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Equine Health Resource

Intracarotid Injection

Synonyms: Inadvertent Injection into the Carotid Artery

Arteries carry freshly oxygenated (bright red) blood away from the heart and out to the organs. Veins carry deoxygenated blood (it is dark colored because its oxygen has been used up by the tissues of the body) back to the heart to be pumped to the lungs for oxygenation.

Medications given by IV injection go first to the heart and lungs before being sent out to the body.

The main artery going to the brain (the carotid artery), lies just deeper than the jugular vein in the neck.

When an intravenous injection is given, there is always a possibility that the carotid artery could be accidentally injected. If an injection is inadvertently given into the carotid artery, the medication is carried directly, within a second, to the brain, where it can cause massive, instantaneous convulsions or seizures.

The shock to the brain from this sudden blast of medication causes seizure-like activity. Horses often fall to the ground or rear over backwards. Horses that have fallen to the ground often paddle their legs violently for several minutes, with their eyes rolled back in their heads. It seems like an eternity if you are there- a very traumatic thing for all involved. In some cases, there can be permanent brain damage done or severe injury from the fall. More commonly, the horse recovers within 5-10 minutes after the incident. Frequently, other injuries are sustained during the episode.

The most common medications that are accidentally injected into the carotid artery are NSAIDS like flunixin (Banamine), and sedatives, but any IV medication can end up in the carotid.

The diagnosis is usually clear because of the time-frame. The horse reacts violently almost instantaneously following an attempted IV injection.

There is no direct treatment, although anti-seizure medications may be helpful immediately following the accident. The priorities are personal safety first, followed by an attempt to manage the horse to prevent injury.

Diagnostics Used

Prognosis & Relevant Factors

The prognosis is fair to good if the horse is not injured in the fall and struggle. In most cases, there is no long- term brain injury, but this depends on the medication and dose.

Horses may flip over backwards and fracture their neck or skull - this is one of the most common causes of death following intra-carotid injection.

QUESTIONS TO ASK MY VET

  • Why did this happen?
  • How can it be prevented from happening again?
  • Should I really be performing IV injections on horses?
  • PREVENTION

    Veterinarians, trained veterinary technicians and possibly managers of large farms should be the only people giving intravenous injections. The key to this skill is practice and repetition. It is not difficult to give an IV injection, but you cannot become good at it consistently unless you perform the skill regularly. The cost of an improperly given IV injection can be very high.
    Author: Doug Thal DVM Dipl. ABVP

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