Holding down for x-rays

Re: Holding down for x-rays

Freckle — Sun, 05 Apr 2009 01:54:32 GMT

i have never held an animal for xray, and i worked for many years in a cardio/internal med referral practice - we saw many animals that wouldn't have survived a ga/sedation, and often the treatment was medical not surgical, so there was no ga after diagnosis. the xrays were often delegated to the nurses, and a vs was only called in if holding was required - although in practice, after inducing the animal, the vet couldnt do anything else while animal was under ga, and so was there at hand if/when needed.

the vet would hold the animal if really necc, with all protective gear, but this was rarely called for - a bit of patience, and a well timed click on the xray machine goes a long way!

saying that, i was more than willing to hold my own dog down for an xray, but bless her, she just lay still :)

freckle x

Re: Holding down for x-rays

Maisy — Sat, 04 Apr 2009 22:45:47 GMT

[quote user="Louisesadieandshads"]

Hi Maisey, yes that is what I mean. It made me wince the first time I thought of it and did it but the cats don't seem to react in the same way. I think it is very useful for some cats but I have only used it for proceedures that have the cat in sternal recumbency and head up so I have no idea how good it would be for xrays. I remember it being mentioned as useful for avoiding sedation in a compromised cat (but controversial) but have not used it for this purpose as I am largely out of practice so don't have many cases to 'play with'. Did your ozzie vet use it for x-raying?

[/quote]

Hi,

The method was often used for xrays, mainly as said vet had little patience with waiting for sedation when a quick chest/abdo view was needed. The pegs would be put on and then sometimes a sandbag over the head if the cat was lifting this up. Otherwise they did stay very still except for the cats that are scruff-shy anyway who wouldn't tolerate it at all.

Re: Holding down for x-rays

Kerry Spain — Sat, 04 Apr 2009 11:55:03 GMT

I've been asked to hold conscious animals for x-rays and Adam I appreciate your input and agree somewhat that it is the cumulative effects which make the difference, however the practice where I used to work asked me to hold on an almost daily basis. I did it a few times and then refused as this would have ment that I was being exposed on a daily basis.

Where I work now my boss holds all the conscious animals for us so we are not put at risk. I think the problem that most nurses have on here is the principle, we shouldn't be being asked by anyone to hold animals. My boss is adement that the scatter is low from our machine and his theory is that he has sired 2 kids now so he doesn't need his gonads any more??!! LOL aaah gotta laugh...

So the answer is NO I don't hold for conscious x-rays but I have done on my own animals in the past as I wouldn't ask anyone else to do it.

Re: Holding down for x-rays

Louise B — Sat, 04 Apr 2009 10:16:48 GMT

[quote user="Maisy"]

Using pegs?! Only ever seen it once when one of our vets from Oz would swear by this method. It worked, but made me wince!

At least I think this is what you mean Louise and I'm not just revealing some old barbaric method that is never used!

[/quote]

Clipnosis/pegging = the application of clothes pegs (or similar) to the scruff of the kneck, placed in a straight line from behind the ears to just above the shoulder blades.

The effect in susceptible cats is a pliable/malleable cat that just lies there (sometimes purring) and shows no sign of stress during or after the procedure of clipping. However, it is controversial and some people think that it is similiar in mechanism to rabbit trancing (rabbit on back freezing) so a welfare issue. However, my understanding is that the physiological/behavioural parameters measured don't back this 'poor welfare' interpretation. However, I have only read one paper on this topic and have not done a comprehensive search on this topic so there could be more out there either supporting of dissing this view.

http://www.youtube.com/watch?v=HluqnWDVMDA&feature=related

The above is a direct link to a clipnosis case and is interesting viewing.

Re: Holding down for x-rays

alan ince — Sat, 04 Apr 2009 07:54:48 GMT

i think that you are all over reacting. How often would you hold an animal for xray???? not very often. For the xrays to cause you harm you would need to be in the primary beam and you would need to xray your self over and over again at such a high dose for there to be any real side effects.

