The treatment delivered is practice dependent, however the

The nursing of wildlife and exotic species is becoming a more common
occurrence in veterinary practice. A swan has been brought in with puncture
wounds to its caudal body. It is vital that veterinary nurses (VNs) and
surgeons have an up to date knowledge of the relevant legislation protecting
this species as well as the necessary husbandry and nursing care needed to
ensure their survival once released back into the wild. This paper aims to
critically examine and evaluate the many factors that need to be considered
when a wild animal is brought into the veterinary practice including first aid,
nutrition and suitable environmental conditions.

 

Legislation

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Swans (Anatidae) are part
of the waterfowl family which also includes ducks and geese and collectively
total around 150 species (Johnsguard, 2012). The Mute Swan (Cygnus olor) is one of the most familiar
birds in the UK; they are large and can measure up to 59 inches in length and
can weigh up to 12 kilograms (Deal, 2016). As native wild birds, swans are
currently protected under the Wildlife
and Countryside Act 1981 which makes them illegal to intentionally injure,
take or kill; the eggs and nests of the swans are also protected under this
act. It also only permits that a sick or injured animal can only be kept until
it is no longer disabled (Cooper and Cooper, 2006). This supports the Abandonment of Animals Act 1960, which
makes it an offence to release a wild animal which is sick or suffering back
into the wild (Fraser and Girling, 2016). The Royal Society for the Protection
of Birds (RSPB) promotes the protection of threatened wildlife such as the mute
swan, and provides the public with information regarding habitat and nutrition
to encourage their conservation (RSPB, 2017). The Veterinary Surgeons Act 1966 and Royal College of Veterinary
Surgeons (RCVS) professional code of conduct affirms that all veterinary surgeons
(VS) must take the necessary steps to provide 24-hour emergency first aid and
pain relief and treat all patients of all species with welfare being the
primary consideration. However, first aid measures may be taken by any person
in the event of an emergency (Fraser and Girling, 2016). The Animal Welfare Act 2006 asserts that any
wild animal brought into a veterinary practice must receive the appropriate
treatment to relieve suffering which includes surgical and medical care or
euthanasia (Fraser and Girling, 2016). The extent of treatment delivered is
practice dependent, however the Royal Society for the Prevention of Cruelty to Animals
(RSPCA) can aid in contributing to the emergency treatment costs of swans if
contacted before the treatment is given and can also provide specialised
restraint equipment (Fletcher and Lea, 2012). Kerr (2010) recommends contacting
a wildlife rehabilitation centre to gain an insight into the likelihood of a
successful rehabilitation and release. These requirements of legislation must
be considered when a wild animal such as the swan is brought into the
veterinary practice and veterinary staff must act accordingly.

 

Handling and restraint

Restraint of large waterfowl such as swans for examination requires
two people as it can become dangerous due to their territorial nature,
therefore the primary priority is to gain control of the head. This can be achieved
by grasping around the neck by hand or with the use of a swan hook which
catches the neck high up under the bill, however these can cause trauma if used
incorrectly (Girling, 2013). The swan can then be wrapped in a towel, pillowcase
or specialised ‘swan bag’ to restrain their powerful wings which can cause
severe injury if not controlled (Smith, 2016). However, in this case, access to
the caudal body is required therefore a swan bag may not be appropriate. Care
should be taken to avoid restricting intercostal and abdominal muscles used for
respiration. The wings and legs should be released to the examiner individually
to ensure safety and effective control of the patient. Fletcher and Lea (2012,
p. 13) suggest that a cloth placed over the head can have a calming effect and
make the examination less stressful. Observations that can be made from a
distance include respiratory rate, demeanour, limb and wing position and
presence of blood and can help the examiner to get an idea of the urgency and
extent of the condition (Meredith, 2016). First aid measures should then be
carried out initially before a direct, protracted examination where baseline
parameter values can be outlined.

 

Triage, first aid and
initial treatment

This swan has received puncture wounds to the caudal body, and
Fletcher and Lea (2012, p.4) state that a bird that is haemorrhaging must be
classed as an emergency. A VN can triage the patient on arrival, however the
goal of wildlife casualty treatment is a successful release back to the wild,
therefore a thorough systematic examination must be carried out by the VS even
if the wounds are not actively haemorrhaging (Tomlinson, 2016). It is of
paramount importance to acquire as much information as possible from the member
of the public who has brought the swan in regarding the incident and how long
ago it occurred so that this can be passed onto the VS and decisions can be
made quickly regarding treatment or euthanasia if appropriate (Mullineaux,
2014).

 

