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VETERINARY PROCEDURES

6/10/00

General Duties and Responsibilities:

The mission of the post-operative care program is to diagnose, treat and prevent disease, pain, discomfort or distress in dogs, cats, swine and ruminants that have experienced general anesthesia or an invasive procedure at the Academic Health Sciences Center under a protocol approved by the University Animal Care Committee.

Attending Veterinarian: The attending veterinarian is responsible for overseeing all aspects of the program, including:

• Design of the facility (in consultation w/ Manager)
• Designation of job responsibilities
• Developing and recording assessment and plan for all clinical cases
• Management of all preventative medicine programs
• Determining contents of inventory
• Being available for consultation (or designating another veterinarian)
• Communication with post-op veterinary technicians, responding to any problems or concerns
• Communication with investigators and their staff about cases and protocol issues
• Communication with animal care supervisors and technicians
• Communication with veterinarians and veterinary technicians in other areas of RAR
• Maintaining compliance with all Animal Welfare Regulations
• Maintaining compliance with Occupational Health programs

Veterinary Technician(s): The veterinary technician(s) is responsible to:

General:

• Communicate with attending veterinarian, advising on any problems or concerns
• Communicate with animal care supervisors and technicians
• Communicate with investigators and their staff
• Communicate with veterinarians and veterinary technicians in other areas of RAR
• Maintain compliance with all Animal Welfare Regulations
• Maintain compliance with Occupational Health programs

Each Shift/As Needed:

1. Walk through the runs and make a general assessment of each animals condition
2. Complete examinations and clinical plan as outlined by the attending veterinarian (longer treatments or routine samples may be delayed until later
3. unless attending veterinarian instructs otherwise)
4. Record observations and treatments given in the post-operative care record
5. Record assessment and develop a clinical plan when possible; consult with attending veterinarian when needed
6. Administer fluids and other time-consuming treatments
7. Collect and submit laboratory samples
8. Admit animals as they come in
9. Clean work areas

Daily:

• In AM write discharge sheet and contact investigator. Determine who is responsible for any after-care and notify the appropriate person
• In AM complete the census sheet for all animals that were in Post-op overnight, separating those under Post-op care and those under general housing
• Write up Medication sheet
• Perform visual inventory and re-stock as needed, ordering if needed

Weekly:

• Complete records of discharged animals, bill for services, submit to attending veterinarian for case summary, file records that have been entered into computer
• On Thursday, prepare weekly case summary for clinical conference.
• Summarize general problems and trends, select several interesting or instructive cases for presentation.
• On Friday, write PM weekend treatment list for supervisors and prepare medications for supervisors. Consult with attending veterinarian to limit PM treatments to those necessary for the continued clinical improvement and comfort of the animals. Limit treatments to those given PO to cooperative animals, IV to animals with IV catheters, or SQ or IM injections except for swine.

Biweekly:

• Perform formal inventory and order needed supplies

Monthly:

• Meet with attending veterinarian to discuss general issues

Specific Protocols:

Anesthetic Recovery- Staging:

Stage 4- Animal in unconscious or semi-conscious and in lateral recumbency. Body temperature, heart rate and rhythm, pulse, respiratory rate and character, capillary refill time and state of hydration are assessed at least every two hours. The condition of the surgical site is monitored and analgesics are administered when the animal becomes semi-conscious.

Stage 3- Animal in conscious and all reflexes are present. The above items are monitored, but less frequently- approximately every 8 hours. Analgesics are continued.

Stage 2- Animal is either sternal, or can stand and move about, but is may show some sedation, ataxia, hypothermia or dehydration. Animal is monitored every eight hours for above items, but attitude, activity, food and water consumption are also assessed.

Stage 1- All functions are normal, unless altered directly by the experimental procedure. Animal is monitored every 12 hours for above items. When there are no clinical problems, or signs of pain, discomfort or distress, the animal can be discharged.

Drug Administration

• Any changes from the listed guidelines must be approved by the attending veterinarian and written in the animal's record
• Any drugs other than those listed below must be given or discontinued only on the order of the veterinarian or the investigator and must be recorded in the record
• If an animal is unable to take prescribed oral medications, a parenteral equivalent should be substituted

  
  Analgesics

  • Administered for the first 3 days post-operatively and PRN thereafter
  • RAR's Standard Post-Operative Analgesia . 
  • First line analgesics are buprenorphine BID-TID at 0.01-0.1 mg/kg in swine and 0.01 mg/kg in other species; or butorphanol at 0.2 mg/kg TID-QID.
  • If swine do not have an IV line placed, immediately following administration of the first dose of buprenorphine, a fentanyl patch is placed on the dorsal aspect of the pinna.

