TECHNIQUE

Intravenous Injection of Elephants  (Disease Investigation & Management - Treatment and Care)

Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords  
Description Fluid therapy for elephants follows the same principles as fluid therapy for horses or cattle. However, in practical terms there may be difficulties in providing sufficient fluids to meet requirements. (B10.49.w21)
  • For example, 100 - 300 litres per day may be required for an adult elephant with severe fluid loss due to a disease such as Salmonellosis. (B10.49.w21)

The following veins are suitable for intravenous administration: 

  • Auricular veins on the posterior (caudal) aspect of the ear;
  • Branches of the cephalic vein on the craniomedial aspect of the proximal part of the foreleg;
  • The medial saphenous vein on the distomedial part of the hind leg. 

(B10.49.w21, B23.77.w12, J375.1.w1, P64.1.w2 W580.Aug2005.w1)

Making up fluids:

  • When large quantities of fluids are required it may be useful to use powdered electrolyte mixtures which are then made up by the gallon using distilled water. (B10.49.w21)
Restraint for injection:
  • Restrain the elephant as appropriate:
    • In a chute or squeeze cage;
    • With the elephant holding one leg up;
    • With the elephant lying down.

    (B23.77.w12)

  • If the elephant will not remain stationary for intravenous drug administration, the elephant should be tranquilised or sedated. (B10.49.w21)
    • Xylazine (0.04 - 0.08 mg/kg intramuscularly for light sedation) or meperidine allow sedation without causing the elephant to lie down. (B10.49.w21)

Injection into the auricular (ear) vein:

  • Move the ear forward and compress the veins at the base of the ear. (B214.3.7.w3)
  • Identify the vein on the back of the ear.
    • Auricular veins have thinner, more pliable and collapsible walls than do the nearby arteries, and, unlike the arteries, lack a pulse. (B70.B4.w1, P64.1.w2, J375.1.w1, W580.Aug2005.w1)
    • Arteries are more rigid than are veins, and contain blood of a lighter colour, which squirts out without application of pressure. (B214.3.7.w3)
  • To increase filling of the auricular veins in cold weather or when the elephant has low blood pressure, making them easier to see, the following may be useful:
    • Place the elephant in lateral recumbency; (B450.14.w14, .W580.Aug2005.w1)
      • Placing a pad of straw under the ear may assist; wait about three minutes for the vein to become more visible. (V.w6)
      • It may be necessary to get the elephant to lift its head slightly when or immediately after the medication is injected, as excess pressure on the ear base may impede injection. (J375.1.w1)
    • Apply warm water, warm compresses (e.g. a warm, wet towel) or dry heat (using a hair dryer); (B336.53.w53, B450.14.w14, J375.1.w1, W580.Aug2005.w1)
  • Insert the needle into the vein.
    • Take care to ensure that the needle is inserted securely into the vein. (W580.Aug2005.w1)
      • Check that the needle is in a vein not an artery. (P64.1.w2)
      • Take great care not to inject perivascularly when using the ear veins. (B10.49.w21, P64.1.w2)
      • A 20 - 22 gauge needle can be used. (J375.1.w1)
    • Or: insert a butterfly catheter into the vein. (J375.1.w1, W580.Aug2005.w1)
      • This has the advantage that, because of the tubing, movements of the elephant can be followed without the placement of the needle in the vein being affected. (W580.Aug2005.w1)
  • Aspirate blood into the syringe to confirm the needle is correctly inserted into the vein before injecting. (J375.1.w1)
  • Inject the drug gently. (J375.1.w1)
  • Remove the needle. (J375.1.w1)
  • Place pressure over the vein to decrease bleeding and prevent a haematoma from forming. (J375.1.w1)

For possibly irritating solutions

  • If solutions which may be irritating if injected perivascularly are to be injected using the ear veins:
    • Use light sedation of the elephant to prevent the elephant from struggling or flapping its ears. (B10.49.w21, W580.Aug2005.w1)
    • Dilute the drug in a larger volume of appropriate fluids - sterile physiological saline or sterile water;
    • Place an intravenous catheter, rather than a needle, into the vein;
    • Inject slowly.

