in a smooth downward motion
Prevents rumen contents from leaking out of tube and entering trachea as tube is withdrawn
Measure pH of sample immediately after sample is obtained
107
Small ruminants fluid collection

Back sheep into corner and straddled or set up on their rump Goats may be pushed against a wall or backed into a corner and straddled Insert a speculum between lower incisors and the dental pad Estimate necessary length as described for cattle and proceed with tube passage as described for cattle
108
Rumenocentesis

Seldom done due to ease and safety of stomach tube method Ventral abdomen caudal to xiphoid process and left of ventral midline is clipped and surgically prepared Veterinarian inserts a needle with syringe attached (14-gauge needle for cattle, 16- to 18-gauge needle for small ruminants) through skin and into rumen Rumen fluid is aspirated into syringe
109
Thoracocentesis
Equine and Bovine
Ventral portion of the sixth and seventh intercostal space 10-12 cm dorsal to the olecranon, above the lateral thoracic vein, and below the anticipated fluid level Sixth or seventh intercostal space 10-15 cm dorsal to the sternum
Camelid
110
Transtracheal Aspiration
Equine percutaneous method

May require sedation Midline of neck directly over trachea about one third down the neck Sterile prep on 4 x 4 inch area Veterinarian will perform procedure
111
Transtracheal Aspiration
Equine endoscopic method

A noninvasive technique Endoscope is inserted through the nasal cavity into the trachea Special tubing is passed through the endoscope Fluid is injected and aspirated to collect sample
Bovine, caprine, ovine, and camelids
Use same methods as for equines
The presence of the endoscope may introduce microorganisms into the sample.
Bronchoalveolar Lavage (BAL)
Indications

Collect fluid samples from the lower airway Better for cytologic assessment than transtracheal aspiration
Complications
Are representative of only a limited area of the lung Subject to contamination from passing the tube through the nares
113
Bronchoalveolar Lavage
Equipment

Sterile BAL tubing Syringe containing 50 ml of 2% lidocaine 3 syringes each containing 60 ml of sterile saline
If both BAL and transtracheal aspirations are performed, the transtracheal aspiration is performed first Horse may need to be sedated 2% lidocaine is injected into the tube whenever the horse coughs to provide local anesthesia to the bronchi and suppress the cough reflex. Saline is injected into the tube and aspirated to retrieve the sample.
114
Abdominocentesis
Horses

Site for tap, lowest portion of the abdomen and ventral midline, usually 2-4 inches caudal to the xiphoid Can be performed on the ventral midline Paramedian 1-2 inches to the right of midline to reduce likelihood of tapping spleen Should not go through skin abrasions, surgical lesions, or edema Minimal restraint in standing stocks, control head; halter, twitch, or sedation Ultrasonography can be used to determine most desirable site. Prep site and do procedure squatting next to horse adjacent to forelimbs. Technician assisting position similarly on the opposite side
115
Abdominocentesis
Horses

Teat cannula or female canine urinary catheter (bitch catheter) method Reduces the risk of bowel penetration Requires the use of a local anesthetic
116
Abdominocentesis
Camelids

Two common sites: ventral midline site or right paracostal (near the ribs) site Youngsters require mild sedation Restrain in head gate, stocks, or chute to access right side 18-gauge, 1.5-inch needle or may require a 3-inch needle Hardware disease site just caudal to the xiphoid and to right of midline In cattle a tail jack may be sufficient but chemical sedation may be necessary. Alternate sites in cattle: flank fold on right side or ventral abdomen
Cattle

117
Abdominocentesis
Ovines and caprines:

Indications: abdominal distention, poor forestomach motility, and suspected uroabdomen Local anesthesia is required Site: lowest point of abdomen 2-4 cm to the right of ventral midline Veterinarian may choose to tap multiple sites Restrain standing and sedate if necessary.
118
Abdominocentesis
Complications:

Large volumes (5-7 ml/kg) of peritoneal fluid are necessary for success Use of syringe increases likelihood of false-negative If it is negative, peritoneal lavage may be indicated Most common complication is failure to obtain a sample and skin hemorrhage or protrusion of omentum More serious complications include penetration of bowel or spleen, damage to the xiphoid process, and introduction of bacteria There is a high incidence of false-negative results with this procedure. Subcutaneous abscessation and cellulitis are uncommon but can occur.
119
Abdominocentesis
Post-procedure nursing care

Monitoring vital signs Observing for pain Observing for abdominal distention Control of bleeding or bruising at site
120
Cerebrospinal Fluid Tap
Indications

