RVNs and Anaesthesia- YOUR views needed!

Re: RVNs and Anaesthesia- YOUR views needed!

zalenski81 — Sun, 13 Oct 2013 22:47:40 GMT

Only just seen this but agree with most of the above posts. Have often wondered why we can't have different grades of nurses who have completed further exams in different skill sets such as epidural and minor surgery so that there is a clear indication of the level of competence in performing these tasks. Like human nurses have different grades.

Re: RVNs and Anaesthesia- YOUR views needed!

Craig McDonald — Sun, 18 Aug 2013 19:22:52 GMT

•how often do you currently work outside the current laws? i.e move the vaporiser tec off your own back? All the nurses at our practice do this. I do check with the vet sometimes like if I think we could need another drug or domitor needs reversing etc but usually I just judge and change accordingly like the other nurses. •Should nurses be allowed to induce using incremental drugs? I have done this several times, given propofol the vet has said upto the maximum does for its weight but if I can tube before I will and will tell the vet this or will ask for more propofol the vet is always in the room and able to stop what they are doing to come and assist if needed. •Should nurse be able to provide analgesia? It would be good to be able to provide the RTA cat with some pain relief but lots of variables and possible contraindications to consider so I don't know about that one really. •What techniques should nurses be allowed to do? - jug cath, epidurals, local blocks... Some nurses are already doing this in practice, we don't tend to do any of the above, have injected local anaesthetic before during an operation when the vet has been next to me scrubbed up and instructing exactly how much and where. •Should any nurse be allowed to do the above or should you have to do another qualification? I think more career progression would be good so that we can have nurse practitioners and prescribing nurses, dental nurses which can do extractions and advanced surgical nurses which can do more surgery. •What should a 'body cavity' mean? As everyone else, abdo/thorax •Where should the line be?... I don't think we should be mini-vets, nurses and vets have different skills which should complement each other well so we can all work as a great team.

Re: RVNs and Anaesthesia- YOUR views needed!

WTF_dinosaur — Sun, 18 Aug 2013 13:21:08 GMT

how often do you currently work outside the current laws? i.e move the vaporiser tec off your own back?

This is a huge thing in our practice, i always try to stick within the current law but constant communication with my VS, i will always mention to them how the anesthetic is going and always mentions when im turning down with a 'turning down from 3-2.75 (use sevo) are you ok with that' normally get a grunt reply but i feel im staying within the law. This may be partly from still being a newbie qualified nurse but may also be partly just the kind a person i am.... only time will tell.

Should nurses be allowed to induce using incremental drugs?

This is a tricky one, we know our stuff were not stupid surely as long as a VS has said the choice of drug can we not give to effect? after all we are all capable of placing a E.T. tube.

Should nurses be allowed to change the iso tec?

In my opinion yes, we're the ones monitoring the anesthetic we're the ones who can see how our patient is doing.

What techniques should nurses be allowed to do? - jug cath, epidurals, local blocks...

I think this should be entirely at Veterinary discretion, if a VS is happy their nurse is capable then why not!

Should any nurse be allowed to do the above or should you have to do another qualification?

I cant see the harm in training us for these then as previously said, at veterinary discretion.

What should a 'body cavity' mean?

Actually going into a body cavity, but then i feel there is no reason as to why we should not be able to do a basic castrate, and dental work.

Where should the line be?...

When entering through and past muscle layers.

Re: RVNs and Anaesthesia- YOUR views needed!

Lauren Valentine — Sun, 18 Aug 2013 12:18:59 GMT

how often do you currently work outside the current laws? i.e move the vaporiser tec off your own back?

Every anaesthetic, in my experience most vets are happy with me being able to judge when I need to change vapouriser settings, and quite often get the response 'I have no idea, thats your department' especially from older vets, in recent years I have found new grads having more of in interest in the aneasthesia side of things (possibly due to more lectures/theory at uni) but ultimately they are happy to leave it to the nurse as we have more experience than them.

