I/V catheter placement.

Re: I/V catheter placement.

Louise Dick — Fri, 21 Jan 2011 17:04:59 GMT

Correctly trained or not, sometimes even the best vet will struggle to find a vein in a completely collapsed animal. I would prefer that a patent iv access was available - those few seconds might make a difference to that animal in an emergency situation.

Don't quote me on this but I'm sure I read that many anaesthetic deaths occur in the post-anaesthetic recovery period in animals who had been deemed to be fit and healthy. Instant Iv access would obviously be preferred during those situations.

Our new protocol is that IV catheters be left in place for at least a few hours until the animal recovering from GA is fully awake/alert. They are bandaged with red vet wrap so that we know a catheter is in place and needs to be removed.

Louise

Re: I/V catheter placement.

Juliet Drummond DAVN (med) RVN D32/33 — Fri, 31 Dec 2010 13:08:07 GMT

hi phrin- i was shocked too, we found out when ringing round for competators prices (we are open about it), i'm guessing they don't use catheters either lol

love the castrate story

Re: I/V catheter placement.

Phrin Vernon RVN — Fri, 31 Dec 2010 00:22:11 GMT

[quote user="Juliet Drummond DAVN (med) RVN"]

i recently heard of a practice charging extra for 'optional' pain relief for elective procedures.

[/quote]

Hi Juliet

I know I said that I wouldn't comment further, but that snippet of your post had my jaw on the floor!

It also reminded me of a situation I was in perhaps 10mths ago, doing a cat castrate, and when I asked the VS (first time I worked with a NZ locum) if I could give a NSAID inj (as per practice protocol), he said no........ I must admit, although it it is not my place to prescribe, I took a defensive stance, and asked him if he would want painkillers if I had just removed his testicles!

Result - an embarrassed laugh, and yes give him metacam. And a vet who is very much more pain concious now

Re: I/V catheter placement.

Juliet Drummond DAVN (med) RVN D32/33 — Fri, 31 Dec 2010 00:04:46 GMT

i personally hate the term 'gold standard' it implies that anything less is not good enough.

personally i would like to have an iv line in all anaesthetised animals (i used to work in referral) , now i'm in general practice, we are a hospital and have excellent standards of care, but we don't put catheters in every anaesthetic. if they need ivft or as classified as a higher risk patient then it is done, and the cost either discussed with the client or absorbed by the practice if it is considered by the vet to be in the patients best interests.

in order to be competative most practices will make little or nothing out of a routine spay or castrate, and i'm afraid i agree with the poster who said they would rather the animal had pain relief during and post op than a catheter (to me analgesia is a must), i recently heard of a practice charging extra for 'optional' pain relief for elective procedures.

to me the reality of the situation is that it is the vets responsibility to decide if the patient has to have a catheter or ivft, this is part of deciding a good anaesthetic protocol.

i'm not suggesting that we as nurses should have no imput in this, but it needs to be approached as an issue of practice policy or standard operating procedure, which should involve a risk assessment.

perhaps it can be discussed at a nurse meeting, and then raised at the vets meeting that all nurses are in favour of catheters. then the vets can decide if it is something they want to do, some of them will probably welcome the chance to discuss it.

as for types of tape and brands of catheters, this is personal preference, i use micropore as standard (does not come out if bandaged in well- there is another thread on this) and elastoplast over the micropore (i hate spirit on clipped skin and straight into the catheter site ow!) to secure in a restless patient.

i love optiva catheters, expensive - yes, but we have a great deal with animalcare that gives us equipment paid for overtime in catheter consumption. so far we have 1 new drip pump, and a capnograph on the way.

just my thoughts on a clearly emotive subject.

Re: I/V catheter placement.

shelly jefferies — Wed, 22 Dec 2010 11:25:27 GMT

We are not in a rich area we have alot of PDSA registered clients and people on benefits. Now we have started the placing of catheters the vets have said how much easier it is and less time consuming.

I agree practice makes perfect with regard to hitting veins, but some people arent willing/able/capable?!?! of this and makes for for stressful situation for all concerned.

