NZ Vet Nurse Journal December 2018

VOLUME 24 No. 88 DECEMBER 2018

Vital pulp therapy Vet Nurse of the Year 2018 Equine sinus surgery Feline blood transfusion Perspectives on CPD

88%

OF NZ CATS ARE INFECTED WITH AT LEAST ONE ENDO OR ECTOPARASITE*

TOXOCARA IS THE MOST COMMON INTESTINAL WORM AND ZOONOTIC TO HUMANS*

FLEAS ARE ACTIVE YEAR ROUND WITH 50% OF CATS INFESTED, EVEN DURING WINTER*

BROADLINE® is the only treatment for cats that kills fleas, ticks, roundworms, hookworms - PLUS tapeworms - in a single easy to use topical application. Because it is a regular monthly treatment, you’re ensuring consistent year-round protection against internal and external parasites.

So for a happier, healthier cat - recommend BROADLINE.

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Boehringer Ingelheim Animal Health New Zealand Limited. Level 3, 2 Osterley Way, Manukau City, Auckland, New Zealand. BROADLINE® is a registered trademark of the Boehringer Ingelheim Group. Registered pursuant to the ACVM Act 1997 | No. A010901 | ©Copyright 2018 Boehringer Ingelheim Animal Health New Zealand Limited. All rights reserved. NZ-18-BDL-123.

* 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

CONTENTS

04

VO LUME 24 No. 8 8 DECEM B E R 201 8

04 EXECUTIVE COMMITTEE OFFICERS

05

President Julie Hutt PO Box 35831 Browns Bay Auckland 0753 021 599 059 president@nzvna.org.nz

Letter from the Editor by Antoinette Ratcliffe

Membership Secretary report by Kathy Waugh

Continuing professional development report by Christina Searle

07

Case study: vital pulp therapy with crown reduction by Jessica Johnston

Vice-President Amy Ross 021 852 664 vicepresident@nzvna.org.nz

11

Vet Nurse of the Year 2018 by Amy

Treasurer & Membership Secretary Kathy Waugh 021 843 277 treasurer@nzvna.org.nz

14

Case study: equine sinus surgery

18

National Secretary Luanne Corles 027 472 1072 secretary@nzvna.org.nz

15

JOURNAL EDITOR Antoinette Ratcliffe journal@nzvna.org.nz Assistant Editor: Catherine Taylor catherine.ellen.taylor@gmail.com

EDITORIAL BOARD Exotics: Kylie Martin Equine: Lyn Hobbs Photography: Miranda Samson OSH: Libby Leader CPD: Christina Searle and Patricia Gleason

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.

COVER:

OUR VISION

‘Kerurū’ by Neil Dalphin, 2017.

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 membership@nzvna.org.nz

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.

20 26 30 30

Ross

by Lynette Hobbs

Human behavior change for animals: New Zealand Companion Animal Conference review by Amy Ross Transfusing the feline patient by Robyn Taylor

CPD corner: perspectives on CPD

by Patricia Gleason

Book review by Libby Leader Increase your word power

23

NZVNA

Letter from the Editor Over the course of preparing this edition of the journal, I moved into a new house where an abundance of native birdlife fill the garden, including kerurū (the ‘Bird of the Year 2018’). And with the kerurū’s increasing media presence, including stories about their suicidal tendencies, it’s been brought to my attention that I need to add avian wildlife emergency care to my 2019 continuing professional development (CPD) plan, something that Patricia Gleason has inspired me to do through her regular column CPD corner.

| Above: Cece and her new friend Ferdinand

Patricia’s column in this edition examines the findings of her survey about CPD perspectives, and she continues to encourage us to plan our own CPD portfolios. Lyn Hobbs walks us through her equine case study on sinus

surgery, and Robyn Taylor’s article on feline blood transfusion outlines everything we need to know about carrying out the procedure in our own clinics.

We also get to congratulate Ellie Clark, our 2018 Vet Nurse of the Year, and read about vital pulp therapy with crown reduction in Jessica Johnson’s article.

I hope you all stay safe over the silly season; may the fish hooks stay on their lines (and not in the mouths or stomachs of your patients), the christmas cake go back in the tin (and not end up as an apomorphine induced vomit on your clinic floor), and the chicken kebab skewers not get swallowed whole by your neighbour’s enthusiastic labrador.

Antoinette

Membership Secretary report There are various benefits of being a member of the NZVNA that make it worthwhile if you are currently in the veterinary nurse industry, for example: Vitae (for veterinary nurses in stress) – from time to time the pressures of our professional and private lives call for some external assistance to ensure we remain confident, capable and able to deal with whatever opportunities and challenges life throws at us. Vitae offer a confidential counselling service, and a 24 hour phone service that’s open seven days a week.

This service also includes up to three fully funded counselling sessions with a trained psychologist.

The NZ Veterinary Nursing Library on SciQuest - contains the complete archive of annual conference proceedings of the NZVNA, and a comprehensive archive of selected articles from the NZ Veterinary 4 December 2018

Nurse, the quarterly journal of the NZVNA. This library provides a unique collection of high-quality articles on a wide range of veterinary nursing topics, in a fully indexed and searchable format.

VetCheck - one of the leading solutions for mobilising pet health information, and is helping drive practice growth and success. Designed for veterinary teams, VetCheck improves communication with the pet owner and engages them to be more proactive with their pet’s health.

By creating and sharing personalised digital pet health reports or health assessments, VetCheck is strengthening client relationships and adding value to the veterinary practice.

These benefits can be accessed via the members only section on our website www.nzvna.org.nz.

Kathy

NZVNA

Continuing Professional Development report It’s approaching that time again, when we all start scrambling to find our CPD certificates from the year to upload to our My CPD Portal by 31st of December.

If you’re anything like me, I try to get it all submitted before the Christmas rush starts! So don’t forget yours this year as the deadline is enforced, and also don’t forget you need to upload proof of hours worked - either a copy of a payslip or a letter from your manager. The process was held up last year as we had to chase so many members who had not uploaded their proof of hours.

So what is CPD? The Royal College of Veterinary Surgeons (RCVS) defines CPD as the process of continually maintaining, improving and broadening your skills and knowledge, as well as developing personal qualities which help to ensure you remain professionally competent in your role.

How you choose to progress in your professional learning is a personal journey. Choosing CPD most relevant to your job, or gaps you may feel you have in your knowledge, is important too.

Why do I have to complete CPD? Voluntary registration with the NZVNA was established in 2016 to replace the AVNP CPD programme. This was developed to prepare the community for future mandatory regulation of our profession.

Getting into a routine of completing and

recording your CPD activities now will ensure an easy transition when regulation of all allied veterinary professionals becomes compulsory.

Many of us complete CPD not only for our own career progression and to improve our competency, but also to ensure we are up to date with the most current ways to treat our patients, and ensure we are doing the very best for what they need while we have them in our care.

The NZVNA is always striving to make sure our members are able to complete their CPD requirements by improving our policies at a review each year. This year we have increased the amount of non-accredited CPD allowance to eight points out of the 20 needed per year; this ensures quality in-clinic CPD training sessions by veterinarians or travelling professionals can be used towards your year’s total.

Voluntary registration is becoming more popular, with half of all members of the NZVNA opting to complete their necessary registration requirement for the year. Ensure you have brought your badge to match your qualification once you have seen that you are on the 2019 list/register.

Keep up the great work everyone and keep those interesting courses flowing!

Christina

Save the date...

NZVNA conference

14th and 15th June 2019, Heritage Hotel, Auckland We are extremely excited to announce that our Keynote speaker will be Dr Dan Brockman. Daniel works with the Soft Tissue Surgery Service and is leader of the cardiac surgery team at the Royal Veterinary College, University of London. He has a particular interest in surgical management of cardiac disease, vascular disease, wound management, plastic and reconstructive surgery, and gastrointestinal surgery. Daniel is ‘head of group’ looking at therapies for congenital and acquired cardiac disease. These include valve replacement for valvular disease, open patch graft for pulmonic stenosis and palliative shunting for cyanotic heart disease.

December 2018 5

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6 December 2018

VITAL PULP THERAPY

Case study: Vital pulp therapy with crown reduction

By Jessica Johnston CVT, VST (Dentistry) BluePearl Veterinary Hospital, Blaine, Minnesota

Jessica Johnston is a native Minnesotan who became a Certified Veterinary Technician in 2008. After six years in a high volume corporate practice, Jessica switched gears to specialty care in Minnesota’s BluePearl hospitals. She found her passion in dentistry/surgery and is busy making the world a better place via one, clean, pain-free mouth at a time.

In 2018, Jessica did her first RACE webinar through BluePearl Vet Connect and was published in the 2018 February/March edition of NAVTA. She is also one of the few CVTs to earn her Veterinary Technician Specialty (VTS) in Dentistry.

Coco, a seven month old, 3kg, neutered male, Yorkshire Terrier, presented for further evaluation and treatment of a traumatic class 1 malocclusion. The right mandibular canine (404) contacted the hard palate causing a palatal defect (figure 1 and 2). The malocclusion was noticed by the family veterinarian two months prior to presentation, and had recommended the owner try digital manipulation. The owner tried this for two months but the occlusion was not corrected. The patient was up to date on vaccines and did not receive any additional home dental care.

Diagnostic process A conscious physical examination was unremarkable. The patient had a 5/9 body condition score and normal hydration status. The vital parameters, including heart rate, temperature, respiration, electrocardiogram (ECG), blood pressure, and capillary refill time (CRT)/mucous membranes (MM), were within the normal reference range. During the conscious oral exam, it was found that the length of the maxilla was appropriate compared to the length of the mandible. However, the right mandibular canine was in linguoversion, meaning: “base narrow or lingually displaced canine teeth: (one or both of the cusps of the mandibular canine teeth are displaced lingually and occlude on the hard palate)” (Holmstrom, Frost & Figure 1: Trauma on the hard palate

Gammon, 2004, p. 504). Generalized mild gingivitis and calculus, as well as several missing teeth, were noted. Two estimates were presented to the owner that included general anaesthesia, dental prophylaxis and full mouth dental radiographs, demonstrating the financial difference between extraction of the canine verses crown reduction with vital pulp therapy.

After consultation with the veterinarian, the owner signed a consent form to proceed with crown reduction with vital pulp therapy of the right mandibular canine, along with a dental prophylaxis.

