TECHNIQUE

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

Sternal recumbency over the edge of a table for jugular access. Click here for full page view with caption. Sternal recumbency over the edge of a table for jugular access. Click here for full page view with caption. Rabbit caudal ear vein cannulation. Click here for full page view with caption. Rabbit caudal ear vein cannulation. Click here for full page view with caption. Rabbit cephalic vein cannulation. Click here for full page view with caption. Injecting into the lateral ear vein. Click here for full page view with caption

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Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords
  • IV injection
  • Venoclysis
  • IV catheterisation
Description Note: Techniques used in wild lagomorphs
  • While most veterinary procedures described for use in domestic rabbits can also be used in wild lagomorphs, it is much more likely that sedation or anaesthesia will be required to carry out such procedures in these animals.

Various sites can be used for intravenous injections / catheterisation in rabbits. Details of the advantages and disadvantages of each site and details which vary between sites (e.g. positioning the rabbit) are indicated below. 

General intravenous injection information
  • Needles
    • 24 gauge needle or smaller regardless of which vein is used. (B615.6.w6)
  • Choose a vein (see the section below on the different sites)
    • The choice of vein for intravenous injections is largely a matter of individual preference. (B600.3.w3)
    • Choose a site where the skin is clean and has no obvious inflammation or infection. (B601.2.w2)
    • For peripheral veins, the needle should initially be inserted into a distal section of vein so that if the procedure is not successful then a second attempt can be made more proximally. (B601.2.w2)
  • Prepare the site
    • Shave or clip the intended injection site. (B601.2.w2, J83.24.w1)
    • Apply EMLA cream (Astra) if appropriate: this is a local anaesthetic cream that contains Lidocaine (Lignocaine) and prilocaine and can produce full thickness skin anaesthesia. (B600.3.w3, J15.20.w2, J83.24.w1)
      • It has been recommended for use on the marginal ear vein venepuncture site (B600.3.w3, B601.2.w2, J83.24.w1) and the lateral saphenous site. (B601.2.w2)
      • Apply over the site 30 minutes (B601.16.w16, J83.31.w2) 45 to 60 minutes (B600.3.w3, J15.20.w2, J83.24.w1) prior to venepuncture (after clipping) and cover with an occlusive dressing or clingfilm. (B600.3.w3, B601.16.w16, J15.20.w2, J83.24.w1)
    • Prior to venepuncture, clean the skin with a cotton swab (J83.24.w1) and wipe the site with 70% isopropyl alcohol. (B601.2.w2)
    • Note: alcohol can be used to part the fur if shaving is not possible. (J213.9.w1)
  • Raise the vein
    • Raising the vein involves applying pressure to the vein to occlude the venous return therefore making the vein fill with blood. This may be performed by the person administering the medication or by an assistant depending on the site and technique used.
  • Insert the needle
    • Insert the needle (bevel upwards) into the vein slowly and at a very acute angle, almost parallel to the skin.
  • Confirm that the needle is in place
    • Confirm that the needle is in the vein properly by gently pulling back on the syringe plunger so that a small amount of blood enters the syringe. Be careful not to use too great a pressure on the syringe plunger because this may cause the vein to collapse and thus stop the blood flow. 
    • If blood does not enter the hub of the needle or the syringe then gently reposition the needle taking care not to damage the blood vessel.
  • Stop raising the vein
    • Release the pressure and stop raising the vein so that the medication can be administered. 
  • Slowly inject the medication into the vein
    • Most intravenous medications need to be administered slowly. (B601.2.w2)
    • If the needle is no longer in the vein or there has been damage to the vessel during venepuncture, the vein will "blow" and the medication will enter the surrounding subcutaneous tissue (subcutaneous swelling can be seen). Immediately stop the procedure and select another site for the injection. 
  • Gently remove the needle from the vein
  • Apply pressure over the venepuncture site
    • Gently apply pressure with a small piece of cotton wool until clotting has occurred. This will help prevent the formation of a haematoma.
  • Dispose of the used syringe and needle
    • The syringe needs to be disposed of in the appropriate clinical waste container and the needle needs to be put into a sharps container.
  • Clean the site
    • Clean any blood from the area after clotting has been achieved.

