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Porcupine Quill Removal 1151.e9

Video
Porcupine Quill Removal Available
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• Quill injury and removal is painful. Anal-
Difficulty level: ♦
is already broken or deeply embedded in
gesics should always be included in the identify or remove a quill, particularly if it
Overview and Goals sedation and/or anesthesia protocol. Consider the soft tissues, is always a risk regardless
• Porcupine quill injury is a common occur- the use of one or a combination of a pure of how thorough the examination is.
rence, particularly in dogs, with the highest mu agonist opioid, alpha-2 agonist, and/ • Quill fracture during removal
incidence occurring in the spring and fall or NMDA receptor antagonist as part of a • Further quill migration or inadvertent
months. multimodal approach. embedding of quills deeper into the soft
• Due to potential for rapid quill migration, • Because quills are often present in the tissues
which can have serious and sometimes fatal oropharynx, a full oral exam should always • Quill migration to vital areas of the body and
consequences, clients should be instructed be performed under sedation, and extreme subsequent serious or even fatal complications
to seek veterinary assistance as soon as care must be taken on intubation to avoid • Infection Procedures and Techniques
possible after quill injury. The goal of quill migration into the airway.
treatment is to remove all quills in a timely • Equipment required: hemostats, scalpel blade Procedure
manner. and handle (in case a cut-down procedure is • Care must be taken if the patient is to be
• Patients treated greater than 24 hours from required to remove embedded, migrating, or intubated to prevent inadvertent migration of
the time of injury should be monitored subcutaneous quills). Needle drivers, tissue quills deeper into the oropharynx or airway.
closely for the next 3 weeks because most forceps, and suture material may be required • While the patient is under sedation/anes-
complications occur within this time frame. for repair in the case of extensive cut-down thesia, an extensive evaluation of the entire
• Quill injury most often involves multiple procedures. body and oropharyngeal examination should
locations of the body. The external head and be performed to identify all quills. Be sure
neck regions, followed by the oral cavity, Anticipated Time to palpate for buried or broken quills in
are the most frequently affected sites, with • Procedure time depends on the location and soft-tissue structures.
the limbs and truncal region less frequently number of quills. • Each quill should be removed individually.
affected. A thorough, systematic examina- • Most patients can be treated effectively in • To effectively remove quills, a needle driver or
tion with particular attention oropharyngeal 30 minutes to 1 hour. hemostat should be used to grasp the quills
region, dermis, and external structures is • Patients with quills embedded deep in the at the base closest to the insertion site, and
essential. soft tissues or body cavities may require slow, gentle traction should be applied to
• Repeat quill injury is not uncommon in several hours of treatment for complete quill pull the quill straight out. Do not bend or
dogs, and owners should be educated about removal. twist the quill (see Video).
prevention of porcupine encounters. • In the case of a quill fracture, a cut-down
Preparation: Important procedure should be performed using a
Indications Checkpoints scalpel blade followed by gentle blunt dis-
• All forms of porcupine quill injury in which • Before quill removal, discuss risks of sedation/ section to identify and remove the remaining
the patient has evidence of quills embedded anesthesia with owners. quill fragment.
within the soft tissues • Inform clients that quills may have already
• Any patient who has a confirmed or suspected migrated into the soft tissues and may no
history of quill injury and is showing signs longer be visible or easy to find with palpa-
consistent with complications from quill tion. In these cases, it may not be possible to
migration, such as lameness, draining tracts, remove all quills. One study in dogs reported
respiratory distress, abdominal discomfort, that 16.5% of patients had suspected quills
or ocular issues remaining after treatment by a veterinarian.
• Quill migration can cause nonspecific clinical • Discuss the potential complications of
signs and should always be considered in a remaining quills, including migration out
patient with current or historical quill injury. of the skin at a later date (requiring another
Quill migration should also be considered procedure for removal) or migration to other
in any patient living in a geographic region locations in the body such as the joints, eye,
of porcupine habitat. lung, abdominal cavity, and neurologic
system. The number and location of quills
Contraindications does not appear to be associated with risk
• Owners should not be advised to remove of complications.
quills on their own. It may lead to patient • Migration to certain locations may lead
discomfort/injury, further migration of to life-threatening complications such as
quills, fracture of the quills, and embedded pneumothorax (p. 797), pyothorax (p. 857),
segments, which are difficult to identify and septic peritonitis (p. 779), or acute neurologic
remove at a later date. decompensation
• Risk of injury to the owner is also a serious
consideration. Possible Complications and
Common Errors to Avoid
Equipment, Anesthesia • Failure to identify and remove all quills.
• Patients may be placed under heavy sedation Palpate all external areas, examine the oral
or may require general anesthesia, depending cavity, gingiva, hard palate, deeper structures
on the individual patient and location and of the oropharyngeal region, as well as all PORCUPINE QUILL REMOVAL Dog with
extent of the quill injury. external structures. Unfortunately, failure to porcupine quills under heavy sedation.

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