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Inhalant Medication Administration



OVERVIEW AND GOAL


To deliver medication to the respiratory tract with maximal efficacy and minimal side effects



INDICATIONS


Virtually any disease of the respiratory tract for which oral or injectable corticosteroids are indicated:


• Lymphocytic-plasmacytic rhinitis

• Allergic rhinitis

• Laryngeal edema secondary to laryngeal paresis/paralysis or mass

• Reverse sneeze

• Chronic bronchitis

• Asthma

• Eosinophilic pneumonia

Any disease of the respiratory tract for which oral or injectable bronchodilators are indicated:


• Asthma

• Chronic bronchitis (occasional)

• Bronchial compression secondary to left heart enlargement (occasional)


CONTRAINDICATIONS


Prior known sensitivity to inhaled medications



EQUIPMENT, ANESTHESIA



• Face mask: specific to species and size of animal’s muzzle

• Spacer: specific to size of animal

• Metered dose inhaler (MDI)


ANTICIPATED TIME



• Inhalation time is usually 7-10 seconds, q 24 h to q 12 h or as needed (bronchodilator).

• Preparation time for animal may be a matter of seconds if animal is trained and comfortable with the device or may last weeks if training is required.


PREPARATION: IMPORTANT CHECKPOINTS



• Approximately 90% of dogs and 65% of all cats will tolerate the placement of the mask and spacer apparatus the very first time.

• Animals that will not tolerate this device initially still can be trained to acceptance. This usually takes a few days to a few weeks.

• Approximately 5% of dogs and 20% of cats will not accept this form of medication delivery even after weeks of training.


POSSIBLE COMPLICATIONS AND COMMON ERRORS TO AVOID



• Some animals cough immediately after inhaling the medications. No treatment for this is required.

• Mild conjunctivitis occasionally occurs if the top of the mask is in contact with the lower conjunctival lid margins.

• Contact dermatitis of the muzzle occasionally occurs.

• “Thrush,” a yeast infection within the posterior pharynx, is a frequent complication in humans. This has not been reported in dogs or cats using inhaled corticosteroids.

• Growth retardation is a potential concern in children using inhaled corticosteroids. This has not been reported in dogs and cats.

• Cats with respiratory distress due to bronchoconstriction will very quickly benefit from inhalation of bronchodilator drugs. The temporary restraint required to administer these drugs has not been reported to result in clinically significant complications in this setting.

• Some cats will hold their breath. If this occurs, it is essential to wait until the animal begins breathing for 7-10 breaths.

• Some dogs and cats have nasal congestion that prevents inhalation by this method. In these cases, it is useful to instill a drop of a topical nasal decongestant (e.g., phenylephrine drops [Neo-Synephrine]) into either or both nostrils and wait 10-15 minutes before using the inhaled medications.


image INHALANT MEDICATION ADMINISTRATION Spacer device connected to a face mask.


PROCEDURE


Technique, initial:


• Shake MDI three to five times vigorously.

• Attach MDI to spacer.

• Position the animal for gentle restraint and to prevent side-to-side movement.

Technique, main:


• Place the mask over the animal’s nose (cats) or muzzle (dog). If right-handed, use left hand to place mask.

• Use right hand to actuate (spray) medication, one puff into spacer.

• MDI for albuterol comes as one dose only (90 mcg/actuation).

• MDI for fluticasone comes as 44, 110, and 220 mcg/actuation.

• Watch animal breathe for 7-10 breaths by watching the chest wall/abdomen.

• Alternatively, count 7-10 condensations of breath within the plastic mask.

• If an animal is resistant and in respiratory distress, it is usually safe to administer the medication with two people involved to temporarily restrain the animal. This is true even in the case of respiratory distress due to asthma.


POSTPROCEDURE



• Wipe patient’s face/muzzle with washcloth.

• Maintain cleanliness of spacer according to manufacturer’s recommendations.


ALTERNATIVES AND THEIR RELATIVE MERITS



• Nebulization does not offer superior drug-delivery results compared to the simple mask/spacer combination.

• Long-acting corticosteroids cannot be administered by inhalation.

• Oral prednisone/prednisolone should be considered when the animal requires immediate antiinflammatory treatment. Inhaled corticosteroids may take 7-10 days to reach full effect. In these cases, prednisone/prednisolone should be administered for the first week concomitantly with the inhaled corticosteroid.

• Parenteral bronchodilators can be used (e.g., terbutaline, subcutaneously [SQ]) if an animal is fractious and cannot be easily restrained.

• Topical medications: no current or prior objective data that document the effectiveness of transcutaneously-administered corticosteroids or bronchodilators in the treatment of respiratory disorders in dogs or cats.

• Alternative therapies: many unproven alternative, evolving, and experimental approaches to treating respiratory disease in the canine and feline species.

AUTHOR: PHILIP PADRID



image INHALANT MEDICATION ADMINISTRATION Spacer connected to a metered dose inhaler (MDI) and a self-sealing mask of the type commonly used for induction of anesthesia. Spacer acts as a reservoir for inhaled medication, so animal breathes the drug into its airways whenever it breathes through the face mask.


Intraosseous Catheter Placement



OVERVIEW AND GOALS



• Insertion and maintenance of a patent catheter in the marrow cavity of a long bone for purposes of administering parenteral fluids, drugs, blood, or virtually any other agent that is routinely given IV.

• The technique is most commonly used in debilitated neonatal and pediatric animals, in which peripheral veins may be very small and difficult to access but also in which the bone is soft and entered fairly easily.


INDICATIONS



• Urgent fluid replacement in a severely dehydrated/hypovolemic kitten or puppy (most common indication)

• Plasma or blood transfusion in an animal that has poor peripheral or jugular venous access

• Administration of drugs when IV access is not available


CONTRAINDICATIONS



• Osteopenia (nutritional or metabolic bone disease) or fracture affecting the target bone

• Infection of the overlying soft tissues

• Sepsis is a relative contraindication. The benefit of fluid administration must be felt to outweigh the risk of osteomyelitis.


EQUIPMENT, ANESTHESIA


Sedation or general anesthesia is necessary for animals that are otherwise well. However, intraosseous catheters are often placed in severely debilitated animals; local anesthesia with 2% lidocaine (typical kitten/puppy dose: 0.25 mL) is sufficient for these animals, provided all tissue layers are intiltrated (subcutis, muscle, periosteum).


• Clippers for hair

• Isopropyl alcohol, surgical scrub supplies, and sterile gauze squares

• Spinal needle: typically 20 gauge, 1½ or 2½ inches (4-6 cm) long

• T-port-type injection cap with side connector

• Sterile gloves

• Tissue glue

• Heparinized saline flushes

• Bandage material: roll gauze, cast padding, stretch and release bandage (e.g., Vetrap), white medical tape

• Suture scissors and bandage scissors

• ± Splint material (e.g., wooden tongue depressor in pediatric patients) to protect the spinal needle after placement


ANTICIPATED TIME


About 20 minutes



PREPARATION: IMPORTANT CHECKPOINTS



• Review anatomic landmarks.

• Consider alternatives (e.g., IV catheter).


POSSIBLE COMPLICATIONS AND COMMON ERRORS TO AVOID



• Damage to nerves (especially sciatic) or vessels. Risk is minimized by manipulating the limbs as described in the following paragraphs.
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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on I

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