General intravenous catheterisation information
  • Indications:
    • Rabbit blood clots quickly, particularly in metal needles, so intravenous catheters may be ideal for all intravenous injection procedures. (B615.6.w6)
    • Prolonged infusion, e.g. fluid therapy, should be administered via in-dwelling catheters. (B602.14.w14)
  • Catheters:
    • 24 or 26 gauge catheter in smaller rabbits. (J213.9.w1)
    • 22 gauge catheter in rabbits larger than 3 kg. (J213.9.w1)
    • Alternatively, a butterfly catheter can be used for short-term fluid therapy. (J213.9.w1) 
      • A butterfly catheter is particularly useful for immediate fluid therapy in a hypotensive rabbit. (J213.1.w1)
  • Choose a vein (see the section below on the different sites)
    • There are a limited choice of sites that are practical for intravenous catheterisation and fluid therapy. (B600.3.w3)
    • Choose a site where the skin is clean and has no obvious inflammation or infection. (B601.2.w2)
    • For peripheral veins, the catheter should initially be inserted into a distal section of vein so that if the procedure is not successful then a second attempt can be made more proximally. (B601.2.w2)
  • Technique for over-the-needle catheters is described below.
  • Preparation of site and raising the vein: as for intravenous injections above. 
  • Intravenous catheterisation
    • Slowly insert the catheter (bevel upwards) into the vein and at a very acute angle, almost parallel to the skin, whilst watching the other end of the catheter for blood return. When blood is seen welling up inside the catheter, stop raising the vein and then use one finger to slide the catheter off the needle and fully into the vein. 
  • Remove and discard the needle.
    • The needle should be put into a sharps container.
  • Attach a bung or a giving set (for fluid therapy) to the end of the catheter.
  • Secure the catheter.
    • Adhesive tape or a few drops of superglue or "Vetbond" can be used to hold a catheter in place. (B600.3.w3)
    • Depending on the site, a light bandage can be applied over the catheter to prevent the rabbit from removing it.
  • Flush the catheter
    • Flush the catheter with saline to ensure patency.
  • If the rabbit is going to be receiving intravenous fluids via a giving set, all the tubing must also be secured away from the animal's mouth to prevent chewing. (B601.2.w2)
  • Note: An indwelling venous catheter should be flushed frequently with saline. (J213.1.w1)
    • Do not use frequent flushing with heparin, particularly in small rabbits. (J213.1.w1)

