VOLUME 24 No. 85 MARCH 2018
Equine colic Procedures for pediatric and neonatal patients National Cat Management Strategy Discussion Paper 2018 Listed and Registered Nurses
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04 Letter from the editor
VO LUME 24 No. 8 53 MA R C H 201 8
by Antoinette Ratcliffe
EXECUTIVE COMMITTEE OFFICERS President Julie Hutt PO Box 35831 Browns Bay Auckland 0753 021 599 059 firstname.lastname@example.org
15 The New Zealand Veterinary Nursing Association would like to thank Hill’s™ Pet Nutrition NZ, our gold sponsors, for their continued support of the NZVNA and the veterinary nursing profession.
OUR VISION Caring for our community by promoting excellence in animal healthcare.
NZVNA FORMS The registration or list badge order forms, merchandise order forms and new membership forms can now all be found on the website www.nzvna.org.nz or by emailing email@example.com
CPD corner: The real skill for the job – Emotional Intelligence Procedures for pediatric and neonatal patients New Zealand National Cat Management Strategy Discussion Paper – how does it affect veterinary nurses? by Amy Callan
Editor: Antoinette Ratcliffe firstname.lastname@example.org
‘Krug’ by Miranda Samson.
by Julie Hutt
by Amy Newfield
National Secretary Fiona Hastie 021 993 045 email@example.com
Exotics: Kylie Martin Equine: Lyn Hobbs Photography: Miranda Samson HR: Patricia Gleason OSH: Libby Leader CPD: Christina Jenkins
by Kathy Waugh
by Patricia Gleason
Treasurer & Membership Secretary Kathy Waugh 021 843 277 firstname.lastname@example.org
Membership secretary report
Vice-President Amy Ross 021 852 664 email@example.com
Assistant Editor: Catherine Taylor firstname.lastname@example.org
DISCLAIMER The New Zealand Veterinary Nursing Association Journal is published by the New Zealand Veterinary Nursing Association Incorporated (NZVNA). The views expressed in the articles and letters do not necessarily represent those of the NZVNA or the editor, and neither the NZVNA nor the editor endorse any products or services advertised. The NZVNA is not the source of the information reproduced in this publication and has not independently verified the truth of the information. It does not accept any legal responsibility for the truth or accuracy of the information contained herein. Neither the NZVNA nor the editor accepts any liability whatsoever for the contents of this publication or for any consequences which may result from the use of the information contained herein or advice given herein. The provision is intended to exclude the NZVNA, the editor and its staff from all liability whatsoever, including liability for negligence in the publication or reproduction of the materials set out herein.
Case study: Equine colic by Georgina Green
Meet the NZVNA Executive Committee by Antoinette Ratcliffe
Increase your word power Instructions for authors submitting articles for the New Zealand Veterinary Nurse journal by Antoinette Ratcliffe
2018 Listed and Registered Nurses Book review by Lauren Prior
Letter from the Editor Welcome to the new look New Zealand Veterinary Nurse journal! As you can see on the contents page, I have set up an editorial board, so I also get the pleasure of welcoming Kylie Martin (exotics), Miranda Samson (photography), Christina Jenkins (CPD), Patricia Gleason (HR), Libby Leader (OSH) and Lyn Hobbs (equine and large animals) to the journal team, and Catherine Taylor as my assistant editor. In this edition we get to congratulate the veterinary nurses and technicians for their hard work last year to gain a place, or maintain their place, on the register and list. Well done everyone! Amy Newfield, the keynote speaker for our veterinary nurse stream at the 2018 NZVA conference, has written an article on Neonates and Pediatrics, and Patricia Gleason discusses emotional intellegence in the CPD Corner. Amy Callan breaks down the NZCAC ‘New Zealand National Cat Management Strategy Discussion Paper’ for us, explaining how this affects us as veterinary nurses and technicians in New Zealand, and Georgina Green walks us through her case study on ‘Equine Colic’. I have also included ‘Meet the Executive
Committee’ to explain what committee members do, and who to contact for specific questions and enquiries. I am currently filling in as the journal editor for this edition, so if you think you might have what it takes to learn how to produce the NZVNJ, please make contact with me and I’ll answer any questions you may have. If you have any ideas for articles please feel free to contact me at email@example.com. Antoinette
Above: Including pictures of your own pets is a perk of the editor position
Membership Secretary report In the last journal I mentioned that we were endeavouring to become more sustainable. To begin this transition we have made the following changes: • Renewal invoices will only be sent out on request. Just prior to your membership becoming due you will receive an email to this effect. If you require an invoice, addressed either to yourself or to your employer, please send an email to membership@nzvna. org.nz • Membership cards will no longer be 4 March 2018
sent out. You will receive an email when your membership has been renewed. Again, if for any reason you require a membership card to be sent to you, please let me know by email. • The New Zealand Veterinary Nurse journal is now available on the ‘Members Only’ page of the website. If you do not wish to receive a hard copy please let me know. The journal can be found at: https:// www.nzvna.org.nz/Members+only/ N.Z.+Vet+Nurse+Journal.html Kathy
President’s Report: Workplace boundaries Do you set workplace boundaries? This is one of my New Year resolutions, and I think it is very important to get your work/ life balance right. In January, while trying to relax with family and friends, my work emails were running hot. Technology lets us work away from the office or place of work, but is it good for us? I know for me personally, I have trouble setting work boundaries. When we are not at work do we check our phones, tablets or laptops? When this is happening you are not relaxing, not taking time for yourself. This not only affects you but those around you, your family, friends and significant others. I have come to realise that if I want my employer to separate ‘work time’ and ‘my time’ it’s not going to happen. I once read, “If you wait for your boss to help you separate work and play, you’re out of luck. Your boss’s only goal is to get you to devote your entire life to slaving for the company without being paid extra. That
is called ‘being on salary.” (http://www. quickanddirtytips.com/get-it-done-guy). Our profession is caring for others, and this makes it hard to set boundaries. We must make a start and care for ourselves first; if we cannot do this then we fail others in our lives. Start making your own rules. Do you take work-related emails or enquires in the evenings when you are not on call? Or will you take any work-related interruptions in the evenings? How late? On weekends? This includes Facebook or other social media. Decide how much time you’re willing to devote to unpaid work after hours or on weekends. Remember, if you’re on a salary, you’re not being paid overtime, so every extra hour is a pay cut. If you are on a wage are you being paid for this time? Start setting your own boundaries and see if this works for you. Try not to mix work and your own time. Try not to think about work while you are at home, this is your time. If you leave work at 7 pm, after 7pm is your time. When you are at the office, clinic or place of work then you are working; if you work from home, have a separate work area and when you leave that room or place, you leave work for the day. When you have set your own boundaries, let the people you work with know. For example, when I leave work for the day my phone will go to voicemail and I will check it first thing in the morning. You must let people know that when you finish for the day, it’s your time and time for you to spend with friends and family. If your employer is reactive to this and threatens you in any way then you will need to seek help. Remember it’s your work/life balance, so draw some reasonable boundaries to make your life manageable and have a life outside of work, it’s very important. Have time to relax regenerate and enjoy life. Julie March 2018 5
The real skill for the job – Emotional Intelligence By Patricia Gleason RVN, Professional Standards Committee
In the last edition of this column, we introduced the Notification Review Group (NRG). The NRG is an extremely positive step forward for our profession and the veterinary industry in New Zealand, but it may also raise some unnecessary worries for veterinary nurses. As we continue to grow and improve our profession, we need to keep a strong focus on developing ourselves both as professional practitioners and as people who contribute to a workplace. I used to be a veterinary nurse educator and had a lot of dealings with veterinary practices and their staff as hosts of workplacements and employees of graduates. When discussing what veterinary practices are looking for in their veterinary nurses, the first things mentioned have nothing to do with theoretical knowledge or clinical skills. At the top of every employer’s list of what they want and need in their staff are the personal attributes – attitude, professionalism, communication skills and an ability to work as part of a team. A key driver of these personal attributes is Emotional Intelligence (EI).
After a career in biodiversity conservation, Patricia completed her Dip VN (Distinction) at Massey University and worked at veterinary clinics in the Bay of Plenty and Waikato before becoming a vet nurse educator. She is a founding member of the AVPRC and Chair of its Professional Standards Committee. She now works in a learning and development role coaching staff and teams in the education sector.
6 March 2018
What is EI? The term emotional intelligence was created by two researchers, Peter Salavoy and John Mayer (not the pop singer). In the mid-1990s, American psychologist and science journalist Daniel Goleman popularised the term and explained it as, “the capacity for recognising our own feelings and those of others, for motivating ourselves, and for managing emotions well in ourselves and in our relationships” (Goleman, 1999, p. 317). Simply put, Emotional Intelligence is a way of being smart that is fundamental to achieving success in the workplace (Cherniss, 1999). At the core of EI is being aware that emotions drive our behaviour – our actions and reactions – so they impact everyone around us. Stress or pressure multiply the effect of emotions, and these impacts can be either positive or negative. Since the initial work on EI in the 1990s,
hundreds of research-based articles have been written on aspects of EI, professional development courses, frameworks and competency sets have been developed, and core EI competencies have been identified (which range from five to ten depending on the author). The EI competencies are commonly grouped according to four dimensions, as detailed by Stamp (2012): • Self-awareness - the ability to be aware of your emotions, including how and when they are expressed; • Self-management - the ability to use your emotional self-awareness to manage your emotions; • Social awareness - the ability to sense what other people might be thinking and feeling; • Relationship management - the ability to use the awareness of emotions of self and others and to have more effective interactions. Why is EI important? Emotions are contagious. Our ability to influence each other’s moods is innate and research has shown that contagion of positive emotions among a group results in less conflict, improved cooperation and improved task performance (Barsade, 2002). Research has also shown that EI is the strongest predictor of workplace performance, whereas IQ and formal job training account very little for the difference between exceptional and ordinary performers (Stamp, 2012). The good news is EI is an area of individual competence that can be developed and strengthened. To influence others’ emotional state in a positive and effective way, we have to navigate emotional undercurrents (Coleman, 1999). The more people work in less controlled or new/changing environments, (which is the daily norm in a veterinary clinic!), the more ability to read human emotions and energies is required for individuals and teams to thrive
As veterinary nurses, we understand the brain and our limbic system, the part of the brain that triggers emotions. We also know that emotional responses, when ‘forwarded’ to the neocortex, can result in rational processing and logical interpretation. EI requires us to make good use of this communication pathway in the brain, to allow us to process these impulses, to understand and reflect on our emotions to arrive at accurate judgements and take constructive, positive action (Newman, 2009). Before you think, “Oh, this is all too much,” no matter how hard we may try, we cannot simply leave emotions at the door when we go to work. Our emotions, and understanding them and their effect on team interactions, can help us create improved relationships and collaboration among the team as well as providing a better client experience (Stamp, 2012). Focusing on our EI will improve every relationship we have, both in our personal and professional lives.
The next edition of CPD Corner will focus on understanding and building on your personal EI strengths, as well as areas for development. References Barsade, S. (2002). “The ripple effect: Emotional contagion and its influence on group behaviour.” Administrative Science Quarterly, 47: 4, pp 644-675. Charles, E. (2014). “What is emotional intelligence and why does it matter in veterinary medicine?” Veterinary Team Brief. Retrieved from: https:// www.veterinaryteambrief.com/article/ what-emotional-intelligence-why-doesit-matter-veterinary-medicine Cherniss, C. (1999). “The business case for emotional intelligence.” Consortium for Research on Emotional Intelligence in Organisations. Retrieved from: http://www.eiconsortium.org/reports/ business_case_for_ei.html Coleman, D. (1999). Working with Emotional Intelligence. London: Bloomsbury.