I currently work in a university hospital and help teach aneasthesia to vet students while the vet teaches surgery. I think I would be quite frustrated if I had taught a student one year and then worked with them after graduation for them to then tell me how to deal with my GA. Having said that, if my Ga is particularly tricky I do always keep my vet informed incase i need a decision re intervention/drug addition.

Should nurses be allowed to induce using incremental drugs?

Yes, we have the training in place for introducing ET tubes so as long as the vet is happy with the competence of their nurse then they could leave them to induce and connect the patient freeing up vet time. WE have seen enough indutions to know how this is done and I'm sure many of us have induced them for practicality reasons.

Should nurses be allowed to change the iso tec? See anser 1

Should nurse be able to provide analgesia? YES! What is the point in asking a nurse to triage a potentially painful patient if they cant help reduce suffering.... is this not why we want to nurse in the first place. Human nurses have this responsibility. As for not wanting to interfere with the vets treatment plan should they decide om something else, Maybe a practice protocol is put into place to ensure that the patient is pain free without restricting the vets choices too much. Many of our emergency patients are not stable enough for surgery asap anyway so pain relief can be changed further down the line after an initial dose.

What techniques should nurses be allowed to do? - jug cath, epidurals, local blocks... Yes and if there are concerns re training then we should introduce these skills into the nurse qualification or have an added qual so these nurses are then registered to do these procedures. I think hospitals and GP surgeries have nurse practioners that are allows to do more than other nurses.
Should any nurse be allowed to do the above or should you have to do another qualification? see above
What should a 'body cavity' mean? chest/abdomen

Where should the line be?...It is a fine line as there as some nurses that I wouldnt want near my pet but I also feel the same about some vets. Dentals I am unsure on, it might make life easier if nurses were allowed to perform these and I think in some countries they are but their qulaifications take less time to study and they are not regulated there. Seems wrong. Only dentists are allowed to remove teeth in humans, theres no chance I would let a dental nurse near my mouth. So I guess I feel this should be a vet job, but one with adequate experience and new grads should definitely be supervised.

To add, our human doctors are still supervised for 1-2years post grad, and everything is signed off, maybe this would benefit the veterinary industry as new grads get very little training in non routine procedures and sometimes it is beyond shocking what they don't actaully know!!

Hope this conritbutes to your research

Lauren :)

Re: RVNs and Anaesthesia- YOUR views needed!

Nicola Smith — Wed, 31 Jul 2013 11:23:56 GMT

In our practice nurses monitor patient and alter vaporiser accordingly, we might mention when turning up or down but not always as a rule. IMO many nurses know more about monitoring ga, circuits, flow rates etc - most vets I have worked with would not know which circuit to choose, what flow rate to use etc, or what the capnograph might be telling us. IMO the vet often cant be concentrating on what they are doing at their end and thinking about whether to turn the animal up or down - in most general practices we do not have another vet on hand when operating - it is a vet performing the op and one or two nurses doing ga and assisting as needed. I think it should be a qualified nurse monitoring anaesthesia - or in the case of trainees there should always be someone else on hand to assist if required. When I first started in practice I was sent into theatre to check the bag was moving and the eye was down and that was it - I do not think this is acceptable - monitoring anaesthesia needs training and an understanding of what the obs mean and why they might be happening in order to correct potential problems.

I think all nurses should be able to intubate all patients - this may be required in an emergency - and the only way of keeping your hand in is by practising regularly. All nurses should also be able to IPPV etc and know what to do in a crash situation.

Incremental anaesthesia is difficult - I have seen vets overdose when doing this particularly if using unfamiliar premed agents so do think this is best left to vets, or by a nurse when a vet is on hand should a problem occur - eg in the same room. It shouldn't be done by a nurse when no vet available.

Other more advanced procedures such as epidurals etc would all require more training but I think if a nurse has been adequately trained and there is a vet on hand for any problems then fine.

Analgesia is a tricky one - I can see how it would be nice to be able to give the rta analgesia straight away but with so many options and not knowing which the vet would want its difficult - esp with consideration for potential side effects eg nsaids and renal function, and many analgesics being controlled drugs. I see no problem with calculating and administering though as long as competent and ok'd by vet eg over phone if not available immediately.

