Penicillin SubQ Injections

[kaylyne28]

Quick history: My 3 month old mini lop, Ellie was diagnosed with Pasteurella (confirmed via C&S). It did not respond to baytril (oral and ear drops) over the course of a month of continuous treatment. So now my vet has me giving Ellie SubQ injections of penicillin in hopes to manage her symptoms.

I’m having a heck of a time doing these injections!! Either rabbit skin is crazy thick or I’m just terrible at this… My vet did show me how to properly give these injections but I messed up doing it the first time (it just went on her fur) and the second time I couldn’t get that last tiiiinyyy bit out of the syringe in time because Ellie, though she’s usually a saint, flipped out…

Does anyone have any tips or recommendations on how to make this process easier? I don’t have a second person to help me unfortunately. If I posted a video of me doing this tomorrow evening would someone be willing to correct me if I’m doing something wrong?

[Azerane]

I’m afraid I can’t give any tips on the injection method as I’ve never done it myself, however rabbit skin is very thin so it shouldn’t be too troublesome to get underneath it. Easier said than done I suppose

[kaylyne28]

Oh no! I guess I’m just bloody awful at this! Which is rather surprising to me as I’m a healthcare student and can give people SubQ injections no problem. I’ve watched about a dozen YouTube videos and it looks so easy but I’m struggling ?

[jerseygirl]

Don’t worry, you’re not alone. I had lots of trouble giving them also. I think my success rate was something like 1 in 4.
Injecting penicillin is notoriously difficult. Maybe it’s just certain types… Ive on;y given short acting procaine penicillin.

Are the syringes pre-drawn or are you drawing the dose right before giving it?
What gauge needle are you using? Sometimes a larger gauge helps.

[kaylyne28]

I’m using a 25 gauge needle /1cc syringe to draw up the medication from the vial and inject it. I’m not having trouble so much with it being hard to push, but just getting the needle in the right spot.

I honestly don’t know how the vet and all the videos I’ve watched make it look so easy!! Also, should I be wiping the top of the vial (the rubber) with an alcohol swab before I draw up the penicillin? I do that for infection control where I work with meds I give people, so would it not be safer to do that with this vial as well?

ETA: injection went far smoother tonight!! Ellie’s nasal discharge is clearing up a bit so I’m hopeful at this point!

[kaylyne28]

So we’ve been at this now everyday since December. Poor Ellie is getting scar tissue bumps from being poked everyday. Is there anywhere other than her scruff that’s okay to give SubQ injections that won’t leave her sore?

[DesertBunny]

I had to give Jet injections since 2010 until he recently passed away. First they were every day but that tapered off to once a week. I would beware of long term exposure with daily injections. It can effect his GI tract and make for tiny hard poops.

Anyway, it took me a long time to master it. And Jet never flinched or complained even though a few times I drew some blood or did a double penetration and it ran all over his fur. Since he was black that was easy to clean up And you do want to clean it ALL up since if ingested Penicillin can have very bad results.

Anywhere from the scruff along the top of his back. I pulled up a “U” (or maybe “V” shaped “tent”) and injected downward at about a 45 degree angle. One of my fingers was always on the “back” side of his skin where the needle went in. That was to make sure the needle actually went IN him and not through the skin (the double penetration) in which case your medicine will be on the wrong side of the bunny.

Don’t inject straight down, and obviously not perpendicular because that causes the double penetration. If the needle is reluctant to penetrate, STOP and regroup. Don’t force it.

I threw all my needles away so I don’t know what size I used. Does 18 ga sound right? I started with a smaller one and had problems. When the vet showed me the larger needle I freaked out. It looked like a spear but worked fine.

I never used alcohol on him prior to injecting. I DID use 2 needles every time. One to draw the medicine out of the bottle and then I switched to a new needle for the actual skin penetration. I always had a third needle handy just in case I blew it. You would be surprised how the rubber on the bottle can dull the needle.

It went really well about 98% of the time. When i blew it, he would look at me like “We have to do this AGAIN?”

 

[Rookie]

Yeah Rookie is on daily penicillin right now. Has been since mid January. He HATES it now….I do too.
At first I found it easier than having to feed him but now feeding him meds is easier than at first. I’ve had times when he jumped away needle half in and I’m like NOOOOO….then had to regroup and do it again…I hope he can finish injections soon as he too hard the little bumps on his back and cause he lost weight grabbing a good amount of skin has been harder.

[Wick & Fable]

My rabbit (Wick) recently began Penicillin shots (started with Bactrim syringe-feed, now currently on penicillin injection and baytril syringe-feed). I’m a trained phlebotomist, so I draw blood on humans. I hope I can provide some helpful tips, because honestly I can say the penicillin injections are more difficult than human draws. Rabbits and different than humans, so my method for sticking Wick may not work for every rabbit, or be ideal for every rabbit.