Collected when central nervous system disease is suspected Analysis includes gross visualization of color, clarity and presence of particulate matter, total protein, cytology, and chemistries
Technicians are expected to prepare the site, restrain the patient, or assist the veterinarian.
121
Atlanto-occipital site (AO tap) (Equine)

Located on dorsal midline just caudal to the poll Horse is placed in lateral recumbence Area is clipped and given a complete surgical prep Nose is directed down toward the front feet to flex the head Veterinarian inserts an 18-gauge, 3-inch spinal needle Syringe is attached to needle and gently aspirated or fluid is allowed to free flow into tube Clean blood from site and cover with betadine-soaked gauze sponge
Requires general anesthesia. If fluid is blood tinged. put trochar into needle and withdraw change locations. Neonates done with 20-gauge, 1.5-inch needle directed at the mandible.
122
Lumbosacral site (LS Tap) (Equine)

Imaginary line across caudal edge of each tuber coxae and another on dorsal midline Slight depression can be palpated at intersection of lines Large area is clipped and sterile prep performed Local anesthetic is injected 18-gauge, 6-inch spinal needle with trochar is inserted perpendicular to midline Trochar is removed from needle Syringe attached to needle and sample aspirated Remove syringe before removing needle
Procedure

123

Horse should be placed in stocks; sedation and twitch required. Patient is standing as squarely as possible. Someone stands behind horse to direct veterinarian. As needle reaches subarachnoid space, patient may move. Both jugular veins are occluded to increase intracranial pressure. Initial sample may be contaminated with blood, so have more syringes. Neonates done standing, in sternal recumbency or in lateral recumbency
124
Complications

Trauma to the spinal cord Herniation of the cerebellum Infection of the meninges Death
Minimize complications by having patient sufficiently restrained so it can remain still and by following strict sterile technique.
125
Camelids AO site

Follow same procedure guidelines as for horses Site is located midline as intersects the wings of the atlas In adults use a 20-gauge, 2.5-inch spinal needle Midline about 2 cm caudal to the dorsal spinal process of the 7th lumbar vertebrae Use an 18- or 19-gauge, 3.5-inch spinal needle for adult llamas and alpacas
Camelids LS site

126
Equine

Minimal restraint needed Jugular vein most common site 18- to 20-gauge, 1.5-inch needle IV catheters can be used for repeated injections or when large volumes must be administered Can also use the cephalic and lateral thoracic veins Make sure the needle is in the vein and not an artery. Injection into an artery results in medication going directly to the brain causing severe reactions or possibly death.
127
Bovine

Jugular vein most often used 16- to 18-gauge, 1.5-inch needle Can also use the coccygeal vein to administer small volumes of nonirritating medications Auricular vein can be used to administer small amounts of medications IV catheters can be placed in the jugular veins
128
Camelids
Jugular vein is most commonly used but not as easily accessible as in other large animal species Injections can be administered either high on the neck or low on the neck IV catheter can be placed in the lower third of the neck The cephalic vein can also be used Placement and maintenance in the cephalic vein is difficult because camelids lie down in sternal recumbency.
129
Ovine and caprine

Jugular vein most commonly used Cephalic vein can also be used IV catheters can be used Auricular vein is most commonly used Located on the dorsal aspect of the pinna Three veins on the pinna; the lateral one is used Cephalic vein can also be used Jugular vein is used in small piglets
Porcine

Large Animal Medication Intramuscular Administration
Restrain animal based on size and temperament Clean injection site with 70% isopropyl alcohol until dirt and debris are removed Needle size is determined by the:

Viscosity of the drug Size of the muscle Volume to be administered Temperament of animal
131
Large Animal Medication Intramuscular Administration
Procedure

QUICKLY insert needle into muscle all the way to hub Attach syringe, aspirate to check for blood; if none present, inject the medication When medication is delivered, remove syringe and needle If in a vessel, remove the needle, replace and repeat in different location Apply pressure if blood or medication comes from site Inserting needle without syringe attached is useful if animal moves. Do not aggressively force the solution into muscle. Repeated IM injections should use various sites.
132
Equine IM Administration
Lateral cervical (neck)

Small volumes should be delivered (<10 ml) Ideal spot is a triangular space bordered dorsally by the nuchal ligament, ventrally by the cervical vertebrae and about a hands width in front of cranial border of scapula Neck muscles not recommended for foals.
133
Semimembranosus and semitendinosus muscles