Crown reduction and vital pulp therapy involves shortening the crown of the canine tooth to the level where occlusal trauma is no longer present to the hard palate. With this option, the veterinarian also discussed ongoing care for the patient’s future oral care. Holstrom, Frost, & Gammon (2004) advise that “radiographic follow-up at six and twelve months, or at appropriate intervals, following endodontic therapy to monitor for direct pulp death and/or subsequent apical changes.”

Preparation A complete blood count and serum biochemistry profile with electrolytes were performed at the patient’s family Figure 2: Pre-surgical intraoral photograph of the right mandibular canine

December 2018 7

VITAL PULP THERAPY

veterinarian two months previously, and the results were within normal reference ranges. The veterinarian reviewed the previous blood work and approved the patient to be premedicated intramuscularly with dexmedetomidine (0.02mg/kg) and hydromorphone (0.15mg/kg). Thirty minutes after the pre-medication injection, a 22 gauge intravenous (IV) catheter was placed in the right lateral saphenous vein. The patient received 28mg propofol (10 mg/mL) via slow infusion through the IV catheter.

The patient was placed on a heated table, artificial tears were administered to lubricate both eyes, and a 3mm cuffed endotracheal tube was placed and inflated until a seal was achieved. After intubation, the patient was attached to a closed anaesthetic delivery system with a half litre bag, and started at 2L of oxygen and 3% isoflurane. ECG leads, pulse oximetry, temperature probe and size 2 blood pressure cuff were placed on the patient. IV fluids of PlasmaLyte™ were started and continued throughout surgery at the rate of 5mL/kg/hr. The patient was continuously monitored and vital parameters were recorded at five minute intervals throughout the procedure.

Isoflurane was adjusted based on vital parameters and response to the procedure as needed.

Once the patient was stable at a surgical plane of anaesthesia, the technician exposed full mouth intra-oral radiographs to document and identify the degree of periodontal and/or endodontic disease.

The technician used size two phosphor plates and a hand held Nomad™ radiograph generator. After exposure, the phosphor plate was developed via Scan –X™ system to create a digital image. A comprehensive oral exam was performed with periodontal probing and dental charting. Upon an anaesthetized exam, the veterinarian and technician confirmed that the canine was in traumatic contact with the hard palate immediately palatal to the right maxillary canine, and radiographs confirmed that it had no changes consistent with endodontic or periodontal disease that contradicted the treatment plan (figure 3). As a result, the 8 December 2018

veterinarian confirmed crown reduction with vital pulp therapy was indeed the best option for the patient’s comfort and oral health. The other clinically absent teeth were confirmed to be radiographically absent and no medical attention was needed.

Surgery Following the confirmed diagnosis and treatment plan, the technician prepared the mayo stand with the necessary instruments and supplies for crown reduction and vital pulp therapy. Regional pain control was given via a local nerve block of 1mg/kg of 0.5% bupivacaine in the right inferior alveolar nerve, to minimize the amount of inhalant anaesthesia needed and to aid in pain relief. A universal size 1 ultrasonic scaler was used to remove supra-gingival and sub-gingival plaque and calculus from the dentition. After scaling, the teeth were then polished with a disposable, soft cup, oscillating prophy angle and medium grit pumice paste. Any remaining paste was rinsed with distilled water using a three-way syringe.

The veterinarian used a sterile 701L carbide cutting bur to amputate the coronal aspect of the canine to the level of the adjacent third incisor. Then a sterile number 2 round carbide bur was used to remove approximately 5mm of the pulp within the crown-reduced tooth. Active haemorrhage was noted upon pulpectomy, as expected with this procedure, signifying pulp vitality. The bleeding was controlled with sterile paper points and a clot was formed in less than five minutes. Once the bleeding stopped, a retrograde amalgam carrier was used to place 2-3mm of Figure 3: Pre-surgical intraoral radiograph of the right mandibular canine

dentinal stimulating material mineral trioxide aggregate (MTA) over the exposed pulp. An excavator was used to smooth the MTA, and clean and expose the dentinal walls. Glass ionomer (Ionoseal™) was then injected on top of the MTA and cured with a light cure gun to initiate bonding to the dentinal walls. An “intermediate layer like glass ionomer is placed on top of the direct pulp dressing to act as an additional layer of protection against bacterial contamination as well as a base for the final restorative” (Niemiec, 2005a, p. 849). Using a three step bonding system

by Adper™ Scotchbond™, a thin layer of etchant (34% phosphoric acid) was applied after the applied glass ionomer to the crown of the canine. After 15 seconds, the etchant was rinsed away and the tooth dried with the three-way syringe. A smear layer was created during etching.

Next, the primer is applied for 20 seconds with a microbrush to remove the smear layer formed on the access site of the canine. The primer was then dried with the three-way syringe. Using a microbrush, the adhesive was applied thinly and cured with a light curing gun. Finally, a flowable composite was placed over the canine and light cured for 20 seconds. The composite was then smoothed and shaped with Shofu discs before a final layer of adhesive was placed and cured to decrease the risks of any marginal leakage (figure 4). A postoperative radiograph was then taken to ensure proper placement of the materials and to provide a baseline for future monitoring of the canine (figure 5).

Figure 4: Post-surgical intraoral photograph of the right mandibular canine

VITAL PULP THERAPY

Figure 5: Post-surgical intraoral radiograph of the right mandibular canine

Post operative care and recovery Following the procedure, the technician checked the oral cavity for any foreign material, and the mouth was rinsed with distilled water via a three-way syringe to remove any debris. The isoflurane vaporizer was turned off and the patient remained on oxygen for five minutes.

Anaesthetic monitoring continued until the ability to swallow was confirmed, at which point the oxygen was turned off and the endotracheal cuff was deflated to allow extubation. The patient was transferred to the intensive care unit for recovery, which was smooth and uneventful.

Within one hour post-surgery the patient was bright, alert, responsive, and able to walk. Approximately two and a half hours following surgery, the technician went over the discharge instructions and medications with the family, which included advising the owner to feed a softened diet and avoid any mouth play for three days. The patient was sent home with buprenorphine 0.3mg/mL (0.2mL twice daily given orally for three to five days) for pain relief. Two weeks later, the patient was seen for a recheck examination to ensure the restoration was still intact.

Conclusion With commitment to ongoing monitoring, crown reduction with vital pulp therapy was an appropriate recommendation for a base narrow canine in this patient. In this case, the procedure eliminated palatal trauma and allowed a healthy, functional tooth while providing the patient with a comfortable occlusion in the long term.

With crown reduction and vital pulp therapy, the patient avoided any surgical

trauma and any potential complications associated with extraction of a mandibular canine, including iatrogenic mandibular fracture. For the patient’s future oral care, dental “radiographs are recommended at six-month intervals for two years following vital pulp therapy in order to ensure a persistently vital tooth” (Niemiec, 2005b, p. 16), and to ensure the sealant and composite remain intact.

“Signs of continued pulp vitality include a decrease in width of the root canal system, lack of periapical lucency, and a root canal system that is the same width as the contralateral canal” (Niemiec,

2005a, p. 849). With client compliance and monitoring, a good prognosis can be achieved for the patient.

References Holmstrom, S. E., Frost, P., & Gammon, R. (2004). Veterinary dental techniques for the small animal practitioner.

Philadelphia, PA: Elsevier Saunders.

Niemiec, B. A. (2005a). Fundamentals of Endodontics. Veterinary Clinics of North America: Small Animal Practice, 32(1), 849.

Niemiec, B. A. (2005b). Step-by-step compendium. Journal of Veterinary Dentistry, 16. Fayetteville, TN: American Veterinary Dental Society.

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December 2018 9

CLIENT HANDOUT

Flystrike © Luke Feldman Group Pty Ltd All rights reserved Photograph by Sam Kennedy

Overview Flies are unpleasant pests that look for injured tissue on living animals to lay their eggs. Flies thrive in warm and humid environments with the peak season from mid to late summer. Fly numbers increase as temperatures increase.

• Regular cleaning of soiled fur from urine or faeces • Treatment of any diarrhoea, worms etc • Surgical debridement of affected tissue in severe cases • Environmental fly controls such as fly traps, chemical control

It takes about eight to twelve hours for the egg to hatch into the maggot form.

The maggots hatch out to feast on the damaged flesh. Infestations are not only irritating, but they can cause serious damage and death.

Prevention Tips on how to prevent flystrike:

Common areas of attack: • Open wounds • Around the eye • Around the anus Risk factors: • Dirty coat • Wounds • Diarrhoea • Unclean skin folds • Obesity • Environmental fly problem Management Treatment of flystrike involves: • Cleaning any wounds • Removing any matted hair

Pet care • Bathe and groom the pet regularly • Check your pet’s skin for wounds or dermatitis daily during fly season • Treat any conditions such as diarrhoea, incontinence, worms etc.

• Clean skin folds daily • Keep the coat short • Adequate weight control as obese animals are less likely to groom themselves • Use pet approved fly repellents or Vaseline® on wounds to prevent flies from laying eggs Environmental care • Control flies in the home environment • Clean dirty or soiled bedding A pet that is suspected of flystrike should seek veterinary attention immediately.

Disclaimer Content is provided for informational and educational purposes only. The information is not a substitute for professional health or other advice and is in no way intended to be used or relied upon to diagnose or treat the health condition of any animal, or as a prognosis of any health condition.

Always seek advice or consult a health or other appropriate professional before relying on any information provided.

Source VetCheck digital pet health summaries, handouts and forms. To add your practice logo and start sharing directly to the pet owner’s mobile phone, visit www. vetcheck.it. Pet owners can now store their veterinary health record, receive pet reminders and get curated pet news at www.petcheck.it

10 December 2018

VNOTY 2018

Vet Nurse of the Year 2018

By Amy Ross RVN, NZVNA Executive Committee member

I would like to start by saying congratulations to the fifteen veterinary nurses that were nominated for the New Zealand Veterinary Nurse Association and Hill’s™ Vet Nurse of the Year 2018 – Alexandra Tutty, Aleishia Tate, Becky Goodall, Catherine Evans, Deb Cartmell, Ellie Clark, Haidee Clausen, Jordan Hardgrave, Melissa Roberts, Monique Loye-Tubb, Rosie McCarthy, Sarah Ellesmere, Sophie Manson, Suzan TimmsLess, and Zoe Hyett.

