June 1, 2015

(Dan) Hey folks, thanks for joining us today on Doc Talk. I’m Dr. Dan Thomson here at Kansas State University’s College of Veterinary Medicine. We’re bound to have a great show. Dr. David Rethorst, from the Beef Cattle Institute at Kansas State University’s with us. And we’re gonna talk about proper injection sites for your cattle. Very important topic. Very timely topic. Thanks for joining us and enjoy the show.

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(Dan) David welcome to the show. (David) Glad to be here, as always. (Dan) Folks, this is Dr. David Rethorst and Dr. Dave is an experienced practitioner. He spent 35 years practicing cow/calf production medicine and individual animal medicine in southern Nebraska, northern Kansas and now the director of outreach here at Kansas State University’s Beef Cattle Institute. We’re proud to have him. And we’re gonna talk about injection sites. (David) One of my favorite topics. Been involved with it a long time Dan. (Dan) Yea, you’ve been involved with beef quality assurance, whether on a state or national level for decades. (David) Since the tablets came down off the mountain. (Dan) Well, let’s talk a little bit about injection sites and just kind of the history of how we got to this point. And dial back to the day when maybe we didn’t understand where and how we should give these injections. (David) Well, you go back to when I graduated from veterinary school and when we were processing cattle we’d give our viral and if we were giving a Vitamin A we’d give those in the top butt like this and we’d step up to the neck and we’d give our clostridial. And then in about 1992 the state purveyors nationwide started screaming that this top butt, 22 percent of ’em had scar tissue or abscesses in ’em. and came to the beef industry and said, what can we do about this? So, that’s when we went to work and we moved those injection sites from the top butt to the neck and by 2002 those top butts had less than two percent injection site blemishes in ’em. So, great success story. But that’s why we give injections in the neck, so we aren’t putting ’em into the sirloin steaks. (Dan) Yea, and one of the things that you said there that kinda sticks with me too, in this day and age of antibiotics and animal welfare and food safety, the meat purveyors came and talked to the cattlemen. (David) Absolutely. (Dan) You know, we’ve gotten away from talking to each other and we just send out a press release and hope the other group reads it and pretty much offends everybody. (David) Right. We put it on Facebook, or a press release or we put it out on Twitter and you know… (Dan) And I think… (David) Just communicate. (Dan) Yep…. one beef. You know, whether you’re selling it to the consumer, or whether you’re raising it on the hoof, we’re all in one beef industry. And this topic, this proper injection site topic, is a prime… (David) Prime example of why we need to communicate. (Dan) And how we can communicate and solve a problem. (David) Right, right. That’s a wonderful success story. (Dan) And so you know, as we get through there, we move the injection site from the round to the neck… (David) Right. (Dan) … and we have that kind of area. Describe the area of the injection site. (David) Well, that area, the top of that is two inches below the top of the neck, because we need to stay below that nuchal ligament, that lets that calf hold its head up, so it’s not, it’s nose isn’t down on the ground. The back of that zone is just in front of the slope of the shoulder and then the bottom of that triangle is the vertebrae in the neck. They’re down low but we certainly don’t want to be bouncing the needle off of those vertebrae. So, we’ve got something this long and at the back of it this high, on most calves, and we can get a couple, three injections in there. (Dan) Perfect. We’re gonna take a break. When we come back, more on injection sites with Dr. Dave Rethorst.