An example of a wildlife casualty emergency checklist that can be
used by veterinary staff can be seen in appendix one. Anaesthetising the
patient for examination is recommended by Meredith (2016), however the patient
must be stabilised to do so. Any haemorrhaging must be arrested before a
lengthy examination and the source can be located by looking for blood deep in
the feathers; minimal plucking of feathers may aid in visualising the extent of
the wound damage (Mullineaux and Keeble, 2016). Swabs can be used to apply
pressure on the site to stem the haemorrhage or, if necessary, ligation of
superficial blood vessels can be carried out in the conscious patient (Goulden,
2016). The swan is most likely to be in hypovolaemic shock and in pain on
arrival therefore examination should be brief so that oxygen, fluids and
adequate analgesia can be administered. Signs of hypovolaemic shock include
tachycardia, pallor and rapid, shallow respiration therefore airway, breathing
and circulation must be assessed. Oxygen can be implemented either via
endotracheal tube if the airway is patent or flow-by which is less stressful. Hyaluronidase
can be added to crystalloid fluids for fast absorption and dispersion if being
administered subcutaneously to replace fluid loss (Keeble and Mullineaux,
2017), however an intravenous drip via the medial metatarsal vein and a
22-gauge catheter is an efficient and common route and is well tolerated by
large waterfowl (Edis, 2016). Gavage tubing is another option for fluid
administration and if severely debilitated, the intraosseous route can be taken
in non-pneumatised long bones although general anaesthesia is required (Keeble
and Mullineaux, 2016). The bite wounds to the caudal body of the swan will be
contaminated and prone to developing cellulitis therefore a broad spectrum
systemic antibiotic ideally selected after culture and sensitivity must be
prescribed by the VS and administered for five to seven days. Low pressure lavage
can be carried out to remove necrotic tissue and debris using copious amounts
of saline or a 1:40 dilution of chlorhexidine (Goulden, 2016); high pressure
may damage tissue. Tap water can also be used and has been shown to be a safe,
cheap and effective alternative for wound irrigation (Foster et al, 2013). However, lavage should be
carried out on an anaesthetised patient therefore the swan’s condition must be
stabilised primarily. An antiseptic agent such as Manuka honey and sterile
dressings can be applied to promote granulation tissue formation but must be
changed regularly to avoid bacteria culminating. Appropriate analgesia should
be administered and Goulden (2016) recommends Rimadyl (carprofen) rather than
an opioid due to both its anti-inflammatory and analgesic effects.

 

Housing

The captive period must be as short as possible as the veterinary
clinic is not a suitable environment. There is a lack of literature regarding
housing principles of waterfowl, however information on wild birds can be
applied according to Flack et al (2012).
The swan must be accommodated in a quiet and warm oxygen rich environment with
a shelter away from predator species, preferably isolated (Fletcher and Lea,
2012). Environmental temperature should be maintained between 21 and 23 degrees
celsius. Appropriate substrates include shredded paper, cardboard or straw,
however Goulden (2016) states that straw has been associated with an increased risk
of aspergillosis in birds, but only if a bad quality is used and ventilation
measures are lacking. Sufficient padding using this substrate material and
blankets can help to prevent keel sores and foot injuries (Hedley, 2016). A
large area of fresh water should be made available for bathing, maintaining
plumage and feeding; this can be a large litter tray filled with pond water
which must be changed daily to prevent the growth of bacteria which can
contaminate the wounds and cause an infection (Flack et al, 2016). However, Chandler and Middlecote (2011) suggest only
implementing the water bath once the wounds have healed as they should not be
submerged as this can repress healing. If not introduced to water before
release, the waterproofing function of the feathers may be inhibited (Goulden,
2016). Grassy areas can also be provided; plant material or pellets can be
scattered in the enclosure and grass to prompt normal foraging behaviour and
feeding. Dodd and Jones (2012) state that encouraging this natural behaviour to
be exhibited is the main aim, however it is not always possible to provide this
level of environmental enrichment in practice, therefore a wild bird must be
referred on to a specialist wildlife centre with suitable facilities as soon as
possible (Flack et al, 2012).

 

Nutrition and nursing considerations

Wild waterfowl are unlikely to be interested in eating commercial
pellet food so fresh vegetables and seeds should be offered (Flack et al, 2012). Swans are herbivores and
usually graze on aquatic vegetation therefore grasses and fresh greens can also
be provided (Goulden, 2016) although Hedley (2016) states that herbivore
pellets or grain soaked in a deep water-filled bowl is suitable for short term
feeding.

 

Wild animals often live with a parasite burden, such as feather lice
in swans. Therefore, parasite treatment may need to be administered to the
patient to prevent numbers from significantly increasing during hospitilisation
and causing further pathological effects. Salmonellosis is common in waterfowl and
has zoonotic potential, therefore the patient should be housed away from other
inpatients, preferably in isolation (Bexton and Couper, 2014) and good hygiene
and barrier nursing is essential to prevent transmission (Hedley, 2016).
Isolating the patient would be a beneficial preventative measure as well as a method
to reduce stress caused by other inpatients.  

 

Once stabilised, regular monitoring of the vital parameters of the
swan should be carried out by the VN to ensure they are improving and returning
to within normal limits (appendix two). Temperature, respiratory rate and heart
rate should be recorded on a hospital sheet, as well as observations of the
condition of the wounds which should be cleaned or re-dressed as appropriate.
Monitoring urine and faecal output, texture and colour is important as signs of
blood can be indicative of internal haemorrhage. Behaviour and general
demeanour should also be observed from a distance as this can give an indication
of pain or ill health (Flack et al,
2012). Pain scoring can be challenging in this species, however a crouched
posture, partially closed eyes and the head drawn towards the body may indicate
chronic pain in birds (National Research Council, 2009). This can help
determine whether the current pain relief is the most appropriate.

 

Managing release

Following successful stabilisation and treatment of the swan, focus
must be on its release if appropriate to do so. The International Wildlife Rehabilitation Council (IWRC) defines wildlife rehabilitation as the
treatment, temporary care and subsequent release of healthy animals to
appropriate habitats in the wild. Therefore, before release, the VS must be
satisfied that the swan is able to survive and thrive in the wild. Record
keeping is essential and rehabilitated wildlife should be permanently
identifiable by microchip or leg ring to follow the progression of the swan
post-release (Tomlinson, 2016).