Lloyd, J. and Walsh, D. (2003). “Template for a recommended curriculum in veterinary professional development and career success.” Journal of Veterinary Medical Education, 29: 2. Retrieved from: http:// jvme.utpjournals.press/doi/abs/10.3138/ jvme.29.2.84 Newman, M. (2009). Emotional Capitalists: The new leaders. Chichester: Wiley & Sons. Stamp, S. (2012). “The Jury is In: Considering the Case for Emotional Intelligence” Veterinary Team Brief. Retrieved from: https://www. veterinaryteambrief.com/article/juryconsidering-case-emotional-intelligence Zeitzman, P. (2017). “Why you need emotional intelligence: This vital soft skill is one every veterinarian should master,” Veterinary Practice News, May 2017. Retrieved from: https:// www.veterinarypracticenews.com/ why-you-need-emotional-intelligence/
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Procedures for pediatric and neonatal patients By Amy Newfield CVT, VTS (ECC), BluePearl Veterinary Partners, Waltham, MA, USA Photography by Miranda Samson
Amy is currently employed at BluePearl Veterinary Partners in Waltham, Massachusetts as the Emergency Head Technician. She currently sits on the Academy of Veterinary Emergency & Critical Care Technicians Council of Regents as the President-Elect. Amy was recently awarded NAVC Technician Speaker of the Year, and WVC Technician Educator of the Year, and will be the keynote speaker of the veterinary nurse stream at the NZVA conference this year.
Introduction Neonatal and pediatric patients can prove challenging when performing certain nursing techniques. The sheer size and lack of developmental anatomy results in challenges that are unique to this age group of canines and felines. Being prepared ahead of time with the understanding of what challenges one may face before the procedure will hopefully help make the technique successful. With any nursing procedure in a neonatal or pediatric, it is possible that even skilled veterinary personnel may not succeed. Generally, the larger and healthier the pediatric or neonate, the better chance of a successful procedure taking place. Thermoregulation One of the largest considerations of hospitalizing a neonate or pediatric patient is thermoregulation. There is a sudden change from the time a puppy or kitten is born from the controlled environment of the uterus to the variable and stressful environment it now lives in. Immediately following birth, the body temperature of a newborn falls very quickly and then eventually does recover and regulate. In a newborn puppy or
kitten, thermoregulation is controlled in stages. First, as soon as they are born, the metabolic rate of the neonate increases to three times the fetal rate. In order for this to happen the neonate must intake adequate food. They are low on glycogen in adipose tissue reserves so, in order for them to increase their metabolic rate, food must be available. The second way that thermoregulation is controlled in neonates is simply to reduce heat loss. This is often achieved by the mother’s and fellow neonates’ warmth (Noakes et al., 2001). The initial body temperature of a neonatal kitten or puppy is between 35.5°-36.5°C. It is recommended therefore to house a hospitalized neonate in temperatures between 29.5°- 32°C (Fortney, 2006). Both neonatal and pediatric patients have almost no adipose tissue and minimal muscle mass, and their skin is significantly thinner than a developed dog or cat. When choosing a heat source, it is important to remember that they cannot often move out of the way of the heat source. Warming, not burning, is important in these patients. Avoid electric heat blankets and ensure that any other type of heat source that is provided is monitored very closely. Warm air sources and warm water blankets may provide an excellent method to helping these patients maintain their heat, but it is important to note that even these methods have the potential to burn patients. Many hospitals also use human baby incubators to help provide a constant warm environment for the neonate or pediatric. While these are very good and certainly do provide a way to control the entire area that the patient is in, these also have a potential to burn or overheat patients. The advantages of using a true incubator is that it will regulate both air temperature and humidity. Because both neonates and pediatrics have little to no adipose tissue they are at risk for dehydration more so than an adult. The humidity for these patients should be maintained between March 2018 9
55 to 60% to prevent dehydration (Little, 2013). Because these patients have little to no adipose tissue or muscle mass, it is imperative that they are kept clean and dry. These patients will likely need to be stimulated to urinate and defecate throughout the day. If they urinate and defecate on their own it is important to bathe and fully dry them. Leaving a neonate/pediatric patient wet on any part of its body may cause it to develop hypothermia. Venipuncture and catheterisation Venipuncture Venipuncture can prove difficult in a neonate or pediatric patient. The largest concern is that multiple blood draws, or a large blood draw, can result in an anaemic patient very quickly. It is imperative that pressure bandages are utilized to minimise haematomas. Even a haematoma under the skin can lead to additional blood loss. This author found it very difficult to find a conclusive number for how much blood can be drawn from a dog or cat, let alone a neonate/pediatric. There were several references from laboratory animal science suggesting that between one and two percent of the total animalâ€™s body weight in kilograms could be removed safely per day (John Hopkins Medicine, 2016). The amount removed would be referenced in litres. For example, an animal that weighed 25kg could have 250ml removed a day. On the veterinary information network there were a few internal medicine diplomats that stated that 10% of blood volume should be removed within a twenty-four hour period. Neonatal blood volume is approximately 68ml/kg (Freshman, 2007). Finding more concrete references proved challenging. There were several human pediatric and neonate references but the author did not feel it appropriate to list them as references for another species that are likely to not apply to canines and felines. With that being said, many of the references were similar to the references found for canine and feline laboratory animals. Under those guidelines a 2.2kg pediatric would only be allowed to have 10 March 2018
about 2.5ml of blood removed during a day. The conclusion is that it is imperative that neonates and pediatric patients do not have excessive venipuncture performed. While obtaining blood for a packed cell volume/total solids is small, if this occurs multiple times throughout the day it may result in more than three milliliters of blood loss because of haematomas. Veterinarians and veterinary nurses should ensure that the amount of blood that is drawn from a neonate/pediatric is the most minimal amount necessary, while also ensuring that the total amount is obtained on the first attempt to avoid a second attempt. Most of these patients will require some type of intravenous (IV) fluid to help support blood volume.This should be taken into consideration if the patient is not on IV fluids and a significant amount of blood was removed from the patient. Location In order to obtain enough blood from a neonate/pediatric patient you may need to get creative. The same veins that can be used for drawing blood can also be used for a catheter placement. The largest vessels, the jugular and saphenous, should be considered if you need to obtain a large amount of blood (> 2mls). They should not be considered if the patient has a coagulopathy or has a low platelet count. Do not use the jugular or saphenous veins if the patient is icteric, unless previous blood work has shown the patientâ€™s ability to clot. If only a drop of blood is needed, as in the case of obtaining a drop of blood for a blood glucose or lactate level, veterinary personnel should attempt an ear prick, lip prick, or even a tail prick. It is impractical to try to gain venous access for a drop of blood in these patients. Veins should be preserved for larger blood draw amounts only. Intravenous/intraosseous catheter placement One of the most challenging nursing techniques that may need to take place on a neonate or pediatric is that of IV catheter placement. Because of the size of the patient, many times catheterising
the jugular vein is easiest. In the case of an emergency, catheterisation of the jugular vein is preferred because it offers the quickest route for drugs and fluids to the central circulation system. However, often times nurses and veterinarians are not comfortable placing a catheter into the jugular vein. The American Heart Association (AHA) recommends intraosseous (IO) as the second route of choice if venous access cannot be obtained, and studies have shown that IO is as effective as central venous access (American Heart Association, 2005). In veterinary medicine, IO is typically reserved for neonates, puppies or kittens. While it may be just as effective as obtaining venous access via the jugular vein, it generally takes slightly longer to obtain IO access as opposed to access of a peripheral vein. Most of the time IV catheter placement will be attempted, then if such attempts fail, an IO attempt may be attempted. Peripheral catheters come in a variety of sizes and types, of which the most commonly used is the over-the-needle catheter. The type and gauge of catheter should be selected based on patient size, catheter location, volume and rate of fluid to be infused, and health of veins. In some larger pediatric dog breeds, larger gauge catheters may be able to be placed (18G, 20G). Smaller gauge catheters such as 22G and 24G should be reserved for neonates under 2.2kg. The use of a larger gauge catheter may not be possible due to vasoconstriction, anaemia, trauma or other damage to the cardiovascular system, which may result in a decrease in vessel integrity. Shorter over-the-needle catheters are preferred because they allow for faster fluid flow. Since it is important to obtain catheterisation on the first attempt to avoid blood loss, shaving the patientâ€™s leg all the way around, preparing all supplies and having adequate restraint are all important to the success of the attempt. It is important to remember that the veins of neonates and pediatrics are thinner. Because they have limited muscle or fat, most of the times the vein is very superficial, meaning it is easy to go through it and cause the
formation of a haematoma. Often, if the first attempt fails, it is very difficult to be successful on the same limb. Using slow methodical movements and ensuring there is adequate lighting and good restraint will also help with successful IV catheterisation. While it can be a little nerve-racking to attempt an IO catheter in a neonate or pediatric patient, sometimes this is the fastest way to obtain access in a patient that is critical. IV fluids, drugs, blood, plasma and dextrose can all be administered into an IO catheter (Norkus, 2012). The absorption time is the same as, if not faster than, venous access. There are commercially made IO catheters, but bone marrow or spinal needles can also be used. In a newborn or young neonate using a regular over-the-needle catheter can also be done. The most common sites are the trochanteric fossa of the femur (right next to the ball/socket joint), the greater tubercle of the humerus (right next to the ball/socket joint), the wing of the ilium, and crest of the tibia. Depending on how critical the patient is, a local anaesthetic such as lidocaine, may be needed in order to facilitate the procedure. In many patients that are very critical, they do not seem to react to the placements of the catheter. The skin can be nicked with a scalpel blade or, in very young neonates, the needle can be advanced without the need to make a small skin incision. Once the bone is felt the pressure should be increased, and the catheter should be rotated in a clockwise or counterclockwise position similar to a drill that is drilling into something. Once a catheter is in the cortex you will no longer feel any resistance. If you move the limb that is associated with the catheter the needle will move along with it. Aspiration into a syringe will bring bone marrow up and also confirm placement. Initially when flushing the catheter there may be mild resistance, but once it has been flushed there should be little to no resistance (Norkus, 2012). Human patients who have had this procedure done state that the
most painful part of the procedure is when the bone marrow is flushed. In emergency situations IO catheters are usually used for no greater than 24 hours. While the risk of complications is minimal and identical to that of IV catheterisation, it is uncomfortable for the patient to have a catheter protruding out of a bone. It makes sitting and laying on the affected limb difficult. Once the patient is stable generally venous catheterisation can be obtained. The EZ-IO gun is currently marketed by ArrowÂŽ. This small handheld precision drill has the ability to place IO catheters in under three seconds in veterinary patients. Initially when this product launched they recommended that patients needed to be greater than 4.5kg. Since that time, the EZ-IO gun has been used in patients at the authorâ€™s hospital weighing as little as 2.2kg. The company who designed the product produced a video in which they drilled over 50 holes into a regular size egg. The egg never cracked and retained regular shape the entire time. While there is no data on how little of a patient this product can be used on, it is likely that any patient requiring an IO catheter can have it placed with the EZ-IO gun. Feeding methods Regardless of the disease or injury, one of the most important components to ensuring the survival of the neonate/ pediatric patient is nutrition. Because they do not have the adipose and glycogen reserves of an adult, when they decrease their caloric intake they can become hypoglycemic very quickly. The safest and most effective way is to have the neonates/pediatric patient eat orally. Since the mother will not be hospitalized with the patient this oral feeding generally must take place with a nipple bottle. The hole in the nipple bottle should be of sufficient size so that when the neonate/ pediatric patient suckles it, formula is readily available. If it is not large enough a hole can be made larger by using an 18 gauge needle. Commercially prepared formula is best when working with a diseased or injured neonate/pediatric patients. Warming the formula using a
