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View Poll Results: How do you prep the horse's skin for a routine IM injection?

Voters
141. You may not vote on this poll
  • Shave the skin and prep with chlorhexidine or betadine

    0 0%
  • Swab with alcohol or another disinfectant, let dry and/or wipe off

    20 14.18%
  • Dab some alcohol on there and go

    15 10.64%
  • Nothing special, maybe wipe off the dirt

    106 75.18%
  • Other (please elaborate)

    0 0%
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Results 21 to 40 of 45
  1. #21
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    Quote Originally Posted by deltawave View Post
    Ah, now it gets interesting. What we have been told by vets, what vets do . . . none of it, I'll wager, supported by any actual evidence whatsoever other than the weight of years of experience. Which certainly has its value, but who can say with confidence that a prep with alcohol (letting it dry) is "better" or "worse" than no prep? Answer: nobody. Because (again, I'm betting) that this is a big UNKNOWN.
    You have rather odd notions of the unscientific status of veterinary medicine: suggestion: don't limit yourself to North American or English journals/studies when collating your data.



  2. #22
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    Quote Originally Posted by deltawave View Post
    Ah, now it gets interesting. What we have been told by vets, what vets do . . . none of it, I'll wager, supported by any actual evidence whatsoever other than the weight of years of experience.

    You asked us our procedure.

    We answered your question.

    You did not ask us to justify the response by providing peer reviewed studies to back up our statement.

    If you want that data, I'm sure people can provide it or link to it.

    Veterinarians aren't witch doctors.
    Brothers and sisters, I bid you beware
    Of giving your heart to a dog to tear.
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  3. #23
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    On the other hand, no pun intended, when I had an injection of triamcinalone into a tendon sheath on my right hand recently, the surgeon did a perfunctory swab with zephiran and immediately injected.
    "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

    ...just settin' on the Group W bench.



  4. #24
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    Feb. 6, 2000
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    There's this:

    Vet Surg. 1997 Mar-Apr;26(2):121-5.
    Evaluation of skin bacterial flora before and after aseptic preparation of clipped and nonclipped arthrocentesis sites in horses. Hague BA, Honnas CM, Simpson RB, Peloso JG.

    and this:
    Vet Surg. 2004 Sep-Oct;33(5):525-30.
    Evaluation of arthrocentesis site bacterial flora before and after 4 methods of preparation in horses with and without evidence of skin contamination.
    Zubrod CJ, Farnsworth KD, Oaks JL.
    "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

    ...just settin' on the Group W bench.



  5. #25
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    Apr. 16, 2009
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    Quote Originally Posted by deltawave View Post
    What is the actual incidence of injection site infections? Is it documented or has it been studied at some point?

    Personally, I clean with alcohol and let it dry most of the time. No added harm, possible marginal benefit.
    I've only given IM Adequan but have also given a lot of allergy shots just under the skin. I always bath the area prior and make sure the site starts clean. Swab with alcohol and dry. Then give the injection. I've never had a problem.

    The Vet always stabs and goes. I've had to deal with two injection sites that produced an abscess due to a vets injection. I understand, the Vet would probably prefer my procedure too, so before vaccinations or if I anticipate a shot, I make sure he's got a clean slate to start with. I can understand, where alcohol on a dirty horse at the time of injection, might just make things worse.



  6. #26
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    Sep. 20, 2012
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    Orange County, CA
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    I used to wipe alcohol, but my vet informed me that without shaving and prepping it, you really wouldn't be able to completely sterilize the area anyway. Even my dog vet doesn't prep for a shot.



  7. #27
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    Jan. 28, 2003
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    Quote Originally Posted by Riley0522 View Post
    I have always been told (by more than 1 veterinarian) to not wipe the area with alcohol prior to IMs. Unless you're shaving it, it seems a bit pointless considering there's basically no way to remove the bacteria from all that hair. I think the rationale was you're probably actually spreading more bacteria into the area rubbing around in there vs just one straight shot with a needle. I've never had a horse abscess from an IM injection that I or a vet has given and I've owned a horse for over 11 years (I've given my own vaccines, IM tranq for trailering, Prolixin [which is not an easy med to give], and Polyglycan).
    This, this, this!!!
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  8. #28
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    I'm not asking for nothing. Just taking a poll. There was no criticism of vets intended, good grief! I wondered out loud if there were studies, and received some citations (thanks). I'm afraid my native tongue is English and therefore if there are Japanese, Italian, Czech, Russian, Swahili or Korean studies out there I'm going to require a translation.

    But the stuff linked so far is helpful (again, thanks) and not the same stuff I was able to come up with.