Located on caudal aspect of hind limb between point of buttock and hock Stand facing tail with your body up tight against horses hip 18- to 19-gauge, 1.5-inch needle is put straight into muscle Inject up to 10-15 ml per site Withdraw needle and redirect in different direction or withdraw it completely and move to another site if more medication needs to be given Often used with minimal complications Excessive volumes will cause tissue necrosis. Good site for IM injection in foals.
134
Pectoral muscles

Located between the front legs Stand next to the shoulder of the horse facing head Reach around with hand farthest from horse, insert needle 18- to 20-gauge, 1.5-inch needle is appropriate Repeated IM injections in this site may cause pain and swelling Safety needs to be considered when choosing this site Insertion usually elicits less of reaction. Assess temperament and be ready to move.
135
Gluteal muscles

Largest muscle mass on hind quarters Accommodates large volumes and repeated injections 18- to 22-gauge, 1.5-inch needle Not often chosen; difficult to detect inflammation caused by repeated injections, and if abscess forms, doesnt have adequate drainage Minimum: halter and lead rope Placing horse in stocks is safer. Distraction technique will desensitize injection site.
Restraint

136
Bovine IM Administration
Consideration

Highly discouraged because meat is consumed 10 ml of substance maximum is administered at any one time
Sites: muscles of the neck should be used, borders are same as horse Restraint

In a head gate or squeeze chute Approach animal from forequarters, stay close and leaning in to animal Can halter head and tie to the side
Ovine and Caprine IM Administration
Consideration
Have small muscle masses Most common semitendinosus and semimembranosus muscles Avoid sciatic nerve Adult sheep and goats, 18- to 20-gauge, 1-inch needle; 20to 22-gauge, 1-inch needle in young Neck, gluteals, and triceps are used for injecting very small volumes Injections into neck may cause soreness and animal may be reluctant to raise its head.
Sites

138
Porcine IM Administration
Complications

Thickness of skin Tendency to store a thick layer of subcutaneous body fat Difficult to restrain Potential damage to meat
Adults 16- to 20-gauge, 1.5-inch needle should be used to avoid the fat; piglets 20-gauge, 1.5-inch needle

Adults: a maximum volume of 5-10 ml per site Piglets: a maximum volume of 1-2 ml per site
Gluteal, semimembranosus, and semitendinosus muscles used in animals not destined for slaughter
139
Camelid IM Administration
Consideration

Sites are generally same as other large animals Neck should not be used due to the potential for causing soreness in area Semimembranosus and semitendinosus muscles are good choices Adults 18- to 20-gauge, 1-inch needle is appropriate Crias 20- to 22-gauge, 1-inch needles are recommended SQ is the preferred route for administration of large volumes because they lack large muscle masses.
140
Large Animal Subcutaneous Administration
General guidelines

Can be given anywhere there is loose skin Indications include vaccines, local anesthetics, small volumes of other medications, and fluid therapy In show animals, there is less likelihood of noticeable adverse reactions Meat production industry recommends drugs be given SQ to reduce tissue damage
141
General procedure
Site selected should have loose skin that is easily grasped Wipe with 70% isopropyl alcohol Insert needle into base of tented skin as described for small animals Aspirate to check for blood Medication should flow easily from syringe, difficult injection may indicate needle is intradermal Bleb/bump is often visible under skin Massage injection area to promote absorption
142
Needle size depends on the:

Viscosity of the substance Size of the animal and the thickness of its skin
20- to 25-gauge, 1-inch or shorter should be used for horses 18- to 22-gauge, 1- to 1.5-inch common choice for calves, sheep, goats, and pigs 16- to 18-gauge, 1-inch or shorter for adult cattle
143
Sites
Loose skin on side and base of neck Behind the elbowlarge volumes can be given On either side of ischiorectal fossa Pigs: axillary and inguinal regions, and skin caudal to base of ear Llamas: just behind the elbow Goats: just behind the elbow Sheep: axillary area, inguinal area, and flank fold
144
Large Animal Intradermal Administration
General guidelines

Cattle, goats, and sheep are tested for tuberculosis in caudal tail fold Cattle 20- to 22-gauge, 1.5-inch needle; calves 25- to 22-gauge, 0.5- to 1-inch needle Swine can be given at base of ear Horses, allergy testing and treat nodular skin lesions and sarcoids, side of neck25- to 27gauge, 5/8-inch needle
145
Large Animal Intraperitoneal Administration
Complications include peritonitis, abscess formation, and injury to internal organs Equines

Fluids and medication given via abdominal lavage Distributes fluids and medications throughout the abdominal cavity, washing internal organs, and breaking up any adhesions
146
Large Animal Intraperitoneal Administration
Bovine