warm water-bath is best, as warming the formula in a microwave can cause part of the formula to be very hot while the rest is not. This can result in burning of the patient. When feeding neonates/pediatrics they should be lying down in sternal recumbency. The bottle should be angled in a manner that is similar if they were nursing with their mother. You can help facilitate this by rolling a small towel and resting them on top of it so they need to lean up to get to the nipple bottle. This is a natural nursing posture for the patient. Depending on the disease or injury, it may not be appropriate for the patient to feed orally. While it is certainly fast, the disease or injury may impede the patientâ€™s natural ability to feed appropriately. Even though the neonate/pediatric patient is feeding off of a bottle, it is important that the calories are calculated out to ensure they are getting enough nutrition. Often it may look like they are feeding, but without actually calculating the volume as well as the number of calories they consumed, it will be impossible to just gauge it based on eyesight. If the patient is too sick to nurse, then bottle feeding should be avoided. Aspiration pneumonia can occur because a sick patient is forced to nurse when they have a weak or absent suckling reflex. Feeding with an eyedropper, bulb syringe, or other syringe should always be avoided because of the high risk of aspiration pneumonia. If you have to squeeze the plastic nipple bottle to force the formula out, then likely the patient is not suckling appropriately or the hole is too small. The patient should have the ability to suckle the formula out of the nipple bottle themselves. Squeezing the bottle will result in a high chance of aspiration pneumonia. If oral feeding is not appropriate for the patient, then a feeding tube should be placed. Orogastric tube feeding Orogastric (OG) tube feeding is also an appropriate way to feed a neonate or pediatric patient. In some patients, placing a nasoesophageal or nasogastric tube may not be physically possible. Getting March 2018 11
a 3.5 Fr feeding tube into the nose of a patient that weighs less than a kilogram may not happen. In these cases, a 5 Fr red rubber or clear argyle tube can be placed down the oesophagus and fed directly in to the stomach to deliver food. The tube is measured from the front of the mouth to the last rib. Similar to the placement of a nasoesophageal (NE) or nasogastric (NG) tube, grasp the patient’s head and keep their head in a normal position. You should pass the tube along the roof of the mouth and stop when it has reached the mark you placed on the tube. The neonate’s head should be flexed forward as the tube is advanced along the roof of the mouth to the predetermined length (Thomovsky E, 2015). Tube position should be checked inserting a small amount of water 0.5-2mls (2mls for larger pediatric puppies and 0.5mls for smaller neonates) through the tube and observing for a cough reflex. It is not practical to take a radiograph because the tube is removed after the feeding. Since feedings would occur multiple times throughout the day this would result in a cost that is prohibitive for most clients. Because there is a risk of aspiration pneumonia when performing this procedure regardless of whether the tube is incorrect position or not, the veterinary staff must auscult the lungs, look for coughing, and observe respiration rate and effort throughout the entire day. While feeding a patient with an OG tube the same early signs of vomiting should be looked for such as agitation, coughing, burping, or excessive salivation. When the tube is removed it should be pinched off to avoid any remaining formula trickling out and down into the lungs as the tube is removed. One of the most common problems that occur is overfeeding (Thomovsky, 2015). It is important that daily caloric intake is calculated out to avoid overfeeding using a feeding tube. Oxygen therapy Neonatal/pediatric patients may need oxygen therapy for a variety of reasons. Unlike an adult canine or feline patient, it may be impossible to fully assess lung function in the smaller patients. This is because it is unlikely that veterinary personnel can obtain an arterial blood 12 March 2018
gas or even a reliable pulse oximetry reading. Assessment of lung function in the respiratory system generally can only take place through auscultation, using a stethoscope, and thoracic radiographs. When in doubt, administer oxygen if you feel that the patient is compromised and may not be ventilating appropriately. Oxygen cages Oxygen cages are popular because they are convenient. Turn them on, put the patient in them and walk away. The disadvantage is you cannot work with your patient if they are in a cage. Every time the door is opened, the oxygen escapes and plummets the FiO2 to room air very quickly so the patient becomes dyspnoeic again. Many times infant incubators also have the ability to drop an oxygen line in so that it can act as an oxygen cage. The concern is that the percent of oxygen going in cannot be regulated appropriately. Therefore, if the hospital is utilizing an infant incubator as a dual oxygen cage it is important to have an oxygen monitor that reads the percent of oxygen going into the cage. Flow-by oxygen This method can be effective, but it is important that the oxygen line is no more than half an inch away from the patient’s nose. Many patients will not tolerate this method. They become agitated and try to move away from the air blowing on their face. Using face masks will certainly make it more effective, but they are poorly tolerated. It is important to remember to remove the diaphragm on the bottom of the oxygen face mask so that the patient can ventilate appropriately and eliminate carbon dioxide and other waste gases. Having a tight seal around the patient’s face will not allow for appropriate ventilation. The efficacy of this technique is still debated since it is unknown how much of the oxygen the animal actually intakes (Crowe, 2008). Nasal Catheters A red rubber tube(s) is placed into the ventral nasal meatus. Because of the size of the patient only a 3.5 Fr red rubber will maybe pass into the nostril of a neonate/ pediatric patient. You can use a drop of proparacaine or lidocaine in each nostril,
but because of the size of the patient it is often easier to just place the tube without the additional discomfort of fluid going up their nose. Nasopharyngeal measurement should be from the tip of the nose to the lateral canthus (Creedon et al., 2012). Marking the red rubber with a line will ensure correct placement. The patient’s head should be held in a normal anatomic position. Because of how small the patient is, the red rubber to should likely be cut since only about 0.5-2 inches will be inserted. The nasal line can be sutured or stapled into place similarly to the nasoesophageal or nasogastric tube. For adult patients a rate of oxygen can be started at 50-100 ml/kg, up to a maximum rate of five to six litres per minute (Creedon et al., 2012). There is no current recommendations that this author could find for neonatal/pediatric patients. Patients can have two nasal lines placed if the first is not improving the patient’s oxygenation status. While it is known that this method provides at least a 40% nasal oxygen concentration, it is possible to administer too much oxygen causing them to be at risk for oxygen toxicity. Oxygen being administered into nasal lines should always be humidified to avoid nasal passages drying out. With patients with head trauma, severe thrombocytopenia and nasal disease, nasal lines should not be used. Sneezing will elevate intracranial pressure. Oxygen toxicity Oxygen toxicity is a very real concern for patients that require long term exposure to high concentrations of oxygen. The lung is the organ most vulnerable to oxygen toxicity and the associated damage is often severe and irreversible. Because these patients do not have fully developed lungs they may be even more at a greater risk than an adult. Continuous FiO2 level of 33% at sea level (PiO2 of 255 mmHg) is considered the safe level for long-term exposure in people. This is the reason that most commercial oxygen cages are capped at about 40%. Higher levels are generally tolerated well over short periods of time. Studies have shown that dogs exposed to 100% oxygen survive an average of two to five days while dogs exposed to 75-80%
oxygen lived to about 14 days (Creedon et al., 2012). Studies performed describe symptoms that start with lethargy, restlessness and coughing (Creedon et al., 2012). Eventually the signs progress to anorexia, dyspnoea and eventually death. Interruption of the exposure to oxygen can also reduce its toxicity. Unfortunately, the signs/symptoms of the patient often mirrors the disease process that is causing the pet to need oxygen in the first place. In adult patients, performing arterial blood gases is important to early recognition of oxygen toxicity. In neonate/pediatric patients performing arterial blood gases is near impossible. Therefore, using oxygen monitoring devices, that ensure that oxygen is only maintained at 40% in the environment where the patient is being kept, is best medicine. Reducing oxygen rates is important to help decrease the chance of oxygen toxicity.
Conclusion Neonatal/pediatric patients require common veterinary procedures in order for them to successfully recover from their disease or injury. The largest issue with performing these veterinary procedures on them is their size. It is difficult to be successful with some of these procedures unless one has had experience performing them in such small animals, and this comes with time and experience. References Creedon J., & Davis, H. (2012). Advance Monitoring and Procedures for Small Animal Emergency and Critical Care. New Jersey, United States of America: Wiley Blackwell. Crowe, D. (2008). Oxygen Therapy. Atlantic Coast Veterinary Conference Proceedings. Fortney, W. (2006). The Care & Feeding of the Sick Neonate. Atlantic Coast Veterinary Conference Proceedings. Freshman, J. (2006). Thread: Non-
thriving puppy. http://www.vin.com/ Members/Boards/DiscussionViewer. aspx?documentid=3606746&ViewFirst=1 John Hopkins Medicine (2016). Guidelines for multiple blood draws: Veterinary Recommendations for Multiple Blood Draws – Volumes and Frequency. http://www.hopkinsmedicine.org/ animalresources/Clinical_Services/ MultipleblooddrawsDSR.html Little, S. (2013). Successful Management of Orphaned Kittens. Atlantic Coast Veterinary Conference Proceedings. Noakes, D., Parkinson, T., & England, G. (2001). Arthur’s Veterinary Reproduction and Obstetrics. Philadelphia, United States of America: W.B Saunders Company. Norkus, C. (2012). Veterinary Technician’s Manual for Small Animal Emergency and Critical Care. New Jersey, United States of America: Wiley Blackwell. Thomovsky, E., (2015). How to Treat the Sick Neonate II. Atlantic Coast Veterinary Conference Proceedings.
Notice of the Annual General Meeting of the New Zealand Veterinary Nursing Association (Inc) Notice is hereby given to all members that the Annual General Meeting of the New Zealand Veterinary Nursing Association (Inc) will be held during the NZVA Conference at the Claudelands Event Centre, Hamilton on Tuesday 19th June at 11.30am. All members of the NZVNA are invited to attend. An agenda, call for nominations, and election of executive committee members’ details will be posted via email and on www.nzvna.org.nz at a later date. Any questions or enquiries, please contact Fiona Hastie, National Secretary via email firstname.lastname@example.org March 2018 13
When life lose its balance
WHEN LIFE IS NO FUN When life is no fun When life loses Help her throughitsit,balance
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Credit: Photos Yves Lanceau / Arioko - Illustration Cubedesigners
feedTHEM her CALM CALM FEED
© Royal Canin SAS 06/2013. All Rights Reserved. Credit: Photo Arioko - Illustration Cubedesigners
© Royal Canin SAS 06/2013. All Rights Reserved. Credit: Photo Arioko - Illustration Cubedesigners
Help her through it, feed her CALM
Help her through it, feed her CALM Moving house, having a baby, going away? Moving
Changes in a cat’s routine can disturb their equilibrium, causing digestive, dermatological and behavioural house, havingdisorders. a baby, going away?
Canin can CALM helps to naturally maintain Changes in aRoyal cat’s routine disturb their emotional through its active Safe for use in conjunction with equilibrium, their causing digestive, balance dermatological ingredients alpha-cazosepine and L-tryptophan. and behavioural disorders. Urinary security behaviour therapy. Royal Canin CALM helps to naturally maintain their emotional balance through its active Safe for use in conjunction with To learn more about CALM, call Royal Canin on 0800 420 016 ingredients alpha-cazosepine and L-tryptophan. behaviour therapy.
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New Zealand National Cat Management es Strategy Discussion Paper how does it affect veterinary nurses? By Amy Callan RVN, Forrest Hill Vet Clinic Photography by Miranda Samson
Amy Callan graduated in 2017 with a Diploma in Veterinary Nursing from Unitec Institute of Technology. She is originally from the North East of England, but now lives in Auckland with her blue and white Border Collie George. Amy also writes the online CPD quizzes on the NZVNA website.
In 2017, the National Cat Management Strategy Group (NCMSG) released a discussion paper on the need for cat management in New Zealand. The paper outlines what cat management entails, why New Zealand needs to have a cat management plan in place, and what we can be doing as nursing staff, as well as the wider veterinary community, to help put this strategy in place. What is the need for cat management? The Cat Management Strategy document has been produced to ensure New Zealandâ€™s ecosystem and native species
are protected, while encouraging responsible cat ownership, and will prevent euthanasia of healthy cats due to overpopulation. This strategy has been put in place with the goal that eventually there will be no feral cats in New Zealand, which in turn would mean there would no longer be any adverse effects on our native species due to cats. What is responsible cat ownership? â€œResponsible cat ownership is considered to include providing appropriate care, shelter, exercise, training, socialisation, identification, registration (where
March 2018 15
required), desexing and confinement” (NCMSG, 2017). In New Zealand, a responsible cat owner also complies with the New Zealand Animal Welfare (Companion Cats) Code of Welfare 2007. Benefits of domestic cats being easily identified (by use of collar with name tag and phone number or, preferably, with microchipping) include, but are not limited to: • Being able to easily contact the owner should the cat go missing • The ability of quickly contacting the owner should that cat be found injured, allowing swift decision-making and preventing the cat from prolonged pain • Decreases the likeliness of the cat being assumed to be stray and not owned, therefore less likely to be rehomed or taken to a shelter Feral cats (see Figure 1) tend to be seen as the biggest threat to New Zealand’s native species, due to their independence and need to find prey. These native species
have been found to be poorly adapted to defending themselves against feral cats; because of this even low numbers of feral cats in a native species sensitive area can have a very threatening effect (NCMSG, 2017). What can we do as… Conservation groups Conservation groups will have the ability to remove cats, if necessary, with nonlethal methods, with the intention of rehoming the removed cat should they be imposing a threat to native species in a specified area where these species are endangered. They will also be able to identify sensitive wildlife areas and notify cat owners to encourage a restriction to the area, which would decrease the removal of cats from this area and decrease the amount of unnecessary killing of cats. Breeders Breeders need to fully inform all new
Figure 1: Categorising cats based on ownership and dependence on humans
These cats are unowned, unsocialised, are independent and do not rely on humans.