We do not charge anything extra into the cost of neutering etc if put catheter in place, but make a point of tellin o on admit we put catheter in and reasons for it. (this heps set apart from other practices who don't.) if non routine surgery we charge for catheter and injection cap, no charge for bit of elastoplast/coflex to hold in place as absorbed in costings else where, where something have a super high mark up. Nurses place them at nurse checks unless completely unhandable which inturn improves our technique. The vets here not that bothered by improving venous techniques!!

Re: I/V catheter placement.

Steph Worsley — Wed, 22 Dec 2010 11:17:06 GMT

I work in referral, yes we do place catheters in 99.9% of our sedations and all our GA's just so we can give extra meds as required +/- IVFT, not all our patients get IVFT throughout as there is the risk of overinfusing etc etc

However I have also worked in several "normal" practices and seen a 50/50 split on catheter use. I know that catheters cost and it mounts up so I can see why some practices do not place routinely and will pick their cases on which to place an IV.

It is not just the cost of the catheter, its the tape, bandage materials, hep flush that all neds to be taken into account. this all adds up and can cost the practice a lot of money, believe me I have seen how much all this adds up to!!

I agree if you are in an affluent area where the general cost of everything is a little bit higher to a poorer area then you can afford to be able to increase the cost of your GA's to include all of this, however if you work in a poor area it is not always affordable to clients, dont forget the cost of your anaesthetics include:
-your time
-the vets time
-the induction injection
-the ET tube
-the vapour
-the servicing of the machines
-the oxygen
-the nitous if you use it
-the time for cleaning the machine/ET tube
etc etc

In the end it is the vets decision if they place an IV or not, yes we can suggest that they do and have everything ready, but in the end it is up to them

Re: I/V catheter placement.

Tracey Louise — Wed, 22 Dec 2010 11:13:14 GMT

The true cost of placing a catheter includes:

* Catheter

* Bung / Injection Cap

* Tape

* Vetrap etc

Much more than 86p to buy all of this

And like sal says its not just down to the cost, there are obviously a lot of other reasons why people think they are not necessary judging by the thread.

And im sure if we are correctly trained, we will hit a vein without the need of a placed catheter. You would be amazed what you are able to do once an emergency arrises.

Re: I/V catheter placement.

Louise B — Tue, 21 Dec 2010 23:38:12 GMT

[quote user="Phrin SVN"]

I would love to be in a position to carry out a study regarding ga survival rates in companion animals - those recieving IV +/- IVFT vs those not... but in private practice that is just not ethical!

[/quote]

Not necessarily. Actually, given that lots of practices choose not to routinely place a catheter in low risk patients I would suggest that it would be entirely possible to conduct a study without you personally being unethical. Study natural variation in veterinary practice behaviour in this respect. Unless you are suggesting that veterinary surgeons are being unethical by not placing an i/v catheter just incase unexpected i/v access is needed ethics doesn't have to come into the study. However, it might inform future 'gold standard' practice.

Re: I/V catheter placement.

Sal the 1st — Tue, 21 Dec 2010 23:36:35 GMT

[quote user="Phrin SVN"]

I just cannot believe that anyone thinks 86p or whatever it is for an IV catheter, is being excessive for a GA - a GA costs what? £30 ish all told incl VAT? £31 incl IV cath - Oooohhhh daylight robbery! Sarcasm intentional in this case!

[/quote]

sorry must have misread that

Re: I/V catheter placement.

Phrin Vernon RVN — Tue, 21 Dec 2010 23:31:15 GMT

That wasn't sarcasm

I was merely stating that:

a) I would sincerely love to be able to conduct a study

and

b) that the cost of a catheter is pennies (OK almost pounds)

I know that not everyone agrees with me - I said so earlier! - This is a subject which is both very important, and has many differing opinions, and I'm not going to take it any further.

Re: I/V catheter placement.

Sal the 1st — Tue, 21 Dec 2010 23:18:08 GMT

its not just down to cost! quit the sarcasm it does you no favours and just accept that not everybody agrees with you.

Re: I/V catheter placement.

