AVIAN & EXOTIC NURSING Darlene H. Geekie, RVT EXOTICS Objectives Client communication Review of restraint technique and challenges Review of phlebotomy techniques and basic nursing care Client Communication A good patient history and proper triage at the initial phone call are imperative. Most exotic species are predisposed to illness and disease due to inadequate husbandry and poor diet. If in doubt bring them out! Clients should get advice if they are concerned about changes in their exotic pets; they should bring them in sooner than later. One day can make the difference between a favorable outcome and death. Small Mammal Considerations for Immediate Care Within 24 Hours or Less Loose stool Head tilt Foul smell Trauma Bloating of the abdomen Reluctance to move Fly strike Anorexia Seizures Excessive salivation Paralysis Any eye injury Loss of appetite Sudden noticeable change in Dyspnea behavior Large abscesses Painful urination or change in frequency and behavior while urinating Avian Considerations for Immediate Care Within 24 Hours or Less Change in frequency or appearance of excrement Fluffed up and reluctant to move Bloating of the abdomen Swelling of legs Seizures Noticeable overgrowth of beak or nails Any loss of appetite Dyspnea, tail bobbing, loss of vocalization or change in sound Nasal or ocular discharge Regurgitation Trauma Anorexia Lesions in mouth Any eye, wing, or foot injury Sudden noticeable change in behavior Prolapse from vent Straining to pass excrement or egg Change in water consumption Poor feather quality Inability to fly (aviary bird or flighted birds)
Reptile Considerations for Immediate Care Within 24 Hours or Less Unable to defecate, straining to pass feces Foul smell Bloating of the abdomen Fluid from mouth, bubbles from nose Seizures Paralysis Loss of appetite Dyspnea Abscesses Loose watery stools Trauma Reluctance to move Anorexia Prolapse from vent Any eye injury Lesions or infection in mouth Depending on species an abnormal change in color can indicate stress and illness Review the chart for: A full husbandry and diet history Prior and current weight Abnormal history of previous anesthetic events Previous illness or injury Current medications that might interfere with the effect of anesthetic drugs Don t dismiss what you can t find in your chart. Ask the client! An accurate weight is not only essential but crucial to the evaluation. This will allow proper dosing of fluids, feedings, and medication. All small exotics should be weighed in grams, as this will allow closer observation in weight loss and/or gain. Normal vital signs are available for most exotics, but it is ideal to obtain individual baseline parameters as early as possible during the initial evaluation. The effects of stress due to handling and traveling can not only greatly elevate your baseline parameters but also provoke cardiac arrhythmias that can be fatal. Every caution should be taken in severely debilitated patients to reduce this stress. When obtaining vitals: Take respiration rates from a distance prior to handling the patient. Keep prey and predator species in separate rooms, if possible, or a least at a distance and out of eyesight from each other. Plan ahead to minimize handling. Reptiles can become cold during transport. Warming prior to exam is advisable for an accurate assessment. Nursing Imaging Radiographs are an essential component to diagnostics in any exotic. This helps to evaluate the respiratory tract, gastrointestinal system, size and shape of internal organs, mineral densities, and fracture, and in birds can be especially helpful in ruling out or diagnosing heavy metal toxicity and reproductive issues. Lateral and VD views should be taken as straight as possible, and care should be taken while restraining. In reptiles two views should be taken for a full evaluation, but in turtles and tortoises a third view is helpful: DV and lateral for all reptiles, plus a craniocaudal view in turtles and tortoises. There are many devices that help with radiographs of reptiles, such as clear tubes of various sizes for snakes, and clear boxes for other reptiles of various sizes. Rabbits and rodents can be done with great care in monitoring the back when restraining to avoid fracture. If sedation is not possible, be patient and slow while obtaining radiographs.
