Shaving for jugular blood samples

RE: Shaving for jugular blood samples

James Colver Cert. Ed, RVN — Wed, 09 Jan 2019 23:03:01 GMT

Yup. Whether or not the vet agrees that there is a clinical justification for running or not running bloods, the decision whether to run or not run the bloods is the owner's. I can't understand what's debatable about that.

RE: Shaving for jugular blood samples

Ben Ogden — Wed, 09 Jan 2019 15:09:31 GMT

[quote user="apache"]

[quote user="James Colver Cert. Ed, RVN"]Decision is still the owner's..[/quote]

Is it though? If I was estimating a price for a dental for an old dog I felt needed fluids I'd price them in. I don't offer them as an extra tag on for £30 or whatever. I don't think I've ever had a case where I gave a price and removed the fluids and painkiller because the owner didn't fancy paying for them. What next, you can spay my bitch but I'm not paying for the anaesthetic so hold her down? How much of this should be optional?

(this is why I don't believe in offering bloods as a up selling tag on item)

[/quote]

I agree with this in principal, however we're an industry driven by market forces. If a client is given an estimate for a procedure with items included that 'could' be optional and they are not aware of that and just have the figure, whats to stop them going down the road for an estimate and being told about 'optional' parts and having the option to reduce the cost?

They have to be informed and THEY make the decision, but within the confines of the Animal Welfare Act (no holding animals down for surgery). The only power of control we have is to make sure we stay within the Veterinary Surgeons Act for what we do.

RE: Shaving for jugular blood samples

Jean Douglas — Fri, 04 Jan 2019 15:54:31 GMT

Hi, totally off topic here - A question for Apache (or any EVNs) Do you not clip for injections into joints in horses? Only there was a brief clip pooped up on social media of an intraarticular injection into a horses hock and we (all small animal VNs ) were screaming "omg its not clipped or scrubbed, and wear gloves" But not being EVNs we didn't know if that was normal?

RE: Shaving for jugular blood samples

apache — Tue, 01 Jan 2019 22:29:08 GMT

[quote user="James Colver Cert. Ed, RVN"]Decision is still the owner's..[/quote]

(this is why I don't believe in offering bloods as a up selling tag on item)

RE: Shaving for jugular blood samples

Sal the 1st — Tue, 01 Jan 2019 21:34:52 GMT

[quote user="apache"]

You could argue that putting everything on fluids will be less expensive and more protective for the patient than ever running bloods.......

[/quote]

Gawd don't get them started on the everything has to go on fluids again - it will run for pages and I will lose the will to live! (can't find a head banging smilie)

RE: Shaving for jugular blood samples

James Colver Cert. Ed, RVN — Tue, 01 Jan 2019 19:11:44 GMT

Decision is still the owner's..

RE: Shaving for jugular blood samples

apache — Tue, 01 Jan 2019 16:13:32 GMT

[quote user="Jean Douglas"]:) James - shouldn't lab work be a clinical decision? Just saying. Not an owner one - a bit along the lines of a mechanic saying "Would you like me to re-shim this engine? or not?" [/quote]

100% agree. There ought to be a good clinical reason for doing some testing, and the testing results needs to change what you do. For example what are you going to do differently in a 12 year old dog with severe dental disease when you find a liver enzyme slightly raised?

I'm not against testing, but only when it's in the animal's best interests. In healthy young animals I don't believe it ever is. You could argue that putting everything on fluids will be less expensive and more protective for the patient than ever running bloods.......

RE: Shaving for jugular blood samples

James Colver Cert. Ed, RVN — Mon, 31 Dec 2018 20:16:09 GMT

The decision is the owner's! Same as the mechanic wouldn't shim the engine without asking the owner of the car if that's what they wanted!

RE: Shaving for jugular blood samples

Jean Douglas — Mon, 31 Dec 2018 17:04:52 GMT

:) James - shouldn't lab work be a clinical decision? Just saying. Not an owner one - a bit along the lines of a mechanic saying "Would you like me to re-shim this engine? or not?"