Phrin Vernon RVN — Tue, 21 Dec 2010 23:12:36 GMT

[quote user="Princess Ophelia Hermione MacBeth"]

Just a couple of quick question:

1. How many less anaesthetic deaths do you think occur as a consequence of placing an i/v catheter?

2. How many more patients do you think experience increased morbidity as a consequence of not placing a catheter pre-emptively?

Perhaps these questions need to be answered (and further questions e.g. ask the same question of subcategories like - 6 month old routine cat speys, etc) before we are so quick to judge practioners who elect not to place an i/v catheter.

Gold standard is all very well but gold standard costs more money. In fact, is it necessarily gold standard to place an i/v catheter? Needs to be proved that it actually makes a difference first. Perhaps that extra £5 on a i/v catheter would be better spent on:

e.g. some pain relief for the patient to go home with

[/quote]

I would love to be in a position to carry out a study regarding ga survival rates in companion animals - those recieving IV +/- IVFT vs those not... but in private practice that is just not ethical!

We are not lacking on pain relief anymore in our practice either

Re: I/V catheter placement.

Sal the 1st — Tue, 21 Dec 2010 23:08:31 GMT

never said you were referral and I am not questioning your opinion just evening things up in that other opinions do exist

Re: I/V catheter placement.

Phrin Vernon RVN — Tue, 21 Dec 2010 23:03:44 GMT

[quote user="Princess Ophelia Hermione MacBeth"]

Just a couple of quick question:

1. How many less anaesthetic deaths do you think occur as a consequence of placing an i/v catheter?

2. How many more patients do you think experience increased morbidity as a consequence of not placing a catheter pre-emptively?

e.g. some pain relief for the patient to go home with

e.g. a kong to provide mental stimulation for the recuperating patient

e.g. diazepam to be given to the patient before arrival at the surgery to help block memory of any aversive procedure

e.g. a more comfortable buster collar so that the animal tolerates wearing one better

etc....

£5 off the patient's next booster, wormer, etc as an incentive to keep up with preventative health care

simply make the procedure £5 less thus making vet care more affordable and accessible to low income people.

[/quote]

We are very competitively priced - in fact we are the cheapest in our area...... I stll think IV access during GA's is gold standard.

And Sal, we are a medium sized mixed practice - a far call from referral

Re: I/V catheter placement.

Sal the 1st — Tue, 21 Dec 2010 22:25:30 GMT

[quote user="Gillian Mostyn"]

I can't let this one go by.......

'just a few pounds' eh? In every patient? How many ops were done each day? How much would that cost annually? If you feel that passionate about it, would YOU be prepared to reduce your pay to help cover this cost?

As you say, you now work in referral practice where cost is, in the main, irrelevant. We aren't so fortunate in general practice.

(I should say that we place IVs in almost every inpatient and use IVFT whenever necc, and in the vast majority of cases over 8 years old. But some practices are under a lot of financial pressure these days just keeping themselves afloat, so things aren't always as simple as they seem.)

[/quote]

I agree with this -we dont all work in referral centres and for some of us cost is a consideration.It doesnt mean that our treatment is lacking or any less than should be expected - but this is how this thread has portrayed those practices that dont place catheters as a routine. I appreciate that different practices do things differently and maybe if we all worked in referral centres charging referral centre prices we would all be placing catheters but we dont . Just wonder if this is where some of the problems I mentioned on the 'why?' thread come about. Is it that nurses are being trained as if they are working in a referral centre and their ideas and expectations are such that the 1st opinion general practice just doesnt measure up and this is why they question?

will further add to this that one of the worst places I ever worked for wasting money was in fact a charity - and this happened (and is still happening) because people working there havnt got a bloody clue how much things cost and because they dont have to worry about generating an income they arent that careful about how they spend it- bit like the NHS really! (sorry no disrespect Nick and others)

Re: I/V catheter placement.

Louise B — Tue, 21 Dec 2010 22:14:36 GMT

Just a couple of quick question:

1. How many less anaesthetic deaths do you think occur as a consequence of placing an i/v catheter?

2. How many more patients do you think experience increased morbidity as a consequence of not placing a catheter pre-emptively?

e.g. some pain relief for the patient to go home with

e.g. a kong to provide mental stimulation for the recuperating patient

e.g. diazepam to be given to the patient before arrival at the surgery to help block memory of any aversive procedure

e.g. a more comfortable buster collar so that the animal tolerates wearing one better

etc....