A general term for owned, or previously owned, cats with some degree of dependence on humans.
16 March 2018
These cats are owned and are completely reliant on their owner for food, shelter etc. Usually well socialised.
Cats with varying degrees or dependence on humans and varying degrees of socialisation with humans and other cats.
Stray cats which are able to be in spaces with other cats.
Stray cats which cannot be in spaces with other cats.
owners on responsible cat ownership by providing them with information on de-sexing, microchipping, vaccinations, deworming and defleaing. New owners also need to know to have their new kitten de-sexed at or before four months of age, before they are able to reproduce. The breeder should discuss this with the new owner. Breeders need to suggest to new owners that they fully contain their new cat to their house and/or having a contained outside space. If this is started while the kitten is only young, it may be much easier for both the cat and owners to abide by, rather than implementing these rules when the cat is much older and already has set behaviours and has become used to roaming outside. Veterinarians and veterinary nurses Veterinary clinic staff need to discuss with soon to be new owners the pricing of all aspects of owning a new cat or kitten. This should include de-sexing, microchipping, vaccinations, flea products and worm products. By discussing this, the soon to be owner will be fully aware of how much the ongoing cost of cat ownership is and will know if they can afford this. Should owners express concerns of the pricing of de-sexing suggest they talk with their local SPCA to find out if they are currently running a de-sexing initiative to lower the amount of abandoned litters or amount of litters owners are unable to house. Veterinarians and veterinary nurses need to promote the de-sexing of cats to all owners during their consultation, and discuss the age at which a cat should be de-sexed, being mindful to include the benefits, both health and behavioural. During this discussion it is always important to convey the message of lowering the amount of unwanted litters of kittens. Clinic staff need to actively promote the microchipping of every kitten (or adult cat not already chipped) that enters the clinic, and discuss how easily lost microchipped cats can be returned to the owner. Already, microchipped cats need to have their microchip scanned reguarly in consult to ensure microchip is working
and registered on the online New Zealand Companion Animal Register (NZCAR). When an owner informs a veterinarian or veterinary nurse that they have changed address or phone numbers, they must remind the owner that their contact details will need to be changed on the NZCAR. Kitten packs need to be available at every veterinary clinic, and provided to every new cat owner with all necessary information in regards to healthcare, microchipping, contact numbers (such as your own vet clinic, local after hours clinics, poison centre etc.) and general care of a new cat.
Veterinarians and veterinary nurses need to encourage owners to bring their cats inside at night, explain that it can assist in increasing New Zealandâ€™s ecosystem, as well as decreasing the risk of injuries to their cat from night time cat fights. It is not uncommon for cats to be euthanised due to an owner not being able to afford the ongoing vets bills, and it is possible that these bills will decrease if their cat is brought inside at night, decreasing the amount of cat bite abscesses that require surgical intervention. Owners Before getting a new cat, owners need to discuss with their family that owning a cat should last the entire lifetime of
the cat, which may be over 20 years, and if they are all willing to take on that responsibility. Owners need to be aware that owning a cat requires time and money; paying for veterinary bills, annual vaccinations, flea and worm treatment, and feeding quality food, are all necessary parts of owning a cat. Choosing how many or what breed of cat they are able to provide for needs to be considered by the owner. For example, do they have space for more than one cat? Are they able to only provide enough food for a smaller breed of cat rather than a large? March 2018 17
Owners need to put in place a restriction for their cat in wildlife rich areas to prevent native species being killed, or a curfew to prevent predation or breeding at night. It is still seen as unusual in New Zealand for cats to be kept as purely inside cats or inside with a contained outside space, whereas in the United States of America it is common, and is becoming increasingly recommended in Australia (NCMSG, 2017). Owners also need to take all necessary steps to prevent their cat straying. Benefits of cat management in New Zealand • A possible decrease in zoonotic diseases may be seen if more cats are contained inside, such as ringworm and toxoplasmosis
18 March 2018
• A decrease in death to both companion and feral cats, due to less need for conservation groups needing to remove them from sensitive native areas, and less offspring being born due to owner awareness of de-sexing • Owners will become more aware of the general health of their cat. The owner of a cat that only toilets outside may be unaware of blood in the urine or faeces, if their cat is straining to urinate, or if it has constipation or diarrhoea • A potential decrease in gastrointestinal disease due to cats not toileting outside, which can result in cross contamination between cats The New Zealand National Cat Management Discussion Paper has highlighted the multiple ways we as veterinary clinic staff, owners and
breeders, as well as other members of the community, can assist in promoting responsible cat ownership and be responsible cat owners. We need to be aware of the ways in which we can decrease the mortality rates of feral and domestic cats, as well as New Zealand’s native species. With the introduction of this discussion paper, we can help New Zealand’s ecosystem, giving it a chance to flourish while also protecting our cats. Reference The National Cat Management Strategy Group (2017). New Zealand National Cat Management Discussion Paper. Retrieved from: http://www. nzcac.org.nz/images/downloads/ nz-national-cat-management-strategydiscussion-paper.pdf
Case study – Equine colic By Georgina Green RVN, Waikato Equine Veterinary Centre Photograph by Miranda Samson
Georgina Green is employed at Waikato Equine Veterinary Centre as a junior nurse. She has been with the clinic for the past year working two days a week, while studying full time and bringing up her four year old daughter. She has recently completed her studies at Wintec and is now a qualified and registered veterinary nurse.
Patient details and history Name: Moody Species: Equine Breed: Warmblood Sex: Mare Age: 16 years Colour: Flea-bitten grey Weight: 606kgs Moody was visited on the farm for a suspected abortion. She had aborted the previous year and had been under the care of a veterinarian for the monitoring of her placenta. She presented with an elevated heart rate and was flank watching and rolling. Early examination showed the foetus was alive and there was no sign of oedema or placental separation, however, the mare was clearly uncomfortable and it was decided that she should be transported to the clinic for further investigation (Leander, 2017). On arrival, the initial ultrasound scan of her abdomen showed no abnormalities,
and it was suspected that she had a haemorrhage in the broad ligament. The mare was constantly monitored; she began to display mild signs of colic during the evening and by early morning she had noticeably worsened. On a further abdominal ultrasound scan, distended loops of intestine could be seen at which point the decision was made to take the mare to surgery for an exploratory laparotomy (Leander, 2017). The owners were advised of the risks associated with general anaesthesia, for both the mare and her unborn foal, and were required to sign a consent form to allow general anaesthesia and surgery to be performed. Patient assessment Prior to surgery, a complete nose to tail physical examination, including auscultation of the heart and lungs, was performed by the veterinarian. Moody’s temperature, respiration rate and heart rate were assessed and found to be in excess of normal limits: Temperature: 39°C (normal: 37.5 – 38.5°C) Heart rate: 80 beats/minute (normal: 36 – 44 beats/minute) Respiration rate: 10 breaths/minute (normal: 20 breaths/minute) It was clear that Moody was compromised, she appeared agitated and her mucous membranes showed pink petechiae. She had no gut sounds (should be audible and rhythmic) and minimal faeces had been passed. Nasogastric intubation (NGT) is important as horses are unable to vomit. Gas and fluid must be removed from the stomach to prevent the risk of gastric rupture (Bassert & Thomas, 2014, p. 946). Fifteen litres of nasogastric reflux was removed and distended loops of intestine could be seen on the ultrasound scan (Leander, 2017).
| Above: ‘Moody’
This type of surgery can often have postoperative complications and the prognosis was poor to guarded for the survival of the mare and delivery of a healthy foal (Leander, 2017). March 2018 19
Stabilisation and preanaesthetic preparation Bloods were not taken for a preanaesthetic panel due to the imminence and necessity of this emergency surgery. Moody received antibiotic cover at her initial consultation (penicillin intramuscular (IM) and gentamicin intravenous (IV)) and she was also given Flunixin Meglumine (5ml IV) one hour prior to surgery. Flunixin is a nonsteroidal anti-inflammatory drug (NSAID), commonly used in the treatment of gastrointestinal diseases which provides both pain relief and protection from toxins (EquiMed, 2016). Prior to the surgery the nurse set up the essential equipment the veterinarian required to perform this surgery: • Laparotomy drape set • Two sterile hand towels • Two colic gowns (reinforced outer protection with waterproof polyethylene/non woven material on the front and sleeves) • Gloves, hats, masks, EZ Scrub™ • Warmed lactated ringer solution (LRS): two five litre bags with 100ml potassium chloride (750mg/10mmol/L) and 50ml Calci Tat® (4.6g/100ml) added, and two one litre bags) • Scalpel blades no.22 and no.10 • 14g needle • Two equine surgical kits (see Figure 1) • Large bowel forceps • Suction unit • Two lap sponges (five pack) • One mare uterine flushing tube (UFT) • Rubbish bin and bag • Colic Jelly (sterile lubricant used in the surgical site) • Fish (see Figure 2) • Soft tissue stapler with spare staples • Sterile swabs (20 pack) • Suture material 0 vicryl, 2-0 vicryl In preparation for surgery the veterinary nurse aseptically placed a 14G 5.25” Mila IV jugular catheter and sutured it in place whilst the mare was still in her stable. Moody was then weighed on her way to surgery knock down to determine the volume of induction drugs required. The nurse picked out the horses’ hooves, to prevent dirt and debris being carried into 20 March 2018
surgery and contaminating the surgical environment, and washed out Moody’s mouth to reduce the chance of food material being carried into the airway during intubation. Induction was achieved with a xylazine 100mg/ml (0.6 - 1.0ml/100kg) premedication and ketamine 100mg/ ml (2.2mg/kg) induction. Xylazine (an alpha-2 agonist) is a short-acting sedative that provides significant pain analgesia. It acts as a muscle relaxant through its effects on the central nervous system. It is commonly used for short-term sedation, and treatment and management of colic (EquiMed, 2016). Ketamine (an NMDA agonist) which provides somatic analgesia Figure 1. Equine surgical kit instruments 1 x size 3 Scalpel Handle 1 x size 4 Scalpel Handle 1 x Rat Tooth Tissue Forceps 1 x Smooth Tissue Forceps 1 x Adson Tissue Forceps 1 or 2 x Curved Metzenbaum Scissors 1 or 2 x Mayo-Hegar Needle Holders 1 x Olson-Hegar Needle Holders 3 or 4 x Straight Mosquito Forceps 3 x Curved Mosquito Forceps 1 x Instrument Pin 6 x Backhous Towel Clamps 5 x Swabs Figure 2. Equine surgical kit instruments Fish, used when the surgeon is ready to suture. It is placed in the midline incision to keep the intestines from popping out while the sutures are closed.
