How many technicians does it take to place an I.V. catheter?
a). One: if your patient is in a complete coma but has stellar blood pressure.
b). Two: if the patient is fairly agreeable and also a manageable size.
c). Three: if your patient is any variable of a Pug. One to roll the arm for placement, one to place the catheter, and one to administer oxygen flow-by while monitoring the degree of purple the tongue is turning. 🙂
d). Four: if the patient is very sick, 80+ pounds, has a heart condition and REALLY wants to eat you.
How many technicians does it take to place an I.V. catheter?
a). One: if your patient is in a complete coma but has stellar blood pressure.
b). Two: if the patient is fairly agreeable and also a manageable size.
c). Three: if your patient is any variable of a Pug. One to roll the arm for placement, one to place the catheter, and one to administer oxygen flow-by while monitoring the degree of purple the tongue is turning. 🙂
d). Four: if the patient is very sick, 80+ pounds, has a heart condition and REALLY wants to eat you.
How many technicians does it take to trim nails?
a). One: if the pet is the nicest, calmest animal on the planet.
b). Two: if the pet is wiggly or the size of a Mister Potato Head toy.
c). Three: if the patient is screaming (think Beagle, Basset, Husky, +/- Maltese-y type dogs, any anxious dog really!). One to hold as best they can, one to trim nails at a lightning pace, and one to sing, make smootchie sounds, hold treats, or tap the head for distraction purposes.
d) Four: to tell the doctor in unison that this patient needs sedation for his/her mani-pedi. 🙂
How many technicians does it take to change a bandage?
a). One: if the patient is under anesthesia following a surgical procedure.
b). Two: if the patient is not too painful, aggressive, or plain old freaked out!
c) Three: if the patient has an ear, hind leg, or tail bandage. One to replace the bandage, one to hold the patient in position, and one to retrieve the bandage off of the floor multiple times after the patient has flung it off of the bandaged area almost immediately after finishing. 🙂
d). Four: if your patient is STILL not bandaged after several tries. One to still hold the patient, one to retrieve more bandage materials, one to curse the lack of stickiness of the white tape, and one to go find a doctor so that they can do it!
How many technicians does it take to perform an ultrasound?
a). One: if the patient has been adequately sedated and the technician has a fair amount of experience and has been given the appropriate amount of time to scan.
b). Two: if newer to ultrasound scanning it is best to have a training buddy to confirm what you are seeing or at least tell you that dark fluid-filled structure is the urinary bladder not the gallbladder. They will also try to be helpful by saying “There’s the adrenal gland! Did you see it?” when you completely did not see it flash across your screen. 🙂
c) Two: if the patient is not a candidate for sedation. One to hold and one to scan. (Get in quick, grab your clips, and get outta there quick!)
d) Two: if the patient is on the larger side of their species. One to scan, one to act as a “kickstand” hold the patient, roll the patient up, down, or completely over so the scanner can get the appropriate views.
Comments
Torbutrol never hurts
Torbutrol never hurts anything Sonogirl…. The pet doesnt want to be there, we don’t want to wrestle with them, the bottom line doesn’t need 3 techs to do a $20 nail trim in 20 minutes…
With a little torb and splash of ace or similar 1 tech can take rads, ultrasound, blood, cysto urine, check ears mouth,… and oh yeh a Dr. can do some things too:) all in a short amount of time. You do the math and look at the face of your staff and communicate it to the owner. Drugs in this case are a very good thing as long as we use the right one
here are some protocols from VIN. http://www.VIN.com with permission
Feline Sedation protocols, courtesy of Veterinary Information Network:
(A) 0.1 mg/kg acepromazine and 0.1 mg/kg hydromorphone SQ. Effect lasts approximately 20-30 min (Kittleson MD)
(B) In a rare case of echoing 8-12 week old kittens I may use a small dose of medetomidine at 0.05-0.1 mg total (Tidholm A)
(C) 0.05 mg/kg acepromazine and 0.05 mg/kg butorphanol tartrate both given SQ, 15 min before examination. (Amberger C)
(D) 0.05mg/kg acepromazine and 0.01mg/kg buprenorphine SQ, 15 minutes before examination (Amberger C)
(E) 0.2-0.4 mg/kg midazolam and 0.1 mg/kg hydromorphone in the same syringe, given IM. (Huston S)
(F) 2-4 mg/Kg IV Ketamine and 0.4 mg/Kg IV Diazepam (Braz-Ruivo, L) This will result in a more profound sedation than the other protocols.