Body cavity is abdomen and thorax

Dentals - I think scale and polish often best done by nurse as we are often more thorough as have more time, but even with this nurses should be taught how to do it properly and not just told to do it. I think extractions should be able to be done by nurses but only those with a specific extra qualification and training and only with vets approval and vet on hand - more difficult extractions should still be vet such as those requiring surgical flaps etc.

Re: RVNs and Anaesthesia- YOUR views needed!

Siobhan Steven — Wed, 31 Jul 2013 10:05:00 GMT

I work as a full time Anaesthesia Technician at a veterinary university.

I induce and intubate various species for procedures, and teach vet students how to. On, cats, dogs, horses and exotics.

Yes, we provide analgesia, I set up and administer CRIs and TIVAs using various drugs, ketamine,fentanyl, lidocaine, propofol, alfaxalone etc...

I do epidurals, local blocks, place jug catheters and place arterial lines

A body cavity is an abdomen/thorax

Yes, we adjust the vapouriser on our cases.

I do all of these procedures with a boarded (European or US) anaesthetic specialist on hand, they may not be in the room but are contactable by two way radio. We have constant tutorials and ongoing training, as far as anaesthesia is concerned my thoughts are nurses are as capable if not more so than some vets in performing these procedures but they need to definitely have training and an extensive knowledge of pharmacology, anatomy and physiology etc.

I have done cat castrates and tooth extractions in the past (not much lately as an anaesthetist), again, these procedures could be performed by a nurse with further CPD and qualifications. I certainly wouldn't want a nurse, or a new grad vet getting 'practice' on my animal.

Re: RVNs and Anaesthesia- YOUR views needed!

fairy — Wed, 31 Jul 2013 09:44:50 GMT

· Should nurses be allowed to induce using incremental drugs?

No- too much scope for error.

· Should nurses be allowed to change the iso tec? Yes, with ongoing communication with the vet

· Should nurse be able to provide analgesia? Difficult one. Especially with RTAs coming in. I would say no. Not without dicussion with a vet. Just because, the vet may want to place the animal under Ga, or may have a different pain management plan than the nurse. What the nurse has given may affect the plan the vet had in mind.

· What techniques should nurses be allowed to do? - jug cath, epidurals, local blocks – . Epiduals and local blocks, no. I would class this as incremental doses into the nervous system and therefore similar to giving propofol. Again, too much scope for error. Jug cath- Unsure.

· Should any nurse be allowed to do the above or should you have to do another qualification? See above

· What should a 'body cavity' mean? Abdo, chest.

· Where should the line be?... I still think nurses shouldn’t be performing cat casts. I think scale and polish is fine and removing teeth if they are falling out. Extractions with tools should be preformed by a vet. I agree that nursing should be progessive but I sometimes think that going back to basic nursing is extremely important.

Re: RVNs and Anaesthesia- YOUR views needed!

Laura Ringsell — Wed, 31 Jul 2013 07:15:09 GMT

I am not going to re- answer as I generally agree with everything Teri-Ann has said but will just add a couple of bits. Inducing - nurses must also be more than competent at placing et tubes in animals of all sizes to avoid too long taken and the inevitable excitation followed by additional induction agent whilst tube placement is established. Dentals - I am sorry but I do not agree that nurses should be able to do extractions unless specific training such as it is incorporated into the BVNA dental course has been undertaken. Broken roots which are then burred away and fractured jaws happen too easily and I think this should be left to someone with the proper training ( I agree vets don't get enough) and who is going to take responsibility. In addition, if a nurse is going to do the dental then the owner must be made aware of this. I would worry that this may turn into a monitoring and doing procedure as they are always left to the end of the day when everyone has had enough. I would rather see appropriate charting and xraying as the nurses responsibility. Sorry for disagreeing on this one.

Re: RVNs and Anaesthesia- YOUR views needed!

