Complications in Equine Surgery. Группа авторов
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2 Complications of Parenteral Administration of Drugs
Julie E. Dechant DVM, MS, DACVS, DACVECC
School of Veterinary Medicine, University of California–Davis, Davis, California
Overview
Parenteral administration refers to the administration of drugs by a route other than the oral route. This would include intravascular, intramuscular, subcutaneous, intradermal, intra‐synovial, and epidural routes of administration. Intravascular and epidural injections will be discussed in subsequent chapters. Subcutaneous and intra‐dermal routes of administration have a low risk of complications and will not be reviewed in this chapter. This chapter will focus on complications of intramuscular and intra‐synovial injections.
List of Complications Associated with the Parenteral Administration of Drugs:
Intramuscular administration
Anatomical and procedural considerations
Local muscle reaction: from mild inflammation to abscess formation
Clostridial myonecrosis
Intra‐synovial administration
Post‐injection synovitis and lameness
Medication errors
Intramuscular Administration
Anatomical and Procedural Considerations
The most common muscle groups used for intramuscular injection are the cervical (trapezius), pectoral, gluteal, and caudal thigh (semimembranosus, semitendinosus) muscles [1, 2]. Most veterinarians do not advocate use of the gluteal muscles, because this site provides poor drainage if any septic complications develop after injection [2]. Injection technique requires identification of local anatomy and recognition of topical landmarks.
The skin overlying the proposed injection site should be clean; however, there is no consensus if topical disinfection with alcohol reduces the risk of bacterial inoculation [1, 2]. For a full‐sized horse, a 1.5” needle should be used to allow for deep penetration into the muscle and it is prudent to use a larger‐sized needle (18–19 gauge), because smaller needles can break off in the muscle if the patient resists the injection. In most circumstances, it is best to place the needle in the muscle without the syringe and then attach the syringe to the hub of the needle. The syringe should be aspirated to ensure no contamination of the site with blood before injecting the medication, because many intramuscularly administered medications are not compatible with intravenous injection (e.g. procaine penicillin) or would have a different dosage if administered by the intravenous route (e.g. sedatives) [1, 2]. Ideally, no more than 10 ml should be injected at one site; the needle is redirected if larger volumes are administered [1, 2].
Local Muscle Reaction: From Mild Inflammation to Abscess Formation
Definition
Local muscle inflammatory reactions are characterized by swelling and soreness after intramuscular injection of a substance. Severe local inflammations with infection show local accumulation of purulent material (abscess).
Risk factors
The cervical and pectoral muscles appear to be more predisposed to muscle soreness, likely because these are smaller muscle groups compared to the gluteal or semimembranosus/semitendinosus muscles.
Repeated injection into the same location.
Some types of vaccines are anecdotally associated with a higher risk of injection site abscesses. Certain medications, typically acidic formulations or those with non‐aqueous carriers (gentamicin, tetracyclines, enrofloxacin, flunixin, phenylbutazone, etc.) are associated with increased tissue reactivity.
Pathogenesis
Local swelling and soreness are common complications, especially after repeated or large volume administrations or administration of irritating medications [2]. Abscess formation is a less common complication following intramuscular injection [1, 2] but may occur if the local inflammatory response is severe or if the injection site has been contaminated with bacteria. Abscesses may form even after intramuscular antimicrobial administration.
Prevention
Maximize aseptic