(Dan) Hey folks, welcome back to Doc Talk. It’s Dr. Dan Thomson here with Dr. Dave Rethorst and we work at the Beef Cattle Institute at Kansas State University and we’re tickled to death that you joined us today to talk about something that we all do- is injection sites. And they always told me, do ordinary things extraordinarily well, would be a good motto towards work. And these injection sites and processing is a quality event, not a quantity event. (David) Right, right. Processing is not a timed event, and we need to do it right. And when we learn to do it right then it becomes faster. And then we pick up our speed. (Dan) Yep. So, let’s talk about… OK, so we’ve described our injection site triangle. (David) Yes. (Dan) And so now we’re gonna talk about some of the different injections that we’ll perform and I don’t think people understand, but isn’t it extra label to an antibiotic if you don’t use the injection route of administration that it’s labeled for? (David) Absolutely. If it’s labeled to be given subcutaneously, it’s extra label if it’s given in the muscle. To do that you need under AVMA laws, written prescription from your veterinarian to do it that way. But, the fact remains, follow the label. (Dan) So, let’s tell our viewers, why it’s important. If I’m supposed to give it at the base of the ear, and I give it subQ in the neck, or at the base of the ear and I give it intramuscularly, or vice versus. It can change with the pharmacokinetics and the withdrawal times, right? (David) Right, it changes the withdrawal times. If we take a product that’s supposed to be given at the base of the ear, for example and we give that SubQ in the neck it greatly extends the withdrawal time on that. Because when it’s given in the base of the ear, the withdrawal time is determined on the fact that it’s injected into fat there at the base of the ear, and when we put it in connective tissue, subcutaneously, it stays there much longer. (Dan) Yep. And that ears not edible tissue. (David) That ear’s not edible tissue. That’s correct. (Dan) And I think that’s the big thing that people need to understand is, if it’s labeled this way, use it this way. Unless your veterinarian has talked to you otherwise. (David) Right. (Dan) And the reason is, isn’t because we’re trying to make your life more difficult. It’s actually trying to make your life simpler because we don’t want the people with the black sedans, tinted windows… (David) Black helicopters. (Dan) No… hubcaps, AM/FM radio showing up and putting you on the FDA’s residue list. (David) Right. Those lists are no fun. I’ve been there with the feed director. (Dan) Yep. So, we want to make sure and I think that’s the reason why if a product’s labeled in a way, unless you have a really good reason and especially unless you have written extra label drug from a veterinarian, you need to use it in the manner in which it’s labeled. (David) Absolutely. (Dan) Well, we’ve got about 30 seconds here before we go to the break, and so what are the three types of injections that we’re gonna talk about when we come back? (David) OK, when we come back we’re gonna talk about a subcutaneous injection, or just underneath the skin. We’re gonna talk about an intramuscular injection which is pretty self explanatory, it is in the muscle. And then we’re gonna talk about an intravenous injection. (Dan) Perfect. Thanks for watching Doc Talk. More in a minute.

(Dan) Folks, welcome back to Doc Talk, Dr. Dan Thomson and Dr. David Rethorst. We’re from Kansas State University and we are at the Beef Cattle Institute. Glad to be with you today. Glad to be talking to you about proper injection sites in your cattle. And Dr. Dave, let’s jump right in. We’ve got subcutaneous, intramuscular and intravenous injections. Let’s jump right in to the most common one now. Most products are labeled subcutaneously, or SubQ, SQ, whatever you want to call it. (David) Right and that injection means we’re giving that in the connective tissue, between the skin and the muscle. In the past we’ve talked that you wanted to use it… a tented, two handed tenting technique to make sure that was given right, and you reach in with one hand and pull the skin out, and give the injection. But you’ve got two hands in the chute. There’s some work comp issues. There’s some product safety issues with certain products. And so what I teach people any more is let’s just do one hand, but go in at about a 15 degree angle, like this in the neck. I want to go in pretty flat using a 5/8ths or a 3/4 inch needle. And one that needle hub hits, then I kind of relax my hand and if you watch the syringe will slide back an 1/8th to a 1/4 of an inch, and that needle pops right up in that SubQ space and you can give an injection in the SubQ and you’re not in the muscle at all. (Dan) And I think on the needle length, I’ve even gone 1/2 inch, 1/2 inch, 5/8ths and then sometimes 3/4, but trying to keep that shorter needle to prevent going into that fascia, or going beyond that SubQ space is why we do that. But I think your angle, I think your needle length but more importantly is what you were saying, check. It’s pretty easy to feel if you are in that space between the SubQ and the fascia or the muscle. (David) Right. Slow down. Make sure. (Dan) Slow down and make sure that you’re in there and then when you deposit that product you’ll get a little bleb. (David) Right. (Dan) And so, needle size. One of the things that I think I get questions on, what gauge needles are you using? (David) Well, on baby calves I like to use an 18 gauge needle. Now, if we’re doing one of these rope and drag brandings and those calves aren’t restrained quite as well, I’ll go ahead and use a 16 gauge needle on those, just to make sure we don’t break a needle off. But once we get to weaning and on into mature cattle, I’m using a 16 gauge needle pretty routinely. (Dan) Yep, and I would tend to agree with that. So on SubQ’s we’re gonna go with 1/2, 5/8, 3/4 inch needles, 16-18 gauge and we’re gonna slide in at an angle and make sure we’re in the SubQ area. IM, what changed? (David) Let’s back up on SubQ just a minute. You know, a lot of people think you can give a SubQ injection behind the point of the elbow and they kind of ignore our injection triangle. Well, the reason we don’t want to be behind the point of the elbow, is that muscle there is real tightly adhered to the skin and you can’t give a true SubQ injection. So, you end up with infection a lot of times. So,I would encourage you to get those products into the injection triangle. We have one product on the market, that on their label it shows injecting behind the point of the elbow, but that isn’t right. (Dan) Gotcha. Well, we’re gonna take a break. When we come back, we’re gonna talk about IM and IV injections with Dr. Dave Rethorst.