It is wonderful to see that veterinary nurses in New Zealand are being recognized by their peers for their dedication and enthusiasm to our profession, and that they are being acknowledged and appreciated for going above and beyond on a daily basis.

Amy has been a veterinary nurse for 20 years and holds a Diploma in Veterinary Nursing. She has previously worked at SPCA Auckland and Unitec, and is currently a veterinary nurse at Auckland Zoo. Amy is also on the Executive Committee for NZVNA, and her portfolios as the vice president include social media, Vet Nurse of the Year and NZ Companion Animal Council, where she sits on the Executive Board.

When we are reading the letters of nomination, we are consistently seeing that veterinary nurses are not only working to the highest standards, and how this makes a difference to their patients and clients experience, but also in assisting and encouraging fellow veterinary nurses, educating students that are gaining work experience and of course being two steps ahead of their vets! We recently shared a post on our Facebook page from Lou the Vet Nurse saying “Be the type of vet nurse you want to work with”, and I would love to work with all of these veterinary nurses.

Our judges were also impressed with the nominations that we received this year, with all of them submitting a different list for their top five! While we would have loved to have all of you at our award presentation lunch, we can only have three finalists so I implemented what I like to call a reverse scoring system. If someone was voted in first place then they received five points and voted in fifth place then they received one point. All points were then totalled and our three finalists were decided upon.

I then had the pleasure of phoning Deb Cartmell from Vet Services Wairapapa, Becky Goodall from At The Vets Christchurch, and Ellie Clark from The Skin Vet Auckland, to let them know that not only had they been nominated for Vet Nurse of the Year, but they were finalists.

All three of them were in shock when I explained that they had been nominated as they had no idea; somehow their colleagues managed to keep it quiet. I then went on to explain that they were finalists from which I received mixed feelings – absolute quiet to rambling to almost in tears, as one finalist had one of those days where it feels like nothing went right and she couldn’t think why NZVNA would be contacting her – what had she done wrong, was she about to be told off and struck off the register?

Thankfully it was the opposite and I was able to make her day brighter.

Not only are Becky, Ellie and Debbie passionate about their work, providing the highest possible care for their patients, but they also look out for everyone in their community.

From implementing palliative care clinics to outstanding patient care, to treating clients and their pets like their own whanau, to undertaking and encouraging others to complete CPD, they are all outstanding role models and we are proud to call them members of our community.

| Above: Julie and Peter Gordon at The Sugar Club

Becky, Deb and Ellie, who are all deserving of the title Vet Nurse of the Year, were brought up to Auckland where they had dinner with representatives from the December 2018 11

VNOTY 2018

NZVNA, before spending a night in the Four Seasons hotel ahead of the presentation lunch at The Sugar Club, located at the top of the Sky Tower. It was at the Sugar Club where Julie Hutt (NZVNA President) got to meet her idol, Peter Gordon.

During the lunch, Julie said that she is so proud that we are able to have Vet Nurse of the Year, and that the standard and calibre of delegates is mind-blowing. She is honoured to have our three finalists with us, and she can’t wait to see what they are going to do in the future.

Patrick Crawley (General Manager Hill’s Pet Nutrition NZ Ltd) said that he

| Above: Ellie with her award

is pleased that Hill’s has a fantastic relationship with NZVNA, and over the years he has noticed the value that veterinary nurses give to the clinic.

Patrick also acknowledged Kate Camby, a veterinary nurse, who has looked after all of the South Island for Hill’s for the past year. Throughout his clinic visits over the past few weeks, Patrick has also seen the Vet Nurse Awareness Week posters in reception areas and staff rooms of clinics, and said that it isn’t just about the vet nurses but the camaraderie that they bring to the team.

All three finalists were presented with certificates and gifts acknowledging their achievements for not only being nominated, but by being recognised as the top three veterinary nurses in the country from those working in over 800 veterinary practices! As there can only be one winner, NZVNA and Hill’s Pet Nutrition NZ LTD are proud to announce that Ellie Clark has been named Vet Nurse of the Year 2018.

| Above: Julie, Ellie and Amy

On receiving the award, Ellie said “So not expecting this and I so thought it would be one of you (Deb or Becky). I hope I do you proud as veterinary nurse of the year and will continue to work hard for the best profession”. She also said “Thank you (to Hill’s) for treating the three of us like princesses over the last few days”.

As well as receiving the title Vet Nurse of the Year 2018, Ellie receives registration and a dinner ticket to the NZVNA conference in 2019, and flights, accommodation and registration to the Hill’s VNA (Veterinary Nutritional Advocate) conference in 2019.

Ellie has an infectious, bubbly personality that can fill the room, making the environment as stress free as possible for everyone around her. She creates a sense of whanau (family) with her clients by knowing each pets special needs off the top of her head, and helping the clients to understand and cope with their pets medical needs in a way that someone without a medical background can understand.

Working in a referral clinic, Ellie makes the referral process as smooth as possible for the referring veterinarian, as well as allowing her boss to deliver a service that she is proud of.

On top of this, Ellie has run webinars for veterinarians and veterinary nurses, as well as being proactive in teaching students and junior veterinary nurses, mentoring and guiding them to a high standard of veterinary nursing.

| Above: Julie, Deb, Ellie, Becky and Patrick

12 December 2018

Ellie has a genuine passion and love of animals, which always shows in her

VNOTY 2018

veterinary nursing care, and she can often be seen going the extra mile for both patients and vets. (Ellie’s full bio can be read on our website www.nzvna.org.nz).

Throughout our promotions of Vet Nurse of the Year, we have seen comments where people have hinted to their colleagues that they should be nominated and #lifegoals.

I encourage all of you to work to the best of your ability, aim for high standards and stand proud of our profession, encouraging others to also enhance our community by being the veterinary nurse that they want to work with. Make sure that everyone in your clinic has access to the nomination form (which can be found on our website), and know that everyone that is nominated will be sent a certificate acknowledging this.

| Above: Julie, Deb, Danielle

The NZVNA Executive Committee would like to thank Hill’s Pet Nutrition NZ Ltd for their continued support of the Allied Veterinary Professionals around New Zealand, the NZVNA, and this prestigious award. Without their support we would not be able to continue to advance our profession.

If you know of a veterinary nurse that deserves the title of Vet Nurse of the Year, please consider nominating them in the future.

| Above: Julie, Becky and Danielle

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EQUINE

Case Study: equine sinus surgery

By Lynette Hobbs CVN, RAT, Executive Committee member Waikato Equine Veterinary Centre

Patient details Name: Archie Species: Equine Breed: Thoroughbred Age: 11 years Colour: grey Weight: 545Kg History Archie was referred to Waikato Equine Veterinary Centre from Taranaki Vets.

We first visited Archie on a trip to New Plymouth when he presented with a purulent discharge from the right nostril, that had been discharging for the last few months.

After sedating Archie with intravenous (IV) sedation, Xylazine 100mg/ml (0.6-1.0ml/100kg) and butorphic 10mg/ml (0.2-1.0ml/100kg), he had a nose twitch placed and we proceeded to pass an endoscope. An ethmoid haematoma was confirmed and a radiograph was taken.

The extent of the haematoma was clearly visible as seen in figure 1.

Figure 1: Xray of Archie’s haematoma

Lyn works as head veterinary nurse at Waikato Equine Vet Centre in Cambridge.

She has been with the clinic for six and a half years, and enjoys the fast paced environment where no day is ever the same. Lyn studied through Otago Polytechnic while working full time and raising a young family. Her hard work and dedication has paid off and she is proud of her accomplishments so far she was also voted onto the NZVNA Executive Committee in 2017 to help give a voice for equine and large animal nurses.

14 December 2018

The owner was advised that sinus surgery would be needed for the horse to regain normal function of his airway. It was decided that Archie would be transported to our clinic in Cambridge within the next two weeks for surgery.

Patient assessment Archie arrived the day before his scheduled surgery. He was settled into a box for the night with water and a hard feed of FiberProtect® and Dunstan Breed & Grow™, but no hay as they tend to eat this over the course of the night and he needed to be fasted for surgery from 7.30pm. The morning of the surgery, Archie did not receive breakfast. Prior to surgery, Archie was weighed and had a physical exam undertaken by our anaesthetist, his heart and lungs were auscultated, and parameters taken all within normal limits (see figure 2).

Preanaesthetic preparation Archie’s surgery was performed standing.

The surgical nurse set up the equipment including an equine surgical kit containing: · One size 3 scalpel handle • One size 4 scalpel handle • One pair of rat tooth tissue forceps, one pair of smooth tissue forceps • One pair of Adson tissue forceps • Two pairs of curved Metzenbaum scissors • Two pairs of Mayo-Hegar needle holders • One pair of Olsen-Hegar needle holders • Four pairs of straight mosquito forceps, three curved mosquito forceps • One instrument pin • Six Backhaus towel clamps and six swabs

Figure 2: Archie’s patient assessment parameters Archie’s parameters

Normal parameters

Heart rate (beats per minute)

38

36 – 44

Respiratory rate (breaths per minute)

12

8-12

Mucous membranes

Pink

Pink

Capillary refill time

<1 second

<2 seconds

37.1°C

37.2 – 38.3°C

Temperature

EQUINE

The extra surgical equipment needed for Archie’s surgery included: · Two disposable sterile surgical gowns · Four hats · Four facemasks · Two pairs of sterile surgical gloves · Sponge holding forceps · Spinal needle · Disposable syringes and needles · Sterile swabs · Pack of five laparotomy sponges · Suture material · Skin stapler · Foley catheter · Sinus drill · Equine sinus trephine

Figure 3: Preoperative video endoscope of Archie’s mass

Figure 4: Sinus portal under the eye made with a small hand drill

Archie was then prepped for surgery.

I aseptically placed a 14g intraflon jugular catheter which would be used to administer IV drugs and fluids. I then sutured the catheter into place.

