Monday, December 2, 2019

'Fraidy Cat Learns: IM Injections

So my birthday was a few weeks ago, and this year I decided to treat myself by getting a little work done for Charlie. Like ya do, right? Don't all "our" presents kinda end up being "horse" presents in the end?

the look of a horse who knows what's coming lol
Anyway, nothing was wrong with Charlie, generally speaking. Like, obviously we were fresh off two great horse shows where Charlie demonstrated his total and complete physical fitness for the job at hand. Obviously, that made me pretty happy, right?

But he was due for his hocks anyway, plus I was kinda interested in repeating the whole "overall wellness check" we did about 6 months ago. Meaning, the same vet came out and we repeated all the same flexions etc (omg soooo much jogging tho....) and compared notes against last June.

yep, that's a sleepy charlie!
Overall, the vet felt like Charlie was presenting better than he had last time, and she'd been generally pretty satisfied with his soundness and condition then anyway. So, ya know, that's nice to hear haha. Particularly, we talked about her feedback from last time on my approach to conditioning Charlie.

If you recall, she basically said last summer that my understanding of conditioning was kinda back-asswards. I was very preoccupied with low-impact work, and "protecting" Charlie from too much high impact. I had this idea of "saving" him, like limiting his jumping etc.

Which, the vet argued that this was not right. She said the purpose of conditioning a horse is to help prepare the horse's body for handling the work. So, if galloping and jumping are part of the work, they need to be part of the conditioning. Obvi you don't generally go full intensity (max speed / max height / max duration). But there has to be shades, ya know?

And... it made a lot of sense when she broke it down like that, right? If I haven't jogged in ages, the first time I go a couple laps around the block might make me pretty sore. But as I get used to introducing that type of impact to my body, all the joints and muscles and sinew become more adapted to that impact. That's uh.... how conditioning works lol.

post-injections restrictions means that homeboy was dying for a good roll!
So yea. Anyway, I made changes to our program since then. And overall the vet was happier with Charlie's general condition and felt like he was presenting a pretty good picture going into the off season.

We still opted to do his hocks, bc that's basically a standard element of Charlie's maintenance package anyway. Plus we added in his front coffins. This year was brutal for hooves with the ground being so hard for so long, and we've had a hard time keeping Charlie as comfortable as I'd like on his feet. Probably this particular treatment will not become part of the "routine," but it made sense given our current conditions.

and a good shake too, obvi haha. i just <3 his goofy face tho
We also spent some time talking about less invasive ways to continue promoting Charlie's health and soundness proactively. Particularly, I asked about feed through and IM supplements.

Like most vets I've talked to, there are very limited circumstances where they recommend most OTC feed through supplements. Tho we did talk a little bit about options like Equioxx, the vet felt like at this particular moment something IM might be a better fit.

She told me that recent research has shown that drugs like Adequan don't necessarily have any increased benefit when given regularly (like monthly, for instance). Rather, she's now of the opinion that doing one boxed treatment (7 doses given one per every 4 days) is sufficient for overall general support.

one box contains 7 doses intended for administration every 4 days
She suggested it's more cost effective to do a box once or twice a year, rather than routine monthly shots. And that this approach can help make the other treatments I'm doing for Charlie last longer and be more effective.

So I picked up a box during that appointment, and a couple weeks later we started the treatment. Which brings us to this post's whole point: administering IM injections.

My barn manager has typically handled Charlie's stabby-jabby needs for me (like the many doses of IM antibiotics he's needed over the years....) but this seemed, for whatever reason, like the right time to learn how to do it myself.

single dose vial. it's really not a huge amount, especially compared to to some of the syringes of excede charlie's had to get in the past!
It's honestly not typically considered a very big deal, in the grand scheme of things. Most of my barn mates are more than comfortable giving IM shots, and this particular drug has pretty low risks overall, even if you end up accidentally sticking yourself or injecting into the wrong spot.

Of course, there are other drugs where that is absolutely not the case. Like... If you accidentally stick your own self with depo or dormosedan, you're.... gonna have a bad time. And some drugs can be extremely dangerous to the horse if they end up going directly into the blood stream instead of the muscle.

It's kiiiiiinda hard to "accidentally" go IV vs IM (into the vein vs into the muscle), but still. Steps should be taken to avoid the drug going literally anywhere except where you want it. The very first (and most critically important) of those steps is: consulting a professional. End of story.