Louisa Slade — Tue, 30 Jul 2013 16:34:58 GMT

Heya

I generally always change the iso settings without asking the vet, i yet them know in a general sense after, i.e i've turned fluffy down a bit, let me know if anything changes your end. we also sell pom -v wormer's and flea tx without a vet being on site although they have been pre authorised for the year.

I don't see a problem with inducing with incremental drugs while the vet is around, I certainly wouldn't want to while the vet was busy elsewhere. I think this would be more down to whether the nurse is confident to do so and the vets feel they can do so safely.

Being able to give analgesia tot eh RTA that turns up while the vets are at lunch would be great but I can't see man vets liking that due to the side effects that come with the drugs. Here as well its only the vets that have the DD cupbard code so thats not a possibility.

Having never done any of the techniques above i wouldn't not feel happy about doing them without a lot of training. Also that maybe helpful in practices that see a large volume of such cases as id imagine that there case load would be quite heavy.

I don't see why nurses don't do cat castrates. Its a very quick and simple procedure. i think its something that nurses can be trained to do once in practice as the vets there can decide if the nurse is suitable trained.

Further training in anaesthesia I think would be a good idea. especially in species such as rabbits. we see a lot at my practice but the amount of students who come over on rotation and have no idea how a rabbit behaves under anaesthetic is surprising. Most are just under the opinion that they die.

Generally i think having to do more qualifications may put people off. Although maybe some formal training for the more advanced techniques may ensure that everyone is working towards the same standards.

Louisa

Re: RVNs and Anaesthesia- YOUR views needed!

shelly jefferies — Tue, 30 Jul 2013 15:58:33 GMT

how often do you currently work outside the current laws? i.e move the vaporiser tec off your own back? ALL THE TIME WITH REGARDS VAPOURISERS, ALTERING LEVELS DEPENDING ON THE DEPTH YOU ARE MONITORING THEM SO KNOW EYE POSITION, BP, HR, RR ETC INFORM VET OF ADJUSTMENTS.

Should nurses be allowed to induce using incremental drugs? YES AS LONG AS THE VETERINARY SURGEON IS HAPPY AND COMFORTABLE WITH THE NURSE IN QUESTION DOING THIS, DONT THINK IT SHOULD BE SOMETHING WHICH IS SEEN AS AN AUTOMATIC ONCE QUALIFIED CAN DO THIS, THE NURSE MUST BE JUDGED COMPETANT BY THE VETERINARY SURGEON.

Should nurses be allowed to change the iso tec? AS FOR THE FIRST QUESTION

Should nurse be able to provide analgesia? YES TO A CERTAIN DEGREE, I NORMALLY ASK MY VETS. SOMETIMES FIND THEY NEED A LITTLE PROMPTING FOR APPROPRIATE LEVELS OR ANALGESIA NOT JUST A NSAID.

What techniques should nurses be allowed to do? - jug cath, epidurals, local blocks... I THINK THIS DEPENDS ON THE INDIVIDUAL NURSE AND THEIR POST QUALIFICATION EXPERIENCE.

Should any nurse be allowed to do the above or should you have to do another qualification? ANSWERED ABOVE

What should a 'body cavity' mean? CHEST OR ABDOMEN

Where should the line be?... HOW DIFFICULT, THE LINE SHOULD BE WHERE AN ANIMAL IS PUT AT RISK. DEPENDANT ON THE NURSES EXPERIENCE AND POST QUALIFICATION TRAINING NO DIFFERENT TO HUMAN NURSES. I DO AGREE SOME NURSES ARE BETTER PLACED TO ADVISE NEWLY QUALIFIED VETS ON CERTAIN TASKS AS THEY HAVE OFTEN SEEN LOADS AND DIFFERENT TECHNIQUES.

Re: RVNs and Anaesthesia- YOUR views needed!

Teri-Ann Baldwin — Tue, 30 Jul 2013 15:29:05 GMT

how often do you currently work outside the current laws? i.e move the vaporiser tec off your own back? All anaesthetics, i always tell the vet what i'm doing and have never had a problem. Nurses have enough knowledge to understand when to change and adjust anaesthetic depths as long as they keep the vet updated.

