Catheters

Re: Catheters

Claire Cameron — Sun, 14 Mar 2010 10:54:13 GMT

[quote user="Ding"]I personally dont think its necessary unless the animal is a risky anaesthetic[/quote]

I have had 2 cat castrates turn out to be complicated anaesthetics recently. Healthy cats, no problems reported but needed IV access on both occassions....no-one knows how each patient will react to an anaesthetic

[quote user="Ding"] i think it causes stress to the animal placing catheters unless theyre sick.. [/quote]

You could use EMLA cream to reduce stress? Surely you need intravenous access is required to administer anaesthetic anyway so may aswell place a catheter then?

[quote user="Sam Leeks"]We dont risk it. We have had very few problems in the 5 years i have worked at my practice, but if there was ever any problems the vet can administer drugs so quickly as the catheter is there.[/quote]

I agree! I have had very few problems BUT some of the problems I have had have been with routine procedures. You just never can predict how a patient will react.

[quote user="Sam Leeks"]. I dont think it stresses the animals out at all, they're premedicated anyway, and to be honest conscious patients react less to this than an i/m injection[/quote]

I second that

Re: Catheters

Saskia Quinn — Sat, 13 Mar 2010 22:25:57 GMT

[quote user="Vicky VN"]

[quote user="SaskiaVN"]

It really is remarkable the amount of practices who dont routinely place iv catheters! In the days (until very recent) of thiopentone induction, did your vets give it straight i/v or through a catheter where they were sure of venous access?

[/quote]

When we used thio / saffan i/v cathers were never placed, the boss would never allow it! But then he only told us to wear latex gloves as our only PPE during chemotherapy too.... Very luckily there were only a few perivascular cases, 1 did result in some sloughing but the others had immediate saline flush and were fine after this.

[/quote]

I understand exactly where you are coming from Vicky!!!

I remember injecting sterile water through an insulin syringe when thiopentone went perivascular!! It must have done the trick as never had any patients back with problems, but I guess they were the lucky ones!

Slightly off topic - but in the days before gaseous anaesthesia was the 'norm', I remember the i/m anaesthetic - 'Immoblion' where dogs were VERY sensitive to noise and had to have cotton wool placed in their ears!! The amount of phonecalls and revisits to the surgery as a result of forgetting to take the cotton wool out was unbelievable!

Re: Catheters

Maisy — Sat, 13 Mar 2010 22:15:49 GMT

Also I think a lot of the time placing i/vs pre-op is something nurses tend to do rather than vets anyway. My most recent boss was fine about all patients having catheters placed before ops but if we were short on nurses and didn't manage to catheterise before he was due to operate, he wouldn't place one and constantly had to be reminded. Same with quite a few of the other vets I've worked with too.

Re: Catheters

Maisy — Sat, 13 Mar 2010 22:12:49 GMT

[quote user="SaskiaVN"]

[/quote]

Re: Catheters

Saskia Quinn — Sat, 13 Mar 2010 22:05:31 GMT

The reason I am asking is because the effects of perivascular thiopentone caused severe tissue damage in the effected area which normally was the cephalic vein and worst case scenarios were skin sloughing.

Did you ever experience the effects of perivascular thiopentone? and if so, what was done about it? Just curious

Re: Catheters

Vicky RVN — Sat, 13 Mar 2010 21:49:15 GMT

[quote user="Ding"]i think it causes stress to the animal placing catheters unless theyre sick.. [/quote]

But if you've giving iv anaesthetic then what is the difference? We generally use catheters for most ops.

Re: Catheters

bongo — Sat, 13 Mar 2010 13:17:28 GMT

We place them for all apart from cat spays/castrates. If there is any doubt I will have one ready and then the vet is more likely to put one in!

I couldnt think of anything worse than having to gain i/v access in the heat of an emergency!!