I am *NOT* a professional by any stretch of the imagination. I'm nowhere near qualified to provide guidance on this subject. But I'm into learning more about the horsey experience, and sharing those learnings with y'all. The general takeaway from this whole thing is: if you're interested in learning how to administer IM injections, it's actually pretty easy with the right instruction.

the whole kit 'n kaboodle
For me, the first step was familiarizing myself with the equipment. Meaning, using my own hands to put stuff together, rather than just watching. Bc let's be real, I learn with my hands.

The box (part A in the above picture) included all the necessary parts plus a few spares. Notably, it included one extra needle (B1 and B2). I guess the idea is to have a spare in case you lose or contaminate one. My barn manager suggested that I use the spare as a "sacrifice" needle, tho.

The needle must pierce the rubber stopper in the vial (D) in order to pull out the dose, and this dulls it slightly. Rather than try to inject the horse with a slightly dulled needle, she suggested keeping one sacrifice needle to always use for pulling the drug into a fresh sterile syringe barrel (E), then using a fresh sterile needle (C) to inject into the horse. This way the horse always gets the sharpest (and therefore most effective) administration.

sacrifice needle marked by tape. should you happen to be ordering needles separately from your drug of choice, my BM recommended "luer lock" needles that have caps that screw/thread on to the needle vs these that pop on and off. the popping off can be a little challenging, or at least i thought so. 
Each needle tip comes in its own protective sterile casing, which can be used keep the "sacrifice" needle safe between uses. We marked this case with blue tape so it was always obvious which to use.

The vials themselves also have little plastic caps that you flick off with a finger nail to expose the rubber stopper that you see in the pic above. So the whole system is pretty well protected for this sacrifice needle that only ever comes out to punch those rubber stoppers.

fresh needle tip on syringe barrel that was filled using the sacrifice needle tip
I actually found that there was a bit of a learning curve to using the syringe barrel and plunger to pull the fluid out of the vial. It's not necessarily hard, it just takes me a couple tries of pulling the plunger down, then letting it rise back up again, then pulling down again, until eventually all the fluid is pulled from the vial and into the syringe barrel.

From this point, you just release any air trapped inside the syringe (again tho, my BM assured me there was no real risk to air bubbles -- that I could inject an entire syringe of air into Charlie's neck and he'd be totally fine. I, uh, obviously do not recommend testing this out).

Then I put the sacrifice needle back into its case (carefully!) and put a new fresh needle onto the syringe, leaving the protective case on until the last possible moment. Mostly, ya know, to avoid stabbing my own self lol.

the "TRIANGLE" plus shiny wet spot marked by alcohol wipe, where we administered the injection. please note my triangle lines are rough estimates based on my limited experience. please consult a professional for in-person guidance.
Honestly the hardest part for me is the act itself. I'm mostly pretty comfortable with understanding the right area in which to aim my injection, roughly the triangle above (again, please seek professional help before trying yourself!). The "triangle" is the space in front of the shoulder, above the spinal column and below the crest, where there's lots of nice deep muscle.

My barn manager suggested "marking" my intended location with an alcohol prep pad (F in the earlier diagram) used to clean the site. She said she likes to grab a pinch of skin both to tighten up the area plus sorta give the horse a bit of a warning. Then she knocks the site 2-3times with a knuckle, then boom. Stabby jabby.

The needle must go directly into the muscle, all the way. Which like, does indeed skeeve me out more than a little bit. Actually, for Charlie's first dose I chickened out at this point and made BM do it. The second time tho... I was determined that I *would* learn this thing.

So I did it! And? It was fine. The sharp needle really helps. Also it helps that Charlie's been stabbed and jabbed every way imaginable during his lifetime. He straight up does not care haha. Good boy <3

clearly he survived. this time.
Once the needle is all the way in, it's a good idea to do a little pull on the plunger to make sure you're not in a blood vessel. Again tho, it's kinda hard to do that by accident lol.

If that's clear, then plunge away. I wanted to go a little slower in pushing the fluid in than was called for - esp with such a thin liquid in such a small amount. If it were a fussier horse I'd definitely have to go faster. Tho if it's a higher viscosity drug (like excede) you can't go too fast or you risk blowing the syringe barrel off the needle tip.

And then... That's it! That's all there is to it. The used needle tip should go into a "sharps" bio-hazard container to ensure the safety of anyone handling waste materials down the line. But otherwise, the horse is good to go for another 4 days until the next dose.