    But really this was more about what people actually do, and I am curious to learn more about the "quick prep" that was mentioned on page 1.
    Click here before you buy.



  9. #29
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    Feb. 21, 2009
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    Quote Originally Posted by Ghazzu View Post
    There's this:

    Vet Surg. 1997 Mar-Apr;26(2):121-5.
    Evaluation of skin bacterial flora before and after aseptic preparation of clipped and nonclipped arthrocentesis sites in horses. Hague BA, Honnas CM, Simpson RB, Peloso JG.

    and this:
    Vet Surg. 2004 Sep-Oct;33(5):525-30.
    Evaluation of arthrocentesis site bacterial flora before and after 4 methods of preparation in horses with and without evidence of skin contamination.
    Zubrod CJ, Farnsworth KD, Oaks JL.
    and this:

    JAVMA. 1988: 193(6): 688-670
    Intramuscular injection techniques and the development of clostridial myositis or cellulitis in horses.

    Basically they found that site preparation technique didn't significantly affect the likelihood of infection.



  10. #30
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    Dec. 13, 2008
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    Quote Originally Posted by Rbow View Post
    ...I anticipate a shot, I make sure he's got a clean slate to start with. I can understand, where alcohol on a dirty horse at the time of injection, might just make things worse.
    Having assisted several vets, I would say this is a great idea. Ultimately, in aggregate from the vet's perspective, risk of infection from most IM injections is really low and it's not their job to do a surgical prep on your horse because you are presenting them with a filthy horse. Ideally, they have a great reputation and many other clients to visit. Most vets will change sites and do a clorhex "clean-up" on a manure caked horse, but you are doing them, yourself and mostly your horse a favor by bringing forth a clean and dry horse (emergencies excepted, obviously).

    I have been taught (by one small animal vet and one horse vet) to do an alcohol swab for "peace of mind" reasons only when the owner is present.

    Again, most injections are pretty safe with no prep at all. But if you do prep, I think technique is the more important factor than shaving or waiting for things to dry. You need to really soak the hair and skin and give it a chance to work, and not smear stuff around or reintroduce contaminants by being sloppy.

    I actually can't recall a vet shaving a joint for a routine corticosteroid inj. I always did a regular 7min scrub with plenty of clorhex and cotton that was soaked in the clorhex solution (as opposed to "squirting" it onto dry cotton, which I'v seen ). One vet rounded up to a 10min scrub. We never waited for anything to dry after doing this. Working with the track vet, I did not wear gloves, but the technique was extremely particular. He did dozens of these per month over 30yrs and never a complication.

    I sorta wonder if by the time you let a well scrubbed and sterilized site dry if you weren't taking a bigger risk of something landing on it or getting bumped, rubbed etc with contaminants than of wet hair "gunking" the needle. If you've actually scrubbed well, I don't think it should matter under most circumstances if the site is a bit wet or a bit hairy.

    I have seen Colstridial infections (not as a result of an injection given by a DVM) and I feel, ahead of site prep for most IM's, it's more important to:
    1) not inject anything that isn't necessary
    2) follow proper technique - Don't touch the needle, set an uncapped syringe down and the use it, use a potentially contaminated needle because you want to save 30cents or don't have a back-up, etc
    3)use meds correctly and store them properly.

    If you have an opportunity to get coached on how to do a good sterile scrub by your vet, take it. It may not be something you need to do before doing your vacc's but the concepts are something every horse owner would benefit from knowing.
    An auto-save saved my post.

    I might be a cylon



  11. #31
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    Delaware Valley
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    I'm glad Deltawave started this thread, but it does occur to me that we can drive ourselves crazy over this stuff. I've owned horses since before the internet, and from what I read on the internet I'm astonished that I didn't kill all my horses, or they didn't kill me. I don't even recall ever being taught how to give a shot. All my vets always assumed I knew how to do it.
    Last edited by TemJeito; Oct. 10, 2012 at 09:57 AM.



  12. #32
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    Jan. 16, 2002
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    Yes, in thinking about the whole thing it's quite possible to freak oneself out! That was nit my intention either.

    I am happy to have gotten a good idea and some real-world wisdom (ie, not shaving joints--seen equal amounts of both) from this thread.
    Click here before you buy.



  13. #33
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    Aug. 22, 2009
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    I use chlorhexidine to clean the area well and then a final alcohol wipe (making sure it comes away clean) before injecting.

    I wash my hands with dial before preparing the drug. I alcohol the vial septum before I enter it to draw out the drug. I use a clean needle and syringe, every time - of course. I change needles between drawing up the drug and injecting the horse as well to make sure the needle is not dulled at all from going into the vial. I also make sure to inject just after drawing up.



