TECHNIQUE

Intramuscular Injection of Elephants  (Disease Investigation & Management - Treatment and Care)
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Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords Elephant IM injection
Description Intramuscular injections should be administered in areas with relatively thin skin and a large muscle mass.
  • Sites commonly used for intramuscular injections in elephants include: triceps muscles (on the lateral foreleg), hindleg muscles, the hip region and the neck. (W580.Aug2005.w1)
  • The best site for intramuscular injection in the elephant is in the large triceps area. The skin is thinner here than over the hindquarters. (B10.49.w21)
  • The caudal and medial thigh (into semimembranosus), the lateral forearm (into triceps) or sometimes the neck may be used. (J375.1.w1)
  • The rump area may be used for intramuscular injections. (P64.1.w2)
    • Note: The skin on the upper hind leg and the hip region is at least 2.5 cm (one inch) thick. (W580.Aug2005.w1)
Restraint for injection:
  • Restrain the elephant as appropriate:
    • In a chute or squeeze cage; (B23.77.w12, J375.1.w1)
    • With the elephant holding one leg up; (B23.77.w12)
    • With the elephant lying down. (B23.77.w12, J375.1.w1)
    • With the elephant in a "dog sitting" posture. (P64.1.w2)
  • A well trained elephant may stand without restraint. (J375.1.w1)

Preparation for injection:

  • Thoroughly clean the skin in the intended injection area(s). (B23.77.w12, W580.Aug2005.w1)
    • Scrub the area for injection several times using alcohol and a cleansing disinfectant. (J375.1.w1)
    • Note: elephants readily form abscesses. (B23.77.w12, W580.Aug2005.w1)

Hand injection:

  • Rub and slap the intended injection site prior to inserting the needle. (B23.77.w12)
  • Insert the needle. (V.w72)
    • Insert quickly through the sensitive skin and into the muscle. (J375.1.w1)
    • For standard length needles on the rump it is important to insert the needle perpendicular to the body surface to ensure it reaches muscle. (P64.1.w2)
    • Note that the needle may be bent and even broken if the elephant moves. (J375.1.w1)
  • Remove the stylet if a spinal needle has been used. 
  • Attach the syringe to the needle. (V.w72)
  • Pull back the plunger slightly to ensure that the needle is correctly placed, not directly in a vessel.
  • Inject slowly. (V.w72)
    • Inject a maximum of 10 - 20 ml (B10.49.w21), 15 - 25 ml (B23.77.w12), 10 - 35 ml (J375.1.w1) at any one site. 
    • For large volumes, prepare multiple sites and inject the drug divided between the sites. (J375.1.w1)

Pole injection:

  • A long-handled pole syringe (jab stick) may be used to inject an elephant from a safe distance. (B10.49.w21, B23.77.w12)
  • Spring-loaded models may be most effective, since the medication is injected quickly, in less than one second. (W580.Aug2005.w1)
  • A pole syringe with an extension pole may be used if required for greater distance between the operator and the elephant. (W580.Aug2005.w1)
  • Note: pole syringes are usually limited to about 12 ml of drug, therefore several injections may be required to administer the whole drug dose. (W580.Aug2005.w1)

Darting:

  • Intramuscular injections may be delivered by darting. (B10.49.w21, B23.77.w12)
  • This may be required in dangerous animals in which use of other options is not possible. (W580.Aug2005.w1)
  • This is the method used commonly for administration of immobilising drugs. (B22.34.w14)
  • Sterile syringes and needles should be used to reduce the risk of abscess formation. (B10.49.w21)
  • The preferred site for darting is the caudal rump; alternatively the upper forelimb on the anterolateral aspect. (B22.34.w14)
Appropriate Use (?)
  • This route is preferable to the subcutaneous route because of faster speed of absorption of the medication. (B10.49.w21)
  • Intramuscular injection by darting is commonly used for administration of immobilising drugs, particularly of animals which are not sufficiently manageable for hand injection and also for injection of potent narcotic agents. (B22.34.w14)
Notes
  • Care must be taken to ensure that personnel working nearby are aware that a hands-on procedure is being carried out. Both personnel directly involved with the procedure, and those working nearby, need to ensure that movements and noise (from telephones, bleepers, shutting doors, heavy machinery etc.) that might disturb the elephant, both inside and outside the elephant area, are minimized during the procedure. This includes activities at nearby enclosures that might be audible to the elephant and could startle it. (V.w6, V.w72, V.w84, V.w86, V.w88)
  • Elephants are quite sensitive to injections. The ease of medicating elephants by injection are affected by:
    • The elephant's personality and training;
    • The elephant handler's confidence and skill;
    • Available restraint facilities.