Now for starters most people hold once in a blue moon and it is generally for a chest or abdo xray which are not exactly high exposures. (and if you are using high exposures then your xray machine needs a service). And i presume that if and when you hold an animal you wear your lead gown and thyroid protectors and your doesometer.

The doseometer is designed to record the radiation levels that you would pick up when xraying, and obviously if it does pick up a reading then you would be advised not to take xrays for a certain amount of time etc.

I used to work doing human radiography where as you can imagine we done procedures like angioplastys and ct scans which would use massive doses of radiation. And when staying in the room we would wear lead gowns and thyroid protectors. Which let me see is what we are all supposed to wear when doing veterinary radiographs. And i can say that no member of staff ever while i was there for over 5 year,no one ever got sick or had a reading from their doseometer saying that they were unable totake radiographs.

As if you know much about the way xrays work you know would know that unless you are in the primary beam (which if you was is stupid, as you would get in the way of your diagnostic xray) then the xrays that scatter are at such a low intensty you actually pick up more in background radiation in just walking around the street.

And in regards to the vet being pregnant i respect her wishes to protect her baby. But i have worked with doctors who would carry out xrays and barium enemas etc while being pregnant, as every h&s report shows that as long as you wear the correct safety equipment and do things correctly then you are not putting yourself at risk. The problem is that so many people dont do things properly and put them selfs at risk which is their own mistake.

So lets get a grip, you far more likely to be savagely attacked by a 2 week old puppy than ever get a health risk from taking an occasional xray and holding the animal

Re: Holding down for x-rays

Sammyannieantha — Fri, 03 Apr 2009 22:52:51 GMT

We never ever ever hold animals for xrays at all. Its not necessary and its soooo bad for your health and safety. You defo have the right to refuse and if they dont like it report it to the Radiation protection adviser.

Re: Holding down for x-rays

Maisy — Fri, 03 Apr 2009 22:43:29 GMT

Using pegs?! Only ever seen it once when one of our vets from Oz would swear by this method. It worked, but made me wince!

At least I think this is what you mean Louise and I'm not just revealing some old barbaric method that is never used!

Re: Holding down for x-rays

Sandra Taylor RVN, MBVNA — Fri, 03 Apr 2009 22:29:11 GMT

Clipnosis Louise??? think i may know what you are on about, but await your reply

Re: Holding down for x-rays

Anne Whipple RVN — Fri, 03 Apr 2009 19:17:03 GMT

Funnily enough was just reading this when xray case came in. Vet blew veins in legs so couldn't use our usual propofol and so she held a perfectly healthy dog for 'quick' pelvic views.

Also saw practice for 2 weeks in the US and they hold EVERYTHING. I had read that but was still quite shocked when I saw it in person. They were equally shocked that we sedate/GA everything ( or are supposed to) and asked how we got anything done!

Definitely think it's not worth the long term health risks though.

Re: Holding down for x-rays

Louise B — Thu, 26 Mar 2009 19:33:04 GMT

[quote user="Sparky"]

I was worrying about this too.....one of the vets who hasn't been with us that long yesterday said he had never held so many animals for radiopgraphs in his whole career....and on saturday I had to hold a dog who was having his last follow on radiographs from a barium series the previous day.

I held on saturday because the vet didn't really want to sedate and it was for quickness, but I didn;t feel comfortable and the vet was pregnant. Even if I don't want children at this point in my life, I don't really want to fry my ovaries. What other choice did I have....I didn't feel like I could suggest sedating to the vet...and the local rules say should only be held by expericened professionals and only if completely necessary if no option...eg old or to ill to have sedation/ga.

This is the first time and hopefully the last time I hold for radiographs, but it worries me how many radiographs that do occur where the vets hold

[/quote]

Hi Sparky, Just say no! I know it is difficult but you need to put yourself here. H&S is there for a reason. Tough if your vet is pregnant. If she wasn't, I take it she would hold. So, she is not holding now because she has made a cost-benefit analysis in her own head and decided that it is better that you to take the risk and not her unborn child. By doing that she is recognising there is a risk! And it is not for her to decide that you should take that risk. Say no, it isn't worth it.