  14. #34
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    Aug. 15, 2009
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    I do nothing other than pick a relatively clean spot. I've never seen a vet do anything either.

    Do diabetics sterilize the site before injecting insulin?



  15. #35
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    Mar. 24, 2004
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    Quote Originally Posted by katyb View Post
    Do diabetics sterilize the site before injecting insulin?
    I am not diabetic but I use Byetta which is a diabetic injectible drug as off-label. It is not insulin.
    I was taught to wash my hands and swab the site with alcohol before the injection. The nurse did not tell me to let it dry first.
    DH tells me the way alcohol works it needs dry to be effective. DH has his chem degree and works in the pharmaceutical industry so I am inclined to believe him.
    Oh, well, clearly you're not thoroughly indoctrinated to COTH yet, because finger pointing and drawing conclusions are the cornerstones of this great online community. (Tidy Rabbit)



  16. #36
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    Sep. 7, 2006
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    Quote Originally Posted by rockfordbuckeye View Post
    I use chlorhexidine to clean the area well and then a final alcohol wipe (making sure it comes away clean) before injecting.

    I wash my hands with dial before preparing the drug. I alcohol the vial septum before I enter it to draw out the drug. I use a clean needle and syringe, every time - of course. I change needles between drawing up the drug and injecting the horse as well to make sure the needle is not dulled at all from going into the vial. I also make sure to inject just after drawing up.
    Wow, that's a lot of effort!

    I'm in the "knock off the crusty mud and stab" group.


    What do you guys do for IV injections?
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  17. #37
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    Jul. 19, 2007
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    Quote Originally Posted by Ghazzu View Post
    On the other hand, no pun intended, when I had an injection of triamcinalone into a tendon sheath on my right hand recently, the surgeon did a perfunctory swab with zephiran and immediately injected.
    I was going to say, I'm trying to think now of any special prep doctors or techs have done on m e and beyond a cursory swipe with an alcohol prep pad I'm not really thinking of any. (And with an epi pen I don't think they even bothered, just jabbed it in my hip.)



  18. #38
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    I just tap, tap, tap the area with my finger or knuckle--stab--pull back to make sure I don't get blood--and push the damn plunger.
    Yank it out and walk away.

    I do all of my own vaccs, IM, and IV injections.
    thus far all has been well--knock on wood.
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  19. #39
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    Aug. 22, 2009
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    I don't think there is any magic to letting the alcohol dry before injecting (?) - I have always read that the reason to do it is because if it's still wet and you inject - as the needle drags through the skin and it take some alcohol with it which can make the injection burn/sting a little more.

    Given the relatively low incidence of cellulitis/infection associated with IM injections, I would wonder if the "studies" comparing techniques were properly powered to detect a difference in outcome. We are talking splitting hairs here. I do the most because I have a medical background and the time, access and patience to do it. I work with nurses who have assured me that things like changing the needle between drawing up the drug and injecting into the "patient" seem to make a difference in comfort - at least when used on human children - but that's anecdotal. Granted my horse has much thicker skin so maybe it's not as big of a deal. My horse is not needle shy so all the extra fan fare does not stress the animal. I figure there is no harm in doing the most vs. the least.

    When I looked at the studies cited:
    1. Vet Surg. 2004 Sep-Oct;33(5):525-30.
    Evaluation of arthrocentesis site bacterial flora before and after 4 methods of preparation in horses with and without evidence of skin contamination.
    Zubrod CJ, Farnsworth KD, Oaks JL.
    Objective— To evaluate the effectiveness of four methods of povidone–iodine preparation on skin bacterial flora of arthrocentesis sites, in horses, with and without evidence of skin contamination.

    Study Design— Prospective randomized study.

    Animals— Twenty-four adult horses.

    Methods— Horses were assigned to either the clean or contaminated group based on housing environment and visual evidence of contamination. Using a moist sterile swab, microbial culture samples were obtained from the skin over the distal interphalangeal joints immediately before and after preparation. Each site was aseptically prepared with 1 of 4 povidone–iodine techniques: 10-minutes scrub, 5-minutes scrub, three 30-second scrubs, or commercial one-step iodophor surgical solution. Colony forming units (CFUs) were determined for each sample, 24 hours after inoculation, on blood agar plates.

    Results— Mean (±SD) pre-scrub CFUs/mL was significantly higher in the contaminated group (9588.33±1223.65) compared with the clean group (4489.00±3842.03) (P<.01). After preparation of the arthrocentesis sites, there were no significant differences in post-scrub CFUs/mL among the 10 minutes (mean clean, 46.00±64.36; mean contaminated, 28.67±18.04), 5 minutes (mean clean, 84.17±109.80; mean contaminated, 40.33±44.52), three 30 seconds povidone–iodine scrubs (mean clean, 95.50±172.29; mean contaminated, 46.67±56.94), or application of a commercial one-step iodophor surgical solution (mean clean, 102.17±161.78; mean contaminated 117.67±143.78); or between the clean (81.96±131.69) and contaminated groups (58.33±85.90) (P<.01).