Venepuncture sites
Marginal ear vein
  • Advantages
    • This vein can be used for intravenous injections and catheterisation. (B600.3.w3, B601.2.w2, B615.6.w6)
    • This is a good choice of vein for intravenous catheterisation and fluid therapy because it is easier to keep the rabbit in the correct position for administration of intravenous fluid therapy than it is for other venous sites. (B600.3.w3)
    • The vein is easily visualised and accessible. (B600.3.w3, B601.2.w2)
  • Disadvantages
    • Thrombosis of the vein can occur with subsequent sloughing of the skin particularly in breeds with small ears. (B602.14.w14, B606.3.w3, J213.9.w1)
      • Sloughing of the ear tips has been reported to occur with catheterisation of this vessel. This may be due to phlebitis caused by administration of irritant solutions or medications; aggressive taping of the ear; or mechanical irritation due to the catheter itself. (B602.14.w14)
      • Care should be taken with injecting medications into this vein because many drugs are irritant and sloughing of the pinna may occur. (B606.17.w17)
    • [Note: pikas (Ochotona spp.) have small ears; ear veins are not useful for venepuncture or catheterisation in these species.]
  • Restraint and positioning
    • This procedure can be carried out in the conscious animal but is significantly aided by applying topical EMLA cream to the venepuncture site 45 to 60 minutes beforehand. (B600.3.w3, B601.2.w2)
    • Sternal recumbency in a relaxed position. (B601.2.w2)
    • The rabbit can be restrained if necessary by wrapping it in a towel. (B600.3.w3)
    • Chemical restraint may be necessary in some animals to prevent the needle being dislodged by head shaking. (B600.3.w3)
  • Raising the vein
    • Firstly warm the pinna for a few minutes to help dilate the vessel, e.g. in a warm hand or a warm cloth. (B601.2.w2, B602.14.w14)
    • The assistant should place pressure on the lateral margin of the ear at the base. (B601.2.w2)
  • Securing the catheter
    • Butterfly catheter: cut one wing off a 21 or 23 gauge butterfly set. Place the butterfly needle in the vein and then superglue (tissue glue, e.g. Vetbond, 3M) the remaining wing to the pinna (to the fur) to keep the needle in place. No bandaging is necessary if the animal is moribund or sedated. However, if the rabbit is on fluids, it is a good idea to tie a small piece of bandage around the rabbit's neck to keep the giving set out of the way. (B600.3.w3)
    • Superglue is not as good for keeping intravenous catheters in place because the wings of these catheters provide too small a surface area for the bonding agent. (B600.3.w3)
Cephalic vein
  • Advantages
    • Intravenous injections and catheters (B600.3.w3, B601.2.w2, B602.14.w14, B606.17.w17, B615.6.w6)
      • Simple injections are easily administered into this vein. (B602.14.w14)
      • In the conscious animal this vein is more preferable for catheterisation than the lateral saphenous vein because it is less affected when the rabbit moves around. (B606.17.w17)
      • This is a good choice of vein for intravenous catheterisation and fluid therapy because it is easier to keep the rabbit in the correct position for the intravenous fluid therapy compared to other venous sites. (B600.3.w3, J213.9.w1)
  • Disadvantages
    • The vessel is of a small diameter and often mobile. (B601.2.w2)
    • The antebrachium of the rabbit is short and this limits the usefulness of this vessel particularly in small breeds. (B600.3.w3, B601.2.w2, B602.14.w14)
    • This vein is only practical for this procedure in rabbits that are a minimum of 3 kg in weight. (B615.6.w6)
    • This site may be more stressful for a rabbit because the handler is working near to the head of the animal. (J213.9.w1)
  • Restraint and positioning
    • Place the rabbit in sternal recumbency and pull one forelimb towards you. (B601.2.w2)
    • The assistant needs to gently hold the head away from the extended limb. (B601.2.w2)
  • Raising the vein
    • The assistant should occlude the vessel at the elbow. (B601.2.w2)
    • Alternatively a tourniquet may be used. (B601.2.w2)
Lateral saphenous vein 
  • Advantages
    • This vein can be used for intravenous injections and catheters(B601.2.w2, B602.14.w14, B606.17.w17
    • Simple injections are easily administered into this vein. (B602.14.w14)
    • Intravenous injections (B615.6.w6)
    • Intravenous catheters (B606.17.w17) for intravenous fluid therapy (J213.9.w1)
    • The vessel is easily accessible as it runs diagonally (medial to lateral) across the lateral aspect of the tibia just proximal to the hock. (B602.14.w14, J213.9.w1)
  • Disadvantages
    • The vessel is often mobile. (B601.2.w2)
    • In the conscious animal this vein is not as preferable for catheterisation as the cephalic vein because its placement is more likely to be affected when the rabbit moves around. (B606.17.w17)
    • This vein is only practical for this procedure in rabbits that are a minimum of 3 kg in weight. (B615.6.w6)
  • Restraint and positioning
    • The procedure is aided by applying topical EMLA cream to the venepuncture site beforehand. (B601.2.w2)
    • A towel can be useful for restraint. (J213.9.w1)
    • Provide a visual barrier to help calm the patient, e.g. cover the rabbit's head with a towel. (B601.2.w2, J213.9.w1)
    • Place the rabbit in sternal recumbency along the edge of the table and gently hold one hind leg over the table edge. (B601.2.w2)
    • The person who is carrying out the injection or catheterisation should hold the tarsus and pull the skin taut to stabilise the vessel. (B601.2.w2)
  • Raising the vein
    • The assistant should apply pressure to the caudal stifle (B601.2.w2) or just above the hock joint (B602.14.w14). Alternatively pressure can be applied across the proximal thigh. (J213.9.w1)
    • A tourniquet may be considered. (B601.2.w2)
Jugular vein
  • Advantages
    • This vein can be used for intravenous injections. (B600.3.w3)
  • Disadvantages
    • This vein is not a practical choice for intravenous catheterisation. (B600.3.w3)
      • Catheterisation is possible with large jugular catheters but sedation or anaesthesia is usually necessary. (B602.14.w14)
      • It can be difficult to maintain an intravenous catheter at this site. (B601.2.w2)
    • Visualisation can be difficult in obese rabbits. (B600.3.w3, B601.2.w2, J213.9.w1)
    • Visualisation can be difficult in females with large dewlaps. (B601.2.w2, B602.14.w14, J213.9.w1) However, other authors feel that the dewlaps do not really pose a problem. (B600.3.w3)
    • Short nosed breeds, e.g. Netherland Dwarf, or rabbits with upper respiratory tract problems, can become distressed or even cyanosed when the head is extended back for this venepuncture. (B600.3.w3)
  • Restraint and positioning
    • Conscious sampling is only possible in very calm or ill rabbits. Sedation or anaesthesia is often necessary. (B601.2.w2, B602.14.w14)
    • If conscious sampling then ideally wrap the rabbit in a towel. (B600.3.w3)
    • Sternal recumbency technique
      • The rabbit needs to be in sternal recumbency facing the edge of a table. (B601.2.w2, B602.14.w14, B615.6.w6)
      • The assistant should stand behind the rabbit and extend the head (avoiding overextension of the neck because this can flatten the vein and cause respiratory distress). (B601.2.w2, J213.9.w1)
      • The assistant should turn the rabbit's head slightly away from the vein to be sampled. (B601.2.w2) An alternative opinion is that it is important that the head is held straight. (B600.3.w3)
      • Draw the forelimbs vertically over the table edge. (B601.2.w2, B602.14.w14, B615.6.w6)
    • Dorsal recumbency technique
      • If the rabbit is under general anaesthesia then it may be possible to take the blood sample in lateral or dorsal recumbency. (B601.2.w2)
      • The assistant should place the rabbit in dorsal recumbency on a table with the head over the edge, grasping the body with one hand and drawing the front feet back towards the rear with the other. (B602.14.w14, B615.6.w6)
      • The person that is carrying out the intravenous injection or catheterisation should take the head of the rabbit with their free hand and gently tip it backwards so that the ventral neck region is exposed. (B602.14.w14)
  • Preparation of the venepuncture site
    • Clip the fur over the jugular furrow. (B600.3.w3)
  • Raising the vein
    • Using a digit to raise the vein at the thoracic inlet. (B600.3.w3, B601.2.w2) The thumb can be used to raise the vein and push the dewlap ventrally at the same time to expose a suitable area of neck. (B602.14.w14)