RE: Shaving for jugular blood samples

Jean Douglas — Mon, 31 Dec 2018 17:01:04 GMT

All the practices I've worked at we always explained everything, including clipping, the possibility of bruising, of maybe needing to cannulate more than one vein etc etc at preop & at admit.

Informed consent. :) and it beats being screamed at by the owner on discharge in front of a full waiting room (which once happened to me - following a V/S admit where the I/V & site clipping where taken being obviously necessary so not mentioned)

RE: Shaving for jugular blood samples

James Colver Cert. Ed, RVN — Wed, 19 Dec 2018 19:34:43 GMT

My one year old dog went to dental specialist for root canal work on a canine after breaking it on a stone at the beach.

When she came home she was very poorly, and azotaemic.

She did not have a pre-GA sample but had she had one, the information would have been useful. Was she azotaemic to start with?

The reference states that pre-op blood work is 'unlikely to yield additional important information if no potential problems are detected clinically' - but unlikely doesn't mean never, so should it not at least be offered for every patient?

RE: Shaving for jugular blood samples

Lynsey791 — Wed, 19 Dec 2018 18:07:59 GMT

I found out my cat had hypercalcemia which required treatment due to pre op blood tests when she was in for a routine dental. I think it would actually be better practice if all humans were given blood screens prior to undergoing a procedure. :)

RE: Shaving for jugular blood samples

Jean Douglas — Wed, 28 Nov 2018 16:54:10 GMT

https://www.journalslibrary.nihr.ac.uk/hta/hta16500/#/abstract

RE: Shaving for jugular blood samples

Sal the 1st — Mon, 26 Nov 2018 19:25:05 GMT

[quote user="apache"]

I think we need to be very careful taking things at face value as "best practice" and challenge the unnecessary gold plating of things.

[/quote]

Thank you - I have been saying this for years

RE: Shaving for jugular blood samples

Sal the 1st — Mon, 26 Nov 2018 19:20:44 GMT

[quote user="talchi"]

I have had those dreaded clients whose bitch needs an ex-lap, and the clients have had a dog show a few days later, and they get VERY upset when you tell them they need to be shaved!

[/quote]

at a previous practice. Open pyo in a Komondor - the smell was absolutely eye watering but the client was adamant we we should only be parting the hair and tying it back to do the surgery, didn't want it clipped at any price, bosses reaction - if you can find a vet that can safely comply with that request let me know and I will make the referral

RE: Shaving for jugular blood samples

apache — Mon, 26 Nov 2018 19:14:05 GMT

See what you make of this:

https://www.ncbi.nlm.nih.gov/pubmed/18179653

"In dogs, pre-anaesthetic laboratory examination is unlikely to yield additional important information if no potential problems are identified in the history and on physical examination"

[quote user="talchi"]f you were to inject into a vein, or withdraw from it, you would want it to be as aseptically as possible surely? ie clipping and cleaning with spirit etc[/quote]

Then why not when injecting under the skin or into a muscle if it's so necessary? Into a muscle the needle could pass through a vein. (I agree if leaving something in then it's important like a cannula). I think we need to be very careful taking things at face value as "best practice" and challenge the unnecessary gold plating of things.

It seems so unnecessary clipping off lots of hair for a blood sample or an iv injection. I've never seen any problems.

RE: Shaving for jugular blood samples

talchi — Mon, 26 Nov 2018 15:55:18 GMT

would you not run them to check the liver and kidney? at college we were told to always offer bloods, especially for geriatric patients, as the drugs are metabolised by these areas, and if there was any issues, we could adjust the drugs or dosages accordingly. also, if you were to inject into a vein, or withdraw from it, you would want it to be as aseptically as possible surely? ie clipping and cleaning with spirit etc.its funny how everyone does things differently isn't it, and how practices do them differently too!

RE: Shaving for jugular blood samples

talchi — Mon, 26 Nov 2018 15:51:24 GMT

hi, at all the practices I have worked at, it is an opt-in on the consent from.i always like to discuss this when going through the form with the owner, and I always advise that it is a blood sample taken from the neck or fore arm area, and that the small shaved patch will be visible but will start to grow back within a few weeks.ive never had anyone complain about shaving a small patch for the bloods before, however I have had those dreaded clients whose bitch needs an ex-lap, and the clients have had a dog show a few days later, and they get VERY upset when you tell them they need to be shaved!