Archie received the following preoperative drugs: Meloxicam injectable 20mg/ml (3ml/kg)

15mL IV

Gentamycin 100mg/mL 34mL IV (6.6mg/kg) Tetanus antitoxoid

One subcutaneous (SQ) injection

Cocktail sedation of: Xylazine 100mg/ml (0.6-1.0ml/100kg) Ace10 10mg/ml (0.25-0.5ml/50kg)

2mL Xylazine 0.5ml Ace10 IV

Morphine 30mg (0.2 - 0.6mg/kg)

2mL morphine intramuscular (IM)

Analgesia and surgery Archie was walked to standing surgery and was placed in the stocks. He received 0.4mL top up of Dormosedan® 10mg/mL (0.2 -0.4 mL/100 kg) for further sedation.

A preoperative video endoscope had been carried out (see figure 3) so that the surgeon could visualise the size and location of the progressive ethmoidal haematoma (PEH). However, on exam it was found that the right side was consistent with a sinus based PEH and a smaller mass in the right nasal passages, ethmoidal region and on the left the appearance was more consistent with a

granulomatous mass covered in a fungal plaque (Quinn, 2018). Some tissue samples were taken via endoscopic biopsy and results were expected the following morning.

Archie’s head was clipped between, around, and under the eye. A surgical scrub was undertaken over the surgical sites. The surgeon then administered Mepivacaine 20mg/mL SQ just under the right eye to achieve a periosteal block and also on the front of the head next to the right eye.

Figure 5: The surgeon using an equine trephine to gain access to the main rostral compartments

Archie was placed on intraoperative fluids (Hartmans) 5L bag with a 10mL drip set at a rate of 60mL/kg/hr.

The two veterinarians that scrubbed in wore hats, masks, disposable sterile gowns and gloves, the circulating staff wore clean overalls, hats, masks and non-sterile gloves.

Archie received another top up of sedation of Dormosedan 0.2mL IV just before the surgeon made his first incision. The first incision was a small sinus portal under the eye made with a small hand drill (see figure 4), an endoscope was placed in through this hole to get a better idea of what was in the sinus cavity. The surgeon began to make the incision for the fronto-nasal flap, the skin was peeled away from the periosteum bone and was held back with Allis tissue forceps by the

surgeon’s assistant. The surgeon then used an equine trephine to gain access to the main rostral compartments (figure 5).

A very large mass consistent with a PEH was completely filling the ventral conchal and rostra maxillary sinus compartments (Quinn, 2018).

December 2018 15

EQUINE

Archie received another sedation top up of Dormosedan 0.2ml IV. The surgeon then went on to remove the mass that was equivalent to the size of a medium avocado. It had distorted the normal anatomy of the sinus. Another top up of Dormosedan (0.1mL IV) was given.

The circulating nurse administered local anaesthetic Lignocaine 2% into the sinus cavity. An opening was made into the caudal maxillary sinus for ease of postsurgical irrigation. It was found that there was a large amount of mucus secretions trapped in the caudal maxillary sinus that were unable to drain into the nostrils and out the nose, because of the obstruction from the PEH. Once the linings and PEH were striped out good drainage was confirmed into the nasal cavity.

Another top was given of Dormosedan (0.15mL IV). The surgeon then flushed out the cavity with 500mL saline and packed the hole with a large lap sponge for five minutes. After removal of the lap sponge it was evident that there was another PEH about golf ball size behind the sinus drainage angle. It was too dangerous to try to remove this one as it would be very difficult with limited access. The PEH was instead injected with 10% formalin. Only a very small amount was used to reduce the risk of interfering with nearby nerve tissue (optic nerve) and the brain (Quinn, 2018).

While the formalin was being injected Archie’s mucous membranes went pale, his fluid rate was increased, and he was given another top up of Dormasedan (0.1mL IV).The surgeon stopped to give Archie a break for a few minutes until his mucous membranes came back to normal. Archie received another top up of Dormasedan 0.2mL IV. The surgeon then went on to close the surgical site, this was done with a combination of sutures non-absorbable nylon suture and staples.

A Foley catheter was placed into the small sinus portal under the eye, so Archie could receive postoperative irrigation of the sinus. It was taped to the side of his halter and tested with 150mL tap water through the tube to see if it ran out his nose.This was done carefully to test that it was working while not dislodging any 16 December 2018

clots. Archie received one last top up of Dormosedan 0.05mL IV.

and out the nose. This was done until the solution is free from debris.

We cleaned the surgical site on Archie’s head, then he stood in the stocks until he was able to walk back to his box.

Archie remained on Sulpha T paste and Phenylbute paste for six days post op.

His irrigation was to continue twice daily for five to seven days, depending on the speed of healing and clearance of abnormal sinus secretion. Once the irrigation is coming through clear for three consecutive days with no smell, the Foley catheter could be removed. The small hole left by the Foley catheter would heal over in a few days. Archie’s sutures and staples were removed at ten days.

Laboratory results The histology report was received the following morning, confirming Archie’s diagnosis (see figure 6).

Post op – patient progress Archie recovered well from sedation. When he was awake enough he was given his hay and hard feed – a mix of FibreProtect and Dunstan Breed & Grow, which are all good sources of fibre. Archie was prescribed antibiotics, Sulpha T paste 30 ml orally (PO), which he received that afternoon.

The next morning Archie received his Sulpha T paste (30mL/500kg) 30mL PO and Phenylbute paste 5mL PO. His sinus irrigation was then started – this was a mix of 9g salt, 5mL iodine solution and 5L water. The irrigation was made up in a 5L pressure sprayer, it is then attached on to the Foley catheter and irrigation is slowly started with no pressure just a trickle through the tubes

An owner update reported that Archie had recovered really well after surgery, however due to the remaining haematoma he is still being treated with formalin by his regular vet, he had one treatment that didn’t respond and has had a second treatment that they are waiting on to see if it has had an effect.

References Dingemans, K. (2018). Anaesthesia Record: Patient Archie. Unpublished case notes.

Quinn, G. (2018). Surgical report: patient Archie. Unpublished case notes.

Figure 6: Archie’s lab results HISTORY: Right - ethmoid haematoma. Left - granulomatous growth; looks fungal.

SUBMITTED TISSUE: One unlabeled container is submitted with four small pieces of tissue that are up to 4x3x2mm. Two pieces of tissue are partly yellow, and the other tissues are nodular tan or dark red-brown (haemorrhage presumed).

HISTOPATHOLOGY: As the tissues were not labelled, changes will be described together. One piece of tissue has a mucosal epithelium with squamous metaplasia that is regularly infiltrated by mostly neutrophils. The submucosa tissues are effaced by suppurative inflammation that distorts normal tissue architecture.

Remaining tissues are composed of liquefactive necrosis admixed with karyorrhectic debris, neutrophils, many degenerate and scattered golden pigment (erythrocyte breakdown product presumed).

HISTOCHEMICAL STAINS: Grocott’s methenamine silver stain (for fungi and some algae and bacteria): Bacilli to filamentous bacteria are numerous in some areas of the examined biopsies. Periodic acid Schiff (for yeast and algae and some fungal hyphae): No organisms seen.

DIAGNOSIS: Rhinitis, chronic, diffuse, suppurative with squamous metaplasia and haemorrhage.

COMMENT: Evidence of fungal infection was not seen in the examined biopsies.

The most prominent change present was suppurative inflammation which was occasionally associated with bacilli to filamentous bacteria. Squamous metaplasia is a normal physiologic response seen with chronic inflammation. The findings should be interpreted clinically as the biopsies may not be representative of the ongoing pathologic process. (SVS Laboratories)

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CONFERENCE REVIEW

Human Behaviour Change for Animals; Companion Animal Conference 2018 review

By Amy Ross RVN, NZVNA Executive Committee member

Amy has been a veterinary nurse for 20 years and holds a Diploma in Veterinary Nursing. She has previously worked at SPCA Auckland and Unitec, and is currently a veterinary nurse at Auckland Zoo. Amy is also on the Executive Committee for NZVNA, and her portfolios as the vice president include social media, Vet Nurse of the Year and NZ Companion Animal Council, where she sits on the Executive Board.

In September I had the opportunity to attend the New Zealand Companion Animal Council (NZCAC) conference in Auckland where we learnt about how we as a community can look at how a change in human behaviour can help to influence an increase in animal welfare on a global scale.

I have been fortunate to attend NZCAC conferences in other years, both as an NZVNA representative and when I was working at SPCA Auckland, and while I have found them enjoyable, I was blown away this year by the scientific program that was offered. Because of this new change in program, the NZCAC conference did have NZVNA CPD accreditation, and it was great to see a small number of veterinary nurses amongst the delegates.

The speakers at the conference came from all around the world, including five keynote speakers â&#x20AC;&#x201C; Professor Peter Thornber from the Commonwealth Veterinary Association, Dr Sara Dubois from British Columbia SPCA, Debbie Busby from Human Behaviour Change for Animals (UK), Associate Professor Ngaio

Beausoleil from Massey University, and Dr Lynette McLeod from University of New England.

While the speakers did talk a lot about the stages of human behaviour and how to influence the behaviour of others, there were a lot of real world examples on how to incorporate these ideas in veterinary clinics by starting with the outcome that you want and then working backwards.

For example with an overweight pet, we need to start with talking about the ideal weight of the pet then from there find out what food it is that is fed, is it quality food? How much are they feeding? How much exercise does the pet get? But the biggest thing is how we go about asking these questions and providing the information that is required to our clients, as the biggest prediction of failure to change is confrontation, and the biggest prediction of success to change is an empathic approach. We also need to remember that animal welfare means different things to different people, and we do need to be understanding of different cultures when we talk to them about

| Above, from left to right: Dr Lynette McLeod, Dr Sara Dubois, Professor Peter Thornber, Debbie Busby, Associate Professor Ngaio Beausoleil, Dr Arnja Dale

18 December 2018

CONFERENCE REVIEW

things such as weight loss, as different cultures have different standards for the norms for body size and this can translate across to their pets. It does not mean that we need to accept their view that it is better for their pet to be overweight as we know the scientific reasons behind why this is not good, but we just need to be careful on how we approach the subject as we respect their culture, but also remember that culture is not an excuse for cruelty and changes can be made.

It is also important to remember that when we are trying to achieve goals that include changes in behaviour (whether it is our own or someone else’s) that there is often a relapse in the behaviour change. We need to build in sustainability, in a stable environment/context, of the behaviour at the beginning of the change and incorporate rewards. This will become habitual ,and the habits are performed automatically. We can then look at how we can approach these relapses when they occur.