Other sites
  • Femoral vein: this is another site that can be used for intravenous injections; however, it is impractical for IV catheterisation. (B600.3.w3). 
  • Lateral thoracic vein in does (B602.14.w14)
Appropriate Use (?)
  • Intravenous medication including fluid therapy
    • Rabbits that are in shock, azotaemic, or critically ill should receive fluids intravenously (rather than subcutaneously). (B602.14.w14, J213.9.w1)

Note: Different sites are appropriate for different individuals and purposes

  • Marginal ear vein
    • This vein can be used for intravenous injections and catheterisation. (B600.3.w3, B601.2.w2, B615.6.w6)
      • This is a good choice of vein for intravenous catheterisation and fluid therapy because it is easier to keep the rabbit in the correct position for administration of intravenous fluid therapy than it is for other venous sites. (B600.3.w3)
    • This vein is easily visualised and easily accessible (B600.3.w3, B601.2.w2)
  • Cephalic vein
    • Intravenous injections and catheters (B600.3.w3, B601.2.w2, B602.14.w14, B606.17.w17, B615.6.w6)
      • Simple injections are easily administered into this vein. (B602.14.w14)
      • In the conscious animal this vein is more preferable for catheterisation than the lateral saphenous vein because it is less affected when the rabbit moves around. (B606.17.w17)
      • This is a good choice of vein for intravenous catheterisation and fluid therapy because it is easier to keep the rabbit in the correct position for the intravenous fluid therapy compared to other venous sites. (B600.3.w3, J213.9.w1)
  • Lateral saphenous vein
    • This vein can be used for intravenous injections and catheters(B601.2.w2, B602.14.w14, B606.17.w17
    • Simple injections are easily administered into this vein. (B602.14.w14)
    • Intravenous injections (B615.6.w6)
    • Intravenous catheters (B606.17.w17) for intravenous fluid therapy (J213.9.w1)
    • The vessel is easily accessible as it runs diagonally (medial to lateral) across the lateral aspect of the tibia just proximal to the hock. (B602.14.w14, J213.9.w1)
  • Jugular vein
    • This vein can be used for intravenous injections. (B600.3.w3)
  • Femoral vein
    • Useful for intravenous injections; however, it is impractical for intravenous catheterisation. (B600.3.w3). 
Notes
  • Manufacturer's data sheet recommendations should be followed as to the recommended route and rate of drug administration (subcutaneous, intramuscular, intravenous).
  • Dirty needles and syringes must be disposed of properly (needles always into a properly marked sharps container. (D249.w10)
  • Lighting
    • The veins of rabbits are generally quite small therefore adequate lighting is necessary for good visualisation. (B600.3.w3, B601.2.w2)
  • Sterile equipment
    • Needles, butterfly infusion sets, or intravenous catheters must remain sterile; only handle them at the hub. (B601.2.w2)
Complications/ Limitations / Risk
  • In wild lagomorphs
    • While most veterinary procedures described for use in domestic rabbits can also be used in wild lagomorphs, it is much more likely that sedation will be required to carry out such procedures in wild lagomorphs.
    • Pikas (Ochotona spp.) have small ears; ear veins are not useful for venepuncture or catheterisation in these species.
  • Clipping
    • Take care not to damage the delicate skin during clipping or plucking. (J213.9.w1)
  • Preventing the patient suddenly jumping during venepuncture
  • Damage to the vein
    • If the needle is no longer in the vein or there has been damage to the vessel during venepuncture, the vein will "blow" and the medication will enter the surrounding subcutaneous tissue (subcutaneous swelling can be seen). Immediately stop the procedure and select another site for the injection. 
  • Prevention of a haematoma
    • Gentle digital pressure (or a brief pressure wrap) over the site of venepuncture is necessary after the needle is removed to prevent the formation of a haematoma. (B601.2.w2, J213.9.w1)

Note: Different sites have different limitations for their use.

