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.

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 (Figure 4-1). Using the opposite hand (the one holding the medication), gently press down on the mandible to open the mouth further (Figure 4-2). 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.

Figure 4-1: Use of the thumb only to open a cooperative dog’s mouth.

Figure 4-2: Use of the opposite hand to place a tablet or capsule on the caudal aspect of the tongue.

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.

Patient Preparation

None required.

Patient Preparation

None required. Technique is appropriate for owners to perform at home.

Technique

Small amounts of liquid medicine can be given successfully to dogs and cats by pulling the commissure of the lip out to form a pocket (Figure 4-5). Deposit the liquid medication into the “cheek pouch,” where it subsequently flows between the teeth as the head is held slightly upward. Patience and gentleness, along with a reasonably flavored medication, contribute to the success.

Figure 4-5 Use of a syringe to administer liquid medication into the oral cavity of a cat.

Spoons are ineffective, as fluids are easily spilled. A disposable syringe can be used to measure and administer liquids orally. Depending on the liquid administered, disposable syringes can be reused several times, assuming they are rinsed after each administration. In addition, disposable syringes can be dispensed legally to clients for home administration of liquid medication. Mixing of medications in the same syringe is not recommended. However, dispensing of a separate, clearly marked syringe for each type of liquid medication prescribed for home administration is recommended.

Special Considerations

Compounding pharmacies are also available and can mix many medications into palatable flavors to help facilitate the oral administration of medications.

Dogs with swallowing disorders should not be treated at home with liquid medications because this could cause complications associated with aspiration.

Patient Preparation

None required.

Technique

Administration of medications, contrast material, and rehydrating fluids can be accomplished with the use of a well lubricated feeding tube passed through the nostrils into the stomach or distal esophagus. When a feeding tube is placed for long-term use (multiple days) and repeated use (described under Gastrointestinal Procedures later), it is generally recommended to avoid passing the tip of the tube beyond the distal esophagus. The reason for recommending nasoesophageal intubation over nasogastric intubation is based on the fact that reflex peristalsis of the esophagus against a tube passing through the cardia can result in significant mucosal ulceration within 72 hours. This is not a factor in patients receiving a single dose of medication or contrast material.

The narrow lumen of tubes passed through the nostril of small dogs and cats limits the viscosity of solutions that can be administered through a tube directly into the gastrointestinal tract. Nasoesophageal intubation can be done with a variety of tube types and sizes (Table 4-1). Newer polyurethane tubes, when coated with a lidocaine lubricating jelly, are nonirritating and may be left in place with the tip at the level of the distal esophagus. When placing the nasogastric tube, instill 4 to 5 drops of 0.5% proparacaine in the nostril of the cat or small dog; 0.5 to 1.0 mL of 2% lidocaine instilled into the nostril of a larger-breed dog may be required to achieve the level of topical anesthesia needed to pass a tube through the nostril. With the head elevated, direct the tube dorsomedially toward the alar fold (Figure 4-6). Pushing dorsally on the nasal philtrum and pushing the nostril from lateral to medially will help facilitate passage of the tube into the ventromedial nasal meatus.

Table 4-1 The French Catheter Scale Equivalents^*

* Multiple types of pediatric polyurethane nasogastric feeding tubes are available in sizes ranging from 8F to 12F that easily accommodate administration of liquids medications and fluids to kittens, cats, and small dogs.

Figure 4-6: Initial dorsomedial placement of a nasoesophageal tube before complete insertion.

Caution: The tip of the feeding tube can be inadvertently introduced through the glottis and into the trachea. Topical anesthetic instilled into the nose can anesthetize the arytenoid cartilages, thereby blocking a cough or gag reflex.

After inserting the tip 1 to 2 cm into the nostril, continue to advance the tube until it reaches the desired length. If the turbinates obstruct the passage of the tube, withdraw the tube by a few centimeters. Then readvance the tube, taking care to direct the tube ventrally through the nasal cavity. Occasionally it will be necessary to withdraw the tube completely from the nostril and repeat the procedure. In particularly small patients or patients with obstructive lesions (e.g., tumor) in the nasal cavity, it may not be possible to pass a tube. Do not force the tube against significant resistance through the nostril.

Gavage, or gastric lavage and feeding, in puppies and kittens can be accomplished by passing a soft rubber catheter or feeding tube into the mouth, tilting the puppy’s or kitten’s head, and watching it swallow the tube. Most puppies or kittens will struggle and vocalize. They usually will not vocalize if the tube has been placed into the trachea. A 12F catheter is of an adequate diameter to pass freely, but it is too large for dogs and cats less than 2 to 3 weeks of age. Mark the tube with tape or a pen at a point equal to the distance from the mouth to the last rib. Merely push the tube into the pharynx and down the esophagus to the caudal thoracic level (into the stomach). Verify the placement of the tube using the same dry syringe aspiration technique to ensure that the tube is positioned in the esophagus or stomach rather than the trachea. Attach a syringe to the flared end, and slowly inject medication or food.

