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1122 Inhalant Medication Administration

occurs; it will be flagged on the Holter Postprocedure • Implantable event monitor (Reveal Plus,
recording. After the recording period (24-48 hours for Medtronic): allows an extended period of
VetBooks.ir • Animal preparation and patch preparation are the bandage material, monitor, wires, and very small (size of a USB jump drive), and
monitoring (up to 10 months). Devices are
Event monitor:
Holter; 6 days to 8 weeks for Event monitors),
implantation is achieved with a subcutane-
the same as for Holter monitors (previously
electrode patches are removed without the use
described).
cases. Devices are donated to a veterinary
• There are only two wires/electrodes and of scissors. The entire system is unwrapped to ous pocket and local anesthesia in many
avoid cutting or damage to the leads and wires.
therefore only two electrode patches (white Removal of the skin patches can be facilitated cardiology group (CanPacers) and are inex-
electrode typically attached to electrode patch with isopropyl alcohol. The cassette or digital pensive. Access to a Medtronic programmer
on right hemithorax). card (or in some cases, the entire monitor) is is necessary, however, to retrieve the stored
• The monitor is wrapped onto the animal as returned to the supplier or sent away for analy- information.
described above. It is essential to leave the sis. Some event monitor systems can transmit • Smartphone-based monitor for direct ECG
record button visible and accessible. the stored information transtelephonically to the recording (www.alivecorvet.com): portable,
• When the animal has an episode, the owner receiving station. If this is not done very soon on-demand ECG recording, good-quality
must press the record button. Doing so after a recorded event, however, the batteries single-lead tracing, online storage of data; no
captures the ECG preceding and after the continue to be drained and the information reachback effect, rhythm may have returned
time the button was pressed. Typically, the eventually will be lost. Be sure to collect the to normal by the time owner applies the
monitors are set to store the preceding Holter diary from the owner as well so that recorder
45-second period of ECG and the subsequent the recorded information can be interpreted in • Wireless, adhesive, waterproof, 14-day continu-
15 seconds, for a total of 1 minute of ECG relation to the patient’s activity level. ous recorder patch (Zio Patch): investigational
spanning the clinical episode.
• Event monitors typically have a total memory Alternatives and Their SUGGESTED READING
of 5 minutes (i.e., five 1-minute episodes), Relative Merits Petrie JP: Practical application of Holter monitoring
although newer models can store 18 minutes • In-hospital ECG: less motion artifact in dogs and cats. Clin Tech Small Anim Pract
or more. but shorter duration and under artificial 20:173-181, 2005.
• Newer models can be programmed to conditions AUTHORS: Amara H. Estrada, DVM, DACVIM; Ashley
automatically store events if the owner is • Holter monitor instead of event monitor: E. Jones, DVM, DACVIM
not present to witness the event. For example, screening for occurrence of latent arrhythmia; EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
the monitor can be programmed to record antiarrhythmic drug monitoring Thompson, DVM, DABVP
any heart rate lower than 40 or higher than • Event monitor instead of Holter monitor:
200 beats/min. long-term (days) monitoring; smaller
• Typically, batteries must be changed every animals; transtelephonic transmission of
5-7 days. recorded information

Inhalant Medication Administration Bonus Material
Online

Contraindications
Difficulty level: ♦ • Face mask: specific to size and shape of
• Known hypersensitivity to the medication animal’s muzzle; veterinary spacer devices
Synonyms to be administered typically sold with a face mask
Metered-dose inhaler (MDI), aerosol medica- • Facial trauma/disfigurement that would
tion, hydrofluoroalkane (HFA) inhaler prevent placement of mask Anticipated Time
• Frightened, agitated, stressed, or untrained Well-trained animal: 30-60 seconds per
Overview and Goal animal treatment
The goal is to administer drugs directly to the
airways to minimize systemic effects. Although Equipment, Anesthesia Preparation: Important
most such medications are administered by MDI can be used in hospital or by pet owners Checkpoints
MDI, other drugs can be administered through at home. Although sedation is not necessary, • The majority of dogs and cats can tolerate
nebulization. The drugs most often administered training the pet to accept the mask and device placement of the mask and spacer. Those
by MDI in pets include glucocorticoids and is often required. that resist initially can usually (≈80% of
bronchodilators. • MDI containing drug of choice cats, 95% of dogs) be trained to accept
○ Albuterol available as 90 mcg/actuation treatments.
Indications ○ Fluticasone available as 44, 110, and • For a novice animal, expose it to the face
Delivery of aerosolized medication directly to 220 mcg/actuation mask and spacer/chamber before starting
the upper and lower airways: • Spacer/chamber device: although treatment with an MDI. Gradually introduce
• Rhinitis (allergic and immune mediated) spacer devices made for humans can be the mask with treats/peanut butter or butter
(p. 890) adapted, veterinary-specific products are on the inside of the mask. Practice several
• Chronic bronchitis (p. 136) preferred. times a day.
• Collapsing trachea (p. 194) ○ Commercially available for dogs and cats • After the face mask is accepted, add on the
• Feline asthma (p. 84) (https://www.trudellmed.com/animal- spacer, holding the combination in place
• Other types of bronchopulmonary disease health) initially for 5 seconds and building up to

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