    (W580.Aug2005.w1)

  • Reaching the muscle is easier when the leg being injected is weight-bearing, since the muscle is taut and is closer to the surface of the elephant. (W580.Aug2005.w1)
  • Injecting into muscles which are not weight-bearing may be less painful. (B23.77.w12)
  • Hyaluronidase may be added to injections to facilitate absorption of large volumes. (B214.3.7.w3)
  • Higher drug concentrations in non-irritant, long-acting formulations would be advantageous if available. (J375.1.w1)
  • Use of topical anaesthetic agents may be advantageous to reduce the pain associated with intramuscular injections. (J375.1.w1)
Complications/ Limitations / Risk
  • Elephants are very large, heavy and strong, highly intelligent, can move surprisingly quickly and can be highly strung at times: 
    • Depending on the management system (free contact / no contact / protected contact), and the character and training of the individual elephant, it may be necessary to carry out any hands-on procedure with the elephant under sedation and/or in an elephant restraint device.
    • There is always some risk to personnel involved when carrying out hands-on procedures on a conscious elephant.
    • There is always some risk to the elephant when sedation is used, especially if full anesthesia is required.

    (V.w6, V.w72, V.w84, V.w86, V.w88)

  • The back, hips and upper neck are not appropriate sites, due to the thickness of the skin. (J375.1.w1)
  • The ventral thorax and abdomen are not suitable sites due to the lack of large muscle masses. (J375.1.w1)
  • Swellings or abscesses may form where intramuscular injections are given. (B214.3.7.w3)
    • Injection deep into the gluteal or shoulder muscles is recommended. (B214.3.7.w3)
  • No more than 10 ml to 20 ml (B10.49.w21) or 15 to 25 ml (B23.77.w12) should be injected at any one site, in order to minimise the risks of complications seen associated when larger volumes are injected. (B10.49.w21)
    • It is possible to inject 30 or even 50 ml intramuscularly at a single site. However, this results in excessive inflammation and swelling. (B10.49.w21)
      • Application of DMSO to the skin over the injection site may reduce swelling over the injection site. (B10.49.w21, B23.77.w12)
    • Larger volumes may also result in longer absorption times. (B23.77.w12)
    • For many medications such as antibiotics, division of the total dose and administration into several sites may be necessary. (B23.77.w12)
    • Administration of antibiotic at up to 30 mL per site, using an 18 gauge 9 cm spinal needle, without subsequent heat or swelling has been reported. The skin was cleaned at the injection site prior to injection of the antibiotic. (J2.27.w1)
  • Elephants readily form abscesses; it is important to ensure that equipment used for intramuscular injections, including darting equipment, is sterile (B10.49.w21) and that the skin is cleaned thoroughly with a disinfectant before the needle is inserted. (B23.77.w12, W580.Aug2005.w1)
  • If an elephant requires a course of injections and objects to the injections, it may be necessary to chain the elephant in order to allow injections to be carried out safely. (B10.49.w21)
  • Multiple injections required for administration of large volumes of medication may not be tolerated by the elephant. (J2.27.w2)
  • Elephants are quite sensitive to injections and repeated injections may not be tolerated. (W580.Aug2005.w1)
  • Insertion of larger gauge needles (e.g. 16 gauge or 14 gauge) is more difficult and more painful for the elephant. (V.w72)
  • If a standard length needle is not inserted perpendicular to the body surface in the rump, the injection may be subcutaneous rather than intramuscular. (P64.1.w2)
  • Many drugs are not available in sufficiently high concentrations to allow practical intramuscular injection. For example, to give enrofloxacin to a 5,000 kg elephant at a dose rate of 5 mg/kg would require injection of 250 ml of 100 mg/ml enrofloxacin. (J375.1.w1)
  • Intramuscular injections in elephants cause both acute pain and continuing pain; lameness may be noted after injection even of 1 ml of tetanus antitoxin. (J375.1.w1)
  • Elephants learn to associate the loaded syringe and needle with the pain of intramuscular injection and may become agitated. (J375.1.w1)

