Reptile handling, blood sampling, fluid therapy and nutritional support Reptile handling

Chelonia When approached many tortoises will retract the head within the carapace. In larger species such as Leopard and African spur thigh tortoises sedation may be required to withdraw the head. In box turtles, sedation will also be required and one should be careful not to get fingers caught in the shell ! In other species the head can be exposed using a number of methods; Whelping forceps or a spay hook can be used The tortoise is tipped downwards, head first down whilst holding the posterior The hind legs are pushed into the inguinal fossa causing the head to protrude.

carapace

The held is held by grasping behind the skull using finger and thumb. Care when pulling the head using this method, tortoises have one occipital condyle and the skull may disarticulate. Long necked turtles and terrapins should be held at the back of the carapace, they bite ! Lizards Lizards should be held in two hands, with the front legs held against the thorax and the rear legs held against the tail. Take great care to avoid the claws (and bite!) of large lizards such as monitors and iguanids. A towel placed over the head may calm some species and may also be used to restrain the animal. Iguanids may be calmed using the vaso-vagal response (by pressing gently on the eyeball). This can be useful as a

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restraint technique for minor procedures such as radiology. Water dragons can be hypnotised by stroking their ventral surface gently. Some lizards may drop the tail if handled roughly (geckos, some skinks) and those with fragile skin (some geckos) should also be treated carefully. Chameleons are best examined with minimal restraint, most will sit happily on a branch. Snakes Snakes should be transported in a knotted bag or pillow case placed in a secure box. Most pet snakes are not aggressive although one should be wary of certain species such as African Rock pythons, Anacondas and Reticulated pythons. If the snake is known to be aggressive then the head should be identified and restrained before opening the bag. Large snakes, over 5 feet long, should be handled by two people. The head should be grasped from behind, and held caudal to the jaws. The body should be supported by the other hand. Most snakes will coil about the arm. DO NOT HOLD SNAKES SUSPENDED FROM THEIR HEAD.

Blood sampling sites for reptiles

Chelonia Left or right jugular vein Sub carapacial vein Dorsal tail venous sinus (not recommended)

Lizards Ventral coccygeal vein Ventral midline vein

Snakes Ventral coccygeal vein Cardiac puncture

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Fluid therapy
As with other animals, the choice of fluids for rehydration should be based on laboratory findings and clinical judgement. Normally lactated Ringers solution or 0.9% NaCl are suitable. Lectade is a suitable fluid for use in stomach tubing. Reptiles that are mildly dehydrated often recover fully after bathing. All fluids should be WARM. Gavage fluids When stomach tubing reptiles a variety of materials can be used including latex nasopharyngeal tubes, urinary catheters and salvaged drip tubing. Chelonia: The tortoise is held vertically with the neck extended. The tubing is passed dorsally over the tongue into the oesophagus. The length of tubing inserted should be pre-measured from the head (extended) to the caudal edge of the pectoral scutes on the plastron (about 1/3 length of plastron). 2% body weight (fluids or feeds) can be given twice daily by this route An oesophagostomy tube can be inserted through the left side of the neck to the same level. It is held in place by butterfly sutures and taped to the carapace. Lizards: The lizard is held vertically with neck extended. The tubing is passed to a level of 1/3 of the body length. 2% body weight (fluids or feeds) can be given twice daily by this route Snakes: Stomach tubing snakes can be stressful and should be reserved for essential force feeding rather than fluid therapy. Intracoelomic or intravenous fluids are preferred. The snake is held vertically and a lubricated stomach tube (preferably semi-rigid) is passed 1/3 of the length of the snake. 2% bodyweight can be given by this route. This procedure requires two people as the snake must be held straight along its length. After

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stomach tubing the snake should be held vertically for five minutes to avoid regurgitation. Intra-coelomic fluids Chelonia: A site in the pre-femoral fossa (cranial to the hind legs) should be surgically prepared. The tortoise is placed in lateral recumbancy and a 25G needle inserted parallel with the line of the body, as close the bridge between the carapace and plastron as possible. Negative pressure should be placed on the syringe to ensure no blood, air or intestinal / bladder contents are aspirated. Up to 3% body weight in fluid may be given by this route once daily Lizards: The animal is held in lateral recumbency. The fluids are given by injection at a site lateral to the midline and immediately cranial to the hind leg (the lower abdominal quadrant). Use aseptic technique and apply negative pressure to the syringe to ensure blood; air or intestinal contents are not aspirated. Particular care must be taken if there is any suspicion of reproductive activity in the female. Up to 4% of body weight in fluid can be administered as a single bolus every 24 to 48 hours. Snakes: Injections are given into the coelomic cavity in the caudal third of the body. The injection site is lateral to the midline where the ventral and lateral scutes meet. Up to 4% bodyweight may be given by this route daily. In very large snakes, the volumes of fluid required may necessitate administration via a drip set. Intra-venous fluids Chelonia: The right jugular can be catheterised after a cut down procedure. However it is difficult to maintain in place and should only be used in the most debilitated animals. Lizards: The cephalic vein can be found after a cut down procedure in large lizards (over 2 Kg). Intraosseous routes are preferred in lizards.

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Snakes: The right jugular can be catheterised after a cut down procedure. However catheterisation of the heart is easier. Both procedures are reserved for severely debilitated animals. Intraosseous fluids In tortoises and lizards, these are normally given via the cranial tibia or proximal/distal femur. In tortoises the bony bridge between the plastron and carapace has also been used. A spinal needle is required (20-24G), however in smaller individuals a hypodermic needle (25G) may be preferred. Fluids are given using a flow line and syringe driver at a rate of 1 1.5ml/kg/hour although rates of up to 5ml/Kg/hour can be used in the short term for severely shocked patients. If no infusion pump is available boluses of between 5-10 ml/Kg can be given slowly every 6 hours. Sterile technique is essential. The intraosseous route can also be used to administer some antibiotics, minerals/electrolytes and anaesthetic agents. Intra-osseous fluids are not practical in snakes.

Nutritional support
A reptile patient that is anorexic should be force-fed only if the cause for the anorexia cannot be determined or if the animal is too weak to eat on its own. Prior to attempting to force-feed any ill reptile, it is imperative that the patient be stabilized and environmental issues are addressed. Rehydration, including replacement of fluids and electrolytes, is mandatory. It is important not to overfeed a patient that has been anorectic for prolonged periods. This can result in a life-threatening hypokalaemia and/or hypophosphataemia. Patients in good condition may receive 75% to 100% of their nutritional requirements over the first 24 to 48 hours. Patients in critical condition should be administered only 40% to 75% of their daily energy requirements to prevent digestive and metabolic disturbances. The amounts fed can be slowly increased over a 7 day period. No more than 2% body

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weight should be given as a single bolus. Critical care formula (Vetark) is a useful supportive feed for all reptiles and allows the approximate calculation of nutrient requirements. Commercial foods such as Pretty pet, vegetarian baby food (Milupa) and liquidised vegetables are also useful when tube feeding herbivorous reptiles. Hills A/d is excellent for carnivorous reptiles.

Identi-chip sites
Reptiles have inelastic skin and tissue glue may be required to seal and wounds left after placement. Chelonia: subcutaneously in skin over the left hind leg / thigh. Lizards: subcutaneously in the skin just cranial to the left leg. Snakes: Dorsally on the left side of midline in cranial third of the body, sub-cutaneously.

Christopher Lloyd BVSc MSc CertZooMed MRCVS