RE: Shaving for jugular blood samples

Robyn — Mon, 26 Nov 2018 15:30:32 GMT

[quote user="livvy370"]

Apache I offer the pre-anaesthetic bloods to everyone even if they are young and supposedly healthy due to having past experience with a couple of young animals developing unfortunate renal and hepatic problems at a young age.

[/quote]

Me too. We had an 8 month old Lab in for routine castration and discovered *horrendous* renal failure on bloods. He was PUPD at home but the owner thought it was normal because of how active/bouncy he was, of course he'd drink a lot! I'm never pushy about it, but when asked I will say that it's a good idea if it's affordable, and that I would do it for my pets (and I would!).

We routinely clip and alcohol swab before jug samples - we were all (vets and nurses included) taught it's best practice. We don't have a section on the consent form, but I'm fairly thoughrough when explaining procedures to owners so I do discuss shaving/where the sample is taken from.

RE: Shaving for jugular blood samples

apache — Mon, 26 Nov 2018 14:45:27 GMT

I agree for cannulae but disagree for needles. We routinely inject into hairy horses without clipping and prepping (including nerve blocks). I spend most of my time with cattle and never clip or prep for injections, blood samples or even epidurals. Most cattle are blood sampled through the tail vein with a lovely coating of faecal bacteria.

Find me the article, because I want to see the evidence it quotes to make such bold statements.

RE: Shaving for jugular blood samples

bumble bee — Mon, 26 Nov 2018 11:59:31 GMT

I was always taught to clip & prep for any venepucture. Have just read an article on phlebitis which can be caused by introducing bacteria from needles & cannulae. Aseptic technique should always be used.

RE: Shaving for jugular blood samples

Olivia Coulton — Sat, 24 Nov 2018 21:39:23 GMT

My practice doesn't have this written either just whether they want the test, I as the admit nurse will check with the owner as to whether we can clip as lots of showing dogs around and some breeders do not like them clipped, not sure what the other staff do. Apache I offer the pre-anaesthetic bloods to everyone even if they are young and supposedly healthy due to having past experience with a couple of young animals developing unfortunate renal and hepatic problems at a young age.

RE: Shaving for jugular blood samples

Meow1950 — Sat, 24 Nov 2018 17:15:29 GMT

[quote user="Jess Ashby"]

Hello all,

What is everyone's protocol regarding pre-anaesthetic blood tests? Do you have this option on the consent form? If you do - do you mention about a shaved patch and where you obtain the sample from? (jugular/cephalic?)

Recently, a client was quite upset as he/she didn't realise that a shaved patch and a small bruise would be visible after having a blood test when her dog was booked in for a routine procedure. He/She had chosen to have the blood test and given consent but upon discharge 3 days later complained that if she had known how the sample was taken she wouldn't have had it done.

Has anyone had a similar incident? Do people write on consent forms how the test is taken?

Many thanks!

[/quote]

We have the option but I never explain that part of it (unless it is a show dog/cat) never had any issues, but of course there will always be that one person!

Maybe I will start!

RE: Shaving for jugular blood samples

Sal the 1st — Sat, 24 Nov 2018 00:31:25 GMT

[quote user="apache"]

We do have a tick box for pre-op bloods but only advise them when clinically necessary. I believe offering them routinely is unprofessional (no evidence it makes anything safer, not routine in humans). No mention of clipping.

[/quote]

Just for the record - when I was working for one of the corporates was once told 'you are way down on your lab figures, you need to be taking more pre ops to bring the figures up' told me all I needed to know really

RE: Shaving for jugular blood samples

apache — Sat, 24 Nov 2018 00:04:04 GMT

Do you even need to clip for a jugular blood sample? I don't routinely. I've not seen anything testing this in dogs, but there is evidence showing it is not necessary with joint blocks in horses. Unless it's a very hairy dog and I can't feel the vein I rarely clip for jugular samples. I would always clip if leaving something like a cannula in a vein.