As well as a lot of discussion around behaviour change, the speakers also talked about “The current case of working horses and donkeys”, which concentrated a lot on Ejiao, a Chinese medicine which is derived in small amounts from boiling

donkeys hides. While there are some companies that are greatly invested in the welfare of the donkeys in their care, they do not look at their welfare prior to supply or when they are loaded onto transport and then onto slaughter.

But while this was a shocking discussion, there were also some really positive discussions about community involvement and ownership, including an Eastern Institute of Technology project, Patu Pets – Furry Whanau, where veterinary nursing students work alongside Patu Aotearoa, a social enterprise initiative dedicated to the holistic health and well-being of local communities in a completely non-judgemental environment that incorporates Māori Culture.

At the dinner, the Assisi Awards were presented. The Assisi Awards are in recognition of outstanding service to animals and are presented to individuals who have contributed to the welfare of animals. It was great to see that for the second year in a row, a veterinary nurse was one of the recipients. While Gina Kemp is not currently working as a veterinary nurse, Gina is the Technical Rescue Coordinator with SPCA National Rescue Unit (NRU), and leads a group of internationally qualified emergency

response volunteers who provide a technical rescue service for trapped animals.

Gina organises and runs training sessions with professional organisations and has obtained Rescue 3 Animal Rescue Technician Instructor status. Since taking on her role three years ago, Gina has built an outstanding team of volunteers whose services have received national recognition. In 2017, Gina clocked up over 600 hours of volunteer service, in addition to her 40+ hours a week job as an SPCA Inspector in Wellington.

Another key take home message for me was to never undermine your own integrity and, when you go on vacation, take your beliefs with you and make your money count towards conservation and animal welfare, then take what you learn and spread the message of both amazing and negative experiences.

As Barrack Obama said, “I’m asking you to believe, not in my ability to create change but in yours”.

The next NZCAC conference will be held in 2020, and I highly recommend you look at attending if you have an interest in animal welfare.

| Above: Break time

December 2018 19

BLOOD TRANSFUSION

Transfusing the feline patient

By Robyn Taylor RVN, Executive Committee member

Many people who are not in the veterinary industry are completely unaware that animals may sometimes require blood transfusions. Most commonly because they are not aware veterinary medicine goes to such lengths. However, as we know, blood is one of the simplest supportive treatments veterinary medicine can supply.

We are all aware, a lot of us from personal experience, about canine transfusions.

Cats are just as likely to need blood as dogs, but less commonly receive transfusions, as the donor is more difficult to obtain and the difficulty surrounding product storage. I was previously the transfusion nurse at the Royal Veterinary College (RVC) in the UK, and have performed many feline blood collections.

This article shares the protocols and procedures designed at the RVC, through a collation of information from publications and international experience, to ensure safe and efficient feline blood collection and transfusion medicine.

Robyn has spent twelve years of her nursing career working at the RVC (Royal Veterinary College) in the UK as a critical care nurse in their ICU unit, and as the blood bank/transfusion nurse for the hospital. Robyn returned to New Zealand in 2014 and is currently teaching veterinary nursing students at Ara Institute of Canterbury.

20 December 2018

•

• • • • • • •

is not exceeded (see blood collection preparation) Have not travelled outside the country and be free of parasites and infectious diseases (screening for a wide variety of conditions can be timely and costly, so ensuring a donor has not travelled overseas ensures the donor to be free of many diseases that other countries may have) Have regular preventative health care including flea and worm treatment Vaccinated, but not within a month either side of a donation Should not be on any medication Should not be pregnant Not have previously been transfused Be of a manageable temperament (minimising stress is very important) Packed cell volume (PCV) >30%

The donor Donor cats are almost always client owned pets, a neighbour’s cat, or the owner of the patient may themselves even have another cat at home which could help their sick pet. Regardless of where the donor cat comes from, there are various guidelines to meet in order to maintain the safety of both donor and recipient.

The last thing you want to be doing is compromising the wellbeing of a healthy donor cat, in order to help the unwell cat, so select carefully and thoughtfully.

Pre-donation blood screening Unlike canine blood, feline blood is not commonly stored due to the unavailability of closed feline collection systems (see later). As a result, the donor is often needed when the recipient requires a transfusion. Because of this, it is wise to have a cat or two ready to call on, who have already been blood typed and tested for general health. They should have been tested for FIV, FeLV, mycoplasma haemofelis, along with a general haematology and biochemistry, blood typing and PCV, before they are used as a donor. Most practices have in house FIV/ FeLV snap tests available, but mycoplasma haemofelis may need to be sent to a lab for analysis (PCR).

The suitable feline donor: • Ideally an indoor cat – although not always possible, it eliminates infectious diseases occurring after initial testing of the donor has been done • Be at least one year old, but no older than eight years old - for complete development of young cats and not to add stress to an older cat • Be > 4kg in weight to sufficiently donate the required amount of blood – you can use a smaller donor as long as the maximum amount of blood per kg

Mycoplasma haemofelis (previously known as haemobartonella felis) This is a parasitic bacteria of the red blood cell causing anaemia. It can be transmitted from cat to cat by fleas and ticks, and of course, blood transfusions.

Due to the anaemia and the transmission of the bacteria to the recipient, a cat carrying mycoplasma haemofelis cannot be a donor. Carrier cats are generally not treated, as the bacteria are not usually aggressive enough to cause any serious harm to the cat. But for sick cats, a course

BLOOD TRANSFUSION

of antibiotics and then steroids are required to suppress the organism and reduce the effects on the cat. This test is a precaution to protect the recipient from receiving infected blood.

FeLV (Feline Leukaemia Virus) FeLV is transmitted from cat to cat by the exchange of saliva, through opportunities such as grooming each other, sharing food or water bowls, and bites. Sexual transmission of FeLV is also highly likely.

About 50% of cats diagnosed with FeLV die within six months, and up to 80% die within three to four years (Jain, Stein, Zinkl, & Feldman, 2000). Lymphomas are the most common tumours caused

by FeLV, but the infection can also cause immunodeficiency and anaemia.

FIV (Feline Immunodeficiency Virus) Like FeLV, this virus is transmitted from cat to cat in the saliva of an infected cat, but it is not as easily passed on as FeLV – cat bites are the most common source of infection. As the name suggests, FIV affects the immune system, leaving an infected cat open to secondary infection.

In the late stages of FIV, anaemia can also be discovered.

Blood groups, typing and cross matching Blood groups The blood group antigen is established by recognising the antigen on the red blood cell membrane. In cats, the blood group system is referred to as the AB system – blood groups are recognised as either A, B, or AB. Blood group A is found to be generally the most common blood group amongst domestic cats. Group B is the next most common, but often found more in pedigree breeds such as British shorthair or Devon Rex, for example. Blood group AB is the least common of all the groups.

Unlike dogs, cats have pre-existing antibodies to the antigen they lack (other blood groups). Therefore, when receiving blood from a donor that is not the same blood group, a reaction will rapidly occur, even after receiving only 1-2mL of blood.

The severity of the reaction is determined on the blood group of the recipient and the blood group of the donor (see transfusion reactions).

Blood typing Blood typing the feline donor and recipient is highly important due to the pre-existing

antibodies, as mentioned above. Presently, there are two well recognized typing systems available to New Zealand. The RapidVet®-H IC is an easy-to-use, compact device showing results as a red line on a white background for easy interpretation.

The RapidVet® range also provides an agglutination card typing system, however this does allow for more misinterpretation due to the need to observe any agglutination with the naked eye. The RapidVet®-H IC (see figure 1) would be preferable in my opinion as this eliminates human error. The RapidVet® range does have a New Zealand distributor.

The second blood typing system commonly used around the world is the Alvedia® quick test. This also displays results with a line marked on a white background indicating the presence of the marked antigen. This product is available from an Australian distributor.

The absence of a mark on the result strip against the antigen being tested for (e.g. feline – A or B or two lines for an AB) is indicative of the absence of that antigen present on the animal’s red blood cells (RBC), therefore a negative result. The presence of a mark on the strip determines a positive result for the presence of that antigen on the animals red blood cells.

This test requires 1mL of EDTA whole blood, and will determine if the cat is A, B, or AB in a matter of minutes.

Type B cats have a high titre of anti A antibodies. This means type B recipients transfused with type A blood would have an acute haemolytic reaction, which could possibly be fatal. Type A cats have weaker anti B antibodies, thus a type A recipient transfused with type B blood would still result in a transfusion reaction, but it would be less severe and more delayed. Type AB cats have no pre-existing antibodies therefore could be transfused initially with type A blood due to the low titre of anti B antibodies in type A blood, Figure 1: RapidVet®-H IC

but ideally a type AB recipient should receive type AB blood.

Because of this strong anti A antibody in type B cats, kittens born as type A or AB blood groups to a type B queen, are at risk of developing neonatal isoerythrolysis, which is an immune mediated haemolytic disease of kittens. The queen secretes anti A antibodies in her colostrum, which is then absorbed by the kittens after feeding.

Haemolytic anaemia and death can occur in blood group A or AB kittens within as little as two to three days after birth.

A quick way to remember: A to B = RIP! B to A = you will be OK! Please invest in blood typing – it is much safer to be sure.

All of the above seems like a lot to do when most clinics do not have prescreened donors available. However, what if you DID have pre-screened donors available on a donor list? This is possible to do in your clinic – simply select a few cats that are regular patients of your clinic, who meet the criteria listed in this article, and discuss the option with the owner, clearly describing the procedure and risks to the owner so they are fully informed. Now you have a cat to perform pre-screening blood tests on and a possible donor if required. Now get more donors, until you have several. This allows you to have blood type groups and also options of availability when needed – we all know a cat may not be so easy to get to a clinic in a hurry so with several cats as options, you can contact another pre-screened cat on your list if your first choice is unavailable Cross matching Blood typing may identify RBC antigens in a patient but cross matching will detect the presence of antibodies between patient blood and donor blood, resulting in a much safer match for a transfusion.

Ideally, cross matching should be carried out before all feline transfusions due to the presence of naturally occurring or pre-existing antibodies. But this may not always be possible, so ensuring the patient is accurately blood typed before the first transfusion is essential, and then be prepared to arrange cross matching before a second transfusion is required.

December 2018 21

BLOOD TRANSFUSION

Please note: cross matching is not a replacement for blood typing. They both have their own place in safe and responsible transfusion medicine.