£5 off the patient's next booster, wormer, etc as an incentive to keep up with preventative health care

simply make the procedure £5 less thus making vet care more affordable and accessible to low income people.

Re: I/V catheter placement.

Gillian Mostyn — Tue, 21 Dec 2010 20:50:21 GMT

[quote user="Caza"]i did try at my old place (general practice) to have an i/v placed for all ops - all i got in reply was it costs too much..... lame excuse i think! takes a few minutes to place them and costs s few pounds![/quote]

I can't let this one go by.......

As you say, you now work in referral practice where cost is, in the main, irrelevant. We aren't so fortunate in general practice.

Re: I/V catheter placement.

Caroline Boothroyd — Tue, 21 Dec 2010 20:31:34 GMT

all of our cases - GAs and sedations have an i/v catheter placed - im at a referral centre.

we use the optiva catheters and T connectors from animal care - we bulk buy off the rep so we get freebie fluid pumps which are great!!

EMLA cream works like a charm on beasts that are a bit jumpy or not sedated :-)

i did try at my old place (general practice) to have an i/v placed for all ops - all i got in reply was it costs too much..... lame excuse i think! takes a few minutes to place them and costs s few pounds!

Re: I/V catheter placement.

Phrin Vernon RVN — Tue, 21 Dec 2010 20:20:44 GMT

[quote user="Gillian Mostyn"]There is a golden rule of doctors and vets: First, do no harm. Also known as: If it ain't broke, don't fix it. As has been said by others, both placing an IV line and using IVFT have the potential to cause harm, and their use should be decided on a case-by-case basis. The vet in charge will be weighing up all the pros and cons and will make their own decision. As always one person's decision may be different from someone else's. But it is a decision for the vet overseeing the case to make - no one else is qualified to do so.

[/quote]

By that logic we should not be neutering or vaccinating either as both have the potential to cause harm. But the pro's outweigh the con's right? Kinda like placing an IV during GA to my mind. I guess that's a whole other thread though

And I hope no one is under the impression that I take the vet to task over these matters! I prepare them, and ask the vet if they can be used - As I mentioned in a previous post, I am under no illusions that I know as much as the vet - I know what I have been taught, and have read - If the vet declines to use the catheter or fluids - so be it - it's not my decision to make, and I know that.

A lot of our vets need prompting though - if you ask them 'Can I put this on fluids?' you more often than not get a reply along the lines of 'Ohhh that's a good idea, yes please'

Re: I/V catheter placement.

Phrin Vernon RVN — Tue, 21 Dec 2010 20:11:19 GMT

[quote user="Tracy Windler RVN"]

[quote user="Phrin SVN"]

I do not mean at all to disrespect anyone else's opinion or way of practice, but personally my opinion is that an IV line is gold standard. And that IVFT in anything above a dog castrate is also gold standard.

[/quote]

I'm afraid I thnk this is grossly excessive. Its just adding to costs of surgery, contributing to public opinion that we are ripping them off.

For example, my friend (no veterinary experience) who I convinced to get her healthy, young bitch speyed, was talked into giving her IVFT during the procedure (she lives 70miles from me, so not at our practice). She felt pressured as it was suggested that it was a bigger risk to carry out the procedure without these fluids. To cut a long story short, the dog was operated on very late in the day, sent home too early (stumbling, stinking of iso, unwilling to move) and my friend was presented with a bill much larger than she expected and now regrets having the procedure done. I advised her to move practices, as this was unacceptable.

I would suggest there is much more to the "Gold Standard" than putting an IV line in every patient.

[/quote]

I agree wholeheartedly, and I agree that it sound's like your friend had a bad experience. However, IV catheters and IVFT are included in our GA price, and bitch spays, if large, or non routine (ie older, pregnant etc) are generally put on IVFT at no extra cost to the client. And we give fairly accurate estimates, and wait until patients are properly recovered before discharging too

[quote user="Tracy Windler RVN"]

As for the point about renal perfusion and differences between animals and humans, I don't think I'm qualified to go into that depth-although **thanks** for the refresher on kidney function (I thought it was 60%, but hey ho). Perhaps you're under the impression that being qualified for 4 years means I have forgotten most of my theory knowedge.