Should nurses be allowed to induce using incremental drugs? If the dose has been correctly worked out and a vet present i can't see why not, this can help the vet. But nurses should be qualified and trained before they are able to do this.

Should nurses be allowed to change the iso tec? Same as answer for Q1

Should nurse be able to provide analgesia? Yes, nurses have the knowledge to assess whether an animal is in pain. Providing basic analgesia would mean nurses are complying with the animal welfare act by preventing pain and suffering to an animal in their care. Nurses can also tell the vet what they are doing if needs be. But a qualified and experienced nurse should be able to administer a POM-V medication.

What techniques should nurses be allowed to do? - jug cath, epidurals, local blocks... If we have been trained adequately i see no problem in a nurse being able to do these things as we do similar things anyway. If it's an issue for an employer then CPD could be offered for nurses to become more experienced in these areas.

Should any nurse be allowed to do the above or should you have to do another qualification? An RVN should be able to do these things without extra training if confident but extra training could be offered if needed. As said above vets are allowed to do these things straight from uni so nurses should not need an extra qualification. We are just as qualified.

What should a 'body cavity' mean? Abdomen or Chest

Where should the line be?... I also agree and think nurses should be able to do dentals, i've had to explain to vets how to do extractions and i've never extracted a tooth in my life only ever seen my old vet do them and explain to me the procedure. Nurses are just as qualified to extract teeth and most see more dentals than vets anyway. One new grad vet even admitted to me they're never shown how to do dentals. Some vets do butchers jobs, nurses should definitely be allowed to do dentals again.. And cat castrates!

Re: RVNs and Anaesthesia- YOUR views needed!

molladog — Tue, 30 Jul 2013 13:12:41 GMT

Totally agree with all of this post...especially about the Dentals... too many horror stories to list.. I used to show all the new vets how to extract teeth properly back in the 'good old days'

Re: RVNs and Anaesthesia- YOUR views needed!

Helen Tottey — Tue, 30 Jul 2013 12:40:10 GMT

how often do you currently work outside the current laws? i.e move the vaporiser tec off your own back? Every anaesthetic I do, stabilising the patient and reducing to wake up in timing to the end of surgery. I generally always tell the vet if I increase it I suppose just for my piece of mind.

Should nurses be allowed to induce using incremental drugs? I think this would depend on the experience of the nurse and the patient. When I first qualified we were allowed to induce neuters but only with the dose for the weight and that was when we used Thiopentone. The vet was always in the room and took over if necessary

Should nurses be allowed to change the iso tec? I am reading this question as the same as Q1

Should nurse be able to provide analgesia? yes, using the standard practice POM-V drugs to a patient under the practice care if the patient is in pain. other drugs that are "written up" for the pet to have should it be required (nurse judgement" should be able to be given. As an SQP there is a painkiller that falls under this category but I can't remeber what it is!

What techniques should nurses be allowed to do? - jug cath, epidurals, local blocks... I think this depends on additional training in your practice and what your vet has taught you and is confident you are able to do. I think this should be allowed under the RVN qualification as we are trained to know our limits and to identify risks and should not require a further qualification

Should any nurse be allowed to do the above or should you have to do another qualification? As above, I don't think another qualification should be needed however I don't think it should be as easy as "you are a RVN so you can do". using the old "green book" style of evidence of experience and training should be enough and when the vet thinks you are competent you should be able to do. Afterall, vets can leave uni and be allowed to do all of these things without additional training, nurses are far more experienced and qualified that a "day 1" vet or even in a lot of cases a "year 1 " vet.

What should a 'body cavity' mean? Abdominal and chest

Where should the line be?... Dental extractions do not fall under "body cavity" and as above, in my experience I would not allow a newly qualified (or even a lot of older vets) to touch my dog or cats mouth. I see far too many awful dental extractions that we never had when our experienced VN's were allowed to do dental extractions.