Canine Sedation protocols, courtesy of Veterinary Information Network:
(A) 0.05 mg/kg butorphanol followed by 0.3 mg/kg diazepam IV. Don’t mix them as you get a whitish precipitate.
Place a butterfly needle, give butorphanol first and flush with saline, then diazepam followed by another flush. Effect lasts 20-30 mins. (Edwards J)
(B) 0.005 mg/kg acepromazine and 0.01mg/kg buprenorphine IV. Effect lasts approx 20-30min. Useful in puppies. (Rishniw M)
(C) Dilute acepromazine to 1 mg/ml and butorphanol to 2 mg/ml in the same bottle, which allows for tiny but accurate doses. It’s essentially a 1:10 dilution of the acepromazine and 1:5 of the Torbutrol manufacturer’s concentration. It is then administered according to a standard chart that is somewhat body surface area related. For example, a 10 pound animal gets 0.3 ml SQ (i.e. 0.3 mg ace, 0.6 mg butorphanol). A 60-pound animal gets 1.2 ml (1.2 mg ace, 2.4 mg butorphanol). Start with less in compromised patients and titrate up as needed. (Wood, G)
(D) 0.3 mg/kg IV butorphanol and 0.15 mg/kg IV midazolam, as above for butorphanol and diazepam. (Braz-Ruivo, L)
(E) 0.05 mg/kg acepromazine and 0.05 mg/kg butorphanol tartrate both given SQ, wait 15 min for effect. (Avoid acepromazine in Boxers, as they are very sensitive to the medication). Alternative to butorphanol tartrate is buprenorphine (0.01 mg/kg) (Amberger C)
Torbutrol never hurts
Torbutrol never hurts anything Sonogirl…. The pet doesnt want to be there, we don’t want to wrestle with them, the bottom line doesn’t need 3 techs to do a $20 nail trim in 20 minutes…
With a little torb and splash of ace or similar 1 tech can take rads, ultrasound, blood, cysto urine, check ears mouth,… and oh yeh a Dr. can do some things too:) all in a short amount of time. You do the math and look at the face of your staff and communicate it to the owner. Drugs in this case are a very good thing as long as we use the right one
here are some protocols from VIN. http://www.VIN.com with permission
Feline Sedation protocols, courtesy of Veterinary Information Network:
(A) 0.1 mg/kg acepromazine and 0.1 mg/kg hydromorphone SQ. Effect lasts approximately 20-30 min (Kittleson MD)
(B) In a rare case of echoing 8-12 week old kittens I may use a small dose of medetomidine at 0.05-0.1 mg total (Tidholm A)
(C) 0.05 mg/kg acepromazine and 0.05 mg/kg butorphanol tartrate both given SQ, 15 min before examination. (Amberger C)
(D) 0.05mg/kg acepromazine and 0.01mg/kg buprenorphine SQ, 15 minutes before examination (Amberger C)
(E) 0.2-0.4 mg/kg midazolam and 0.1 mg/kg hydromorphone in the same syringe, given IM. (Huston S)
(F) 2-4 mg/Kg IV Ketamine and 0.4 mg/Kg IV Diazepam (Braz-Ruivo, L) This will result in a more profound sedation than the other protocols.
Canine Sedation protocols, courtesy of Veterinary Information Network:
(A) 0.05 mg/kg butorphanol followed by 0.3 mg/kg diazepam IV. Don’t mix them as you get a whitish precipitate.
