Anaesthetic monitoring

Re: Anaesthetic monitoring

Caro Laithwaite VN — Sun, 02 Aug 2009 16:51:34 GMT

As is often said. You can have all the fancy equipment you want but unless someone is 100% trained on the use pros, cons and what happens if something goes wrong it is a waste of time. And peretty much no practice trains it's staff they just buy the equipment then it's use is absorbed by osmosis.

Really useful that.

Re: Anaesthetic monitoring

Kim Buckley — Sun, 02 Aug 2009 16:46:53 GMT

Haha yeah because most of us have really nice well kept nails to file!

Re: Anaesthetic monitoring

Nick Shackleton — Sun, 02 Aug 2009 16:37:32 GMT

[quote user="Kimbo1985"]

One of our vets went on some CPD recently and they spoke a lot about the various monitoring equipment you can buy. The last thing the lecturer said was the most vital and useful piece of equipment is the nurse!

[/quote]

Makes a change! I got told that anaesthetic records are useful as they give the nurses something to do other than file their nails!!!!

Re: Anaesthetic monitoring

Kim Buckley — Sun, 02 Aug 2009 16:16:00 GMT

Re: Anaesthetic monitoring

Nick Shackleton — Sat, 01 Aug 2009 17:28:56 GMT

Do you have a a refractomoter??? Cos you can do a manual serum protein on that.

Re: Anaesthetic monitoring

Deemus — Sat, 01 Aug 2009 16:58:09 GMT

I work in possibly THE most backwards practice in the country. We aren't computerised, have no blood testing equipment (apart from a glucometer which almost caused heart failure in the boss when I bought it), we STILL wet develop and we have NO anaesthetic monitoring machines.

So.... no pre op bloods unless it's really cronky or a clotting defect is suspected. I/v catheters are placed when the Head Nurse (me) creates enough stink it's not worth not doing it. My self and my trainess use a stethoscope or oesophageal stethoscope and or pulses. All my nurses (and myself) monitor eye position, CRT, colour, HR/pulse, RR and anaesthetic levels every five minutes.

I have previously worked in practices (including referral centres) where there is a lot of monitoring equipment on offer. As we are a training practice (yes really, lol) I prefer my nurses to have a real look at the patient. Equipment such as respiration monitors can lead to being relied upon, causing the nurse to record rate but not other observations such as depth and quality of respiration. The beeping of the machine becomes almost a comfort and yet gets zoned out at the same time.

The vet's wear sterile gloves and/or gowns. Masks for dentals but not routinely for other procedures.

Fluids are given on a case by case basis. I have to admit that the vets aren't overkeen on using fluids (even when suggested). Our lot still prefer to use s/c fluids (I can hear the sucking on teeth from here lol).

One major breakthrough recently was the introduction of Vetergesic as a pre med. Caused a bit of a stir and much flapping but they're getting used to the idea. It's even been used at half dose along with ACP for sedation for xrays, GASP!

I feel a bit like I'm swimming against the tide at my current practice but it's better than it was and as they say, Rome wasn't built in a day.

Re: Anaesthetic monitoring

Nicola Smith — Sat, 01 Aug 2009 12:58:16 GMT

Hi,

We offer pre op bloods to everyone, strongly recommend for over 8's.

Everything gets iv catheter and iv fluids throught out, even neuters

In theatre pulse ox and GA chart doing usual obs every 5 mins, with normal or oesoph steth whichever we prefer. Temp monitored including coming round.

Always wear sterile gloves, mask hat etc.

Re: Anaesthetic monitoring

Nick Shackleton — Sat, 01 Aug 2009 11:56:17 GMT

to you jenny!

Re: Anaesthetic monitoring

Anonymous — Sat, 01 Aug 2009 11:51:37 GMT

Thanks everyone, like I said was just interested to see how other places do things... I think I have been spoilt in the practice I work in, we do plus ox, capnography, oesophageal steth, ecg and bp as well as IVFT fluids in high risk cases and pre-op bloods when the vet thinks they are necessary, although they are offered to all patients coming in.

I just got a bit thrown when I've been to practices where monitoring seems to be minimal and the monitoring nurse is often in and out of the room getting other things ready and checking on other patients... Think I know how I prefer to do it all!

Jenny

Re: Anaesthetic monitoring

Nick Shackleton — Fri, 31 Jul 2009 14:25:07 GMT

Don't work in GP clinic 100% referral (soft tissue, ortho and neuro) so here is what we do!

All paitents undergoing GA have IV access
All patients have fluid therapy (10ml/kg/hr)
ECG, HR, RR, Pulse ox, capnograph, BP (oscilmetric, dopler and Direct BP), temp
Pre-op as required (ie the vets decide on a case by case basis)
Oesophagel stethoscopes depending on procedure
monitiored every 5 mins
all patients have access to warm air heater/blankets

Re: Anaesthetic monitoring

Laura Ringsell — Fri, 31 Jul 2009 13:49:02 GMT

Hi there - you are going to get alot of varying ideas here....this is what we do - not necessarily what is ideal or what i wish we did but then that is so often how it is:

only non routines get iv catheters (so no for castrates and spays) unless they are charity cases and then they don't get them either. Used to be iv access for everything but budget needed to be squeezed!
hr, rr eye position crt in prep and then capnography once in theatre - always pulse ox, resp generally bp, rarely temp probe and ecg (vet wont wait while you connect all that stuff)
monitor and record every 5 mins - schering plough do really good sheets but you need to use their products to qualify!)
iv fluids for cats over 8 and dogs over10
pre-op bloods if the owner wants them
don't have oesophagel stethoscope where i am now :(

Here's some more questions you may want to consider:

how long do vets 'scrub' for - i have seen seconds to 10 minutes for a cat spay

do they wear surgical gloves for all procedures

what types of circuits are in use - and does o2 get adjusted by people who pay the bills:) not by the nurse calculating the TV?

what suture material is used

Re: Anaesthetic monitoring

Edwina [Eddie] Norbury — Fri, 31 Jul 2009 12:51:44 GMT

Hi there, this is what we do. Always offer pre ga bloods taken from jugular.IVFT to all sick animals and anyone over 9-10yrs old.A catheter is aways placed.

Prep room-- we use a pulse oximeter and capnograph. we record this every 5 mins on a hospital form alongwith record of eye position,pupil size,blink reflex jaw tone,crt,mmb colour,pulse, and heart rate, resp rate.

Once in theatre we add ECG and blood pressure and a temp probe.And a reflective heat mat. We can also place an oesophageal stethoscope.All recorded every 5 mins. Exhausting!! Oh and dont forget to watch the re-breathing bag to make sure animal is still live-cant trust machines!!

Re: Anaesthetic monitoring

Caro Laithwaite VN — Thu, 30 Jul 2009 21:09:00 GMT

If you look up in the education section under veterinary nurses wiki you will see several monitoring forms up there (menu on the right) I think l have a couple more to add if l can find them. And always looking for others..... (anyone this is a broad hint)

Re: Anaesthetic monitoring

Anonymous — Thu, 30 Jul 2009 21:04:57 GMT

Oh, one more thing...

Do you routinely place i/v catheters for ops, or is the induction agent just given directly i/v?