In a way I'm really glad I'm finally learning this skill. I don't ever expect to keep horses at home, so some of these more delicate medical tasks can generally be left to the professionals managing the care of my horse at boarding facilities. And, for instance, I don't really have any undying urge to learn how to do an IV injection.

But IM injections are pretty accessible, relatively low risk (depending on the drug) and extremely common in day to day horse care and keeping. So it seems useful to at least be comfortable with the equipment and process.

Maybe you already know how to do them? Or are interested in learning in the near future? Or haha maybe the idea of stabbing your horse with a needle is an absolute no go???


41 comments:

  1. Depending on the volume of liquid you need from the bottle, it may come out a little easier if you pre-fill your syringe with the dosage volume (eg. 3 cc or whatever) of AIR (like, draw back the plunger to have that much air in it) and then insert the needle into the bottle, push the air into the bottle (to provide an appropriate amount of positive pressure) and then withdraw the liquid. That way you're not fighting a vacuum which makes the liquid hard to get out and causes the syringe plunger to be quite sticky. This is also more of a factor if you're doing larger volume injections.

    We do a lot of stuff in-house. My friend is a vet tech and so needles and shots and basic blood draws are not a call-the-vet situation unless it's required by law, like for a Coggins.

    ReplyDelete
    Replies
    1. Ooooh that's interesting about the air.

      Delete
    2. yea my barn mgr showed me that trick too but lol i still kinda had a hard time getting that smooth pull while doing it on my own. i guess it's just one of those things you have to get the hang of!

      and yea, being able to do all that stuff in house definitely seems like a huge advantage. for me, my "house" is by choice basically always full of pros more qualified than i am that i've been able to rely on, since i generally want to board at competition barns. that might not always be true, tho, so it's good to learn for myselft!

      Delete
    3. Yep - I was coming here to suggest that trick too!

      Delete
  2. I've given ace a couple of times (I was downright terrified), but it's been years. Most everything else, I've just given orally, including ace the few other times since as well as dex for Hayley in a last ditch effort to try and see if it was a miracle and could save her. If I need to do it again, I need a new tutorial... It's been way to long!

    ReplyDelete
    Replies
    1. yea i hear ya, the act of giving the shot was absolutely not my favorite, but i'm hoping that by the time this course of adequan is over i'll be reasonably comfortable with the whole thing. it's nice to at least know you CAN do it if the moment calls for it!

      Delete
  3. I learned to this a long time ago and it really is useful. I do it just like you did and never had an issue.

    ReplyDelete
    Replies
    1. that's good to hear! the only times i've heard of friends having issues was more to do with reactions to the drug vs any actual issue with the injection itself. tho the way my barn mgr was talking, i got the verrrrry strong impression that she has, at one point or another, accidentally stuck herself with dorm lol. which.... yea, it's good to know of those kinds of accidents so i can be more careful!

      Delete
    2. The first time Ed saw me give a shot to Irish he almost fainted. :) I will be curious to hear how this works for Charlie.

      Delete
    3. ha somehow i believe that! and yea i'm hoping it works well for charlie. so many of his issues are muscular in nature but i really just want to do everything i possibly can to keep him sound and happy!

      Delete
  4. Great to hear that Charlie is responding well to your changes in conditioning! This vet sounds great too - lots of practical info to pass on, which helps a lot. Interesting about the regular IM vs a shorter series like you are doing.

    I think learning skills like giving IM shots is pretty handy. My Mom was a nurse, so she taught me how to do shots when my dog needed some meds and we did any boosters the horses needed too. I had a refresher from my vet a few years ago, so that was helpful. I have my horses at home, so doing a shot now and again saves me at least $100 on a barn call, so worthwhile, IMO.

    I've also given myself shots (not so fun) and other humans, as well as flushing IV lines and various things like that! I prefer stabby-jabby on animals v people, for sure. And definitely handling the syringes, etc gets easier with practice.

    ReplyDelete
    Replies
    1. "practical" is exactly the right word for this vet - and i really appreciate it! in a way, it's kinda like reassuring or reaffirming to have her check in regularly on charlie just to sorta make sure we're seeing the whole picture in his training. so far, so good!

      and yea i imagine having the horses at home would force you to learn a lot of these skills much sooner than i need to, since i've definitely kinda used my barn mgrs as a crutch haha. tho omg, yea i don't think i'd like giving my own self a shot at all, yikes...