and dissociative anaesthesia, is injected three to five minutes after administration of xylazine (when it has reached its peak effect) (Lee, n.d.). Moody was ‘dropped’ using a specialised, padded swing door in the knock down area with the aid of the anaesthetic technician, veterinarian and nurse. Induction of anaesthesia occurs approximately 60 seconds after the IV administration of ketamine. The horse drops to the ground, typically with the forelimbs buckling and the hindlimbs straight. The nurse holding the horse’s head exerts steady backward pressure on the horse to try to make the horse sit on its hindquarters rather than fall on its nose (Lee, n.d.). Anaesthesia and analgesia Moody was hoisted onto the surgical table, placed in dorsal recumbency, the table sides were raised to support her in this position, and she was connected to the anaesthetic machine for maintenance of anaesthesia. The surgery area was heated via air conditioning to help maintain the patient’s body temperature. Eye drops were used to keep her eyes lubricated and prevent them from becoming dry. Anaesthesia was maintained on 2% isoflurane, with an oxygen flow rate of 6L/min. The duration of anaesthesia was two hours and forty five minutes, with the patient standing to recover one hour and two minutes after the end of anaesthesia. The nurse had previously clipped the area (from rostral to the xiphoid area to the udder, and to the flank folds on either side) for the ultrasound scan, so she tidied up the clipped area and began sterile preparation of the surgical site: 1. Scrubbed with chlorhexidine scrub solution until three swabs come off clean, minimum contact time eight minutes 2. Wiped over area with swabs soaked in methylated spirits to remove any remaining scrub 3. Sprayed the incision site with tincture To help maintain circulating blood volume, Moody was placed on intraoperative IV fluids (LRS) at a rate of 10ml/kg/hr. The fluids were warmed prior to use and
administered using a fluid pump. IV fluid therapy equipment consisted of: a five litre fluid bag, giving set, one-way valve, extension set, Mila high-flow T-port and attached to the jugular catheter. Lee (n.d.) states that fluid therapy is a life saving measure which forms an integral part of equine critical care, especially in any condition that can lead to shock, including colic. Reasons for IV fluid administration are: to treat hypovolemia, to provide hydration support, and to correct acid base or electrolyte abnormalities. The two veterinarians who scrubbed in wore colic gowns and closed gloved for the procedure. All staff present at the surgery wore hats, masks and gloves to help maintain an aseptic environment. Moody was found to have a strangulating lipoma: a fatty tumour that forms on the mesentery (that encloses the intestines) in a horse’s abdominal cavity, that has formed a pedicle causing the tumour to become looped around a section of small intestine. The loop had tightened, preventing ingested material from passing and cutting off the blood supply to the compressed tissue, thus causing the horse to display signs of colic (Kentucky Equine Research, 2011). The devitalised bowel was resected and an end-to-end anastomosis was performed (Leander, 2017). Dobutamine (a sympathomimetic amine) was administered during surgery to increase the patient’s heart contractions (used where there is low cardiac output); this was given as a bolus and then the amount was decreased 15 minutes into surgery. Dobutamine administered at the rate 1 – 5 mcg/kg/min is very effective for inotropic support (Lee, n.d.). Thirty five minutes into surgery Moody’s heart rate rose to 80 beats/minute, at which point a right jugular catheter was placed with a second line in order to supply a constant rate infusion (CRI) of lidocaine at a rate of 0.05mg/kg/min. West (2008) states that lidocaine is an antiarrhythmic agent (counteracting/ preventing cardiac arrhythmia, or abnormal heartbeat irregularities), and its anti-inflammatory effects can aid in the treatment of inflammatory conditions such as laminitis and some colics.
At one hour and twenty minutes into the surgery, Moody’s anaesthetic plane became light and IV maintenance of anaesthesia was required. This was achieved by administering an additional 50mg of ketamine. The anaesthetist set the oxygen flowmeter to deliver six litres of oxygen during surgery. Throughout the surgery, Moody was taking six breaths per minute, however, at the beginning of surgery and at one hour and twenty minutes into the surgery (when her anaesthetic plane had become light), Moody experienced inadequate respiratory depth and manual ventilation (IPPV – intermittent positive pressure ventilation) was required to improve her oxygenation and to facilitate balanced anaesthesia. The oxygen flowmeter was increased to supply eight litres of oxygen at this time and decreased back to six litres once manual ventilation was no longer required. There were two attending veterinarians, one performing the surgery and the other scrubbed in to assist. The nurses’ role was to prepare and open the surgical packs, and get any other items the veterinarians required during the surgery. Moody was monitored closely by the anaesthetist to ensure the correct depth of anaesthesia was maintained, and the results of the parameters monitored were recorded every five minutes (see Appendix 1 – Anaesthesia Record). Respiration rate, mucous membrane colour, capillary refill time, eye position, palpebral reflex, movement in response to surgery and muscle relaxation were all monitored by physical examination. The equipment used to monitor Moody during anaesthesia included: • Reservoir bag (used instead of a ventilator) to aid assessment of ventilation rate and enable intermittent positive-pressure ventilation (IPPV) where required • Electrocardiography (ECG) to determine the rate, rhythm and nature of the cardiac depolarisation and repolarisation. The ECG also measured blood pressure via an arterial line. • Pulse oximeter to measure oxygen saturation in the blood
Potentially life-threatening values: • Heart rate less than 24 beats/min with a mean arterial pressure (MAP) less than 60 mmHg • Respiration rate less than 4 breaths/min After the isoflurane was turned off, the circuit was flushed and Moody was hoisted to the padded recovery area, where she received flow by oxygen prior to extubation (14 minutes after cessation of anaesthetic). She woke up slowly and remained in the recovery area for post anaesthetic recovery and monitoring. Post-anaesthesia and patient progress The mare recovered well after anaesthesia and she was provided with supportive care: • LRS with added electrolytes prepared using a 5 litre bag with 100ml potassium chloride (750mg/10mmol/L) with 50ml Calci Tat® (4.6g/100ml) • Ice boots on front feet for 48 hours (ice boots, cryotherapy or cold therapy has been shown to prevent laminitis in at risk equine patients. Moody was at risk due to endotoxins released from the devitalised tissue, which can affect the blood flow and damage the laminae in her hooves) Post-surgery, Moody was scanned in order to assess her foal which was found to be alive and have normal heart rate. Bloods were taken post operatively and Moody’s lactate level was 3.7mmol/l which is an unhealthy level. A healthy adult horse usually has a lactate level of less than 2mmol/L (Ryder, 2007). Unfortunately Moody did not have her lactate level tested prior to surgery due to the urgent need to start her surgical procedure as soon as possible to obtain the best outcome for her and her foal. Her lactate levels continued to be monitored after surgery. Whilst hospitalised, Moody was closely monitored by the nurses and she continued to receive antibiotic treatment (penicillin and gentamicin) daily. She also received meloxicam 30mg/ml (0.5mg/kg) orally, an NSAID used to provide analgesia and reduce inflammation, together with altrenogest 2.2mg/ml (18mg/kg) to help maintain her pregnancy. March 2018 21
The day after surgery, it was discovered that the lignocaine CRI was not working and she had only received 10 litres of LRS over three hours,due to the fact that Moody’s left jugular vein had collapsed. With the constant monitoring that was taking place, this situation should have been noticed and dealt with much sooner. A new catheter was placed in her left jugular vein and the fluids were reconnected and spiked with 200ml Calci Tat® 4.6g/100ml (5ml/kg) to slightly raise her blood pressure. ‘Colic caused by a strangulating lipoma will not resolve with medication, walking the horse, or any other treatment except surgical removal of the tumour. If surgery is done fairly soon in the course of the colic, prognosis is good for a full recovery. However, because lipomas seem to be most common in older equines, the horse may have other health problems that delay recovery’ (Kentucky Equine Research, 2011). Sadly, Moody developed peritonitis on day four post-surgery. Free abdominal fluid was seen on the ultrasound scan and two tubes were placed to enable the nurses to lavage her peritoneal cavity twice daily. A week later it was drained and flushed. Despite this, she was eating well, was surprisingly bright, and she only lost 5kg during her 12 days at the hospital. The owners were instructed to wear gloves and administer chloramphenicol 0.5mg/ml (30mg/kg) orally twice daily, phenylbutazone (NSAID) 200mg/ml (4.4mg/kg) given orally twice daily, together with continuing administration of altrenogest. The owners were to monitor her right jugular vein, her temperature and to assess her for any indications of lameness due to her still being at high risk of developing laminitis. An on-farm check-up was arranged for removal of her staples from the surgical incision. Due to the post-operative complications Moody suffered, her prognosis for survival and delivery of a healthy foal remains guarded. Her demeanour and appetite should be monitored to assess her quality of life (Leander, 2017). 22 March 2018
Discussion With a ‘low risk’ patient, the nurse would have groomed the horse prior to surgery in order to help maintain an aseptic environment. However, due to the urgency of the surgery, the amount of time the mare spent lying down and with not wanting to increase her stress levels, this was not possible. Preanaesthetic preparation should have included evaluation of her blood, namely packed cell volume (PCV), total protein (TP) and lactate, at a minimum. This would have helped to provide an indication of the horse’s prognosis. ‘Past horse case studies revealed that colic cases seen on the farm that had lactate levels below 2mmol/l rarely needed referral. Levels greater than 3mmol/l suggested a need for referral, and levels above 6mmol/L were generally associated with a poor outcome’ (Ryder, 2007). The results can help to indicate when particular therapies should begin and end, when the horse requires referral, and when it is time to surrender (Ryder, 2007). In addition to performing a blood lactate test, it may have aided faster diagnosis if a peritoneal lactate sample had also been taken: ‘In horses evaluated for colic, a peritoneal lactate concentration higher than the simultaneously measured blood lactate concentration is indicative of intestinal strangulation’ (The University of Georgia, 2012). The decision to use xylazine premedication and ketamine induction agent was sensible in order to ensure that the patient was offered the best chance of a smooth recovery. Lee, (n.d.) suggests that the major advantage of this combination is that recovery is usually smooth. The horse is usually standing 30 to 40 minutes following a single administration of xylazine and ketamine (Lee, n.d.). As Moody was a ‘high risk’ patient, ideally the initial scrub should have been performed to remove the majority of gross debris prior to induction and anaesthesia in order to reduce the anaesthesia time. Although it was necessary for the mare to be placed in dorsal recumbency for this surgery, Lee (n.d.) expresses that ‘when a horse is placed in dorsal recumbency, the weight of the abdominal contents
presses on the diaphragm and limits lung expansion, leading to hypoventilation’. Isoflurane was definitely the best choice of inhalation agent for maintenance of anaesthesia during this surgery. Moody not only required IPPV during surgery but she also experienced a low cardiac output. Lee (n.d.) states that controlled ventilation (IPPV) is recommended for isoflurane anaesthesia and that under controlled ventilation, the cardiac output has been demonstrated to be significantly higher during isoflurane anaesthesia. This surgery was necessary to provide the mare and foal with the best chance of survival. The surgery was performed with efficiency, the anaesthesia was good and the mare’s recovery from anaesthesia was amazingly good with her standing to recover (Dingemans, 2017). Considering the possible complications which could have occurred, this was a very successful anaesthetic. References Bassert, J., & Thomas, J. (2014). McCurnin’s Clinical Textbook for Veterinary Technicians (8th ed.). St. Louis, Missouri: Elsevier. Dingemans, K. (2017). [Anaesthesia Record: patient Moody Blue]. Unpublished case notes. EquiMed, LLC. (2016). Flunixin Meglumine. Retrieved from http://equimed.com/ drugs-and-medications/reference/ flunixin-meglumine EquiMed, LLC. (2016). Xylazine. Retrieved from http://equimed.com/ drugs-and-medications/reference/ xylazine Kentucky Equine Research. (2011). Lipomas: Deadly Tumours in Horses. Retrieved from http:// nrm.equinews.com//article/ lipomas-deadly-tumors-horses Leander, A. (2017). [Veterinary Report: patient Moody Blue]. Unpublished case notes. Lee, L. (n.d.). Equine Fluid Therapy and Intensive Care. Retrieved October 23, 2017, from http://cmapspublic3.ihmc. us/rid=1N9M94B8H-P3SBKS-1576/ Equine%20-%20Fluid%20Therapy%20 and%20Intensive%20Care%20%20 -%20Laura%20Lee.pdf
Lee, L. (n.d.). Equine Anaesthesia. Retrieved from https://instruction. cvhs.okstate.edu/vmed5412/ pdf/23EquineAnesthesia2006.pdf Ryder, E. (2007, July 4). Lactate Provides Useful Indication of Prognosis. Retrieved October 23, 2017, from http://www. thehorse.com/articles/19156/lactate-
provides-useful-indication-of-prognosis The University of Georgia. (2012). Interpreting lactate measurement in critically ill horses: diagnosis, treatment, and prognosis. Retrieved from https://www.ncbi.nlm.nih.gov/ pubmed/22271469 West, C. (2008). Intravenous
Lidocaine for Controlling Pain and Inflammation. Retrieved from http:// www.thehorse.com/articles/20783/ intravenous-lidocaine-for-controllingpain-and-inflammation Zantingh, A. (2017). [Surgical Report: patient Moody Blue]. Unpublished case notes.