Wick is a runt Netherland dwarf, also at 3 months, so he is very small. I use my left-hand (dominant) for the needle, and right-hand to grasp the ideal “skin tent”. I recommend not having the needle in your hand until you establish a good stick location. To identify the location, with my right-hand (non-dominant), I place 2 middle fingers at the under belly and my thumb near his spine. I pull my middle fingers up towards my thumb, while pressing my thumb towards the middle fingers a bit as well. When I pull up with this motion (like a pinch & pull), I get a small skin tent. With Wick being skinny, my fingers are usually always pulling fur, which consequently pulls up his skin (it doesn’t seem to hurt him though; very small pull). Rabbits are furry, so their skin is difficult to see (are you sticking skin or fur?). I brush the fur in the opposite direction at the potential sticking site so I can see where the skin begins. I also use a finger to poke at the tent I’ve pulled up. Wick’s stick sites are usually a bit closer to his spine than the ground, but it definitely hovers the half-way point.

Once I have the tent established and I have a good idea of where the skin actually is, I stick the needle through the tent’s entrance (not at the ground of the tent or at the very top, but right in the center of the tent’s entrance). My vet specifically stated to stick parallel to the muscle, meaning my needle is usually parallel to the floor. Large angles of entry (sticking perpendicular or at any angle) is only required if you’re trying to target something deep in the skin. Since the shot is as superficial as it can be, the angle of entry should be as close to 0degrees, as compared to the muscle, as possible. It makes it a bit less nerve-wracking, because if I know I’m 1) parallel to the back muscles and 2) sticking above the back muscles, there’s no way my needle will collide.

This is where I’m not sure the anatomy of rabbit skin vs. human skin, but with humans, the longer you linger on the top layers of the skin, the longer it hurts and more likely to bruise/sore. Once I’m ready to stick, press the needle in— once you know it’s in, don’t hesitate and push the plunger to expel the penicillin. Again, only the skin needs to be penetrated, so I don’t need to stick too far. Once I’m done, I withdraw the needle (same angle as I entered; angle of entry/exit should match), have one finger ready to push down slightly on where the needle exits, and while I’m putting the needle down somewhere safe, I use my non-dominant hand to gently massage/rub the area around the injection.

I hope this helps you!

The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.

[DesertBunny]

That’s very interesting.  Your comment about the angle especially.  Going straight down even seemed scary which I never did. If I went perpendicular I always ended up going in then out and the medicine obviously missed the mark.

I could tell when the needle actually penetrated his skin because I could feel a crunch in my hand. Not really a crunch but I don’t know how else to describe it. If I didn’t feel that, usually my injection went bad. With Pen G running all over him. Thank goodness he was black so it made cleaning up easier. What gauge needle did you use? I wish I had kept at least one of mine so I could tell everyone. They looked HUGE for a little bunny. I started out small (16 ga maybe?) but ran into issues because the Pen G is pretty thick.

Oh yes: Don’t forget to put the Pen G BACK in the refrigerator after the injection. I made that error and had to go buy more – at least a couple of times.

Oh…. the needles had pink caps. I know they are color coded for size because the first smaller ones I used had blue caps.

[Rookie]

I was given yellow capped needles. They work okay

[Wick & Fable]

Typically as gauge number goes up, the needle size gets smaller (counterintuitive). I was given 22 gauges (light blue cap) for Wick’s injections. The gauge size is sometimes printed on the needle guard/cap. It may read “22×3/4A”, for a 22 gauge for example.

Only if you’re very safe about it, you can get use to doing injections by putting a sponge on a table, then putting a very thin sheet on top (whatever you have which seems to feel most like your rabbits skin thickness and resistance). If you can’t find anything, you may want to just use a few pieces of paper so you can get used to the motion at least, while keeping in mind rabbit skin required different pressure. Safely and responsibly, you can use one of your needles (either one you’ve used or one you’re never planning to use) and poke through the top sheet and into the sponge on your table. Unless you’re using a very thin sponge, you should aim to stop before hitting your table. Imagine the table sponge as the area in the skin tent, and the sheet on top of the sponge as your rabbits skin. You can also practice low degrees of entry with this as well. Never leave a needle uncapped unless it’s in your hand. If it’s placed on the table, be sure to cap it immediately. If you have safeguards that are one time-lock use, make sure your area is clear and people around you know there’s an exposed needle!

The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.

[Rookie]

My vet made me practice it a few times with a stuffed bunny. The feeling of the needle going through one layer than the other layer was similar to the real deal.
Bunnies have two skin layers…if you only hit the first layer the syringe won’t work.

[Rookie]

So I just gave Rookie his penicillin, I took a video…I’ll have to see what the quality is like…it took me about 48seconds…if the video is good not sure how to share it with you all…?