Depending on the feeding tube type, the end of the tube may or may not accommodate a syringe. For example, soft, rubber urinary catheters are excellent tubes for single administration use. However, the flared end may not accommodate a syringe. To affix a syringe to the outside end of a tapered feeding tube or catheter, insert a plastic adapter (Figure 4-7) into the open end of the tube.

Figure 4-7: Use of a plastic adaptor (“Christmas tree”) to affix a syringe to a nasoesophageal feeding tube.

Special Considerations

Esophageal (versus intratracheal) placement of the feeding tube can be verified with a dry, empty syringe. Attach the empty syringe to the end of the feeding tube. Rather than injecting air or water in an attempt to auscultate borborygmus over the abdomen, attempt simply to aspirate air from the feeding tube. If there is no resistance during aspiration and air fills the syringe, the tube likely has been placed in the trachea. Completely remove the tube and repeat the procedure. However, if repeated attempts to aspirate are met with immediate resistance and no air enters the syringe, the tube tip is positioned properly within the esophagus. If there is any question regarding placement, a lateral survey radiograph is indicated.

Definitive confirmation of proper tube placement can be made by diluting 1 to 2 ml of an iodinated contrast agent with sterile saline, instilling the liquid into the tube, then taking a lateral thoracoabdominal radiograph to confirm entry of the contrast material into the stomach.

Patient Preparation

None required.

Technique

The usual methods of applying medication directly to the eyes include liquid (drops) and ointments. The route and frequency of medication depend on the disease being treated. Liquids and ointments are appropriate for owner administration.

Liquid medications (usually 1 or 2 drops) can be applied directly to the cornea. It is important to instruct the owner on the proper technique and to stress that because liquids only fall downward, the patient’s nose must be directed upward before one attempts to administer liquid medications onto the eye. It is still quite difficult to encourage a drop of liquid, as it is squeezed from its container, to fall horizontally, despite frequent attempts to do so. Ointment, as a 1/8- or 1/4-inch strip, is typically administered directly onto the sclera (dorsally) or into the lower conjunctival cul-de-sac such that as the lids close, a film of ointment is spread across the cornea.

Special Considerations

The tip of the applicator tube for liquids and ointments should never be allowed to make contact with the eye or conjunctiva. Doing so is likely to result in contamination of the medication, especially with liquid medications.

Patient Preparation

None required.

Technique

Liquid solutions are more effective vehicles for administering medication into the external ear canal. Physically removing debris may be necessary in some patients that require topical otic medications. Occasionally, oral supplemental medication may also be required. When applying the medication, a few drops of liquid are generally sufficient. The ear should be massaged gently after instillation to facilitate the spread the medication within the external ear canal.

Special Considerations

Medicated powders generally are contraindicated in the external ear canal. Also, the application tip of liquid medications must not come in direct contact with the skin. Doing so is likely to result in contamination of the entire dispensing bottle.

Patient Preparation

None required.

Technique

Intranasal administration of liquids in dogs and cats is usually limited to a single dose of a vaccine specifically labeled for intranasal administration. There is little indication for routine instillation of liquids into the nostrils of dogs and cats. Rarely, administration of isotonic solutions directly into the nostrils is indicated. In contrast to single-dose vaccines, lavage solutions applied intranasally are usually multiple-dose containers. Therefore the tip of the administration device should not be allowed to directly contact the patient’s skin or nose. Doing so may result in contamination of the entire bottle. Oily drops are not advised because they may damage the nasal mucosa or may be inhaled.

The technique for intranasal administration of vaccine is straightforward and usually works quite well…the first time. Some animals, dogs more than cats, will aggressively resist intranasal administration of vaccine. Attempts to overcome this resistance include covering the eyes with a towel or otherwise distracting the patient with noise or other visual cues.

Special Considerations

Concerns expressed over the loss of vaccine immediately after intranasal administration are generally unfounded. Manufacturers of intranasal vaccines typically include a greater antigen (virus or bacteria) titer per dose than is necessary to induce a protective immune response. If the patient resists aggressively and the vaccine is indicated, parenteral preparations are available for all intranasal vaccines and should be considered.

Patient Preparation

Several objectives should be considered when treating dermatologic disorders with topical medication: (1) eradication of causative agents; (2) alleviation of symptoms, such as reduction of inflammation; (3) cleansing and debridement; (4) protection; (5) restoration of hydration; and (6) reduction of scaling and callus. Many different forms of skin medications are available, but the vehicle in which they are applied is a critical factor (Box 4-1).