    Conclusions— Preparation of the distal interphalangeal joint arthrocentesis site with each of these techniques significantly reduces the bacterial flora to a similar level for arthrocentesis in horses with and without evidence of skin contamination.

    Clinical Relevance— Aseptic preparation of the skin over the distal interphalangeal joint may be accomplished with any of these techniques.

    So this study didn't conclude a difference between TYPES of iodine scrub of LENGTH of scrub - but there was no placebo option.

    2. Vet Surg. 1997 Mar-Apr;26(2):121-5.
    Evaluation of skin bacterial flora before and after aseptic preparation of clipped and nonclipped arthrocentesis sites in horses. Hague BA, Honnas CM, Simpson RB, Peloso JG.
    Objective—This study evaluates skin bacterial flora before and after aseptic preparation of clipped and nonclipped arthrocentesis sites in horses.

    Study Design—The hair over one midcarpal joint and one distal interphalangeal joint on each horse was clipped. The contralateral joint served as the nonclipped comparison.

    Animals or Sample Population—Twelve adult horses.

    Methods—A prescrub sample for microbial culture was taken from the dorsal surface of all four joints for each horse. Each site was aseptically prepared with povidone iodine and 70% alcohol, followed by postscrub sampling for microbial culture. Colony forming units (CFUs) were determined for each sample, 24 hours after inoculation of blood agar plates.

    Results—There was no significant difference (P >.05) in number of postscrub CFUs between clipped and nonclipped skin over the midcarpal or distal interphalangeal joints. Percent bacterial reduction (mean ± SD%) after aseptic preparation differed significantly (P=.02) between clipped (99.8 ±.003%) and nonclipped (96.2 ±.05%) skin at the midcarpal joint, but not at the distal interphalangeal joint (clipped, 98.5 ±.03% and nonclipped, 97.8 ± 0.21%). There was a significant difference (P=.009) in number of prescrub CFUs obtained from clipped and nonclipped skin for the midcarpal joint. There was no significant difference in number of prescrub CFUs between clipped and nonclipped skin at the distal interphalangeal joint. Bacteria isolated from both clipped and nonclipped skin sampled postscrub included Bacillus sp, nonhemolytic Staphylococcus sp, and Micrococcus sp.

    Conclusions—The presence of hair over the midcarpal and distal interphalangeal joints does not appear to inhibit the ability of antiseptics to effectively reduce bacterial flora to an acceptable level for arthrocentesis.

    Clinical Relevance—Aseptic preparation of the skin over the midcarpal and distal interphalangeal joints can be accomplished without hair removal in horses.

    So this study said no difference between clipping and not clipping - but again - no placebo arm with no scrub.

    3. JAVMA. 1988: 193(6): 688-670
    Intramuscular injection techniques and the development of clostridial myositis or cellulitis in horses.

    A survey of 584 veterinarians in equine practice was performed to determine their intramuscular injection techniques and the influence of those techniques on the development of clostridial myositis or cellulitis. Usable responses were obtained from 439 veterinarians (75.2%). Of these, 414 used a new needle and syringe for each injection, 241 swabbed the site with a cleansing/disinfectant agent, and 242 swabbed the top of multidose injection bottles with a similar solution. Only 2 clipped the hair at the injection site. Twenty eight of the respondents reported that at least 1 horse developed a clostridial infection at the injection site following 1 of their injections. None of the various injection techniques had a significant influence on the development of clostridial infection at the injection site.

    I couldn't pull the whole article on this because it's so old - just the abstract. But it's retrospective and opinion survey data (er...not really strong evidence) based off recall from vets - and they were only asked about a specific type of infection (not about any infection).

    So to me it seems we don't really have strong enough data to make any solid conclusions. Case studies of 12 and 24 horses is not robust data unfortunately.



  20. #40
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    Do diabetics sterilize the site before injecting insulin?
    Sterilize is the wrong word, but clean the site? Yes, they SHOULD. Seen lots and LOTS of cellulitis and abscesses from insulin injections, much of which is due to poor technique including the most appalling stuff--reusing needles, etc. Diabetic supplies are expensive. Of course simple numbers (never mind a diabetic being more prone to infection in general) of multiple injections every day vs. the 2-3 per year an average horse would receive would be worth comparing.
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