Re: Holding down for x-rays

Louise B — Thu, 26 Mar 2009 19:02:34 GMT

Has anyone here used 'clipnosis' as an alternative to holding, bagging or sedating in cats? I have used it for cats to do other things - mainly blood glucose and catheter placement but I haven't tried it for x-raying.

Re: Holding down for x-rays

A Little TLC — Thu, 26 Mar 2009 12:27:47 GMT

I have never ever held down for an xray. We use sand bags and rope, as i only work with wildlife, they dont tend to lie down when told, however, we dont always use GA.

I've always managed great x-rays! I think holding them down while being zapped is a bit mental really!

Re: Holding down for x-rays

Sandra Taylor RVN, MBVNA — Thu, 26 Mar 2009 10:17:07 GMT

[quote user="Bouncyfi"]I agree that holding for xrays is bad but we should be aware of the regulations and always saying a vet should do it, isn't true[/quote]

I think what people on here are trying to say though is,that it is the vet who ultimately requests the patient to be held, so in theory if they want it held they should be holding it themselves.

Re: Holding down for x-rays

Sparky — Thu, 26 Mar 2009 09:51:59 GMT

This is the first time and hopefully the last time I hold for radiographs, but it worries me how many radiographs that do occur where the vets hold

Re: Holding down for x-rays

Fiona Leathers — Thu, 26 Mar 2009 08:56:42 GMT

[quote user="Bouncyfi"]

According to Ionising Radiaiton Guidelines - the vet requesting the held xray should hold or anyone else who is trained in it.

[/quote]

I'm going to quote myself again as I keep seeing the same arguement that the vet should do it - it is not law that that only the vet should do it - anyone else trained - is the key phrase in the Ionising Regulations.

I agree that holding for xrays is bad but we should be aware of the regulations and always saying a vet should do it, isn't true.

Re: Holding down for x-rays

Gillian Mostyn — Wed, 25 Mar 2009 22:50:45 GMT

[quote user="SaskiaVN"]From what I have heard, if an animal requires a conscious x-ray, for whatever reason, and requires to be held for this procedure, the vet in charge must do it.[/quote]

The rule that it is against H&S applies to everyone. Thus noone should be instructed to hold an animal for x-ray. And noone can be made to do so by someone else. And if asked, they should just say no.

Occasionally a vet will decide to hold an animal themself. In that case they are choosing to take the risk - and accept any consquencies. As I said, I would no longer be willing to do this myself unless here were exeptional circumstances. But as long as they aren't puttng anyone else at risk, then that is their choice.

Re: Holding down for x-rays

Saskia Quinn — Wed, 25 Mar 2009 22:34:42 GMT

I appreciate your reply Gillian. I was interested in the point of view of a vet under such circumstances. From what I have heard, if an animal requires a conscious x-ray, for whatever reason, and requires to be held for this procedure, the vet in charge must do it.

Thats fine as it protects the nurses, however, who/what is there to protect the vet? Surely it should be the practice principal? Even you, Gillian, have had bosses admit animals for you to take a conscious x-ray?

What I am trying to say is that the vet normally protects the nurse, as in they wont ask him/her to hold for x-ray, but then it is the vet who ultimately has to hold. To me, this is unfair to the vet.

Re: Holding down for x-rays

Gillian Mostyn — Wed, 25 Mar 2009 22:29:01 GMT

Without going into deails of various conditions, my basic opinion is that none should be instructed to stay in a room when radiographs are taken That is paramount to asking someone else to put their health at risk to reduce the risk to an animal. People come before animals in my world - no question. Besides, it is against so many H&S regulations you'd be loopy to even consider it.