      Delete
  5. "Tho if it's a higher viscosity drug (like excede) you can't go too fast or you risk blowing the syringe barrel off the needle tip."

    ask me how I know this.....

    The alcohol prep pad mark is a good idea. I've given way too many IM injections and I am probably far too casual about it. I'd REALLY like to learn to give IV, mostly because if Shit is Going Down I want to be able to really quickly administer a sedative.

    But I am paranoid.

    ReplyDelete
    Replies
    1. omgosh i can totally see in my mind's eye blowing excede all over the place bc i pushed too hard on the plunger... i'm actually so glad my barn mgr told me about that bc yea, it seems easy to do...

      and yea honestly i'm hoping to get a bit more "casual" about the whole IM thing eventually. for now tho i'm trying to be very "by the book" while learning all the dos and don'ts. none of my friends ever seem to have any trouble tho!

      Delete
  6. I learned how to do IM in college, and these days I only use that knowledge on my mom's donkey, who has a habit of learning the vehicle the vet drives and NOPING right out of the situation as soon as he sees him, lol. The vet referred to it as a rodeo. But when I do it, I walk right up to him, stab him and we're good (obvs while still doing all the same exact steps you do). I joke that my parents paid lets-not-talk-about it thousands of dollars for my horse degree just so we can get shots into that donkey.

    ReplyDelete
    Replies
    1. lol that sounds like a very "donkey" thing to do haha!! and hey, i mean, even if you're not working in the horse industry directly, it certainly seems like everything worked out with your job prospects and getting that darned donkey shot up ;)

      Delete
  7. I'm such a weirdo and despite being a vet tech, hate giving IM injections. They are SO much easier in a horse than, say, a cat, and really, none of them are hard, but I think having to go so deep skeeves me out too. Lets just say I am not a good vet tech and it's probably why I don't do it for a living anymore, lol. Definitely a good skill to have! Before you know it you'll be giving IV injections too ;)

    ReplyDelete
    Replies
    1. omgosh i totally believe that tho -- as a kid i used to want to be a horse vet right up until i got a closer look at what that job actually entails... yea, that's a pass for me! and lol i don't see IV happening in the near future. never say never, i guess, but it's not on my list for now bc ick LOL

      Delete
  8. I've done a lot of IV blood draws on mice and rats, but the thought of giving an IV injection in horses scares me. I've done IM, SQ, and IP in horses, rodents, and dogs but the thought of screwing up and IV freaks me out. I'm sure if it was an emergency and I had to, I could, but I'd rather not find out.

    ReplyDelete
    Replies
    1. oh man, yea i'm with ya. like i can totally appreciate wanting to know how ICE, but then again that's part of why i choose barns staffed by such experienced pros LOL. tho in reality, i bet horses are overall easier than some of those other animals you work with - esp the teeny tiny mice!

      Delete
  9. I’ve done aiM injections before but it has been many many years. Dusty does all my animal stuff. I do give a ton of injections into people though. Try the air technique to help with pulling the fluid out. Also make sure the tip of the needle is always under the fluid line inside the bottle. With smaller volumes sometimes that’s tricky.

    ReplyDelete
    Replies
    1. lol see that's the way to do it - just marry a vet who will handle all the stabby jabby needs!! and re: my syringe filling technique, just needs more practice!

      Delete
  10. When I learned IM/IV last year I was pretty sketched out, plus it was trial by fire. Your method of learning and continuing on is must more conducive to comfort lol! But yeah soon you'll feel old hat at it if you don't already.

    ReplyDelete
    Replies
    1. oh man, yea i was thinking about you actually while we were going over this. trial by fire is.... kinda the opposite of what i want for this kind of stuff. bc yea omg that's so stressful!! but hey, it's nice to know you could get it done when the pressure was on!

      Delete
  11. The ability to give IM injections is such a useful skill to have! I learned how when I worked at the therapeutic riding center, and it's come in handy over the years (especially when I was breeding Gina- I felt like I had a zillion injections to give her). I really need to learn to give IVs, but they freak me out!

    ReplyDelete
    Replies
    1. oh man, yea i can totally see how once you know how, there are suddenly seemingly endless occasions to do it. charlie has gotten so many needle sticks since i've owned him that i've almost not even paid attention to. now that i can do some of them tho i'm sure that feeling will change haha

      Delete
  12. The first few times I had to give IM injections, I was a wreck. I was convinced P would drop dead, but so far that hasn't happened. Now I'm probably a bit too flippant about it, so this was good little reminder! Glad C is doing well and your revamped conditioning program clearly paid off!