Technique

In all cases, apply topical medications to a clean skin surface in a very thin film, because only the medication in contact with the skin is effective. In most cases, clipping hair from an affected area enhances the effect of medication. When dispensing medications to owners for home administration, the owner should be instructed to wear disposable examination gloves if using fingers and hands to apply the medication.

Special Considerations

With the widespread availability of compounding pharmacies, prescribing compounded medications for topical and oral administration recently has become a popular dispensing technique for dogs and cats requiring long-term, daily medication. Caution is warranted. Some compounding pharmacies that serve the veterinary profession are using inappropriate or ineffective vehicles in which the drug has been compounded, or the drug itself, purchased in bulk, is of a lower grade and possibly an ineffective product once compounded. Studies on the quality and efficacy of compounded drugs for use in veterinary patients are limited. However, of those studies that have been performed, serious questions are being raised over the bioavailability of the drug administered.

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.

Technique

Dogs and cats have abundant loose alveolar tissue and easily can accommodate large volumes of material in this subcutaneous space. The dorsal neck is seldom used for subcutaneous injections because the skin is somewhat more sensitive, causing some patients to move abruptly during administration. A wide surface area of skin and subcutaneous tissue over the dorsum from the shoulders to the lumbar region makes an ideal site for subcutaneous injections.

Administration of drugs, vaccines, and fluids by the subcutaneous route represents the most commonly used route of parenteral administration in dogs and cats. For small volumes (<2 mL total), such as vaccines, a 22- to 25-gauge needle generally is used. The site most often used is the wide area of skin over the shoulders. The large subcutaneous space and the relative lack of sensitivity of skin at this location make it an ideal injection site. Cleaning of the skin with alcohol or other disinfectant generally is performed before injection. Several injection techniques are used. A common technique entails grasping a fold of skin with two fingers and the thumb of one hand. Gently lift the skin upward. Using the opposite hand, place the needle, with syringe attached, through the skin at a point below the opposite thumb. Aspiration before injection is not typically necessary when using this route of administration. After administration and on removal of the needle from the skin, gently pinch the injection site and hold it for a few seconds to prevent backflow of medication or vaccine onto the skin.

When larger volumes are to be administered—fluids in dehydrated dogs and cats—the skin directly over the shoulders is the injection site most commonly selected. Generally, only isotonic fluids are administered by the subcutaneous route. Depending on the patient’s size, needles ranging from 16 to 22 gauge can be used. Because of the larger volumes of fluid involved, warming of the fluids before administration is recommended. Doing so can enhance significantly the patient’s tolerance for the displacement of skin during the period of administration and, in small patients, prevent hypothermia.

Depending on the rate of administration and breed of dog, relatively large volumes of fluid generally can be given in one location. Cats typically tolerate 10 to 20 mL/kg body mass in a single location. Large dogs can tolerate volumes greater than 200 mL of fluid in a single location. When administering large volumes, it is usually not necessary to use multiple injection sites for purposes of distributing the total fluid volume. Doing so actually may increase the risk of introducing cutaneous bacteria under the skin. Because the administration time required to deliver larger volumes is longer, and the injection needle will be placed in the skin for extended periods, it is appropriate to cleanse and rinse the skin carefully before actually inserting the needle. Isotonic, warmed fluids may be administered by large syringe or through an administration tube attached to a bag. Monitor skin tension and the patient’s comfort tolerance throughout the procedure.

Although fluid absorption begins almost immediately on subcutaneous administration of fluids, significant pressure caused by the bolus of fluid delivered can develop within the fluid pocket. On removal of the needle, firmly grasp the injection site with the thumb and forefinger for several seconds. The procedure is not complete until one has verified that back-leakage of fluid from the subcutaneous space onto the skin is not occurring. Depending on the patient’s hydration status and physical condition, fluid absorption may take from 6 to 8 hours.

Technique

Recently, implantable subcutaneous ports* have been introduced for use in patients requiring regular administration of subcutaneous fluids at home. A 9-inch silicon tube is preplaced under the skin and is sutured in place by a veterinarian. Objectively, this offers easy access to the subcutaneous space without the need for needle penetration. Owners simply attach a syringe or extension tube tip to the port and administer the appropriate volume of fluids at an appropriate rate and frequency.

Special Considerations

Because of the usual requirement for long-term placement of an implantable fluid administration tube, there is some risk of infection under the skin and around the incision site. Some cats do not tolerate the device.

Patient Preparation

None required.

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.

Patient Preparation

None required.

Patient Preparation

None required.