Blood collection preparation Hopefully your donor has previously been tested for mycoplasma haemofelis, had a haematology and biochemistry screen run, and a previous PCV check, as then there is a value to compare against. The wellness of the cat on the day of donation should be assessed by talking to the owner. Has any diarrhoea, vomiting, or inappetence been observed? Normal eating and drinking? Any recent medications to be noted, including vaccinations? Ideally, the donor should be an indoor cat but this is not always possible due to the lifestyle of many cats and their owners.

Therefore, it is wise, along with measuring the donor’s PCV (>30%), to repeat an FIV/ FeLV test if you have a kit in house at time of donation. Each feline donor should always have a physical examination from a veterinarian to ensure they are in good health, have been fasted for sedation purposes, and of course they should be weighed. The volume of blood that is widely recommended to be taken from a feline donor is 12-15 mL/kg (Davidow 2013).

Therefore, in order to get a full “feline unit” (60mL of anticoagulated blood) the donor needs to be >4kg. A smaller cat could still donate in emergency circumstances, but the volume of blood collected would need to be calculated and strictly adhered to.

Taking more than the 60mL feline unit is not recommended even if the donor cat is large – often the recipient will not be able to receive more than 60mL due to volume.

In my experience, 12mL/kg is the maximum volume of blood collected from a donor cat, under 4.3kg.

Sedation is usually required to achieve a full donation from a cat. Therefore, their temperament is not as important as it is with canine donors. However, ensuring the feline donor is manageable is important none-the-less. A stressed and aggressive feline donor can cause the sedation to be less effective, and overall is an unpleasant experience for a cat that is generally helping you and your patient out! Donor welfare is your top priority.

Two sedation protocols I have worked with many times, are designed for two situations: 22 December 2018

Ideally an intravenous (IV) catheter is placed in the cephalic vein of the donor and sedation administered. Use EMLA™ cream if you have it and ensure it is on for at least 30 minutes prior to IV access.

Alternatively, if the donor is not so cooperative, intramuscular (IM) sedation may be required first, then an IV catheter placed and additional IV sedation administered if required. However, the IM protocol below is unpleasant for the donor as it can sting. I strongly urge you to ensure your chosen feline donor can tolerate a conscious IV catheter placement without experiencing excessive stress.

Any bloods required from the donor specifically pre donation (FeLV/FIV snap test, PCV) should be drawn from the IV catheter at time of placement. This is to preserve the jugular vessels for the blood donation.

Sedation protocol one (immediate effect – be prepared for donation) IV - ketamine 3mg/kg IV - midazolam 0.2mg/kg If a top up dose of sedation is still required, a half dose of the sedation can be given IV. Sedation protocol two (only if initial IV access is not possible) IM - ketamine 5mg/kg IM - midazolam 0.25mg/kg Followed by: IV - midazolam 0.2mg/kg IV - butorphanol 0.2mg/kg If IM sedation is required, the cat should be left in a quiet space, for 15 minutes to allow maximum effect of sedation to occur before placing an IV catheter.

NOTE: if IM sedation appears to be satisfactory for a donation, an IV catheter should still be placed for venous access in case of emergencies and for fluid therapy post donation.

Acepromazine (ACP) should be avoided as a sedation for blood collection due to the unwanted side effects such as hypotension. Hypotension will create a more difficult blood collection due to the smaller jugular vessels and slower blood draw/flow.

Materials required for blood collection: • 21 or 19 gauge butterfly catheter • syringes with anticoagulant (one 60mL,

or three 20mL, or six 10mL) Citrate, Phosphate, Dextrose (CPD) can be aseptically drawn from a canine blood collection bag • sterile swabs • skin prep solutions • surgical spirit (or alcohol based solution) • clippers • 22 gauge IV catheter and materials to secure in place • compound sodium lactate fluids (Hartmanns) and giving set Currently there is no manufactured ‘closed’ feline blood collection system commercially available. Therefore, to collect the blood from the feline donor, a 21 or 19 gauge butterfly catheter and syringe attached with anticoagulant in, is the most effective method to use. This is referred to as an open collection system.

Open collection system Transfer of anticoagulant into a syringe(s) and collection of blood via a butterfly catheter attached to that syringe, or alternatively transfer the anticoagulant into a 60mL syringe and collection of blood via a butterfly catheter attached to the 60mL syringe, with a three way tap, and then the blood gently pushed into a sterile feline (paediatric) blood collection bag.

Both these systems have had exposure to room air and the environment, as it has been assembled piece by piece. These systems are not suitable for storing blood products longer than 24 hours refrigerated, due to the increased risk of microbial growth.

Closed collection system A sterile blood collection bag(s) manufactured with anticoagulant already inside, and needle already attached. No exposure to the environment or room air has occurred prior to blood collection.

This system is suitable for blood product storage – human and canine blood collection system.

The anticoagulant used for feline blood collection can be the same as for canine blood collection – CPD. To prepare for a feline collection, the CPD is aspirated from a canine collection bag, ensuring sterility is maintained at all times. This CPD is then

BLOOD TRANSFUSION

aseptically transferred into the syringes to be used for the blood collection. The amount of CPD required is 1ml CPD / 7mL fresh whole blood. Therefore, if using a 60 mL syringe for blood collection, 8.5mL CPD needs to be added to the syringe prior to collection. This results in 51.5mL of whole blood being collected from the donor.

60mL (syringe) /7mL (blood) = 8.5mL CPD = 60mL of anticoagulated blood collected – 8.5mL CPD = 51.5mL fresh whole blood Often the use of a 60mL syringe for blood collection can cause the jugular vein to collapse. To avoid this difficulty, the use of three 20mL syringes instead is useful. If the jugular vessel is still collapsing, 10mL syringes could be used for collection – alternatively, the blood collection may need to be drawn more slowly.

Syringe preparation: 60mL syringe – add 8.5mL CPD 20mL syringes – add 2.8mL CPD 10mL syringes – add 1.4mL CPD Because of the nature of sedation (it may not last too long), being prepared prior to administering sedation is essential. Ensure you have everything you need for blood collection before sedating the donor – the IV sedation will only take approximately

30 seconds to take effect. Preparing extra syringes is also wise, as if there is a clot or some other problem and a fresh syringe is required to complete the collection, it could be time wasted drawing up the CPD into a new syringe whilst the sedation begins to wear off. Be prepared!

Donation procedure For a smooth feline donation, three people may be required – one phlebotomist, one person to hold the cat in position, monitor respiration and pulse, and one person to draw the blood into the syringe.

Once an IV catheter has been placed aseptically and secured in the cephalic vein, the IV sedation is administered. This sedation will only take 20 –30 seconds to take effect so ensure you are ready for the blood collection process. Gently position the donor either sternal with head elevated, or lateral with head extended. Both positions are suitable for a successful collection, but one position may present the jugular better than the other position. The jugular site is clipped and cleaned in an aseptic manner. The phlebotomist raises the jugular with one hand and gently inserts the butterfly catheter into the jugular with the other.

At this point you would ask your helper

to gently begin drawing on the syringe attached to the tubing of the butterfly catheter. If no blood comes back, maintain a small amount of negative pressure on the syringe as the phlebotomist gently manoeuvres the needle until the blood comes back. The helper holding the cat’s head in position should also be monitoring the donor’s pulse rate and respiration rate, to ensure the sedation has not had any detrimental effects which could compromise the donor or collection process (see figure 2).

As the blood is being drawn, the person drawing the syringe should gently rock the syringe back and forth to ensure the blood is being adequately mixed with the anticoagulant. If more than one syringe is being used (20mL/10mL syringes), as each syringe is filled, the person should pinch off the tubing, disconnect the anticoagulated blood-filled syringe, place a sterile cap on it, and attach the next prepared syringe, and continue drawing.

Take care not to draw too quickly – the jugular vein can collapse, and you may also haemolyse the red blood cells.

Once the blood collection is complete, remove the butterfly catheter from the vein and apply pressure with a sterile

Figure 2: Restraint of a feline blood donor

December 2018 23

BLOOD TRANSFUSION

swab for about five minutes, to minimise haematoma formation.

Post donation care Cats have a smaller circulating volume of blood than dogs (65-75mL/kg) (Voigt & Swist, 2011), therefore it is wise to replace the volume of blood taken with a crystalloid. At the RVC in London, we gave the donor 10mL/kg/hour for three hours. Crystalloid does not hang about in the vascular space all that long (about 30 minutes to one hour), and with blood pressure mildly compromised, it is one method to maintain good volume in the circulation for a longer period of time.

Ideally this should be administered via an infusion pump, to ensure accurate volume is given so as not to overload the donor, but if a pump is not available it would be wise to calculate the volume required, withdraw the difference from the bag of fluids to eliminate the risk of fluid overload, and administer the fluids using an appropriate giving set such as burette or paediatric giving set, allowing more accurate volume administration over three hours.

As the donor has been given ketamine and midazolam, it may become hypersensitive during recovery. A quiet cage where you may still observe and monitor the donor is the best way to aid a smooth recovery. At a point where you are confident the donor is at no risk of vomiting/regurgitation and aspiration (usually approximately two hours post donation) they can be given some food as their “tea and biscuits” boost and as they will be hungry having not had their last expected meal!

Storage and use As mentioned earlier, because of the unavailability of commercial closed feline blood collection systems, the blood collected using an open collection system, should not be stored, or processed into other blood products and stored long term. Although, due to availability of a semi-closed feline blood collection bag system, some veterinary practices do store feline blood and process it into plasma (FFP) and packed red blood cells (PRBCs). This does require the appropriate equipment and is only conducted at large veterinary hospitals with a high demand of blood products.

24 December 2018

Without long-term storage of the feline collected blood, the fresh whole feline blood should only be kept in refrigerated conditions of 1­6°C for a maximum of 24 hours. After this time, any blood not transfused to a patient, should be discarded. Therefore, collecting blood from a cat, only when you need it is most common, heightening the need to be prepared with pre-screened donor cats.

If using a size 60ml syringe of anticoagulated blood (one syringe only), the transfusion should be completed within six hours as the syringe will have been sitting at room temperature for that period, and microbial growth is a risk. If the fresh whole blood has been collected using multiple syringes such as 20mL or 10mL volumes, only one syringe will be transfused at one time, with the other syringes of collected blood remaining in the fridge. This arrangement allows for a much slower transfusion, as each syringe has up to six hours to be transfused, up to 24 hours total, for the complete required volume to be given to the recipient before discarding any remaining blood. Such a slow transfusion could be beneficial if volume overloading the recipient is a concern.

