TECHNIQUE

Regional Digital Intravenous Perfusion in Elephants  (Disease Investigation & Management - Treatment and Care)

Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords  
Description Regional digital intravenous perfusion may be useful in the elephant for treatment of deep infections of the foot.

Procedure for the foreleg:

  • With a standing elephant, elevate the limb to be treated by having it placed on a stand. (P30.1.w9)
    • Elevation of the limb is not required for an anaesthetised elephant in lateral recumbency. (J2.34.w2)
  • Fit a tourniquet below the elbow.
    • a pneumatic tourniquet may be used inflated to 10-12 psi. (P30.1.w9)
    • a hand-held rope tourniquet has also been used successfully. (J2.34.w2)
  • Choose an appropriate vein. (J2.34.w2, P30.1.w9)
    • Superficial veins along the posterior or lateral aspect of the carpus or metacarpus may be chosen. Significant pressure is required to administer the drug and flush afterwards. (P30.1.w9)
    • Larger anterior veins over the carpus, metacarpus or digits may be used. Flow of drug into these veins has been reported to be "excellent". (P30.1.w9)
    • A palmar superficial vein was used in an adult Elephas maximus - Asian Elephant in lateral recumbency under general anaesthesia. (J2.34.w2)
  • Insert into the vein either a 21 gauge butterfly catheter or a 22 gauge 1.5 inch long needle with an adaptor and a 21 gauge butterfly attached. (J2.34.w2, P30.1.w9)
  • Administer the required perfusion solution(s) through the butterfly catheter: (P30.1.w9)
    1. 10 to 20 mL of local anaesthetic solution;
    2. Antibiotic solution diluted to 20 mL with 1:1 local anaesthetic and heparinised saline;
    3. 20 ml heparinised saline if a second antibiotic was given;
    4. The second antibiotic, diluted to 20 mL with 1:1 local anaesthetic and heparinised saline;
    5. 60 to 120 mL heparinised saline.

    (P30.1.w9)

    • In a Elephas maximus - Asian Elephant being treated for a sole abscess the perfusion solution included 1 ml heparin in 5 ml 0.9% sodium chloride, combined with 5 ml of 2% lidocaine, combined with 2 g cefoxin reconstituted to 20 mL in 0.9% sodium chloride, combined with 2 g gentamicin diluted to 50 mL with 0.9% sodium chloride, (J2.34.w2)
  • Leave the foot elevated and the tourniquet in place for 20 minutes after the antibiotic has been administered. (P30.1.w9)
  • Release the tourniquet and allow the foot to be put down. (P30.1.w9)
Appropriate Use (?)
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)
  • Modifications of this procedure could be used for elephants in protected contact, or with standing sedation. (P30.1.w9)
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)

  • Some venous scarring occurred with the repeated treatments. (P30.1.w9)
  • Use of a higher total volume (500 mL), aiming to ensure adequate perfusion, "appeared to contribute to venospasm and thrombosis." (P30.1.w9)
Equipment / Chemicals required and Suppliers
  • Pneumatic foot tourniquet designed for elephant foot surgery: (Pneumatic Tourniquet, CDA Products, Potter Valley, California, USA) [if available].

    • Or a rope tourniquet. (J2.34.w2)

  • Heparinised saline solution.

  • Local anaesthetic solution: lidocaine or mepivacaine hydrochloride have been used successfully. (J2.34.w2, P30.1.w9)

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)
  • This procedure has been carried out in a free-contact situation, using food rewards, repeatedly (daily then reducing to every other day, three times per week, twice a week and finally one a week, over a total period of approximately eight months, and was "well tolerated" by the elephant. (P30.1.w9)
Cost/ Availability
  • Costs of some of the drugs may be considerable. (P30.1.w9)
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)
  • 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 J2.34.w2, P30.1.w9, V.w6, V.w72, V.w84, V.w86, V.w88, W580.Aug2005.w1

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