Indicated if IV not possible and for treatment of peritonitis Site: in the paralumbar fossa Reserved for neonates with umbilical infections Neonatal pigs because of the impracticality of placing IV catheters Site: paramedially between the midline and flank 16- to 18-gauge, 3-inch needle
Caprine and ovine
Porcine

Fluids are body temperature, nonirritating, and isotonic.
147
Large Animal Intranasal Administration
General guidelines

Vaccines and local anesthetics are administered Oxygen administered to help pneumonia, hypoxic-ischemic encephalopathy, or preparturient females at high risk
Procedure
Wipe nasal discharge away Bring free arm under mandible and reach around placing hand on top of muzzle Lift head slightly Needleless syringe is introduced into nostril and injected
Restrain head, halter and lead rope and/or chute or stanchion. Patient may sneeze. Piglets can be held, hog snare used for larger pigs.
Large Animal Oral Administration
General guidelines

Variety of forms including tablets, capsules, powders, pastes, and liquids Simplest way to administer oral medications is to put it in food or water Administered in a variety of methods including syringes, drenching, balling guns, and nasogastric and orogastric intubation Putting medication in food or water is not always feasible and is usually unreliable.
149
Syringes

Paste form in pre-measured dosing syringesaccurate dosing and easy administration Tablet form crushed and mixed with water, or dissolved in water over time Restrain headhalter, chute, stanchion Insert syringe into mouth at commissure of lips Advance as far back into mouth as possible Depress plunger until all medication is given Lift head slightly to encourage swallowing If unpalatable, mix with molasses, syrup, or applesauce.
150
Drench (dose syringe)

Sheep and goats limited to small volumes of fluid (<30 ml) Restrain with nose slightly elevated and pulled toward the handler Tip of dose syringe is inserted into interdental space Plunger is slowly depressed
151
Balling guns (pilling)

Several sizes available, picked to size of patient and bolus Restrain head in chute or stanchion; sheep/goats are backed into corner Stand next to head, facing same direction as animal Reach over bridge of nose and grasp mouth at interdental space, press on hard palate, to open mouth Insert balling gun down center of mouth sliding it back to pharynx When thumb rings reach the lips, depress plunger Keep head slightly elevated Commonly used in cattle, sheep, and goats. Too large of a balling gun can split soft palate and rupture pharynx. Inspect for sharp edges.
152
Nasogastric Intubation

NGT Horses, cattle, adult sheep and goats, neonatal camelids When large volumes of oral medications need to be administered For oral fluid therapy or extended enteral feedings Most commonly used in horses Medications include mineral oil, fluids, and bismuth. Cattle, sheep, goats, and camelids have smaller nasal passages, so NGT is more difficult.
153

OGT Food animals and camelids To administer medication, food, or fluids through tube passed through mouth and directly into stomach Orphans or weak neonates who cannot nurse can be fed milk replacer Also passed in an attempt to decompress a patient with gastric dilation Medications include activated charcoal solutions or stomach lavage to treat for ingested toxins.
154

Animal will swallow as tube passes over base of tongue and into esophagus Coughing can indicate tube entered trachea and should be removed Verify correct placement of tube Inject 5-10 ml of air into tube and simultaneously auscultate cranial abdomen; if gurgling sounds or borborygmus are present, tube has been placed in gastrointestinal tract. 5 ml of sterile saline solution may be injected into tube; if animal coughs, tube is in trachea and should be removed. A radiograph can be taken to evaluate tube placement.
155
Intramammary Administration

To treat and control mastitis Cows, sheep, goats Must be performed aseptically Procedure

Completely milk out udder Clean teats with teat dip and dry with cloth for each teat Wipe each teat with alcohol-soaked sponge and dry Infuse teats, occlude tip, and gently massage
Intramammary Administration
The teat is grasped at the base, and a sterile teat cannula (may be disposable) on an antibiotic syringe is partially inserted into the teat up to 4 mm. The antibiotic is injected slowly into the canal. Sheep and goats with small orifices may need a tomcat catheter. Dont move animal outside while udder is wet to prevent chapping and frostbite.
157
To treat ocular diseases and conditions

Ulcers, abrasions, lacerations, keratitis Topical ointments and solutions used When applying both ointment and solution, apply the solution before the ointment Drops may come in a small plastic bottle with a dispenser or may be administered using a small syringe with no needle attached
158
Ocular lavage to treat painful eye conditions, or patients who become resentful of repeated application Subpalpebral lavage system