Re: Catheters

Sally Seddon — Sat, 13 Mar 2010 11:28:01 GMT

We dont routinely place iv caths, we are trying to get into doing it tho. I work in a practice where change does not happen very often! Some of the nurses that i work with have been there for ever and do things 'the way they always have done', this gets a bit annoying really.

I personally find it easier if a cath is in place when the vet comes to ga an animal. Dont know if anyone else has noticed but i dont think animals tend to jump as much when a cath is being placed as they do when injected iv (hope that makes sense). Obviously if iv access was needed during the ga then its already there and makes everything quicker and easier.

Re: Catheters

Kim Buckley — Sat, 13 Mar 2010 10:47:37 GMT

The other reason I would like to see them placed is due to the amount of times I've seen vets *** up getting an I/V. It makes it so much more stressful to the animal. I've been in practice on and off now for 6 years and in that time I've seen at least 4 animals die post routine op. That's enough for me to want catheters placed in all anaesthetics!

Re: Catheters

dinkyd — Sat, 13 Mar 2010 00:17:31 GMT

Its purely down to experience.In My previous practice iv lines were not routine and yes I did experience problems-not often but once is enough!

Where I am now, all patients have iv lines placed except cat castrates-and our cat spays are D/T/K and are intubated.

All our refferal cases have iv lines placed for surgery.

Re: Catheters

Nick Shackleton — Sat, 13 Mar 2010 00:15:35 GMT

[quote user="Ding"]

[quote user="Nick Shackleton"]

[quote user="dinkyd"]

Ok so for those nurses who feel iv access isnt a problem....just when does it become a problem?

Your "routine neuter" may just be that ......BUT it only takes ONE patient to become that problem and that is when iv access is a problem when you scuffle about trying to find your iv line,et tube,tape, circuit etc.......that iv line is crucial!Could that have been your one patient you could have saved?

[/quote]

I couldn't agree more!!! sure a couple of extra quid if worth it if it saves a few lives.......

[/quote]

just out of interest- have you both had problems in practice before i.v catheter placement was common place? Im not being obtuse - just an honest question! Just wondering how often emergencys happen needing i.v access..and did the patient die as a result?

[/quote]

Until recently I worked in a practice that used IV catheters routinely (last 5.5years) can't really remember much before that (must be age related) lol

but having IV access has saved precious time in emergency situations and where aggressive fluid therapy needs to be given in cases of blood loss/hypotension.

Like I said before if you went into hospital for a hysterectomy would you really expect to hear the anaesthetist to say "oh well we don't need iv access and she don't need fluid therapy, she's only getting spayed/speyed/neutered* after all"

*delete as appropriate

Re: Catheters

Heidi O'Toole — Sat, 13 Mar 2010 00:05:47 GMT

[quote user="Nick Shackleton"]

[quote user="dinkyd"]

Ok so for those nurses who feel iv access isnt a problem....just when does it become a problem?

[/quote]

I couldn't agree more!!! sure a couple of extra quid if worth it if it saves a few lives.......

[/quote]

Re: Catheters

Nick Shackleton — Fri, 12 Mar 2010 23:12:25 GMT

[quote user="dinkyd"]

Ok so for those nurses who feel iv access isnt a problem....just when does it become a problem?

[/quote]

I couldn't agree more!!! sure a couple of extra quid if worth it if it saves a few lives.......

Re: Catheters

dinkyd — Fri, 12 Mar 2010 23:09:57 GMT

Ok so for those nurses who feel iv access isnt a problem....just when does it become a problem?

Re: Catheters

Heidi O'Toole — Fri, 12 Mar 2010 22:16:36 GMT

ooh interesting discussion!

I agree with both 'sides' haha- i feel that the way things run in my current practice is sufficient. i dont feel the need to have to bring it up as a problem -or suggest that what we do already isnt 'gold standard' as i feel an animal wouldnt be put at risk, on purpose in any way,i understand and am not niave to the fact that 'routine' ops can go 'wrong' and you do need i/v access quickly but it has never become a problem , theres never been that moment where ive even thought that things need to be reviewed...thats just my opinion though - after discussing it here, i will ask everyone in work how they feel to see if they feel the same....its is defo good practice though!!

bet you all scrub up to do ops too!!. . ONLY JOKING! lol.