Patient preparation A transfusion can be administered via any vein. Although a dedicated IV catheter is not essential, it would be advisable if the patient requires additional IV fluid therapy or supplementation of any electrolytes.

Fluids containing calcium, such as compound sodium lactate/Hartmanns, should never be administered through the same IV access as whole blood transfusion. The calcium binds to the citrate in the anticoagulant resulting in a precipitation reaction. Unless essential, it is often advisable to stop other fluid therapy during a transfusion, to reduce the risk of fluid overload.

Preparing for transfusion and beginning transfusion The product Because feline blood has been collected using an open collection system, it should ideally be used straight away, therefore there is no need to warm the blood, as it will not have been stored in the fridge. If, however the collection of blood has used

the approach of multiple syringes of 20mL or 10mL volumes instead of a single 60mL syringe volume, the remaining syringes should be stored in a 1-6 C° fridge. To warm the next syringe of blood to be used, remove it from the fridge and let it sit at room temperature for approx 15 minutes prior to use. DO NOT actively warm it in warm water. This can haemolyse the cells and greatly increase the risk of contamination.

Beginning transfusion As the transfusion is fresh whole blood, there is no need to dilute it with sterile saline - it should pass through the giving set easily as the plasma acts as enough of a dilution. A standard transfusion set is too large to use with cats, as much of the transfusion would remain in the set, requiring flushing with saline.

This could result in volume overload or haemodilution. There are commercially available disposable in line filters that can be attached directly to the syringe or between two extension sets. These filters (18 micron) remove clots, leukocytes and platelets.

Attach an extension line/set to the syringe of fresh whole blood. Attach the in-line filter to the end of the extension set.

Ideally, attach a second extension set to the other end of the filter, so the filter is not directly attached to the cat’s IV catheter connector. Gently push the blood through the extension set tubing and filter, until it reaches the end of the tubing.

Attach the blood filter extension set to the cat’s IV catheter connector (see image on opposite page).

If a syringe driver (see figure 3) is being used, set the infusion rate to 1mL/kg/ hr, this being a safe rate to monitor the recipient cat with temperature, pulse and respiration checks (TPR) every 15 minutes, for transfusion reactions for the first 30 minutes, then increase the rate to suit requirements of the recipient, and continue TPR checks every hour until complete. Initial five minute checks are not recommended – at 1mL/kg/hr the patient has not received a ‘haemolytic reaction volume’ since the last five minute check – it only serves to stress your patient. It is also not recommended to exceed a rate of 10mL/kg/hr unless in extreme emergencies. If a syringe driver

BLOOD TRANSFUSION

is not available the blood transfusion will need to be injected very slowly manually maintaining a strict transfusion reaction monitoring protocol, such as the TPR checks mentioned earlier.

The Recipient Ensure the IV catheter chosen for the transfusion is clean and patent. All transfusions should always have some patient monitoring associated with them to recognise any haemolytic reactions early (see figure 4). A pre TPR should be performed on the recipient to establish a baseline of parameters. A recent PCV should also be recorded.

Transfusion reactions As discussed earlier, the typing of both donor and recipient is very important in

minimising any haemolytic transfusion reactions due to the pre-existing antibodies in cats. Although transfusing a Type A recipient with Type B blood is less reactive than transfusing Type A blood to a Type B recipient, this should be avoided and the same blood type should still be transfused.

The main reason is because although the transfusion reaction will not be as severe with B blood to A recipient, the half life of the red blood cells is still only approximately two days, buying some time for your patient, but a further transfusion will most likely be indicated after those two days. The half-life of the red blood cells in Type B recipients having received type A blood, could be as short as minutes to hours! Recipients of allogenic

Figure 3: Syringe driver in use

(same type) transfusion have a half-life closer to 30 days.

The initial clinical signs seen of a severe reaction are tachypnoea, restlessness, vocalisation, urination, vomiting, salivation, collapse, apnoea, bradycardia and hypotension. These signs can be followed by tachycardia, dysrythmias, and hypertension. Due to the acute intravascular haemolysis occurring, haemoglobinuria in the urine and haemoglobinaemia in the serum of a PCV will be evident. Although the severity of these reactions will vary, such acute transfusion reactions can lead to death.

Preparing high quality blood does require attention to detail and great care to ensure contamination, due to microbial growth, is avoided. So, ensuring there is a strict protocol for blood collection and any storage of products is essential. With the correct equipment and commitment to the well being of both your patients and donors, great outcomes in your patients can be achieved with feline transfusions.

References: Jain, N., Schalm Stein, C., Zinkl, J., & Feldman, B. (2000). Schalmâ&#x20AC;&#x2122;s Veterinary Haematology (5th ed). Oxford, United Kingdom: John Wiley and Sons Ltd. Voigt, G. L., & Swist, S. L. (2011).

Haematology Techniques and Concepts for Veterinary Technicians. Iowa State University Press: Wiley-Blackwell.

Figure 4: Feline patient receiving a blood transfusion

Further reading: Barfield, D., & Adamantos, S. (2011). Feline blood transfusions: A pinker shade of pale. Journal of Feline Medicine and Surgery (13), 11-23.

Davidow, B. (2013). Transfusion Medicine in small animals. Veterinary Clinics of North America: Small Animal Practice 43 735-756 Kenichiro, Y., & Holowaychuk, M. (Eds.), (2016). Manual of Veterinary Transfusion Medicine and Blood Banking. New York, USA: Wiley-Blackwell.

Kohn, B., & Weingart, C., (2012). Feline Transfusion Medicine. In M. J. Day,& B., Kohn (Eds.), BSAVA Manual of Canine and Feline Haematology and Transfusion Medicine, (2nd ed). United Kingdom: British Small Animal Veterinary Association.

December 2018 25

CPD CORNER

Perspectives on CPD

By Patricia Gleason RVN, Professional Standards Committee member

We are now at the end of our fourth year of voluntary registration for veterinary nurses in New Zealand, and our industry continues to change quickly. Voluntary registration brought with it a requirement for a minimum of 20 hours of Continuing Professional Development (CPD) each year. With this column, it seemed like a good time to get some perspectives on CPD from practitioners throughout the industry and around the country.

An informal ten question survey was shared, hoping to gain a few insights into how CPD for veterinary nurses is viewed within industry. Within a week I had 48 respondents - not bad for an email to a few friends and one post to Facebook.

Responses to the demographic questions asked indicate the survey was completed primarily by both Level 5 and Level 6 Diploma qualified veterinary nurses, but also a few veterinarians, practice managers, veterinary nurse educators, and other veterinary nurses within the industry but not in clinical roles. The average duration of employment at the current employer was four and a half years, but this ranged from six months to over 15 years. From the personal messages received, it is known the survey was completed by staff in clinics as far north as Auckland’s North Shore and as far south as Dunedin, hitting both metro and provincial clinics. A very big thank you to everyone who took the time to complete the survey and share your views.

After a career in biodiversity conservation, Patricia completed her Diploma in Veterinary Nursing (Distinction) at Massey University, and worked in veterinary clinics in the Bay of Plenty and Waikato before becoming a veterinary nurse educator. She now works in a learning and development role coaching staff and teams in the educational sector.

26 December 2018

This survey was designed simply to gather anecdotal evidence. The questions were not presented or phrased in such a way to determine causality or prove correlations.

Please keep this in mind as you consider the possible analogies presented within these findings and recommendations.

Findings The very first CPD Corner discussed individual development plans, yet 69% of respondents indicated they – or the veterinary nurses they work with – do not utilise individual development plans (see figure 1).

That being said, most respondents found it easy enough to access CPD that is relevant to them and/or their role (see figure 2).

Nearly all respondents recognised a positive impact of CPD on both the individual veterinary nurse and the clinic (see figure 3). In terms of impacts on the clinic, a few of the participants said: “The knowledge we gain from CPD creates more value in veterinary nurses from veterinarians in particular, and we contribute more during discussions and planning patient care.” “We are in a profession that is constantly changing and progressing. As veterinary nurses we need to be relevant and at the cutting-edge of the industry to help drive our teams and encourage team development and treatment plans. Great veterinary nurses + great veterinarians = great animal care and best practice.” “CPD motivates veterinary nurses, improves confidence and job satisfaction, makes them more integral team members and makes veterinary nursing more employable.”

The impact of CPD on individuals was also positive (see figure 4): “If you can communicate with your veterinarians at their level, they grow greater respect for you and include their veterinary nurses in group discussions regarding approach and treatment of patients. My veterinarians value my opinion and often ask my advice.” “(CPD) creates a happier environment when you work to your interests.” “My veterinary nurses take a great deal of pride in their current CPD plans and development.

It is a topic we share and discuss on a regular basis, and we use clinic meetings to share ideas and implement things where necessary. It gives them a sense of achievement and that they are developing their skill set in their chosen area.”

In terms of the type of CPD, it is clear many are taking advantage of online learning as well as conferences and available short-courses. There were also quite a few

CPD CORNER

commenting on in-clinic learning initiatives (see figure 5).

The breadth of topics of CPD was remarkable as well, and spanned the whole range of veterinary nurse duties (see figure 6). It should be noted that many of the additional comments included two topics overlooked from this list – nutrition and dentistry. Both are areas where highly knowledgeable and skilled veterinary nurses can have tremendous impact on patient care and the business of their clinic.

Participants indicated that time and funding were the two biggest challenges faced in completing CPD, and supplementary comments allude to feelings there is a lack of management support for veterinary nurses to complete CPD (see figure 7).

“It can be frustrating…as not everyone in clinic management has a grasp on the importance of CPD. It is self-driven by the veterinary nurses… Having veterinary nurses maintaining currency through CPD is relevant to them in practice, useful for their day to day work.”

Some responded that they had challenges sharing what they had learned or being supported to apply what they learned to the job and within their teams. “The main thing we struggle with is passing on what we have learned via CPD. We all do so many varied courses that we find it hard to pass that information on so it can be used in the clinic.”

Conclusion For me, the survey results raise a few more questions that it may be worth exploring more formally within the profession, particularly as we move closer to accreditation of veterinary nurse education and professional regulation.

