For small, fluffy, adorable creatures, rabbit care can actually be a huge challenge in the veterinary practice. They are seen to be more difficult and fragile than the standard cat or dog, and some of the veterinary team are unsure of the best protocol when handling and hospitalising.
Rabbit anaesthetics and their recovery carry a much higher fatality risk, however, there are steps that can be followed to reduce this risk. This can be as simple as ensuring that a catheter is placed for all rabbit patients – day patients or hospitalised patients – and that their intravenous fluid therapy (IVFT) rate is calculated correctly.
From experience, the marginal ear vein is not always the most suitable placement for patients. For day patients, such as surgical patients, the ear vein is the most suitable as the catheter is only in place for a short time and is mainly used for administering medications or a small fluid bolus. On the other hand, imagine how small the vein is in a dwarf rabbit – much harder to hit! In this case, the lateral saphenous is more suitable for rabbit patients, but now the challenge is restraint. This may require the rabbit to be pre-medicated before placing the catheter, depending on their behaviour. If this is the case, the rabbit should be monitored as though already under anaesthetic from the time of pre-medication.
Site clearance
For patients hospitalised for longer periods, the lateral saphenous is also much more suitable. This vein usually allows access to a larger catheter, is an area less likely to kink it, is less annoying than weighing down the ear, and is less likely to be pulled or shaken out of place. A catheter site for all animals should be routinely checked and flushed throughout the day but, for a lateral saphenous catheter site, I suggest stripping back and replacing the bandage twice daily. This site is close to an area of urine and faecal matter and can introduce infection into the catheter site.
Depending on the case, this may be less of an issue if the rabbit has gut stasis and not passing as frequently, however, this does not mean the check frequency decreases. The cephalic vein is used for cats and dogs, yet can be used with rabbits. Problems arising from this catheter placement are kinking of the catheters and blowing the vein. Day patients can be considered with the cephalic vein over those hospitalised or receiving higher rates of IVFT, but before administering any medications, the catheter should be flushed each time to ensure patency.
Small changes
As nurses, we know how to place catheters, however, there are some small changes I implement to make life easier when placing one into a rabbit. Surgical spirit, although contraindicated for surgical site preparation, can be used for the preparation of the catheter site, especially in the case of several attempts to place as this will keep the bacterial levels from increasing.
The temperature of the rabbit is unlikely to drop significantly if used sparingly with a cotton ball or pre-wrapped wipe, and only used on the catheter site. A mix of chlorhexidine and saline is also just as suitable and out of personal preference what I like to use. A local anaesthetic cream, such as EMLA should be used 15 minutes before cleaning as this will allow time for the ear to go slightly numb. Sprays, such as Ethycalm can also be used immediately before inserting the sharp part of the catheter. I spray this on a cotton ball or swab and hold on to the ear for several seconds as it is much gentler than spraying directly onto the site, as it is loud, and very cold causing the rabbit to react.
Some people love to use a winged catheter, and some avoid them like the plague (myself included), yet when placing a rabbit catheter in the marginal ear vein, a winged catheter is more likely to stay in place and secure safer than a non-winged catheter. The biggest change when placing a rabbit catheter compared to a cat or dog is the size of the syringe used to flush the catheter once placed. A 1ml syringe of saline should be used to flush the catheter once placed as this pushes less pressure through the vein meaning it is less likely to blow, and it is less likely the rabbit will react and dislodge the catheter. The catheters used for rabbits are much smaller than those used for cats and dogs, usually a purple 26 gauge (the smallest) or a yellow 24 gauge. Previously using a larger flush syringe, I struggled to push the volume through this small catheter or caused the fluid to go subcutaneously after blowing the vein.
Stabilisation
To aid the stabilisation of the catheter in the marginal ear vein, a tongue depressor, a small roll of soft band or the cardboard from the inside of a vet wrap can be placed at the inner ear. This gives the ear something to wrap around and hold the shape to tape in the catheter. If using the cephalic vein, a shortened tongue depressor can be used to “splint” the leg to avoid kinking, but this should only be used for short periods as it is uncomfortable for the rabbit.
Rabbits receiving IVFT, T-connectors should be used to avoid any loose needles being taped into bungs or ports in fluid lines as these can be easily pulled out and are a hazard to the patient and the staff. For rabbits in a run, use extension lines and hanging fluid bags from the ceiling above to prevent kinking or twisting (using this personally I have had great success with less kinking). Bitter apple spray on a taped fluid line is also a good method for discouraging any chewing for those receiving IVFT within a kennel and being cheeky.
Most IVFT rates are calculated the same as cats and dogs for a 50ml/kg/day dose but a recent study demonstrated rabbits will intake up to 120ml/kg/day1. Just as we increase and adjust medications for their faster metabolism, we should be implementing this also.
For rabbits presented with dehydration, this dose can be increased up to double, and gut stasis and inappetent rabbits should be classed as dehydrated, therefore doubling (Mayer, 2024). This, however, may make staff nervous, as preventing over-infusion is drilled into us. Whether this rate is used, or a lower one, I suggest regular check boxes for the patient should be used instead of relying on fluid pump timers to ensure the rabbit is monitored closely. On admission, every owner should be asked whether their rabbit uses a bowl or a bottle for their water and should be supplied accordingly. If unsure, then both should be supplied.
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