Re: Catheters

loobylou — Fri, 12 Mar 2010 22:05:46 GMT

We place iv canulas in all our ops except cat castrates. We have only recently implemented this but we all feel happier to know we have iv access if anything does go wrong.
Placing a canula should be no more stressful than administering an induction agent 'off the needle' and will reduce the risk of perivascular administration.

Re: Catheters

Sam Leeks — Fri, 12 Mar 2010 22:05:04 GMT

I also wouldnt want to wait until patients die to put something like placing catheters routinely into practice. Surely if we can do everything we can to prevent problems occuring we should. It doesnt take long to do and far less stress for everyone.

Re: Catheters

Nick Shackleton — Fri, 12 Mar 2010 21:56:20 GMT

that's good asking lots of questions!!!

I would also add, it's very hard to place an iv in a patient when it's in dorsal recumbency and in the 'heat' of the moment!!!

Re: Catheters

Phrin Vernon RVN — Fri, 12 Mar 2010 21:54:14 GMT

[quote user="Ding"]

oh right, fair enough. we dont place them routinely. We have had little to no problems for animals with anaesthesia and having to administer i/v drugs... It is good practice, i agree, but if tis not broke- dont fix it...?

[/quote]

I agree - It's good practice. We too have had little difficulty in getting IV access when needed if a catheter has not been placed. Personally (and you must forgive me - I am studying anaesthetics at college at the mo - I go into overdrive about whatever the current subject is LOL), I think that the catheters usefullness in providing a stress free induction is hugely beneficial. We have been learning this week about how a stressful induction can cause release of catecholamines, which can lead to an unstable and difficult GA.

The vets at work get sick of me blathering on, and questioning them about a different subject every Wednesday...... the day after college!!

Re: Catheters

Nick Shackleton — Fri, 12 Mar 2010 21:50:08 GMT

[quote user="Ding"]

[/quote]

I would think that IV catheters are part of gold standard anaesthesia and therefore best practice! Things are only 'routine' cos we do them day in day out, don't mean that things can go wrong.

I've seen 'routine' procedures bleed heavily during the surgery. luckily we had iv access and therefore rapid fluid therapy treatment could be given.....

I personally think it should be standard. Would you have a hysterectomy without the surgical team having IV access??? Why should it be different in dog and cats.

Re: Catheters

Heidi O'Toole — Fri, 12 Mar 2010 21:46:19 GMT

Re: Catheters

Nick Shackleton — Fri, 12 Mar 2010 21:46:10 GMT

[quote user="phrin"]

We try to in all but cat spays & castrates. The nurses usually place them whilst pre-medding - means that when induction time comes round the animal is nicely sedated, IV access is ready, induction is stress free, and the whole GA improves!

The catheters are included in the price of our GA's so we have no problems on that front. Some of the vets are still a bit reluctant for some unfathomable reason, but as I said, the nurses usually just place one at premed time - job's a good 'un! Lol!

[/quote]

nice one!

Re: Catheters

Phrin Vernon RVN — Fri, 12 Mar 2010 21:42:09 GMT

Re: Catheters

Sam Leeks — Fri, 12 Mar 2010 21:37:43 GMT

All procedures have catheters placed, even cat castrates that are over in minutes. We dont risk it. We have had very few problems in the 5 years i have worked at my practice, but if there was ever any problems the vet can administer drugs so quickly as the catheter is there. I dont think it stresses the animals out at all, they're premedicated anyway, and to be honest conscious patients react less to this than an i/m injection.

Re: Catheters

Kim Buckley — Fri, 12 Mar 2010 16:46:37 GMT

It's something I would like to see done in my practice.