For injections by pole syringe

  • Pole syringes are usually limited to about 12 ml of drug, therefore several injections may be required to administer the whole drug dose if this method is used. (W580.Aug2005.w1)
  • It may be less possible to chose the exact injection site. (J375.1.w1)
  • It is not possible to prepare the skin prior to injecting. (J375.1.w1)
  • A larger, longer needle is required than for hand injection. (J375.1.w1)

For injections by darting

  • It is not possible to prepare the skin prior to injecting. (J375.1.w1)
  • A larger, longer needle is required than for hand injection. (J375.1.w1)
  • Trauma to the tissue associated with darting, in combination with the lack of preparation of the injection site, may result in significant, deep wounds, which can become infected. (J375.1.w1) See: Subcutaneous Abscess in Elephants; Wounds in Elephants
Equipment / Chemicals required and Suppliers
  • Standard needles (4.0 cm/1.5 inches long) for injections into the triceps area. (B10.49.w21)

  • 3.75 cm 18 - 20 gauge needle. (J375.1.w1)

  • Longer needles for injections into the muscles of the hind quarters. (B10.49.w21)

    • Needles 2.0 to 3.0 inches long (5.08 - 7.62 cm) are required for injections into the muscles of the hind quarters. (W580.Aug2005.w1)

    • Spinal needles may be required. (W580.Aug2005.w1)

    • Needles of 18 gauge should usually be used. (W580.Aug2005.w1)

    • Needles of 14 to 20 gauge and 3.75 cm (1.5 inches) length for injecting into the fore quarters. 

    • Thicker needles (16 gauge or even 14 gauge) may be required for administration of thick medications. (W580.Aug2005.w1)

    • For injections into the hind quarters, spinal needles with stylets, at least 18 gauge and of 6.25 - 8.75 cm (2.5 - 3.5 inches) length are required to ensure the needle reaches into the muscle. (B23.77.w12)

      • This may be important particularly for large males. (J375.1.w1)

  • Syringes.

  • Pole syringes, if required for injection at a distance. (B10.49.w21)

  • Darting equipment, if required for injection at a distance. (B10.49.w21)

Expertise level / Ease of Use
  • Expertise and experience of the elephant handler(s) are critical when carrying out hands-on procedures on a conscious elephant. (V.w6, V.w72, V.w84, V.w86, V.w88)
  • The ease of injection varies depending on the personality and training of the elephant being medicated, available restraint facilities and the elephant handler's skill and confidence. (W580.Aug2005.w1)
Cost/ Availability
  • Required equipment is generally inexpensive (except for e.g. dart guns).
  • Equipment required for hand injecting is readily available.
Legal and Ethical Considerations
  • When working with elephants it is important always to remember that their size and weight means that they can injure people easily, whether intentionally or unintentionally. The potential risks to all personnel involved must be considered before any hands-on procedure is initiated, and remembered during the procedure. It is critical that all personnel are highly trained and understand their respective roles and responsibilities during the procedure, that one person has overall command responsibility, and that no unnecessary people are present within the contact area. (V.w6, V.w72, V.w84, V.w86, V.w88)
  • The safety of both veterinarians and animal care staff must be considered when an elephant is receiving an injection. (B23.77.w12)
    • If a restraint cage or squeeze cage is not available, lying the elephant down will maximise human safety during hand injection. (B23.77.w12, W580.Aug2005.w1)
  • Allergic drug reactions are always possible, although rare. The veterinarian should be prepared for such a reaction. (W580.Aug2005.w1)
Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee Susan K. Mikota DVM (V.w72)
References J2.27.w2, B10.49.w21, B23.77.w12, B214.3.7.w3, J375.1.w1, P64.1.w2, V.w6, V.w72, V.w84, V.w86, V.w88, W580.Aug2005.w1

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