[kaylyne28]

I’ve gotten pretty good at the injections and I’ve been using different areas to inject, but I noticed that my poor sweet baby bun has what I believe is a sterile abcess My vets office is closed tomorrow. Would it benefit her to put some neosporin on the wound as it seems quite deep and she’s acting like she’s in pain??

 

[jerseygirl]

Hi Kaylyne, you could put neosporin on it but not the kind with pain relievers in it. Maybe the ointment itself would be soothing?

@Rookie, you would need to load your video to a sharing site (youtube, photobucket, imgr, instagram etc) then share the link here. ps. I love that your vet had you practice on a stuffed bunny!! I should suggest that to mine. I need the practice!

@Wick, that you so much for your very informative post!!

[Rookie]

https://youtu.be/psaW0nNpfa8
I uploaded the video for you guys to see. Again I’m by no means an expert…this was a good day and rookie was being easy.

[jerseygirl]

Oh man, you made that look so easy! And how good is Rookie!!

Thanks for sharing the vid. I could actually see the moment the needle got through the layers of skin. You can see the resistance give way.

[Rookie]

As I said…we have our good and our bd days..lol…yesterday was much tougher.
Yes you can really feel and see it for sure. The needle kind of just slides in. The first time I did it it was so weird and scary….I was like OMG OMG OMG….lol
Some little tricks I found that made things easier…
With my pinching hand I am actually pressing ever so slightly on the base of his head so he doesn’t think of jumping away…and I found that if I don’t just cover his face but also roll up the towel on his sides and at his bum then he won’t try and back up either.

[kaylyne28]

Yeah that was a good video!! Ellie went to the vet yesterday. The vet gave her some metacam for pain relief and has me doing a saline flush 2x a day to the wound. She said to put some neosporin on the wound and she discontinued Ellie’s Pen G because she’s still symptomatic while on it.

I guess she’s just going to be a boogery bun for the rest of her life.

[Rookie]

Rookie is off the injections as if today. Back on oral meds for the next near 2 months. Which I’m glad cause I was feeling really bad having to poke him everyday. He was getting restless with it.

[jerseygirl]

There wasnt any other antibiotic from the C&S test you can try?
Sometimes these infections need to be hit with dual antibiotics. Like one injectable and one oral or nebulised.

Do take note if there is any change to her “snuffliness” while she is on metacam for the wound. If it happens to bring down inflammation in the nasal passages, it might be something you can continue with when she’s particularly bad.

[kaylyne28]

We’ve tried baytril (oral and injections) for nearly 2 months with no success. The vet opted to try penicillin. Just after initially starting Pen G, Ellie was a whole new bunny!! No snuffles or boogers and she was back to herself 100%. But she relapsed last month and became a booger monster again. We haven’t tried a nebulizer, but the infection is isolated to one ear and one nasal sinus so idk if nebulized meds would be effective?

Even on the metacam now for a couple days she’s still quite snuffly her abscess has healed beautifully though without a scar!

[Blair]

Hello!

Please please please keep an eye out for “scabby” patches at the injection site with long term use of subq penicillin injections. My poor wee bun was on amoxycare injections for 2 weeks and this has caused necrosis of her skin and she has had to have quite major surgery to try and fix the damage. Underneath her fur it just felt a bit scabby but when they clipped all the fur back it was big black spots of “dead skin”. Hopefully she is on the mend now but we were never told that it was something that we should look at for!

[Blair]

Hello!

Please please please keep an eye out for “scabby” patches at the injection site with long term use of subq penicillin injections. My poor wee bun was on amoxycare injections for 2 weeks and this has caused necrosis of her skin and she has had to have quite major surgery to try and fix the damage. Underneath her fur it just felt a bit scabby but when they clipped all the fur back it was big black spots of “dead skin”. Hopefully she is on the mend now but we were never told that it was something that we should look at for!

[DesertBunny]

Are you sure that was caused by the Pen G?  I had to give it to mine for 6 years! And that never happened. But it can  cause poop problems. Smaller, harder poops.  Never had the problem of scar tissue on his back. Injections were given 1x week.

[kaylyne28]

Yes I’m absolutely certain that the scar tissue and abscess was from the Pen G. She was on injections 2x daily for over 3 months. The vet took a swab of the fluid from Ellie’s abscess to see potentially what had caused the abscess in the first place. Her poop never changed at all (thankfully!!!!) and the vet had me collect samples for her to look at every week in case we needed to start Ellie on a digestive regiment.

Thanks for the reminder about checking her skin!! I gently feel where I’ve been giving injections and I examine her skin by gently blowing on her fur to part it. So far the only skin issues she’s had is the scarring and the abscess (which has now healed beautifully! )

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