Administration Techniques For Medications And Fluids

By | 2013-07-26

Oral Administration: Tablets and Capsules — Canine

Patient Preparation

None required.

Technique

The simplest method of administering tablets or capsules to dogs is to hide the medication as bait in food. Offer small portions of unbaited cheese, meat, or some favorite food to the dog initially. Then offer one portion that includes the medication. Pill Pockets Canine Treats is a commercially available alternative.

Note: Oral medication frequently is dispensed to owners without regard for the clients knowledge of how to administer a pill or tablet or without asking whether the client is even physically able to administer medications. Clear instructions that include having the client perform the technique in the hospital significantly improve compliance.

For anorexic dogs or when pills must be given without food, give medications quickly and decisively so that the process of administering the medication is accomplished before the dog realizes what has happened. With cooperative dogs, insert the thumb of one hand through the interdental space, and gently touch the hard palate. This will induce the cooperative dog to open its mouth (). Using the opposite hand (the one holding the medication), gently press down on the mandible to open the mouth further ().

Quickly place the tablet or capsule onto the caudal aspect of the tongue. Quickly withdraw the hand and close the dog’s mouth. When the dog licks its nose, the medication likely has been swallowed.

Dogs that offer more resistance can be induced to open their mouths by compressing their upper lips against their teeth. As they open the mouth, roll their lips medially so that if they attempt to close the mouth, they will pinch their own lips. Alternatively, dripping water onto the nostrils or blowing into the patient’s nose sometimes encourages the patient to accept and swallow oral medications (tablets or capsules). Pilling syringes are also available and in some dogs seem to work well.

Special Considerations

Critical to the oral administration of medication is the ability of the owner to effectively administer the medication at home. Animals that aggressively resist oral medication should be treated by alternative methods — for example, parenteral administration of medication. It is inappropriate, and unsafe, to delegate treatment responsibilities to the owner of a dog (or cat) that might injure the individual who is attempting to treat the patient.

Oral Administration: Tablets and Capsules — Feline

Patient Preparation

None required.

Technique

Caution: Only experienced individuals should attempt this technique of administering tablets or capsules to cats. Even cooperative cats that become intolerant will bite. Therefore, this is not a technique recommended for most owners to try at home, even if specific instructions have been given.

Two methods of pill administration are used in cats. In both methods the cat’s head is elevated slightly with the nose pointed upward. Success in administering pills and tablets to a cat entails a delicate balance between what works well and what works safely. In cooperative cats, it may be possible to use one hand to hold and position the head () while using the opposite hand (the one holding the medication) to open the mouth gently by depressing the proximal aspect of the mandible (). Press the skin adjacent to the maxillary teeth gently between the teeth as the mouth opens, thereby discouraging the cat from closing its mouth. With the mouth open, drop (do not push) the medication (try generously lubricating the tablet or capsule with butter) into the oral cavity. The cat can be tapped under the jaw or on the tip of the nose to facilitate swallowing if you really think this works. If the cat licks, administration was probably successful.

Alternatively, some cats will tolerate a specially designed “pilling syringe” in an attempt to administer a tablet or capsule. The pilling syringe works well as long as it is inserted cautiously and atraumatically into the cat’s mouth. However, if resistance ensues, the rigid pilling syringe may injure the hard palate during the ensuing struggle. Subsequent attempts to use the syringe may be met with increasing resistance and increasing risk of injury. Success with a pilling syringe depends largely on the cat. Pill Pockets Treats are also available for use in cats and are manufactured in chicken and fish flavors. In addition, as is the case in dogs, some cats will respond to the application of water drops on the nostrils or blowing into the nostrils to encourage swallowing.

Special Considerations

When dispensing oral medications for home administration to cats, do not expect clients to force a tablet or capsule into a cat’s mouth. Although some clients are remarkably capable and confident with their ability to administer oral medications to cats, the risk of injury to the client can be significant. Whenever feasible, liquid medications or pulverized tablets should be mixed with the diet or an oral treat readily accepted and consumed (see the following discussion).