  • Marginal ear vein
    • Thrombosis of the vein can occur with subsequent sloughing of the skin particularly in breeds with small ears. (B602.14.w14, B606.3.w3, J213.1.w1, J213.9.w1)
      • Sloughing of the ear tips has been reported to occur with catheterisation of this vessel. This may be due to phlebitis caused by administration of irritant solutions or medications; aggressive taping of the ear; or mechanical irritation due to the catheter itself. (B602.14.w14)
      • Care should be taken with injecting medications into this vein because many drugs are irritant and sloughing of the pinna may occur. (B606.17.w17)
      • See: Iatrogenic Segmental Ear Gangrene in Elephants and Lagomorphs
  • Cephalic vein
    • The vessel is of a small diameter and often mobile. (B601.2.w2)
    • The antebrachium of the rabbit is short and this limits the usefulness of this vessel particularly in small breeds. (B600.3.w3, B601.2.w2, B602.14.w14)
    • This vein is only practical for this procedure in rabbits that are a minimum of 3 kg in weight. (B615.6.w6)
    • This site may be more stressful for a rabbit because the handler is working near to the head of the animal. (J213.9.w1)
  • Lateral saphenous vein
    • The vessel is often mobile. (B601.2.w2)
    • In the conscious animal this vein is not as preferable for catheterisation as the cephalic vein because its placement is more likely to be affected when the rabbit moves around. (B606.17.w17)
    • This vein is only practical for this procedure in rabbits that are a minimum of 3 kg in weight. (B615.6.w6)
  • Jugular vein
    • This vein is not a practical choice for intravenous catheterisation. (B600.3.w3)
      • Catheterisation is possible with large jugular catheters but sedation or anaesthesia is usually necessary. (B602.14.w14)
    • Visualisation can be difficult in obese rabbits. (B600.3.w3, B601.2.w2, J213.9.w1)
    • Visualisation can be difficult in females with large dewlaps. (B601.2.w2, B602.14.w14, J213.9.w1) However, other authors feel that the dewlaps do not really pose a problem. (B600.3.w3)
    • Short nosed breeds, e.g. Netherlands Dwarf, or rabbits with upper respiratory tract problems, can become distressed or even cyanosed when the head is extended back for this venepuncture. (B600.3.w3)
Equipment / Chemicals required and Suppliers
  • Appropriate-sized sterile needle and syringe.
    • 24 gauge needle or smaller regardless of which vein is used. (B615.6.w6)
  • Appropriate-sized catheter.
    • 24 or 26 gauge catheter in smaller rabbits. (J213.9.w1)
    • 22 gauge catheter in rabbits larger than 3 kg. (J213.9.w1)
    • Alternatively, a butterfly catheter can be used for short-term fluid therapy. (J213.9.w1)
      • A butterfly catheter is particularly useful for immediate fluid therapy in a hypotensive rabbit. (J213.1.w1)
  • EMLA cream (ASTRA Pharmaceuticals Limited, King's Langley, England).
  • Required medication.
  • Appropriate tape, bandage material and/or tissue glue as required for securing the catheter.
Expertise level / Ease of Use
  • This procedure should only be carried out by an individual with appropriate clinical training and practical experience.
Cost / Availability
  • Equipment used for intravenous catherisation or injections is relatively inexpensive and readily available.
  • Medication used may vary in cost and availability.
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 lagomorphs 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 any country, drugs are unlikely to be specifically licensed for use in non-domestic mammals. 
    • In Europe the prescription cascade must be followed, and the client's informed consent should be obtained, whenever a drug is used which is not licensed for use in a given species. (B284.5.w5)
    • 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).
Author Nikki Fox BVSc MRCVS (V.w103)
Referee Tiffany Blackett BVetMed MRCVS (V.w44); Debra Bourne MA VetMB PhD MRCVS (V.w5); Molly Varga BVetMed DZooMed MRCVS (V.w125)
References B600.3.w3, B601.2.w2, B601.16.w16, B602.14.w14, B606.17.w17, B615.6.w6, J15.20.w2, J83.24.w1, J83.31.w2, J213.1.w1, J213.9.w1

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