[/quote]

No need to be sarcastic. I was taught 75%, and without raiding the practice library or doing fancy googling of peer reviewed papers (which I can't do, because I am crap at googling), I don't know which of us are closest to the facts.

I'm not qualified to go into the differences between human and cat kidneys either, apart from the fact that it seems to be the general view that cats got a raw deal when kidneys were being handed out.

I discussed this thread with a vet at work, and he agreed that IV lines should be a given, and that IVFT during anaesthesia, especially in kittys can only be a good thing in the majority of cases, so long as the patient and the fluid rate are monitored closely.

We'll have to agree to disagree on this one Tracy

Re: I/V catheter placement.

shelly jefferies — Sun, 19 Dec 2010 18:53:14 GMT

Oh dear I seemed to have oppened a can of worms here when staritng this thread.......

We now place catheters in anything aged over 7years or procedures lasting over 30 minutes, ie not cat spays/castrates or dog castrates. This is now great for us.

I get what everybody is saying about gold standard and the comments people are making about fluids. We DO NOT put fluids on every animal, only on things which have had pre-op bloods and show an indication for doing this.

I have found most animals not that bothered by the placement of the catheter, and it means one needle stab not one for pain relief inj, one for premed, one for i/v anaesthetic and one for post op painrelied. This in my opinion is only a good thing.

As for infections all ours are placed as aseptically as possible and in 15 years have never seen an infection from a catheter site.

Nor have i ever been bitten by an animal during catheter placement and if it is the sort of animal that is going to scratch or bite you, you are just as likely to get got during premeds or induction!"

The second main reason for wanting to place catheters is to minimis extravascular injecting. We have lots of vets in our practice and far from few are good at hitting i/v's!! Now they have not got the pressure to do so and we don't have to cope with p***ed off animals having drugs injected s/c

It is not that I/we were trying to overule our vets (far from it) we were trying to improve things for every body concerned.

But at least it has got everybody thinking

Re: I/V catheter placement.

Nicola Smith — Sun, 19 Dec 2010 15:24:18 GMT

Have to say iv catheter placement not a problem where I work - only the same as an iv injection. We have no problems even with youngsters - cats and dogs and cannot recall anyone being injured while doing so. Also we know GA going in - no risk of blowing vein or jumping off needle. We are happy with our protocol and it works for us but each to their own.

Re: I/V catheter placement.

Tracey Louise — Sat, 18 Dec 2010 21:20:13 GMT

[quote user="Tracy Windler RVN"]

At my current practise, we only place i/v's in cases where the vet feels it necessary. She feels that it is another source of infection, sterile or not and would rather get on with the procedure as quickly as possible. I don't have a problem with this, its all swings and roundabouts in general practice.

[/quote]

I love this comment, and totally agree.

We also only place catheters where the VET feels necessary, if they thought it was then they would place one. Afterall, they are responsible for the animal.

Re: I/V catheter placement.

Tracey Louise — Sat, 18 Dec 2010 21:20:08 GMT

[quote user="Tracy Windler RVN"]

[/quote]

I love this comment, and totally agree.

Placing a catheter can also be pretty stressful for a patient, and i would say that i have been bitten and scratched more during this procedure than any other.

We also only place catheters where the VET feels necessary, if they thought it was then they would place one. Afterall, they are responsible for the animal.

Re: I/V catheter placement.

Gillian Mostyn — Sat, 18 Dec 2010 16:39:37 GMT

There is a golden rule of doctors and vets: First, do no harm. Also known as: If it ain't broke, don't fix it. As has been said by others, both placing an IV line and using IVFT have the potential to cause harm, and their use should be decided on a case-by-case basis. The vet in charge will be weighing up all the pros and cons and will make their own decision. As always one person's decision may be different from someone else's. But it is a decision for the vet overseeing the case to make - no one else is qualified to do so.