Place a butterfly needle, give butorphanol first and flush with saline, then diazepam followed by another flush. Effect lasts 20-30 mins. (Edwards J)
(B) 0.005 mg/kg acepromazine and 0.01mg/kg buprenorphine IV. Effect lasts approx 20-30min. Useful in puppies. (Rishniw M)
(C) Dilute acepromazine to 1 mg/ml and butorphanol to 2 mg/ml in the same bottle, which allows for tiny but accurate doses. It’s essentially a 1:10 dilution of the acepromazine and 1:5 of the Torbutrol manufacturer’s concentration. It is then administered according to a standard chart that is somewhat body surface area related. For example, a 10 pound animal gets 0.3 ml SQ (i.e. 0.3 mg ace, 0.6 mg butorphanol). A 60-pound animal gets 1.2 ml (1.2 mg ace, 2.4 mg butorphanol). Start with less in compromised patients and titrate up as needed. (Wood, G)
(D) 0.3 mg/kg IV butorphanol and 0.15 mg/kg IV midazolam, as above for butorphanol and diazepam. (Braz-Ruivo, L)
(E) 0.05 mg/kg acepromazine and 0.05 mg/kg butorphanol tartrate both given SQ, wait 15 min for effect. (Avoid acepromazine in Boxers, as they are very sensitive to the medication). Alternative to butorphanol tartrate is buprenorphine (0.01 mg/kg) (Amberger C)
Thank you Dr. Lindquist, I
Thank you Dr. Lindquist, I love Torb for sedation purposes. I wish all practices had such drug protocols and were actively implementing them. In my over 13+ years as a technician I have been reprimanded several times for suggesting using light sedation for these procedures. I have also seen dogs near asphyxiation due to stress and restraint because “the client is waiting and does not want their pet sedated”. I would gather if the client saw the wrestling matches that I have seen they would opt for sedation immediately. The treatment area should not be a fight club, it is not us against them, or the strong ruling the weak. Primum non nocere. 🙂
Thank you Dr. Lindquist, I
Thank you Dr. Lindquist, I love Torb for sedation purposes. I wish all practices had such drug protocols and were actively implementing them. In my over 13+ years as a technician I have been reprimanded several times for suggesting using light sedation for these procedures. I have also seen dogs near asphyxiation due to stress and restraint because “the client is waiting and does not want their pet sedated”. I would gather if the client saw the wrestling matches that I have seen they would opt for sedation immediately. The treatment area should not be a fight club, it is not us against them, or the strong ruling the weak. Primum non nocere. 🙂
I’ve also had many DVM’s not
I’ve also had many DVM’s not agree with my suggestion of a little sedation. When this happens I will ask them if they have a moment to show me how they would treat the patient. Usually within moments of the patient crying, urinating, expressing their anal sacs or anything unpleasant they approve sedation. I think at times the DVM’s forget what we the technicians go through EVERY day.
I’ve also had many DVM’s not
I’ve also had many DVM’s not agree with my suggestion of a little sedation. When this happens I will ask them if they have a moment to show me how they would treat the patient. Usually within moments of the patient crying, urinating, expressing their anal sacs or anything unpleasant they approve sedation. I think at times the DVM’s forget what we the technicians go through EVERY day.
I think that many doctors are
I think that many doctors are driven by the “uptight client” so I can understand them wanting to just get it done, but sometimes this is just not the greatest option for the anxious patient. This can often put the technician in a more precarious situation. I know I have literally (and quite stupidly) offered up an arm to an anxious patient, knowing full well it was not safe and that more than likely I was about to need stitches in the next few seconds. in one of these situations I received my first dog bite. Not a fun learning experience for sure. Now my patient was more ramped up from the adrenaline of the bite, he still had not received the treatment he needed, and my clinic was now down a technician for 2 WEEKS! Major bummer all the way around.
I think that many doctors are
I think that many doctors are driven by the “uptight client” so I can understand them wanting to just get it done, but sometimes this is just not the greatest option for the anxious patient. This can often put the technician in a more precarious situation. I know I have literally (and quite stupidly) offered up an arm to an anxious patient, knowing full well it was not safe and that more than likely I was about to need stitches in the next few seconds. in one of these situations I received my first dog bite. Not a fun learning experience for sure. Now my patient was more ramped up from the adrenaline of the bite, he still had not received the treatment he needed, and my clinic was now down a technician for 2 WEEKS! Major bummer all the way around.
I also want to suggest that
I also want to suggest that we start sedating these patients BEFORE they come into the office. Oral gabapentin, trazodone or alprazolam are all safe and fairly short acting. I find scanning to be very difficult in patients that have sat in their cage and barked/whined/and ingested air all morning prior to being given injectable sedation for the scan. Also, they are often so worked up by then that a bit of ace or torb does nothing, and then we need to resort to general anesthesia or dexdom in appropriate cases. And even so, then, they’ve ingested so much gas that seeing structures is so much more difficult.
In our vet patients, I think we need to be far more proactive about treating the anxiety before it starts.
I also want to suggest that
I also want to suggest that we start sedating these patients BEFORE they come into the office. Oral gabapentin, trazodone or alprazolam are all safe and fairly short acting. I find scanning to be very difficult in patients that have sat in their cage and barked/whined/and ingested air all morning prior to being given injectable sedation for the scan. Also, they are often so worked up by then that a bit of ace or torb does nothing, and then we need to resort to general anesthesia or dexdom in appropriate cases. And even so, then, they’ve ingested so much gas that seeing structures is so much more difficult.
In our vet patients, I think we need to be far more proactive about treating the anxiety before it starts.