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Take the Fear Out of Injections

A series of small steps will pay off with a happier pet, a relieved client and stress-free return visits.

Take the Fear Out of Injections
Take the extra few seconds and extra cents and use a fresh needle each time.

One of my clients used to joke that she did more shopping when she saw me at the veterinary hospital than she did at the grocery store or on Amazon. She’d buy food for all four of her pets, chronic medications, heartworm and flea/tick preventives, treats, toys, harnesses, toothbrushes, and even ID tags and collars. By the end of her appointment, she’d be carrying shopping bags from her “one-stop shop.”

I wonder how often that happens anymore. Today, so many pet owners purchase food, treats, accessories and prescriptions online rather than from us. And with most veterinary hospitals functioning on a model where about 25% of practice income comes from dispensing, we have two options:

  • Find ways for pet owners to buy from us instead of online.
  • Find alternative ways to keep revenue in the hospital through good medicine.

When I lecture or consult with veterinarians, one of the foundations for success that I share is creating an injectable toolbox. I’m referring to a newer way of practicing: assembling and utilizing injectable therapeutics and vaccination protocols for improved efficacy with patients and the hospital’s financial health. Over the past 20 years, we’ve seen incredible advancements in antiemetic therapies, extended-release antibiotics, monoclonal antibodies for atopic dermatitis and, soon, pain control and exponential improvements in vaccine technology. Adding these strategies to your hospital protocols and workflow makes practicing veterinary medicine more exciting, rewarding and successful. And it helps your practice to grow by keeping professional services within your hospital.

This all sounds too good to be true, doesn’t it? It is if you forget to manage the discomfort of a hypodermic needle. A needle and injections can cause fear, anxiety and stress both in the patient and its owner and affect their emotional health. If you fail to acknowledge and address this pain point (no pun intended), not only can the pet feel discomfort, but it can injure itself even more by trying to escape. Instead of building the bond of trust between the veterinarian and pet owner, we destroy it.

Here are seven strategies for preserving the emotional health of your patient and its owner.

1. Embrace Human Medicine Techniques

The pediatrician’s office requires me to apply a bear hug to my children at vaccine time. However, some techniques used in forward-thinking children’s hospitals can help veterinary patients, too. Applying a topical anesthetic to numb the superficial skin layer is incredibly helpful. A generous amount of prilocaine or lidocaine gel can be applied to the desired site at the start of a physical exam for help with vaccinations, blood draws, subcutaneous injections and intravenous catheter placements. There is no reason our patients need to feel the needle stick. This technique is especially beneficial in lean patients, toy breeds, and allergic dogs and cats with sensitive skin.

2. Out With the Old and In With the New

Many veterinary hospitals draw up vaccines, antibiotics, anesthetics and even insulin with one syringe and needle and inject the patient with the same syringe/needle combination. While the habit might save on inventory costs, it can cost you patients and clients in the long term through discomfort and the creation of fearful memories. The more often a needle is used, the more potential for it to burr and damage tissue. Take the extra few seconds and extra cents and use a fresh needle each time. You’ll see a significant difference.

3. The Power of Touch

Although veterinary practices seem busier than ever, we can’t skip two critical steps with patients. The first is to stop using the “sneak up and stick” approach. Patients respond better to slow, deliberate movements, softer voices and contact at the least stressful body part, usually the shoulder. While other locations might be the goal sites (cephalic for a catheter, lateral thigh or between the shoulder blades for other injections), slowly work from the shoulder to another location. The second and even more important point about touch surrounds the injection. Instead of a quick, forceful pinch of the skin immediately before a needle stick, pinch gently at one spot, then rub or pat gently, pinch another place and gently pat, and finally, pinch the spot numbed by gel, inject and rub gently.

4. The Higher the Treat Reward, the Better

Not every patient is motivated by food, and not every hospitalized patient should get a fatty treat, especially those suffering from gastrointestinal disease. Unless the patient has food allergies, don’t skimp on creativity. Turkey hotdogs, deli meat, turkey or ham baby food, frozen peanut butter in a Dixie cup, bacon-flavored Easy Cheese and sausage will tempt those picky palates.

5. Set the Stage for Success

Prepare the environment even when you’re pressed for time. If your patient is standing on the ground, make sure a nonskid surface like a yoga mat or treaded rug is underneath the animal. If a patient is on a table, use a warmed towel impregnated with pheromones or a fleece blanket. If possible, play appropriate music, speak softly and have only the minimum number of people present. Also, prepare food distractions ahead of time and place any injections, vaccines or catheter supplies out of sight until they are needed.

6. Choose Needles Wisely

Last but not least is the vaccination, an injection performed 100 times a day in some hospitals and animal shelters. First, remember that bigger isn’t always better. Many experts suggest simulating insulin injections by using a very small needle, either 25- or 27-gauge. Some might argue that the smaller gauge means a much longer injection time and more patient discomfort. However, that leads me to my second point regarding the flow of the vaccine.

A larger volume given quickly can traumatize the subcutaneous tissue at the injection site. The average time to administer a 1-milliliter vaccine is three to five seconds. With the advent of half-milliliter vaccines, the time can be cut significantly. Low volumes and smaller needle gauges mean much more patient comfort, especially in toy and small-breed dogs.

7. Reward Twice

In the end, don’t let the injection conclude your interaction with the patient. Such a negative experience might be imprinted in the patient’s amygdala. Instead, finish on a positive note by offering both a gentle touch and the yummiest treat possible.

We’ve seen so much change in our profession during the pandemic, primarily out of necessity. Some of the processes will remain and drive long-term changes in how we interact with patients and pet owners. Establishing a belief, mission and practice around injectable medicine elevates every layer of veterinary medicine, from professional growth and personal reward to patient health and financial stability.

Fearless columnist Dr. Natalie L. Marks is an educator, consultant and practicing Chicago veterinarian. Dr. Marks is a leader within the Fear Free movement, was a member of the original Fear Free advisory board and is Fear Free Certified Elite. She passionately believes that all veterinarians should be committed to the physical and emotional health of their patients.


Reading a patient’s body language can instantly signal where the pet is emotionally. As a reminder, here are some of the more common indications of stress in patients.

  • Trembling
  • Tucking the tail
  • Ears flattened or backward
  • Dilated pupils
  • Crouched body
  • Yawning
  • Pacing
  • Panting
  • Excessive vocalization
  • Urination or defecation