Appendix 1. Anaesthesia record
March 2018 23
Meet the NZVNA Executive Committee By Antoinette Ratcliffe LVN, NZVNA Executive Committee member, NZVNJ editor
The NZVNA Executive Committee consists of Officers and General Committee members who are elected to their positions at AGM. The current Officers are Julie Hutt, Amy Ross, Kathy Waugh and Fiona Hastie; the committee members are Christina Jenkins, Jen Hamlin, Laura Harvey, Antoinette Ratcliffe, Luanne Corles, Libby Leader, Lauren Prior and Lynette Hobbs. We meet monthly, either via Skype or in person, to organise the next conference, discuss items of concern brought to the attention of the committee by association members and the industry, to provide feedback on portfolio
development, and to further develop our strategic plan.
Julie Hutt – President Julie started working as a veterinary nurse the 1990’s, and after having a break to try other possible careers, she realised that she missed the challenges and learning that the veterinary industry brings. Julie went on to complete her National Certificate in Veterinary Nursing, and continued to study anaesthesia and critical care. She has since furthered her education and learning by completing other diplomas and courses every year. Julie has now moved to teaching but still enjoys working in surgery for a couple of days a week and passing her knowledge onto a new generation of veterinary nurses.
In 2005, Julie was elected onto the NZVNA Executive Committee. Her role as president of the NZVNA over the last few years has seen many accomplishments as the profile of the NZVNA has grown. Julie is passionate about working towards the regulation of veterinary nurses in New Zealand and the protection of our title; we are a profession to be proud of. She enjoys working with such a dynamic, passionate group of people who she values and admires for their commitment and friendship, and she feels honoured to be on the Executive Committee.
Amy Ross – Vice President and Social Media portfolio Amy first qualified with a Certificate in Veterinary Nursing in 1997, and worked in a private practice for a few months before taking a veterinary nursing position at the Auckland SPCA. Over the following nine years, Amy also completed her National Diploma in Veterinary Nursing. After leaving the Auckland SPCA, Amy worked at Unitec teaching the veterinary nursing students and in 2008 joined the NZVNA council.
she also represents veterinary nurses on the NZ Companion Animal Council (NZCAC).
Amy’s portfolios include Media (Facebook and instagram), Vet Nurse of the Year, and 24 March 2018
Executive Committee members are either allocated already established portfolios, or they develop their own portfolio in an area of interest that needs representing in the NZVNA. A few changes in portfolios were made at our meeting with Sue Crampton in November 2017, where we also developed a long term strategic plan for the next five years. If you would like to contact any of the Executive Committee members about their portfolios, their details can be found on our website www.nzvna.org.nz.
After the birth of her first daughter Amy decided not to go back to teaching so that she could spend more time raising her family. Amy started working at the NZCCM at Auckland Zoo in 2011 on a casual basis, only taking a year off after the birth of her second daughter. Amy’s family includes three cats, Peppa (an oriental), Ash (a siamese), and The Ginger Shadow (a domestic short hair).
Kathy Waugh – Treasurer and Membership Secretary Kathy has been on the NZVNA Executive Committee since 2000, and has held a number of portfolios including being a past president. Kathy has been the Treasurer since 2003 and Membership Secretary since 2013, and she also manages the website and is the friendly voice at the other end of the 0800 telephone number. Kathy’s love of animals started at a very young age, and she came to veterinary nursing as a second career when her children were young. She was at home with three children (twin daughters and a son
– all under three) when the opportunity to study to become a qualified veterinary nurse was offered to her, she jumped at the chance. Kathy is a Practice Manager in a mid-sized small animal practice on Auckland’s North Shore. Her passions include continuing education and geriatric animal care. Kathy finds working with the NZVNA Executive Committee invigorating, as she enjoys working with other passionate people who want to give back to our great profession.
Fiona Hastie – National Secretary Fiona graduated from Massey University in 1999 with the Diploma in Veterinary Nursing. She decided after working for a few years that she’d like to give something back to her community, and was elected onto the NZVNA council in 2007. Fiona has worked in small animal practice for most of her career, but she also has a passion for large animals too having grown up on a farm in Northland, and more recently has developed an interest in exotics and conservation. For the past decade Fiona’s role has been in practice management, looking after four clinics, in 2015 she decided on a change, and joined the Royal Canin team as a veterinary sales executive in the Auckland South/Waikato area, and has recently become the Royal Canin North Island Field Sales Manager. For a challenge,
Fiona works at the NZCCM at Auckland Zoo, as a casual veterinary nurse in their vet department on weekends when she can.
Christina Jenkins – CPD portfolio Christina graduated in 2012 from Massey University with a Diploma in Veterinary Nursing and a Bachelor of Veterinary Technology, and began working in a large small animal practice in Franklin. She wanted to pursue a life of teaching, and found herself at the start of 2016 back in Palmerston North at Massey University Veterinary Teaching Hospital as a rotating 24/7 emergency nurse. Christina has since moved into the role of emergency and critical care department coordinator. She has also taken on the role as co-supervisor of the clinical teaching of the Bachelor of Veterinary Technology students in the small animal hospital.
Christina joined the NZVNA Executive Committee after she gained a third place in New Zealand Veterinary Nurse of the Year in 2015. Christina subsequently took on the role as the CPD coordinator, having demonstrated her passion for continuing professional development since graduating by completing her AVNP/CPD points annually.
Fiona holds the HR portfolio which she enjoys as she gets first hand connection with our members. For the last three years Fiona has also held the National Secretary position on council. She enjoys increasing the profile of the NZVNA throughout the veterinary nurse community. When Fiona isn’t working she spends time at the beach, supporting surf lifesaving and Mairangi Bay Surf Club, or socialising with family and friends. Fiona has recently trained as a marriage celebrant, so weddings are something you might see her at from time to time.
Supporting members to achieve their goals with CPD is a passion of hers, and she enjoys helping out fellow members throughout New Zealand. Outside of work Christina enjoys riding her horse, cake decorating and travelling.
March 2018 25
Jen Hamlin - Chair of the Allied Veterinary Professional Regulatory Council Jen’s veterinary nursing career started in California in the early 90’s when she qualified with a science degree in chemistry and veterinary technology, initially working as a vet tech at an equine/farm animal practice. After developing an interest in avian medicine, she worked in a high profile avian and exotics practice. Jen then decided to pursue an undergraduate degree and went to the University of California, Davis where she majored in Neurobiology, Physiology & Behaviour (NPB). In 2002 Jen came to New Zealand on holiday and immediately felt at home here, so decided to stay. Jen worked as head nurse and practice manager
26 March 2018
at an ophthalmology referral practice, and gained her Diploma in Veterinary Nursing. Jen is now a senior lecturer and programme manager for the Diploma in Veterinary Nursing at Otago Polytechnic and is currently working toward her doctorate in veterinary nursing education. She is a consultant editor of The Veterinary Nurse, the only peer reviewed scientific veterinary nursing journal in the world, and is also a consultant editor for VetStream, Lapis. For Jen it is important to give back to the community that has helped to develop veterinary nursing professionalism in New Zealand, and she believes that as a professional community, we have the ingenuity and drive to see big things happen.
Laura Harvey - Occupational Health and Safety and Vet Nurse Day portfolios, New Zealand Companion Animal Health Foundation representative, Education Standards Committee representative Laura became part of the veterinary nursing industry in 2008, having graduated from Unitec with a Diploma in Veterinary Nursing. In 2013, Laura’s career focus changed from small animal practice when the opportunity to follow a dream and start teaching veterinary nursing at Unitec came along. Teaching has become her passion, and now after having completed her Bachelor of Science, Post Graduate Certificate
in Veterinary Education, she is also working toward a Master of Science, along with starting in the exciting field of research around the veterinary nursing industry in New Zealand. Laura joined the NZVNA in 2013 which has allowed her to be a greater part of the industry that has provided her with some great friends, interesting times, and awesome work stories, while contributing in a useful way to the profession of veterinary nursing.
Antoinette Ratcliffe – Journal Editor, Editorial Board coordinator Antoinette has been a veterinary nurse since 2007, having graduated with a Certificate in Veterinary Nursing in between completing a Bachelor of Media Arts (first class hons) and her Masters of Art (visual arts) degrees. She has worked in small animal clinics in Auckland and Wellington and has volunteered at the Wellington Zoo and Wellington SPCA. Antoinette is currently the head surgical nurse at Forrest Hill Vet Clinic in Auckland, and has stepped in as editor of the New Zealand Veterinary Nurse Journal for this edition, but is currently on the lookout
for a new editor. Her previous projects on the Executive Committee include editing the 2017 conference proceedings, being the journal editor from 2016 – 2017 and working with a graphic designer to produce a fresh design for the journal.
Outside of work Laura spends most of her spare time walking or training her new addition to the family, a staffy cross named Min.
She has one cat called Cece (and two ghost cats, Ma’a and Conrad), as well as a collection of her own taxidermy that not only entertains Cece, but also provides her with a rewarding and interesting career as an artist. In her spare time she also teaches taxidermy classes in Auckland and Wellington.
Luanne Corles – International Veterinary Nurses and Technicians Association representative Luanne has worked in the veterinary industry for 25 years, mostly in small animal clinics in Auckland and Hamilton. Luanne’s passion is in cat and dog behaviour, nutrition and preventative healthcare, and she has enjoyed running puppy preschools and weight loss clinics. She would like to see all veterinary nurses involved in a consulting nurse program in their clinic.
also arranged the gifts for this years conference. Luanne’s family includes a Samoyed named Minnie, four cats (Hagrid, Lyla, Hartley and Layla), a budgie named Harry, a husband and has a daughter who is currently away studying Classics at Victoria University in Wellington.
Luanne has a Bachelor of Science degree in Animal Science and Psychology and a Certificate in Veterinary Nursing. She has been a member of the Executive Committee since 2016, and is the NZVNA representative for the IVNTA. She Robyn Taylor – Professional Standards Committee representative Robyn graduated from Massey University with a Diploma in Veterinary Nursing in 1999. Since then she has worked in both first opinion and referral practices focusing on companion animal nursing. Robyn has spent most of her career abroad at the Royal Veterinary College, in the UK where she learned so much with the high case load, and where her true passion became transfusion therapy. She was soon doing a mix of blood collection for storage, sorting transfusions for all sorts of situations, and intensive care nursing with the critical care team. Robyn is now part of the ARA of Canterbury
team, tutoring our future veterinary nurses.
Libby Leader Libby grew up in Christchurch and always had an interest in animals. Having worked at animal groomers and boarding facilities around Christchurch and Brisbane, she was inspired to further her knowledge and completed her Certificate in Veterinary Nursing at Christchurch Polytechnic Institute of Technology (now ARA) in 2008. Libby then started working in a general veterinary practice and fell in love with surgery. She landed her dream job at a surgical specialist nurse, and worked her way up to become the clinic’s Team Leader.
Libby is passionate about continuing education and was elected into the NZVNA Executive Committee in 2016, where her energy is spent helping to keep nurses upskilling and enjoying their profession.
Robyn was successfully elected to NZVNA Executive Committee in 2016, where she has since been sharing what she has learned abroad. She is excited about the direction veterinary nursing is going in New Zealand, as there are exciting times ahead for our profession.
Libby has a cat called Devlin, many fish (gold and tropical) and she recently added a new baby to her family. She enjoys watching movies, walking and spending time with friends and family.
March 2018 27
Lauren Prior Lauren grew up in Manchester in the U.K. and moved to New Zealand in 2005 with her family, where she completed her Bachelor of Science (majoring in Biology and Animal Behaviour) from The University of Auckland, and a Diploma in Veterinary Nursing from UNITEC. She has been a veterinary nurse since 2013, first working in a small single vet practice and then a busier general practice clinic for a few years. Lauren now works full time as a Senior Veterinary Nurse at Veterinary Specialists Auckland, a specialist surgical referral hospital.
Lauren’s passions include education and continuing professional development, pushing for veterinary nurses to utilise their skills and knowledge to their full potential, and advocating for the advancement of our career as a whole.
