Re: phenobarbital IV infusion

Steph Worsley — Sat, 23 Feb 2013 14:14:44 GMT

our seizuring patients are placed on pretty much constant monitoring either by nurse/vet or vet student, any changes in dose rate (we use propofol infusion for the status dogs) is decided upon by the vet.

If a patient is known to siezure but has not presented seizuring then they are not under constant monitoring but are checked more often than our other patients

Re: phenobarbital IV infusion

Whippy — Sat, 23 Feb 2013 14:05:55 GMT

it does thanks. x

Re: phenobarbital IV infusion

Alison Clare Hickman — Sat, 23 Feb 2013 13:56:17 GMT

My answer is - depends on the practice protocol, client expectation and bank balance in my experience.... and the limit of your professional responsibilities.

I hate to say it, but in some cases it was a matter of what it would cost to pay me overtime, (and therefore the cost to the client and / or practice) balanced against the need to monitor the patient. The decision for this balance was always made by the vet, despite my willingness to stay and help.... I would mention that I have never worked in a hospital-status practice where I would expect to stay up and monitor the patient.

It isn't simply about the cost thought of course, there is the potential hazard /safety issues connected with monitoring a large and anxious patient, (especially a fitting animal). Potentially very dangerous, particularly so if in sole-charge.

Thinking about the admin method of the IV meds you have mentioned . What would your vet instruct you to do regarding any decision to increase/decrease flow-rate? There is the potential for overdose/underdose. As an RVN I am very conscious of my professional decision limitations. When I've thought more deeply about your question and my answer I realise I have only ever experienced the monitoring of patients where the vet has administered a bolus infusion (or a series of) to effect. I have never been expected to monitor a continuous-rate infusion of this sort. Would scare me greatly! Unless the vet was readily available. But if they were, then why expect me to do it?....

Okay, okay, confusing myself let alone you now...sorry!

For what this reply is now worth here is what I have done / experienced:

1) stayed up all night (kipped fitfully on a couple of vet-beds just in front of the kennel). Vet off-site. Small dog, easily handled and contained.

2) baby monitor device alarm set to wake me if patient moved (I was in a nurse accommodation the other side of the building, so could attend in approx 3-5 mins from waking). Medium sized dog. Vet off-site. Check patient every hour or sooner if alarm sounded.

3) shared fully awake shifts with the vet throughout the night. Large dog. Vet on site (she & I elected to share accommodation in the nurse flat).

4) the vet did it all with no assistance.

Not sure if any of this will be of use to you...did me some good to reflect on it though. Thanks.

Ali h