  Antibiotics

  • Given to animals with incisions or IV lines
  • Given for 10-14 days, or until the sutures or IV line are removed
  • Broad-spectrum- ceftiofur (Naxcel) at 5 mg/kg SQ or IV SID or Clavamox 11 mg/kg PO BID, PRN thereafter

  Antipyretics

  • Administered to swine with a temperature >104 F
  • Other species with a temperature >103 F
  • Use dipyrone at 50mg/kg. Re-dosing requires approval by veterinarian

  Fluids

  • May be administered SQ or IV to any animal with >5% dehydration
  • Total daily volume must not exceed the fluid lost (% dehydration x body weight) plus the daily maintenance (80 ml/kg/day)
  • Fluids may be given full bore to a total volume of 80 ml/kg to any animal that has not had any type of cardiac manipulation if it is in shock

  Anesthesia or Sedation
  An animal, even if in distress, should not be anesthetized or sedated before a veterinarian has assessed it, unless: it is necessary to perform a live-saving procedure, such as intubation, removal of an obstruction, or prevention of injury. If injury can be prevented in another way such as restraint, wrapping or dimming the lights, that should be done first.

Billing for Services- Post-op per diem is charged for any animal that has spent the night in post-op, even if a morning examination has not been performed. Post-op per diem includes examinations and medications. Administration of fluids or other treatments are billed to the investigator. Time for procedures performed is billed in 15 min increments, in additon to the cost of the procedure.

Record Keeping- The basic function of the record is communication of case information to other people, possibly in the distant future. With that in mind, the following guidelines should be followed:

• Cover (Data) Sheet- Signalment, Description of Experiment, Medications and Post-Op Requests are filled out by the investigator, but the veterinary staff should ensure that is is complete. Drawing on the picture is for convenience; it is not required. Drug treatments and major problems (any problem greater than 24 hour duration or that is listed under euthanasia criteria) should be entered on the cover sheet. The computer case summary is filled out after the animal is discharged by the veterinary technician or attending veterinarian.
• Daily Examinations- Anyone who is involved in a case should record their observations, assessment, plan and treatments. Keep record entries brief and to the point. Enter information using appropriate medical terminology. Extra information that is not directly related to the above should be included as a post-it note that is not retained with the permanent record.
• Paper records should be kept in black or blue ink. Do not white-out entries. If a mistake is make, cross through and initial it.
• Record entries must be marked with time, date and initials

Disease and Injury Prevention

• Outer clothing worn when working with animals should not be worn outside of the facility
• Gloves should be worn when handling animals, or hands should be washed afterward
• Sharps must be disposed of in red plastic sharps containers. Needles should not be re-capped unless necessary, and then only using a one-handed technique.
• Animals that are quarantined on order of the veterinarian must be handled last. Gloves and shoe covers must be worn and discarded afterward (or boots with a foot bath may be used), and a separate lab coat must be worn and removed afterward.

Euthanasia- a separate list of post-op euthanasia criteria is available. These are guidelines. Euthanasia decisions should be made based on the animal's clinical condition and prognosis along with the experimental endpoint and euthanasia criteria indicated in the protocol. In general, an animal should only be euthanized on order of an investigator or veterinarian, unless in an emergency situation as described below.

Medical Problems

Nonemergency Conditions should be discussed during the veterinarian's morning or afternoon rounds, or as time permits in between

Emergencies- Contact veterinarian if time permits. If veterinarian or investigator are not available and you are unable to control the emergency, euthanize the animals if it is in distress.

Cardiopulmonary arrest

1. Examine airway to determine if there is a blockage. Remove blockage. Intubate if necessary.
2. If animal is not breathing, perform assisted respiration, continue at least 1 breath/15 s throughout procedure
3. Determine if heart is auscultable. If not, if available, administer epinephrine IV or intracardiac at 1 ml of 1:1000 per 10 kg, and/or perform cardiac massage
4. If cardiac function has not returned after 3 min, or if respiratory function has not returned after 10 min, discontinue cardiopulmonary resuscitation
5. If animal experiences cardiopulmonary arrest a second time within 12 h of the first episode, do not attempt to resuscitate

Seizures- only for Status Epilepticus (uncontrolled major muscle activity with unconsciousness)

1. Isolate animal from other animals and from hard or sharp objects
2. Administer diazepam at 0.5 mg/kg IV. Re-dose if necessary
3. If no response is seen, administer barbiturate to effect: phenobarbital at 10 mg/kg IV, slowly, thiopental at 10 mg/kg, pentobarbital at 25 mg/kg.

Pulmonary edema

• Assess for edema. Signs include the following: dyspnea, crackles in lung fields, ± foamy oronasal discharge
• Administer furoseamide (Lasix) at 1-5 mg/kg IV or IM

Abdominal Wall Dehiscence

• Prevent animal from contaminating internal organs, wrap or restrain animal
• Contact investigator and veterinarian
• If this is the second occurrence, the animal should be euthanized

Shock

1. Attempt to determine the source of the shock
2. If animal is on a cardiac study the veterinarian or investigator should be contacted
3. If the animal is not on a cardiac study, administer fluids for shock as directed under "Drug Administration- fluids"
4. If the animal is hemorrhaging attempt to control it by applying direct pressure