Lynette Hobbs – Equine Portfolio Lynette graduated from Otago Polytech in 2012 with a Certificate in Veterinary Nursing. She then decided to take a different path from continuing on to the diploma and instead completed Otago Polytechnic’s Rural Animal Technician course as she wanted to pursue a career in large animals, specifically equine, as she had worked on stud farms and racing stables both in New Zealand and Australia for 13 years. Horses are a great passion of Lynette’s, so equine nursing felt like a natural step for her to take. Lynette was employed as a small animal nurse by Hamilton Veterinary Services while she was student in 2012, which included 30% equine nursing. This slowly grew over the years and her position in the clinic changed to full equine nursing in 2015. The
equine side of the practice grew rapidly and consequently the clinic opened a purpose built facility just for horses in 2016 (Waikato Equine Veterinary Centre) where Lynette became head nurse. Lynette enjoyed this transition, taking on the responsibility for all the best practice set up, as well as policy and procedure writing. The day to day running of this facility continues to be rewarding.
In her spare time she loves to dote on her cat (Pixie), she is also avid reader, she enjoys being outdoors, at the gym and she is a novice mountain biker and skier.
Lynette as elected into the NZVNA Executive Committee in 2017 and has recently started working on establishing an equine portfolio. She is passionate about CPD and finding things that suit large animal tech’s and there future development. She enjoys spending time with her family, fur babies (horses, cats and dog) and enjoys a good bottle of wine.
Veterinary nurses dinner at the NZVNA 2018 conference is on Tuesday 19th June in Hamilton 28 March 2018
2018 NZVA conference 19-22 June 2018 Claudelands Events Centre, Hamilton www.nzva.org.nz/ conference2018 Registrations open 1 March 2018
This year’s two-day veterinary nursing programme focusses on highly practical content – emergency treatment, dentistry, compassion fatigue and anaesthesia – and features well known and respected speakers in their field - Amy Newfield, Angus Fechney, Bridey White and Marcia Fletcher: Amy is a Veterinary Technician Specialist in Emergency and Critical Care and is currently the National Veterinary Technician Training Manager at BluePearl Veterinary Partners in Massachusetts. She currently sits on the Academy of Veterinary Emergency & Critical Care Technicians Board as the President. She is published in over 15 subjects and has received numerous awards as an international speaker. Angus runs a small animal dental education and referral business in Palmerston North. He visits several veterinary clinics within the Central
North Island and provides a referral service from the Massey University Veterinary Teaching Hospital where he also teaches companion animal dentistry to undergraduate students. He is currently enrolled in a part-time dental residency program with a view to sitting specialist board exams. Bridey is currently Technical Officer for the Wildbase Oil Response Team. Bridey worked in rehabilitation of wildlife in a zoo setting and at Wildbase, Massey University. In 2011 she managed a team of volunteers in the response efforts after the grounding of the C/V Rena near Tauranga. Bridey provides support for oiled wildlife response activities including assisting with the development of Oiled Wildlife Response training courses and teaches undergraduate students avian behaviour, training zoo animals, caged bird welfare, oil spill response and managing compassion fatigue. Bridey engaged with Massey University’s School of Social Work to collaborate in research of wellness in wildlife careers to develop CPD for veterinary nurses in compassion fatigue. Marcia is the senior anaesthesia technician for the anaesthesia service.
She passed her specialty examinations in America to become a Veterinary Technician Specialist in Anaesthesia and Analgesia in 2011 and was awarded the NZVNA Vet Nurse of the year in 2012. Marcia also joined the credentials committee for the Academy of Veterinary Technicians in Anaesthesia and Analgesia. Marcia’s passion is instilling knowledge, teaching at Massey and via her anaesthesia articles in the NZVNA journal and she won the IVABS teaching award in 2016. She also teaches CPR techniques, and is certified in both basic and advanced life support by the American College of Veterinary Emergency and Critical Care.
After all of this there is plenty of opportunities to meet with friends – old and new – and make new connections during the conference dinners. The conference will be followed by an equine veterinary nurse workshop (see NZVA website for details) on Friday 22 June.
All creatures GREAT & SMALL 2018 NZVA conference | 19–22 June 2018 VETERINARY NURSING Programme Tuesday 19 June
Wednesday 20 June
Caring for the critical pet | AMY NEWFIELD The critical patient requires different and more intensive nrusing care than you “routine” patient. This talk focusses on intensive monitoring techniques and tricks of the trade.
Pneumonia in the dog and cat | AMY NEWFIELD Pneumonia can occur for a variety of reasons. This talk focuses on the reasons it occurs and how to care for the patient. Complications from and treatment of pneumonia will also be discussed.
What lies beneath - the importance of early and ongoing treatment of periodontal disease | ANGUS FECHNEY There is a common misconception that visible tartar on teeth is the most important aspect of periodontal disease. Treatment of subgingival disease with realistic homcare advice is paramount to good management of this common disease..
The human - animal bond – why we do what we do! | BRIDEY WHITE The human animal bond is mutually beneficial with direct behavioural and physiological effects on animals and people. The base physiological response we undergo from nurturing animals is not under conscious control.
9.30am 10am 10.30am
Morning tea | Exhibition Hall Monitoring the IV fluid patient | AMY NEWFIELD You can kill a patient if you don’t monitor them appropriately. It’s important to understand the risks of fluid therapy. This talk focuses on monitoring the IV fluid therapy patient with basic and advanced skills.
Fluid therapy... too many choices AMY NEWFIELD Choosing the right type of fluid for your patient can be difficult. 11.30am The talk discusses how fluids are selected, the differences between colloids and crystalloids and appropriate rates for patients. 12pm
New Zealand Veterinary Nursing Association AGM
CPR: RECOVER initiative | MARCIA FLETCHER The RECOVER initiative has been utilised in veterinary hospitals worldwide for around 6 years now. It is deemed the absolute gold standard in resuscitation. This talk covers the evidence based RECOVER techniques for both basic and advanced life support. Ischemia/reperfusion injury | AMY NEWFIELD How is it possible that returning blood supply back to an area where it was cut off could kill an animal? This syndrome produces a chain of devastating events and is a relatively new topic in veterinary medicine. Ths talk will discuss how it affects patients and ways to prevent it.
12.30pm Lunch | Exhibition Hall 1.30pm Keeping that bite intact - alternatives to tooth extraction | ANGUS FECHNEY Preferring the opportunigy to save their pet’s teeth, clients are increasingly looking for different options. This talk will discuss 2pm different treatment options and the value of keeping teeth in place. 2.30pm
Nursing care for the septic patient | AMY NEWFIELD This talk focusses on what sepsis is, diagnostics used and treatment options.
Rough inductions and difficult recoveries | MARCIA FLETCHER We have all dealt with stressful inductions or recoveries that didn’t go “according to the book”. This talk covers the background to these tough cases and provides tips and tricks to get both the patient and the anaesthetist through the process as smoothly as possible. Compassion fatigue and burnout – can I catch it? | BRIDEY WHITE Professions involving animals attract people with diverse backgrounds and skills. Often under intense conditions with animal mortality and euthanasia a reality, a natural consequence is burnout or compassion fatigue. Multidisciplinary techniques can be used to enhance resilience for animal care professionals or practitioners.
3.30pm Afternoon tea | Exhibition Hall Emergency anaesthesia | MARCIA FLETCHER When time is of the essence if can be difficult to think clearly and to stabilise successfully. This talk discusses how we can better prepare ourselves and the patient and ultimately promote less morbidity and 4.30pm mortality in these cases.
Nursing care of the upper airway surgery patient | AMY NEWFIELD There are a myriad of reasons why the upper airway requires surgery and upper airway surgery patients require unique nursing care postoperative. This talk focusses on, but not limited to, respiratory function, how to administer oxygen and tracheostomy tube care.
5.30pm Happy Hour | Exhibition Hall 7.30pm NZVNA Dinner
Friday 22 June - Equine Veterinary Nursing Workshop See website for more details. This programme was correct at the time of publishing. For more details visit www.nzva.org.nz/2018conference
OF NZ CATS ARE INFECTED WITH AT LEAST ONE ENDO OR ECTOPARASITE*
TOXOCARA IS THE MOST COMMON INTESTINAL WORM AND ZOONOTIC TO HUMANS*
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* Woollett B, Forsyth M, Beugnet F. Survey of fleas, ticks and gastrointestinal helminths in cats and dogs in New Zealand. Companion Animal Society Newsletter, 27 (1), 32-38, 2016
Increase your word power All definitions from Dictionary of Veterinary Nursing (2nd edition), D. R. Lane and S. Guthrie.
Joining together, or intercommunication between two vessels, to form a functioning organ; used surgically after an intestinal obstruction. Physiologically the word is used to denote the linking of the arterial with the venous part of the circulation. Medication used in the treatment of heart disorders to stablise the hearts rhythm. May also be used to describe a substance that prevents cardiac arrhythmia. A disorder of blood coagulation. Removal of the electrical potential across a membrane as a result of the movement of charged ions; part of the transmission of nurse impulses. Surgical opening of the abdomen to examine the enclosed organs visually and reach diagnosis.
Affecting the force of muscle contraction, usually refers to the cardiac muscle.
Used to describe a newborn puppy, kitten or similar animal at the stage when it would not survive without its mother or similar intensive care.
Did you know that your NZVNA membership means that you are also a member of the World Small Animal Veterinary Association (WSAVA)? Did you also know that the NZVNA is the only veterinary nursing association in the world to offer this membership benefit to their members? You can find out more about WSAVA at www.wsava.org, where you can also subscribe to their e-bulletin. 32 March 2018
Instructions for authors submitting articles to the New Zealand Veterinary Nurse journal By Antoinette Ratcliffe LVN, NZVNA Executive Committee member, NZVNJ Editor
NZVNJ is published quarterly in March, June, September and December each year. The printing costs are covered by NZVNA membership fees and advertising. Authors are expected to submit their articles as a Word document suitable for publication. If authors need assistance with writing, please contact the editor. Articles The article should have a title. Following the title, please also include the name of the author, their qualification, and their clinic name. Contributions must be original. Articles or extracts from articles may be completely copied only if there is permission from the original authors and source of publication. It is the responsibility of the author rather than the editorial board to obtain this permission. The author should disclose if they have published the same article, or a very similar article, elsewhere. Articles that are clearly editorials/ advertising that contain obvious product placement with be labelled as such, and an editorial fee will apply. Author biography Each article needs to be submitted with an author biography. Please provide approximately 50 words about the author, written in third person. Proof reading The authors should proof read their article looking for spelling errors, and omitted details. While the editorial board will proofread the articles, the articles should be presented error free. References A list of references should be applied if appropriate. Follow the guidelines for APA referencing for method of reporting references.
The number of references must be kept to a reasonable number relative to the length of the article. The editorial board will omit references if the list is judged to be too long. Figures Good quality illustrations that clearly illustrate the necessary points should be submitted with the article. Submit any photos or graphics in the original form (ie: TIF, JPEG, PDF files) as they lose their clarity when extracting them from Word documents. Photographs need to be as high resolution as possible, with no filters added. All figures should be clearly numbered with the same number that they are referred to in the article. Captions should accompany thumbnail sized images and be concise and accurate. This information needs to be supplied with the text on a separate page at the end of the article. Diagrams/figures can be copied from textbooks only if there the original author and the source is clearly acknowledged. It is the responsibility of the author to obtain this permission before submitting the article to the editorial board. Timing of article submission and publication Articles will be published as soon as possible after submission. Articles therefore need to be submitted at least two months prior to publication, preferably earlier. Depending on when the article is received, the size of the particular issue and the need for peer reviewing, articles may be held over for a later issue at the editors discretion. Peer review process Articles may be sent to appropriate people in that field of expertise for peer review/ proof reading if the editorial board deems March 2018 33
it necessary. This is to endure accuracy within the text to protect the readers, the authors, clients and patients of veterinary practitioners. NZVNA website Articles will be placed on the website in the form of The New Veterinary Nurse Journal e-copy and can be accessed by NZVNA members. Quizzes may be made using published articles for nurses to
complete for CPD points. These will be made available on the website. Planning a case report? When writing an article take the time to look at how articles in previous journals are arranged. Information needs to follow some logical headings as detailed below: • Introduction • History (including patient details) • Clinical signs/patient assessment
• Materials and methods • Results of investigations (ie: lab results, radiographs) • Discussion • Conclusion • References Not all of these headings will need to be used in all articles and some may be combined depending on the type of case and amount of information available.
