If you spend a lot of time around horses, you might be familiar with the many different opinions about intramuscular versus intravenous injection of medication. You probably also know a few basic animal husbandry skills related to administering such drugs via both methods.
For example, proper cleansing and sterile precautions are advised any time you break the skin’s barrier. Following manufacturer and veterinary instructions for all medication is crucial. Properly storing all medication is essential to help reduce the risk of infection.
However, even if you follow all of the directions and take all the necessary precautions, there is no guarantee that something might not go awry.
Recently, we had the opportunity to speak with Dr. Bri Gindlesperger of the Carolina Equine Clinic, who wanted to share a cautionary tale about one Quarter Horse owner’s unfortunate experience with an intramuscular injection.
Earlier this month, the clinic received a call from the owner of a 20-year-old Quarter Horse. She was concerned about her horse’s appearance and behavior after administering an intramuscular injection of Banamine.
“The horse colicked on Thursday evening,” Gindlesperger says. “Her owner gave her 3 mL of Banamine, which isn’t even a full dose. On Saturday morning, she called and said that the horse’s neck muscle was swollen, she couldn’t lift her head, and she had a fever and a temperature of 105. In the effort of preserving finances, we didn’t do a culture to see if it was Clostridium, but all the evidence pointed towards that.”
Caption: In this particular case, the vets decided to use a procedure known as fenestration, which involves making large incisions in the skin to help release some of the internal pressure made from gas produced by the bacteria.
Clostridium is a type of anaerobic bacterium that can cause an infection known as clostridial myositis or myonecrosis. Because this type of bacteria is anaerobic, it thrives in an environment without oxygen.
“We tend to see this most often with cases involving Banamine, but you run the risk anytime you break the barrier of the skin,” she says. “With the skin over the muscle and all of the connective tissue, the bacteria grows inside and produces gas that makes it blows up like a balloon. It keeps making gas until you get a pressure build up. Then, you can have myonecrosis, or the death of the muscle and tissue. The dead tissue will ultimately slough off.”
In this particular case, the vets decided to use a procedure known as fenestration, which involves making large incisions in the skin to help release some of the internal pressure. Gindlesperger says although the procedure isn’t pretty, it’s benefits are threefold.
“Because Clostridium is anaerobic, it grows in the absence of oxygen,” she says. “By making the incisions, the air will help to kill the bacteria. It will also help to release the build up of gas, and allow the infection an outlet by which to drain.”
Gindlesperger says she and her fellow colleagues have seen similar cases in the past. Although these pictures are relatively graphic, she says this is actually a rather mild case. She credits the owners prompt notification of the clinic as one of the main factors that helped this story to reach a successful outcome.
“We were very lucky in this case, because the owner noticed a problem, gave us a call, and we were able to get on her pretty aggressively with a surgical procedure and antibiotics. In some cases, this can be fatal. Once the injection starts, the tissue necrosis could’ve worked its way down towards the leg. She could’ve actually winded up with a large open wound.”
Caption: The surgical incisions are packed with antibiotic-soaked gauze to keep the cuts open and treat infection.
“They can also lose a lot of fluid, because it is basically like having a burn patient. There is no barrier to keep the muscle and connective tissue happy. It looks gross in the images, but this is actually a fairly mild case. This can be deadly.”
Although this case involved an intramuscular injection of Banamine, Gindlesperger says you run the risk of an infection any time you give an injection.
“Things you can do to be preventative are to groom the dirt off your horse and use a cotton ball with alcohol on the area you plan to inject, just like you would do with a person. If you’re in a crisis situation and your vet can’t get there for an hour, you can also give a dose of Banamine in the mouth. There are a lot of people that are just not comfortable giving a vein injection. They don’t want to do it on their own.”
“We are not going to ever get completely away from injecting muscle shots in horses. For instance, some vaccines are always going to be given in the muscle. But with some types of drugs, you can get around it by giving them orally.”
The Carolina Equine Clinic is happy to report that the horse involved in this particular case is recovering well and is now off of antibiotics. She should be able to return to work any day now.
For any specific questions about intramuscular, intravenous, or oral administration of medication, it is always best to consult your veterinarian for advice.
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