(Dan) Folks, welcome back to Doc Talk. Dr. Dan Thomson here with Dr. Dave Rethorst from the Beef Cattle Institute at Kansas University. We’re talking about something that Dr. Rethorst spends a lot of time in the state working with producers well, he is working all across the United States working with producers on beef quality assurance and specifically today we’re talking about injection sites that people may think is a very simple, easy thing to talk about. But it’s something that we gotta make sure that we continue to get right. As we talked about subcutaneous, let’s move into the IM or IV. (David) OK. (Dan) We won’t talk about IC- intra cow. (David) Intra cow. (Dan) But we will talk about intramuscular and intravenous injections today. So, let’s go with the IM. What are we doing there? (David) IM, we’re giving that product in the muscle. We want it deep in the muscle. There’s not a lot of products that are labeled IM anymore. Most of ’em are labeled… (Dan) SubQ. (David) SubQ. But if we are given a product… there’s times you want to give a viral intramuscular, something like that. If I’m using it intramuscular on a calf, I’m using an inch needle. Like on a weaning calf, I’d use a 16 gauge inch needle. If I’m intramuscular, on a mature cow, I’m using a 16 gauge, inch and half needle, cause I want to be… make sure I’m in the muscle where I get the absorption that I’m after. (Dan) So, technique on IM? It’s not gonna be at that 15 degree angle. (David) No, it’s going to be straight in. (Dan) Perpendicular. (David) Perpendicular to the surface you’re injecting into. (Dan) OK. (David) You can be… use an inch and half needle. You can be off a little bit and still get into the muscle belly, but you want to be basically straight in. (Dan) And I think it’s important to understand, that where we’re giving that injection, between that vertebral column and between that nuchal ligament, that’s muscle all the way across. (David) Absolutely. (Dan) So, when we’re given that… if we’re too low you’ll know it. (David) You’ll bounce it off the bone. (Dan) You don’t want to do that. (David) Right. (Dan) I’d rather err… (David) If you’re too high, you’ll hit that ligament and you’re gonna have sore neck calves and the product isn’t going to work. (Dan) Exactly. So, let’s talk about IV. (David) OK. IV, occasionally still give some antibiotics intravenously on an individual animal basis… (Dan) Milk fevers… some of those… (David) Milk fevers, the calcium magnesium products, something like that. I like to use a 14 gauge, two inch needle and make sure it’s threaded down the vein and that way I don’t have trouble with it popping out. Some people will use a 16 gauge needle, but again it goes back to knowing the technique. Flunixin is labeled intravenously. We could do an IV with a 16 gauge, inch to inch and a half needle on them. It’s critical we bring that up. A lot of Flunixin is given intramuscular, causes nasty, nasty injection site lesions. So, when we’re using that product we need to be giving it IV. (Dan) Perfect. Thanks for joining us today. (David) Glad to be here. (Dan) And thank you for joining us today. Remember always work with your local veterinarian. And if you want to know more about what Dr. Dave and I do here at K-State, you can find us on the web at www.vet.ksu.edu. You’ve been watching Doc Talk. We’re sure glad you joined us. I’m Dr. Dan Thomson, and I’ll see you down the road.

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