    ReplyDelete
    Replies
    1. thanks i'm so glad the vet was happy with charlie too! and yea omg the fear of him dropping dead is REAL tho, so real lol. luckily he didn't even notice...

      Delete
  13. We learned to give injections in school by going through the 50 lessons horses and stabbing them all for practice. If that's not proof lesson ponies deserve sainthood simply for existing, I don't know what is!

    ReplyDelete
    Replies
    1. omgosh bless those lesson pony hearts tho <3 we had to do the same thing with our horses one year when we were quarantined with the flu, but it wasn't im shots -- it was taking temps. every horse twice a day, every day. those horses honestly deserve sainthood too LOL

      Delete
  14. I was sooooo scared to do IM injections the first time I gave Amber adequan a long time ago. It really helped that she did absolutely nothing when my vet-tech friend showed me the first time, so I was not as worried she would fly over backwards lol. But at one point the barn I worked at had a lot of sick horses, and I learned REALLY fast how to give IV injections for banamine. So I've definitely gotten more comfortable with doing it, and so since the dog needs adequan, and the horses need their yearly shots, I'm the designated "sticker" between me and my mom lol!

    ReplyDelete
    Replies
    1. oh man, IV banamine scares the crap out of me haha. and like... penicillin... no thanks, hard pass, i'll leave those things to the pros! still tho, it's good to know those skills - esp since you guys keep horses at home it's great to be able to handle it yourself instead of always having to call a vet out!

      Delete
  15. I can't speak for every Australian but giving IM/IV injections has been pretty commonplace for me and most of the people I know (I can do sub/cut as well but have never had to, so I think I would feel not nearly as keen on that).

    My personal preference for IM injections is into the pectoral muscle. There's more room, more depth of muscle, if you DO get a haematoma it is much easier to drain there than on the neck, and you don't have the interference of the cervical vertebra and the nuchal ligament like you do on the neck. I avoid HQ IMs as much as possible.

    It's also much easier if giving high volume drugs, or having to administer repeatedly over the course of days (or I feel it is anyway).

    Glad to hear Charlie is doing so well! Would you mind if I asked what you are injecting into his hocks? Partially because I have never done anything like it but I have never even been offered the choice for something like this.

    I feel like the US has so much more by the way of sport medicine and management on offer sometimes.

    ReplyDelete
    Replies
    1. that's cool that education on this stuff is so common in your area. i feel like the opportunity for me to learn has existed for a long time but.... i've kinda resisted and there's been no real push haha.

      re: the ingredients, different vets use different substances, and some have different preferences on antibiotics etc, but for this appointment we did some combination of steroids and antibiotics into each set of joints. the vet used different steroids for the hocks vs the coffins (which i believe were polyglycan?) and explained it to me using normal words. something about using higher viscosity steroids relative to the joints range of motion? and something else about there being a limit to how many of any one steroid you can administer into a horse's body at one time? i wish i could remember more details, but she only wrote abbreviations on my tear sheet and idk what it all means haha.

      Delete
  16. I had to learn this summer 2018 when Gwyn got a series of Adequan. I hadn't thought about the sacrifice needle tip! If I ever need to do this again, I'll definitely employ that technique.

    ReplyDelete
    Replies
    1. definitely! it's not something i would have thought about myself either but made so much sense when the barn mgr explained it haha

      Delete
  17. Oh man, I had to learn this long ago. I had just started a job as barn manager and we had a sick horse. All the bigger bosses were off to nationals, and I had to medicate the sick horse while they were gone. With Penicillin! I was so worried the horse would react... Thankfully he didn't, and survived my learning curve. The poor thing.
    But it's a great skill to have, you never know when you'll need it!

    ReplyDelete
    Replies
    1. oh jesus, to be perfectly honest i'm not sure there will ever be a time in my life where i'll be brave enough to voluntarily administer penicillin! talk about trial by fire! glad it worked out for you tho haha, and probably nothing seems stressful after that!!

      Delete
  18. Definitely a good skill to have, though I can't say I've done it myself.

    ReplyDelete
    Replies
    1. definitely! turns out there really isn't all that much to it, either!

      Delete
  19. I've had to stabby jab Kenai several times, but I have yet to stabby jab one of the horses! I applaud you.

    ReplyDelete

Thanks for leaving a comment! If you have trouble with this form, please email: fraidycat.eventing at gmail.