Did you know about our new facebook groups ‘NZVNA equine and large animal vet nurses & techs’, and ‘NZVNA avian and exotic vet nurse and technicians’? They provide a fantastic community to discuss all nursing things in your field! You can find links to these groups, and more, on the NZVNA facebook page.
34 March 2018
2018 Listed and Registered Nurses Listed Veterinary Nurse Assistants for 2018 Date of expiry 31st December 2018 Jessica Erb Lauren Harvey Danielle Lord-Harman Brittany Pyne Halyna Tsalko Carina Viljoen
Listed Veterinary Nurses for 2018 Date of expiry 31st December 2018 Helena Akesson Sue Alexander Jessica Ashley Hannah Ballantyne Nicola Bancroft Rose Barry Emily Beard Kate Becker Robyn Bell Yasmine Bird Danica Bishell Jessica Blackwood Christine Boldero Nicky Bonisch Joyce Britt Rochelle Burton Robyn Carney Tanya Carr-Smith Melissa Cayless Tegan Cattley Jessica Chalklen Amanda Charman Janice Clark Lorna Clark Lisa Coppins Luanne Corles Brierly Corney Amanda Coton Derryn Davidson Teishan Davis Heather Downes Bridget Efstratiou Mary Fawcett Angela Fletcher
Rachelle Gee Jessica Gibson Anne Maree Giddy Rebecca Goodall Roberta Graham Kerri Gray Emma Hall Kirsty Hannaford Brittany Hanser Carolyn Harding Sophie Hatfull Beth Haywood Samantha Hector Tahnee Heney Claire Heslin Joyce Henton Lucille Hitchcock Denise Hughes Kodie Hyde Zoe Hyett Stevie Jamieson Lucy Johns Dale Johnstone Carol Julian Gemma Kahi Christina Kelliher Cheryl King Julie Kravcenko Alisha Langford Celina Lovejoy Brittany Mackintosh Catherine Marfell Angelina Martelli Sarah Maskell Brooke McGregor Kate McKenzie Deborah Mckie Cherie McLean Philly McMurtrie Seiko Messenger Lana Nilsson Natalie Oleksy Tori Osborne Rebecca Page Cindy Paton Kylie Pentecost Katharine Perkins Bernadene Pickett
Antoinette Ratcliffe Cassandra Renner Deborah Riddell Emma Riley Kate Robinson Keiko Sakuma Kelly Saunders Georgina Scholes Linda Shefford Karen Shell Nicola Smith Sharleen Spatcher- Harrison Janetta Stead Brenda Strang Tahlia Sullivan Hayley Suurenbroek Tina Swan Laura Tangaroa Roanne Trimmer Alexandra Tutty Catriona Veen Cornelia Waddingham Marisze Wana Kim Watson Kathy Waugh Lisa Welch Sandra Wells Courtneay Whitt Kelly Wight
Listed Rural Animal Technicians for 2018 Date of expiry 31st December 2018 Lynette Hobbs
Registered Veterinary Nurse Specialist Date of expiry 31st December 2018 Bianca Kuhlmann (Exotic species)
Register of Veterinary Nurses for 2018 Date of expiry 31st December 2018 Georgia Affleck Kathy Airnes March 2018 35
Chelsey Alexander Jocelyn Alexander Yana Amir Gemma Anderton Ellen Andrews Caroline Arkesteijn Heather Ashdown Melissa Balchin Lauren Barclay Justine Barnett Elizabeth Bateman Keira Bateman Kirsten Beaumont Lara Beetham Helen Bellwood Poorna Beri Sara Best Darien Beuth-Pukepuke Lisa Bickner Emma Blake Lisa Marie Boddy Ellesha Boot Hayley Bradshaw Holly Broadhead Lauren Brouard Monique Bowers Amanda Boyce Lucia Boyd Sarah Boyles Tara Brannigan Sarah Bray Lauren Browning Natalie Bryson Jane Burgess Robyn Burnett Rachel Burr Amy Callan Marysha Campbell Debra Cartmell Jolene Causer Catie Cawley Emma Chan Emma Cherry Natalie Christensen Joanna Christie Eleanor Clark Lauren Clark Jasmin Clarke Rebecca Clere Laura Cooper Lance Corles Victoria Cossou 36 March 2018
Jane Craker Emma Crichton Jenny Davis Stacey Davison Kelsey Dennett Emily Daley Afra Dixon Kate Donaldson Bridie Douglass Leilani Down Lauren Draper Nicola Dreadon Aimee Duke Katie Duncan Kirstin Eade Sarah Ellesmere Lisa English Cathrine Evans Elizabeth Evans McKenzie Evans Renee Evans Natasha Falkner Tania Farley Katherine Featherson Regan Finnerty Holly Fisher Billie Fletcher Jessica Fletcher Marcia Fletcher Donna Fountaine Amber Fulljames Sarah Fulton Meera Gandhi Nicolette Garner Alice Gasnier Melissa Geerligs Amy Grant Georgina Green Jennifer Hamlin Chloe Hands Amber Hardie Michaela Harding Laura Harvey Fiona Hastie Madeline Henderson Tasha Hildred Jessica Holly Alyssa Holtz Donna Horton Kirsty Hotson Jamie Hubbert Amelia Hudson
Isa Hulena-Leslie Kayleigh Hutchison Felicity Hull Julie Hutt Megan Irvine Samantha James Christina Janse van Rensburg Wendy Jarnet Karen Jenions Richard Jin Cassandra Johnson Becky Jones Glynn Jones Katherine Jones Laura Kaan Holly Kendrick Joanne Kennedy Tania Kilkolly Eve King Natasha Kirk Vicki Knox Barbora Kratochvilova Amanda Krieg Bianca Kuhlmann Peng-Yu Lai Yang Lan Denise Laurie Joanna Lea Elizabeth Lees Nikki Leigh Ashley Lâ€™Heureux Rebecca Lindsay Shelly Lineham Phoebe Loper Danielle Lord-Harman Estelle Low Katrina Lowe Sharna Loye Monique Loye-Tubb Dorraine-Kim MacColl Heidi MacLennan Steph MacPherson Steph Mann Hannah Marchal Fiona Marmont Sally Marriott Alison Marshall Nicole Marston Amanda Martens Michelle Martin Maria Maw Michelle Metcalf
Danielle McCabe Kezia McCabe Belinda McKie Emma McLeod Nastassja McMillan Megan McPherson Grace Mitchell Rachel Montgomery Angela Morrow Clare Morton Brook Muir Trina Mullan Melissa Murphy Kristina Naden Terri-Lee Nathan Jessica Nielson Christine O’Brien Karen O’Dea Jann O’Reilly Kaylene Otterson Georgina Ovington Michelle Parker Alyce Parry Crystal Payne Amanda Peach Amanda Pearson Andrea Pieper Doris Podusel Christina Polidori Jamuna Pradhanang Saraswoti Pradhanang Rosanna Prentice Lisa Preston Lauren Prior Lana Quaid Amy Raine Rosalia Randall Rachael Read Tegan Redshaw Cherie Reid Leah Reid Catherine Rice Oyana Riley Brooke Roberts Nicola Roberts Racheal Robertson Stacee Robertson Jenny Robinson Heather Rogers Kacey Rogers Tayler Rolleston Laiken Ronowicz
Robyn Rooney Amy Ross Nichole Rowley Lisa Roycroft Tami Rubie Leeann Ruddell Chelsea Russell Chelsea Rutene Helen Ryan Danielle Ryden-Stokes Renee Saward Ruth Scheurich Akiko Schimoda Angela Schuck Melissa Shuttleworth Laura Siew Emma Simpson-Boyce Venessa Skiffington Danielle Slobbe Erika Smith Kristina Smith Sheree Smith Courtney Spencer Tereza Spickova Krysta Stanley Lucy Statham Rebecca Stewart Kate Still Siheng Sun Brianna Sutherland Megan Sutherland Latasha Sweeney Mikayla Symons Sarah Taggart Carlotta Taylor Catherine Taylor Robyn Taylor Tamzyn Templer Jade Thompson Janine Thompson Alexcia Thorogood Hannah van der Brink Melissa Vanderkley Jone van der Westhuizen Jesse Vale Che Vaudrey Celine Verkuylen Renee Vieviorka Marieke Waghorn Shivarne Wakeley Rebekah Walker Nicky Wallace
Lisa Watene Jeni Watts Sonya Watts Briony Whatling Bridey White Nicole White Rebekah Willink Sarah Wilson Amber Wilton Cody Winstanley Christina Winyard Adriana Woloschuk Chelsea Woodbridge Edwina Wooderson Nikita Woodhead Sue Woodworth Allysha Wright Kerwyn Wyatt Christine Yeung Marie Yorston
Register of Veterinary Technologists for 2018 Date of expiry 31st December 2018 Natalie Anderson Emma Annear Melanie Beachen Toni Beasley Ashleigh Bryan Jessica Byres-Clark Haidee Clausen Alyssha Dent Lisa Hamilton Brittany Hanff Emma Hawkins Madeleine Hill Olivia Holt Christie Jasson Christina Jenkins Stella Lee Kate Leveridge Sophie Manson Kerry McLaughlan Paige McLean Alianna Munakata Aliesha O’Connell-Shanks Samantha Robbins Melissa Roberts Ellie Stonestreet Abbey Sutherland Ashley Xu March 2018 37
Errors in Veterinary Anaesthesia Reviewed by Lauren Prior RVN, NZVNA Executive Committee member
By John W. Ludders and Matthew McMillan Published: 2016 Publisher: Wiley Blackwell 168 pages (hardback) $96.85 (Book depository, price sourced January 2018)
Errors in Veterinary Anaesthesia is the first book to offer a candid examination of what can go wrong when anaesthetising veterinary patients and to discuss how we can learn from mistakes. Key features • Discusses the origins of errors and how to learn from mistakes • Covers common mistakes in veterinary anaesthesia • Provides strategies for avoiding errors in anesthetising small and large animal patients • Offers tips and tricks to implement in clinical practice • Presents actual case studies discussing errors in veterinary anaesthesia About the Authors John W. Ludders, DVM, DipACVAA, is Professor Emeritus at Cornell University in Ithaca, New York, USA. Matthew McMillan, BVM&S, DipECVAA, MRCVS, is Principal Clinical Anaesthetist and Critical Care Co-ordinator at Queen’s 38 March 2018
Veterinary School Hospital at the University of Cambridge in Cambridge, United Kingdom. Review Upon opening this textbook I expected to find just that, a textbook of facts, figures and reference pages for when things go terribly wrong in an anaesthetic setting. I was, however, pleasantly surprised to also find a book with an engaging narrative that reads easily and smoothly, and which provides more personal and individual accounts of anaesthesia that can test even the most experienced of our team members. The authors describe common errors in veterinary anaesthesia and provide practical and achievable approaches to avoid, mitigate or recover from such errors. From the beginning the book discusses crucial terminology, ‘the language of veterinary medicine’, and describes this as an underpinning of good anaesthetic knowledge. McMillan and Ludders go on to suggest that opening up communication within your practice, and extending that communication into anaesthetic settings in the form of checklists, for example, can greatly reduce the number of human induced errors we as veterinary professionals can see. Combined with ‘real life’ case reports and appendices full of checklist templates, tables of reference and protocol suggestions, this books allows readers to put information into context and use it in practice. Interestingly, Errors in Veterinary Anaesthesia proves not only thought-provoking for all those involved in anaesthesia, but practice management, protocol instigation and those participating in morbidity-mortality rounds. In summary, this book is a well written, concise and refreshing look at the topic of veterinary anaesthesia, and although short, it is an extremely useful text for anyone looking to improve their anaesthesia knowledge and improve patient safety in their practice.
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Talk to your Virbac Area Sales Manager about easOtic® and Epi-Otic® together can help your client’s ears get better faster.
nz.virbac.com/ears easOtic® is a Restricted Veterinary Medicine available only under Veterinary Authorisation. Epi-Otic® and easOtic® are Registered Pursuant to the ACVM Act 1997. ACVM Nos. A6006 and A10305.
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