Restraint It is important to be patient and to be prepared when handling birds. Determine what equipment you might need prior to capture to minimize handling time and stress. Small birds: Can be caught in the cage with a towel or bare hand o Place hand in cage, slowly blocking door. If you have a dimmer, it is advisable to do this in dim light to avoid panic in the bird. o Once your hand is close to the bird, shut the light off and quickly grab the bird gently around its body. o Position your hand around the neck and under the jaw to gain control of the bird s head. Do not squeeze the neck or crop. o Watch that the towel is not rubbing on the bird s eyes. o Wrap the bird in the towel to hold its wings and keep its body from moving around. Again, do not squeeze the body. If needed, hold the towel below, around the legs and tail feathers, to avoid placing pressure on the caudal air sacs. Large birds (parrots): Can be toweled on the fist or on the ground o Grab the bird gently around the body and neck. o Position your hand around the neck and under the jaw to gain control of the bird s head. Do not squeeze the neck or crop. o Watch that the towel is not rubbing on the bird s eyes. o Wrap the bird in the towel to hold its wings and keep its body from moving around. Again, do not squeeze the body. If needed, hold the towel below, around the legs and tail feathers, to avoid placing pressure on the caudal air sacs.
Rabbits/rodents: Being a prey species, rabbits are unpredicatable when handling. Caution should be taken while handling rabbits to protect them from life-threatening back injuries. o Approach slowly and calmly. o Hold one hand on the head and the other supporting the rump. o Rabbits can be wrapped in a towel to help minimize struggling and kicking. Rodents can be scruffed with their bodies supported or placed in a towel. Protect its eyes from injury while scruffing gently. Reptiles: Always understand the species you are restraining and know what can hurt you. o With most lizards, you will need to restrain the head while holding the lizard s front legs and holding its rear legs, controlling the tail, if nessesary. o Snakes should be restrained with the head being a primary focus of concern. Blood Work Most patients can have a negative energy balance that must be addressed prior to induction. Anesthesia is often postponed to correct this by providing fluids and nutritional support until the patient is stabilized. If possible, preanesthetic blood should be run to assess the patient s hydration and nutritional status. This can be done with a sample of no more than 1% of the patient s body weight with a minimum of 0.25 to 0.3 ml whole blood for most reference labs to run a CBC/Chem. Most important parameters to obtain: PCV/TP: hydration and circulating blood volume assessment Blood urea in mammals: waste product assessment Uric acid in reptiles and birds: waste product metabolism assessment Glucose: nutritional status assessment (Longley 2008)
Avian Phlebotomy Collection sites: Right jugular Medial metatarsal Wing, brachial vein (not advised) Bevel down always! Equipment: 25 to 27 g insulin or TB (1 ml) syringe Slides for CBC and micro tubes for Chemistry Blood slides should be done immediately after collection Amount: 1% of body weight volume should be reduced for sick or dehydrated birds. If this is not done with care and a steady hand, laceration of the vessel can occur, causing blood loss leading to death. Mammalian Phlebotomy: Collection sites: Jugular vein / cranial vena cava Cephalic Lateral saphenous vein Marginal ear vein Equipment: 22 to 25 g needle with a TB (1 ml) syringe to 3 ml syringe Clippers with a size 50 blade, only if needed plucking can be used Slides for CBC and microtubes for Chemistry Blood slides should be done immediately after collection Amount: 1 ml/100 g of body weight (Mitchell andtully 2009) Reptilian Phlebotomy: Collection sites: Ventral coccygeal vein (preferred method) Ventral abdominal vein in some species Cardiocentesis Equipment: 22 to 27 g insulin or TB (1 ml) syringe Slides for CBC and microtubes for Chemistry Blood slides should be done immediately after collection
Amount: 0.5% to 1% of body weight in grams Max 5 to 8 ml/kg, but usually 1 to 1.5 ml/kg is sufficient (Mitchell and Tully 2009) Technique for ventral coccygeal: Clean site. Preheparinize syringe. Insert needle between the scales at a 45-degree angle until you hit the coccygeal vertebrae. Pull needle back slowly until you begin to aspirate blood. Pull blood at a very slow rate until the needed amount is achieved. References Harcourt-Brown F. Textbook of rabbit medicine. Oxford, UK: Butterworth Heinemann, 2002. Longley LA. Anesthesia of exotic pets. London: Saunders Elsevier, 2008. Meredith A, Johnson-Delaney C. BSAVA manual of exotic pets, 5th ed. Gloucester, UK: BSAVA, 2010. Mitchell M, Tully TN. Manual of exotic pet practice. St. Louis: Saunders Elsevier, 2009. Ritchie BW, Harrison GJ, Harrison LR. Avian medicine: principles and applications. Lake Worth, FL: Wingers, 1997.