As far as whether it is justified to take concious restrained xays - very very rarely. We have a massive amount of choice of seation and anaesthesia that there are almost always options. One of the posts above mentioned a collapsed kitten. With a litle forethought - why was't the xray taken while it was collapsed?? If a very quick GA is needed in a kitten, what about iso in an induction chamber?

The other thing to mention is that if an animal is being restrained, and wouldn't stay still with sandbags etc., you will be unikely to get a good quality diagnostic xray anyway.

I have to say I have occasionally chosen to hold an animal - I can't remember why at the moment. I would never ask anyone else to do it. And most of those occasions were years ago. I have become older (unfortunately) and developed a stronger sense of self-preservation. And, as you say, you realise that an xray is all well and good, but you're going to have to GA to fix the problem!

I have had bosses that admitted animals for ME to 'take a quick concious xray'. I used to be intimdated enough to agree to it. Wouldn't do now!!!!!

Re: Holding down for x-rays

Saskia Quinn — Wed, 25 Mar 2009 22:14:24 GMT

[quote user="Gillian Mostyn"]

Refuse. Point blank. Your health comes first.

[/quote]

Gillian, as a veterinary surgeon, I am interested in your opinions on this regarding holding for x-rays? Of course, if an animal is too ill for sedation, chances are it will be too ill to *** about (for want of a better word) on the x-ray table. However, depending on the positioning, say you had no choice other than to hold it in order to get a good x-ray, would you? Would the x-ray diagnose any condition needing an immediate general anaesthesia for you to fix/repair? Surely if its too ill to be sedated for x-ray, its definitely too ill for a GA therefore both the x-ray and the repair requiring ga if necessary can wait until the patient is stable enough?

I know there will be certain things exempt from this for example a fractured spine or condition that would require immediate euthanasia for something that 'cannot' be fixed and to prevent further suffering.

Re: Holding down for x-rays

Faye Sewell — Wed, 25 Mar 2009 21:52:18 GMT

Never have done, never will do!. Have been asked in the past but refuse!

Re: Holding down for x-rays

Gillian Mostyn — Wed, 25 Mar 2009 21:50:00 GMT

Refuse. Point blank. Your health comes first.

Re: Holding down for x-rays

Sammyannieantha — Wed, 25 Mar 2009 21:28:11 GMT

At our practice we never ever ever hold an animal for xrays and EVERYONE respects and follows this matter, at the end of the day thats what sedation and ga is for!!

Re: Holding down for x-rays

katy coleman — Tue, 24 Feb 2009 17:19:24 GMT

I cannot believe that vets are still asking their nurses to restrain for xrays, thats what sed/ga is for!!!

I have not and will not ever restrain and thankfully where I work I am one of H+S officers so i can safely say it will never happen plus my employers are not the sort that would ever ask.

If it is that ill then it will lay still and if its not that ill then it can at least have whiff of gas, and cost should never even come into it, why should your health be scarificed to save someone a bit of cash??? I think not.

Re: Holding down for x-rays

Shane — Tue, 24 Feb 2009 16:59:00 GMT

hell, I remember ages ago when the dinosaurs still roamed the earth and I was in the military in SA, we used to take xrays of horses and never even had lead aprons!

No lingering side-effects so far, so luckily for me. Came to the UK and was never allowed to restrain, which I believe in, so refuse if someone wants you to do it!

Re: Holding down for x-rays

jan — Tue, 24 Feb 2009 16:33:07 GMT

The regulations say that if a conc X-ray is nec then the V/S ordering the exam should hold it. Our policy is if its well enough to not to lie still under bags then its well enough for GA /sedation/iso. Its all very well to say it OK we don't mind but when someone delelops skin/ thyroid cancer they will mind!

Not only do the nurses here not hold they won't "push the button" if there is a V/S in the room. Necessitating the procedure to need 2 V/S to do it. This is policy from our partners (& RPS) Funnilly enough when this is explained to Locums etc then it suddenly becomes OK to sedate!