    (B10.49.w21, B23.77.w12, J196.72.w1, W580.Aug2005.w1)

    • OR: A leg vein may be chosen for injection rather than an ear vein. (B10.49.w21, D301.2.w2, W580.Aug2005.w1) see below.
For repeated injections
  • If repeated intravenous injections are required, place an intravenous catheter. (W580.Aug2005.w1)
    • Once the catheter is in place, use glue, tape or sutures to stabilise the catheter. (J375.1.w1)
    • The elephant must be supervised constantly to ensure the catheter is not removed. (W580.Aug2005.w1)

Injection into the cephalic (forelimb) vein:

  • Identify the vein on the medial side of the proximal foreleg.
    • The cephalic vein is easily identifiable in some elephants but in other individuals may be less easy to find. (W580.Aug2005.w1)
    • It may be necessary to perform a surgical cut down to place a catheter. (J375.1.w1)
  • Insert the needle or, for injection of larger volumes, a butterfly catheter, into the vein. (W580.Aug2005.w1)
    • A butterfly catheter has the advantage that, because of the tubing, movements of the elephant can be followed without the placement of the needle in the vein being affected. (W580.Aug2005.w1)
    • For repeated injections, insert a catheter. (J375.1.w1)
      • Stabilise the catheter using sutures and bandages. (J375.1.w1)
      • The elephant must be supervised constantly to ensure the catheter is not removed. (J375.1.w1, W580.Aug2005.w1)
      • Unless the elephant is very cooperative, physical restraint may be required to prevent the catheter being removed. (J375.1.w1)

Injection into the saphenous (hindlimb) vein:

  • Identify the saphenous vein on the lower hind leg. (B70.B4.w1)
    • Note: this vein may be easily visible but is deeper than it appears. (W580.Aug2005.w1)
  • Insert the needle or, for injection of larger volumes, a butterfly catheter into the vein. (W580.Aug2005.w1)
    • A butterfly catheter has the advantage that, because of the tubing, movements of the elephant can be followed without the placement of the needle in the vein being affected. (W580.Aug2005.w1)
    • Note: Use a one inch needle and insert to its full depth, perpendicular to the skin to reach the vein. (W580.Aug2005.w1)
Appropriate Use (?)
  • For injection of sterile fluids and pharmaceutical products suitable for intravenous injection.
  • Intravenous injection may be preferable to administration of large volumes of a drug intramuscularly, which would require multiple injection sites. (J2.27.w2)
  • For routine intravenous injections, the auricular veins are usually easiest to use. (J375.1.w1)
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)
  • A butterfly catheter has the advantage over e needle, particularly for administration of larger volumes, that because of the tubing, movements of the elephant can be followed without the placement of the needle in the vein being affected. (W580.Aug2005.w1)
  • Use of a long indwelling catheter reduces the risk of extravascular leakage. (J2.27.w2)
  • If flow of fluids is slow during an intravenous infusion, slow injection with a large syringe may be used. (B214.3.7.w3)
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)

  • 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)

  • Perivascular administration or intra-arterial injection of some drugs when injecting into the ear veins may lead to necrosis and sloughing of the affected portion of the ear. (B10.49.w21, J196.72.w1, J375.1.w1, P64.1.w2, W580.Aug2005.w1)
    • Segmental gangrene and sloughing of a portion of the ear has been recorded in two elephants following intravenous injection of phenylbutazone into the auricular vein. (J196.72.w1)
    • Sloughing of the skin has been reported following injection of concentrated (5%) thiopental sodium. (J329.10.w1, P64.1.w2)
  • Irritating solutions may result in phlebitis. (J375.1.w1)
    • This risk is reduced by diluting irritating drugs before administration. (J375.1.w1)
  • Sepsis may result if the skin is not properly prepared before injection. (J375.1.w1)
    • This risk is reduced by aseptic preparation efore the needle or catheter is inserted. (J375.1.w1)
  • While the cephalic vein is accessible in the standing elephant, in a free-contact situation there is some risk to the veterinarian from head and trunk movements of the elephant. (W580.Aug2005.w1)
  • Elephants may remove an intravenous catheter if not supervised. (W580.Aug2005.w1)
    • Catheters in the auricular veins are within reach of the trunk. (J375.1.w1)
  • Accidental intra-arterial injection may result in haematoma formation. (D301.1.w1)
Equipment / Chemicals required and Suppliers
  • Needle or butterfly catheter

  • Syringe

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 --
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. (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 MCVS (V.w5)
Referee  
References B10.49.w21, B23.77.w12, B70.B4.w1, B214.3.7.w3, J2.27.w2, J196.72.w1, J375.1.w1, P64.1.w2, V.w6, V.w72, V.w84, V.w86, V.w88, W580.Aug2005.w1

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