Oral Administration: Liquids

Topical Administration

Administration by Injection (Parenteral Administration)

Patient Preparation

It would be admirable to prepare the skin surgically before making needle punctures to administer medications. Because such preparation is not practical, carefully part the hair and apply a high-quality skin antiseptic such as isopropyl alcohol. Place the needle directly on the prepared area, and thrust the needle through the skin. Although the use of antiseptics on the vial and skin is not highly effective, the procedure removes gross contamination and projects an image of professionalism. Before aspirating medications from multiple-dose vials, carefully wipe the rubber diaphragm stopper with the same antiseptic used on the skin. Observe this basic rule with all medication vials, even with modified live virus vaccines.

Subcutaneous Injection

Intramuscular Injection

Patient Preparation

None required.

Technique

Because the tightly packed muscular tissue cannot expand and accommodate large volumes of injectables without trauma, medications given by the intramuscular route should be small in volume. These medications are often depot materials that are poorly soluble, and some may be mildly irritating. Unless the animal is extremely thin, give injections into the lumbodorsal muscles on either side of the dorsal processes of the vertebral column.

After proper preparation of the skin, insert the needle through the skin at a slight angle (if the animal is thin) or perpendicularly (if the animal is obese). When injecting any medication by a route other than the intravenous one, it is imperative to retract the plunger of the syringe before injecting to be certain that a vein was not entered by mistake. This is especially crucial with oil suspension, microcrystalline suspension, or potent-dose medications.

Special Considerations

Never give intramuscular injections in the neck because of the fibrous sheaths there and the complications that may occur. Also, intramuscular injections into muscles of the rear legs can cause severe pain, lameness, and occasionally peroneal nerve paralysis because of local nerve involvement.

Intradermal Injection

Patient Preparation

Intracutaneous (or intradermal) injections are used for diagnostic testing purposes. Prepare the skin by carefully clipping the hair with a No. 40 clipper blade. If the skin surface is dirty, gently clean it with a moist towel. Scrubbing and disinfection are contraindicated because they may produce iatrogenic trauma and inflammation, which interfere with the test.

Technique

Stretch the skin by lifting a fold, and use a 25- to 27-gauge intradermal needle attached to a 1-mL tuberculin syringe. Insert the point of the needle, bevel up, in a forward lifting motion as if to pick up the skin with the needle tip. Advance the needle while pushing the syringe (levered) downward until the bevel is completely within the skin. Inject a bleb of 0.05 to 0.10 mL of fluid. If the procedure is done correctly, the small bleb will appear translucent. Intradermal injections generally are used in patients subjected to intradermal skin testing for allergenic antigens. Administration of compounds by the intradermal technique is not necessarily simple. Inadvertent administration of medications into the subcutaneous tissues is easy when attempting intradermal injection. For that reason, specific training and experience are recommended before attempting intradermal skin testing of allergic patients.

Transdermal (Needle-Free) Administration

Patient Preparation

None required.

Technique

Intradermal administration of vaccine and drugs in veterinary and human medicine largely has been limited to the complexities of accurately delivering the desired dose into, and not under, the skin. In 2004 a transdermal administration system (Vet-Jet Transdermal Administration System, Merial, Duluth, Georgia) was introduced for cats (recombinant feline leukemia virus [FeLV] vaccine) that was designed after a similar device used in human (pediatric) medicine. Recently the transdermal administration system used for administration of the recombinant FeLV vaccine has been re-designed. This same administration system is now used for the transdermal administration of the oral melanoma vaccine. The transdermal administration system consistently delivers a precise volume of vaccine into the skin, subcutaneous tissues, and muscle. Use of the transdermal administration system should only be used to administer those vaccines approved for this method of delivery.

Special Considerations

Administration of vaccine using the transdermal administration system requires training to understand proper procedure for loading and administering vaccine. At this writing, sale of the transdermal administration system for delivery of the canine oral melanoma vaccine is limited to select specialists in veterinary medicine.