Simply Koi and More Koi

Hi Dunc,

See i knew you would be able to explain it better than i

So is there any particular time you would go for IM over IM or visa versa

So if say a koi has a wound on its head would you go for a IM in the pec due to the closeness of the wound and injection point

If say a fish has some internal bacterial or organ issues would you be looking at going IP for a better outcome

Hi Gazza;
Dunc seems to have so many things on the go I watched and noticed there was no answer but perhaps I can help.

I don't think it makes a scrap of difference if the site of the injection is anatomically close to the site of the infection or not. What we need is tissue levels of the antibiotic above the MIC of the bug we are trying to kill for as long as possible. To achieve this we want the drug circulating in the blood stream supplying the affected area.
IM injections in all species including man shows erratic absorption, and sometimes very slow adsorption, due to local tissue reaction with oedema and reduced local blood flow delaying the take up of the drug.

The things in favour of IM are; that it is safe and easy to do, unless you cause a local abscess, the downside is slower absorption and unpredictable take up.
In favour of IP is predictable rapid absorption and high peak plasma levels but there is the potential of inducing a life threatening perforation of an abdominal organ. If the fish is held upside down so the internal organs fall away from the anterior abdominal wall this risk is minimised.

There are some drugs that are contra indicted for IM use and some contradicted for IP use (normally local pain) so read the pack insert carefully whichever route you choose.

Hope Dunc agrees with me or I will get a flea in my ear and be banned.

Pete

Hi Pete,

Yes Duncan is always very busy but will pick up on these questions most of the time and i only ask just to keep him on his toes as i may already know some of the answers i was being a bit crafty as he can explain things much better than i

I personally do prefer IM and have done this before more than once but i have been lucky enough to have some great training under my belt by someone who knows his stuff

For all our benefit what needles do you use for injection? I find the insulin syringes with attached needles the most useful. Athough the needle gauge is a bit fine for some of the more viscous injections.

Peter

Hi Pete,

Yes i do the same and keep a few around just in case

This will be a good one for Duncan to come in on as he does have a few others and i know he likes using differing needles depending on what type of antibiotic he is using as the oil based ones can be a bit thicker.

Hi I also use the insulin needles for say baytril and gentamycin

hi

right i am finding these days i tend to do more IP injections than anything else and for good reason

i find with most IM injections the localised injection site infections to be unacceptable this comes about from various reason from muscle splitting to localised pH necrosis to just plain piercing a scaale or severla scales

i have learned to great expense you can ruin a good fish while treating a simple infection with IM when this happens

if you inject some injectables into the pec muscle if its a large fish requireing a good volume you can rot the pec muscle right off no more so than when useing nuflor

far better to get you head around IP injections it pays dividends for what its worht i have never pricked the internals of a koi yet and if you apply it right its very unlikey you will

for what its worth for those who dare not chance the stomach method, i have a way of injecting IP around the pec fin, this puts you in the peritoneal cavity with no danger in stabbing anything vital i will demo this on the wet lab day

One other point; although the higher concentrations give you a smaller injection volume, which is good for IM use, unfortunately by definition they are more concentrated. These means that they have a higher osmotic pressure so as soon as the injection goes in it draws fluid from the surrounding tissue until the tissue OP and the injection are equal.

A good way to mitigate this a reduce the local affects is gently to massage the area of the injection after you have given it......... it is what every good nurse does after she has stuck a needle in a babies back side....... its not just distration therapy but by dispersing the injection through the tissues it lessens the local affects.

Peter

hi peter

the are a couple of problems with massaging a carp A the pec muscle which more folks choose is very small and a massage here is going to be very limited if you try and masage where scales are dorsally i''ll bte your gonna massage a few scales out

the pec muscle wont take big injections and oil based AB's these tend to be too bigger volume for such a small muscle rot the muscle right off

also one of the big reasons i dont do IM anymore is because of blowback this is where you inject into the muscle, the muscle contracts and half the delivery comes back out the way it went in, so i prefer not to do this anymore

its worth learning the technique it gives much better results

in fact with most decent size fish its worth injecting IV this is easier than you think provided the fish is well out of it i could give you the how to on this if you want also how to take a blood sample ???

dunc

Hi Duncan

I obvioulsy need to practise iv but I see some potential problems. IP as we have said before can cope with higher volumes and gets good absorption. IV OK for Baytril but have you any experience of giving aminoglyccosides by this route. Not the injection but in terms of outcome i.e. our fish getting better?

Peter

hi peter

even i only have limted experience with IV injections its not soemthing I/we tend to lean towards but we forget its another tool we have at out disposal and not just for taking blood samples

but in a strange way this is the buffer i come up against when talking about IP let alone IV

most folks go/opt for the IM route where as the outcome is probably more predicable and safer the IP route. when you consider the messy outcome of a lot of IM injections i would pick the IP route all the time the only difference is the koi has to be more sedated where as i can im inject fish with no sedation. if we take this a stage further the fish has to be out cold completely for IV

most folks fear is the piercing of the intesting and this simply is rare, but if you think about it logically i'll bet many fish have been stuck with a needle in the gut and nothing has happened, the gut has simply sealed again after removal i refuse to beleive that every proceedure has been completed as per the book and the fish has survived leats i have never off'ed a fish with this method and i have never spoke to anyone who ha done the same but ill bet the worse fear happens

with IV as i say i have do it but i would us it for small injections, and i would stear clear of gentamycin this is not recommened for IP so i would assume the same for IV untill i had chance to trial it, the same would apply for nuflor which is oil based i dont think the arterial system would take to kindly to a slow release oil based fluid

but i could teach this method and some time you just have to bite the bullet and have a go

incidentally i teach IV on my wet lab i think it should be embraced

Hi Duncan
Totally agree with all your points including teeeching how to get Iv access. If, as you said earlier, you sometimes get "squirt back" using the IM route, this is a definite sign that we are trying to put to much volume into a particular compartment in the fish.

I tend to use LuerLock syringes so the needle lock on the syrung and you don't get an eyefull of what you were trying to inject !

Peter