Narrow rubber tubing is inserted through incisions of the eyelids directly in the conjunctival sac Fluids administered by this system Tube is inserted into the nasal punctum and passed through a small stab wound in the nares
Nasolacrimal lavage system
159
In both systems the tubes are attached to the skin so they stay in place. Medication delivered should be warmed so it doesnt cause discomfort. Injections should be made slowly. Tubes may become plugged. Air through the tube may startle the horse.
160
Epidural Administration

Deposits drugs into the epidural space Done to provide anesthesia for pain control Provides complete anesthesia and muscle relaxation caudal to the block Cranial epidural is located at lumbrosacral junction (between L6 and S1) Caudal epidural is located between S5 and C1 or C1 and C2
161
Equine Epidural Administration
Good restraint is necessary
Sedation may be necessary
Technician prepares the area aseptically 18- to 19-gauge, 1.5-inch needle is passed into the epidural space with a pop Medication is delivered May place an epidural catheter for multiple administration Area is found by lifting tail up and down while feeling for the vertebral space with other hand. The area is usually close to where the coarse tail hairs begin.
162
Bovine Epidural Administration

Animal must be sufficiently restrained Locate site by lifting tail up and down to find the first moveable joint (S1-S2) Area is surgically prepped 18-gauge, 1.5- to 3-inch needle is inserted into the epidural space with a pop 3 ml of 2% lidocaine is commonly used
163
Camelid Epidural Administration
Tail is moved up and down to find S5-C1 space, usually the first moveable joint
Area is clipped and surgically prepped
20-gauge, 1.5-inch needle is inserted into the epidural space Many owners dont want their animals shaved, so a very small area is all that is shaved.
164
Ovine and Caprine Epidural Administration

Same procedure as for cattle 18- to 20-gauge, 1.5-inch needle Sheep and goats are sensitive to local anesthetics
165
Porcine Epidural Administration

Lumbrosacral junction (L6-S1) is used Considered a cranial epidural Draw an imaginary line vertically up from the patella to the back and a dorsal midline site is clipped where the line meets the back Surgically prep the area 18- to 20-gauge, spinal needle used; length determined by the size of the animal
166
Transdermal Administration
Fentanyl, scopolamine, nitroglycerine, and estrogen are commonly administered via transdermal route through an impregnated patch that stays on the skin Other ointments, solutions, and creams can be applied with gauze sponges, swabs, or directly from a gloved finger Wear gloves when applying these patches or medication so some of it doesnt enter through your skin.
167
Intrasynovial Administration
Antibiotics and anesthetics can be injected directly into a joint Results in high, localized drug levels Commonly used in horses Aseptic technique is necessary Proper restraint is important Sedation may be required Joint lavage done on anesthetized animals During joint lavage two needles are placed into a joint. The fluid is injected with one needle and aspirated with the other needle.
168
Rectal Administration
Used to deliver medication to patients that cant tolerate oral medications as a result of ileus or regurgitation Used to deliver an enema to a constipated patient Tube size is selected based on size on patient
24 Fr enema tube or fenestrated tube: adult animals, foals, and calves
169
Enema Administration

Administered to encourage defecation Tube, composition of fluid and volume will vary with size and condition of animal Fluids

Nonirritating Room temperature but not above body temperature
Foals are sometimes given enemas to help them pass meconium
Warm water, gentle soap, mineral oil used

Retention Enemas

Use of a Foley catheter with balloon Tube is inserted and balloon inflated Enema solution is infused Catheter is clamped with hemostat and left in place for at least 15 minutes Remove hemostat, deflate balloon, and remove catheter
171

Diagnostic Sampling and Therapeutic Techniques

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Chapter 20

Diagnostic Sampling and Therapeutic Techniques

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Arterial Blood Sample Collection

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Arterial Blood Sample Collection

Dorsal metatarsal artery Femoral artery Sublingual artery

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Urine Collection Female Catheterization

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Restraint: standing, sternal, or lateral recumbency

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Ultrasound useful to determine needle or catheter placement

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Alternative: can use 18- to 20-gauge overthe-needle catheter.

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Sites in dogs and cats

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Bone Marrow Aspirate Dogs and Cats

Evaluate the cells in the bone marrow

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Bone Marrow Aspirate Dogs and Cats

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Bone Marrow Aspirate Dogs and Cats

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Fine Needle Aspirate

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Fine Needle Aspirate

Restrain so mass is accessible

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Fine Needle Aspirate

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Fine Needle Aspirate

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Medications directly into a vein

Cephalic, medial saphenous, femoral veins

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Used for solutions with osmolalities 600 mosm

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Peripheral Vein Catheterization

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