TECHNIQUE

Intraosseous Injection of Hedgehogs (Disease Investigation & Management)

Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords IO injection
Description Before performing any clinical technique, the associated legal and ethical considerations should be consulted, knowledge of the potential complications/ limitations/ risk should be gained, and the level of expertise and qualification required must be ascertained.

A detailed description of fluid therapy is available. (See: Fluid Therapy for Hedgehogs)
Consult the pages in combination, as necessary.

  • Intraosseous injection is a technique, rarely used in the hedgehog, which is most commonly described in the literature as a possible route for fluid therapy in shocked or seriously injured individuals. The following description has been included for completeness.
  • Placement of an intraosseous cannula in the hedgehog requires general anaesthesia in the vast majority of cases. Access without general anaesthesia may be possible if the animal is unconscious or severely collapsed.
Site Selection:
  • Intraosseous fluid administration can be performed into the proximal femur in the hedgehog.(B284.6.w6, D92)
Technique:
  • Ensure that all equipment is available prior to starting the procedure.
  • Ensure adequate restraint of the patient; usually requires general anaesthesia for the hedgehog. (See: General Anaesthesia of Hedgehogs)
  • Local anaesthetic may be used in the area.(D92)
  • Carefully clip and clean the injection site and disinfect with surgical spirit. Sterility is essential.
  • Select an appropriate gauge and length of needle designed for intraosseous use with a stylet.
  • Carefully introduce the needle into the medullary cavity of the bone, using a twisting action.
  • Check placement by slowly injecting a small volume of sterile saline, or similar. 
    • Check for resistance or the development of local swelling which can indicate incorrect placement. 
    • Radiography can be used for conformation of correct placement if doubt persists.(V.w26)
  • Infusion pumps should be used to control the rate of fluid administration to the hedgehog casualty.(D92)
  • The needle is usually left indwelling for infusion of fluids or drugs.
  • The needle/cannula should be held in place with a) tape wrapped around the end of the cannula and sutured to the skin; or b) sterile tissue glue. Additional bandaging may be required.
  • Monitor the injection site for evidence of leakage, swelling or haematoma formation during the injection or infusion.
  • Check the patient for evidence of pain or discomfort if conscious during the injection, alternatively continue to carefully monitor the general anaesthetic.
  • On removal of the needle, apply pressure to the site using cotton wool to prevent seepage and minimise risk of bleeding.

(B284.6.w6, D92, V.w26)

Appropriate Use (?)
  • Used occasionally in the treatment of shocked hedgehogs with collapsed peripheral circulation.
  • Fluids via this route are rapidly absorbed into the circulation, even in collapsed and shocked patients. (B284.6.w6, D92)
  • May be used for fluids and non-irritating drugs.
  • Administration of fluids such as plasma volume expanders, Hartmann's Solution, corticosteroids, antibiotics can be performed by the intraosseous route in shocked hedgehogs.(D92)
Notes
  • Manufacturers data sheet recommendations should be followed as to the recommended route and rate of drug administration.
  • Excellent drug and fluid absorption via the intraosseous route.
Complications/ Limitations / Risk
  • Great care should be taken with correct placement and avoidance of accidental limb damage (e.g. fracture) during needle placement.
  • Adequate skin preparation should be performed to help prevent development of local infection (e.g. osteomyelitis). Sterility is essential.
  • Plugging of the needle with a core of bone may occur if an ordinary hypodermic needle is used.
  • Monitor for signs of fluid overload (increased respiratory rate, cardiac dysrhythmia, agitation or collapse) during fluid therapy.
    • Care should be taken to avoid fluid overload, particularly with the small body size of the hedgehog. (D92)
Equipment / Chemicals required and Suppliers
  • Special intraosseous needles with a stylet are commercially available.(D92)
  • Infusion pump.
Expertise level / Ease of Use
  • Procedure should only be undertaken by an individual with appropriate clinical training and practical experience; this would usually be a veterinarian or someone with advanced veterinary technician training.
Cost/ Availability
  • Equipment more expensive than for standard intravenous injection.
Legal and Ethical Considerations In some countries there may be legislation restricting the use of this type of technique to licensed veterinarians. For example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides, subject to a number of exceptions, that only registered members of the Royal College of Veterinary Surgeons may practice veterinary surgery." (See: LCofC1 - RCVS Guide to Professional Conduct 2000 - Treatment of Animals by Non-Veterinary Surgeons)

Use of Drugs (Medication):

  • Many drugs are not registered for use in particular species and care should be taken in their use, with proper regard for possible toxic effects. Consideration should be give to relevant legislation regarding the use of drugs.
  • In the UK, guidelines regarding the use of drugs are set out in the Royal College of Veterinary Surgeons Guide to Professional Conduct 2000 (see: LCofC1 - RCVS Guide to Professional Conduct 2000 - Choice of Medicinal Products).
Authors Becki Lawson (V.w26)
Referee Debra Bourne (V.w5), Suzanne I. Boardman (V.w6), Tiffany Blackett (V.w44)
References B284.6.w6, D92V.w26 

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