From the survey results, it is clear that some veterinary nurses and clinics are doing things well – they are using individual development plans, decision makers are funding and/or providing time to complete CPD. It would be great to know more about how this is happening, so we can share tips and approaches with our colleagues who may be in a more challenging environment. How might we elevate the community of practice of

veterinary nurses so that we are able to engage in collegial discussion and learning at times other than the annual conference, knowing not everyone is able to attend?

I know the NZVNA Executive Committee is Figure 1: Individual development plans

always open to hearing your ideas and thoughts, so do feel free to get in touch with them.

Figure 5: Common types of CPD being accessed In what type of CPD have you/the nurses you work with most commonly engaged?

Do you/the nurses you work with use individual development plans to guide selection of CPD?

Conferences Short courses

Yes

Online No Mentoring Other

In-clinic sessions 0

10

20

30

40 50 60 70 Percentage (%)

80

90

100

Other 0

Figure 2: CPD accessibility

10

20

30

40 50 60 70 Percentage (%)

80

90

100

Figure 6: Frequently accessed topics for CPD

How easily are you/the nurses you work with able to access CPD that meets personal development needs?

What topics are most frequently the subject of CPD for you/the nurses you work with?

Extremely easily Very easily

Anaesthesia

Somewhat easily

Imaging Diagnostic procedures

Not so easily

Customer service

Not at all easy 0

10

20

30

40 50 60 70 Percentage (%)

80

90

100

Figure 3: Impact of CPD in the workplace

Surgical nursing Animal behaviour Disease pathology Anatomy and physiology Personal development Pharmacology and therapeutic remedies

How much of an impact do you feel the CPD completed by vet nurses has on the day to day work in your environment?

Infection control Wounds and wound care Business skills

A great deal of impact A lot of impact A moderate amount

Leadership/ management Emergency medicine

Little impact

Other

No impact at all 0

10

20

30

40 50 60 70 Percentage (%)

80

90

0

10

20

100

30

40 50 60 70 Percentage (%)

80

90 100

Figure 7: Biggest challenges faced in completing CPD

Figure 4: Personal and/or professional impact of CPD

What is the biggest challenge you/the nurses you work with face in completing CPD?

How much of an impact do you feel CPD by vet nurses has on them personally and/or professionally?

Cost/ funding

A great deal of impact

Time allowance

A lot of impact

Support by the workplace

A moderate amount

Priority placed on CPD

Little impact

Motivation

No impact at all

Other 0

10

20

30

40 50 60 70 Percentage (%)

80

90

100

0

10

20

30 40 50 60 Percentage (%)

70

80

90 100

December 2018 27

CPD CORNER

Recommendations Every organisation is unique and has its own way of working. These recommendations are intended to help challenge your thinking about your approaches to CPD to enhance your personal professional learning, to become systematic in how you share your learning with colleagues, and ultimately to provide for improved/enhanced patient outcomes.

1. Create individual development plans linked directly to business goals Challenge your thinking and approach to CPD to consider your role, not just as a veterinary nurse and responsibilities for patient care, but as an important contributor to the business for which you work. Regardless of the size of the clinic/organisation you work for, there are business goals driving management activities and decisions. In the case of large practices with many branches, management staff commonly have clear directives around profit margins that need to be met as well as standards of patient care and customer service. From any employer’s perspective, providing for staff CPD is a financial investment and will be focused on a return on investment to the business. Therefore, requests for funding and/or time should be thought through, planned and linked to the business objectives.

Familiarise yourself with the business plans and consider how the CPD you are interested can be linked to the business achieving its goals. Work with your manager to create an individual development plan aimed at your personal growth, which also aligns to team and business goals. This will help position your requests to be considered and framing requests for CPD in this way may help decision-makers justify time and funding decisions.

2. Set specific learning and development goals Ultimately, your CPD is about you and your personal professional development.

However, you work as part of a team and it is the collective efforts of individuals and teams which create success in any organisation. As such, any individual 28 December 2018

goals (even if they seem very focused on your personal professional development) should be targeted at helping to achieve the team and organisational goals. It is possible to do this, allowing staff to build on their individual strengths and areas of interest and contribute to the collective knowledge and skill set within the clinic/workplace. If the team discusses its strengths and areas for development together, then individuals – veterinary nurses and veterinarians alike - can find the area where they can best contribute.

In this way, individual learning and development goals become more essential to team success and thus create more collective support.

When individual goals are made in isolation, there may not be those synergies within the team or management

support. When all staff are doing their own thing, it becomes challenging to find time or motivation to share and integrate learning. However, if there has been collaboration in the type of learning and development that will be of focus among the whole team, interest and motivation to share and learn from each other becomes more prevalent and far easier.

For example, you might consider a professional learning and development goal of becoming a registered specialist veterinary nurse/vet tech through NAVTA (https://www.navta.net/page/specialties).

Depending on the discipline you select, this could have tremendous marketing power for your clinic, and would clearly provide benefit to your care team and patients. A goal like this provides a clear learning and development pathway over

Figure 8: CPD cycle (source: CIPD, 2018)

Identify and plan Impact

Act

CPD cycle Share

Reflect

Apply • IDENTIFY – understand where you’ve come from, where you are and where you want to be.

• PLAN – how you can get to where you want to be, with clear outcomes and milestones to track progress.

• ACT – upon your plan and be open to learning experiences.

• REFLECT – make the most of your day-to-day learning by routinely reflecting upon experience.

• APPLY – create opportunities where you can translate theory to practice and put your learning to work.

• SHARE – your learning in communities of practice to generate greater insight and benefit from the support of your community.

• IMPACT – measure the overall impact your learning has had on the work you do.

CPD CORNER

time, so that courses selected relate to the specific long-term goal you want to achieve rather than selecting courses that might just look interesting.

3. Be systematic with CPD The CPD cycle (CIPD, 2018) outlines an ongoing process for the establishment, reflection and achievement of learning (see figure 8). Following the steps in this cycle allows for a more systematic approach to your learning and development, helping you and your employer recognise the benefits of this investment. Become more systematic and practice working through all steps of this process – too often we dip in and dip out at different steps without being intentional about our planning and learning. Practice looking at the impact of our learning on ourselves, our teams and clinics.

4. Be disciplined and intentional in sharing your learning and development with others In line with the CPD cycle, those who have studied adult education and learning can

attest that the surest way to consolidate your learning is to teach someone else.

Phil Race, an educationalist in the UK says, “Other people’s knowledge is just information. Teaching is helping people turn information into knowledge… by getting them to do things with the information, and giving them feedback about their attempts.”

Figure 9: Ripples on the Pond (source: Race, 2014) Verbalising

Assessing

making informed judgements

Wanting/ needing Doing Making sense Feedback

Race’s well known model of experiential learning is referred to as Ripples on a Pond (see figure 9), because he equates the stages of learning to dropping a pebble in a pond and seeing the various ripples move outward. Dropping the pebble is the need/desire or motivation for the learning. Then practice doing, seeing the results, reflecting on it to make sense, receiving feedback, and then verbalising – or sharing your learning with others (Race, 2014).

One must learn by doing the thing; though you think you know it, you have no certainty until you try’ (Sophocles, 495 - 406 B.C.) - but most importantly, keep learning and keep growing.

References Chartered Institute of Personnel and Development (2018). CPD cycles.

Retrieved from https://www.cipd.co.uk/ learn/cpd/cycle Race, P. (2014). Making learning happen: A guide for post-compulsory education (3rd ed.). London: Sage.

Are you interested in contributing to the New Zealand Veterinary Nurse journal as part of your 2019 CPD plan?

We are on the look out for proofreaders, peer reviewers, photographers, and writers who are interested in having their work published.

CPD points for published articles range from 5 to 10 points, and proof readers now get 1 CPD point per article proofed.

Please contact the editor for further information at journal@nzvna.org.nz December 2018 29

BOOK REVIEW

Manual of Veterinary Transfusion Medicine and Blood Banking Reviewed by Libby Leader LVN, NZVNA Executive Committee member Edited by Kenichiro Yagi and Marie Holowaychuk Published: 2016 Publisher: Wiley Blackwell 375 pages (paperback) $105 (Fishpond, October 2018)

Both Holowaychuk and Yagi are specialists in emergency and critical care.

Holowaychuk is currently practicing in Canada and is an accomplished speaker, researcher and clinician. Yagi is a veterinary technician from California who holds numerous seats on veterinary-related societies in America. He established and now manages the blood bank at his clinic in Los Altos, California. Together they have collected a number of contributors from around the world, including New Zealand’s very own Robyn Taylor, to compile the first thorough text book on transfusion medicine and blood banking.

medicine both in animals and humans. I found it to be a wonderful insight to how far we have come, and a little knowledge on human transfusions. The following chapters go in to component therapy, blood products and their administration. The book is easy to follow with quick reference charts, diagrams and images to help illustrate what is required for best practice.

Although the subject of blood transfusion and blood banking is constantly evolving, the editors have compiled the most relevant and up to date information that can be utilised world wide, making this textbook the most current book on the market. The majority of the current blood-related text available relates to canines and felines, however this book elaborates on other animals’ transfusion requirements, ranging from, livestock, equine, to avian and exotic pets.

The final chapters in the book discuss transfusion medicine in other species. This has great information about safe measures to help care for species that may not come in to your clinic on a regular basis, or that you may treat daily but it is hard to find the most current and useful information all in one place.

The Manual of Veterinary Transfusion Medicine and Blood Banking starts with the history and evolution of transfusion

The text then goes into detail on how to set up and manage blood banking within the veterinary practice, ranging from blood collection for immediate use, to larger scale collection, storage, transport, donor selection and welfare.

I think the way that this book is laid out helps to minimise the myths of transfusions being a scary last resort and can give your clinic the know-how to implement these practices on a much more regular basis for your critical cases.

Increase your word power All definitions are from the Dictionary of Veterinary Nursing (2nd edition), D.R. Lane and S. Guthrie

Antigen

Substance that, under suitable conditions, stimulates an immunological response and reacts with antibodies

Ethmoid

Like a sieve; the ethmoid bone of the cranium is perforated with many fine holes that allow the passage of fibres of the olfactory nerve as they run cranially to innervate the nasal membranes and organs of small

Granuloma

Description of a tissue mass that has an appearance similar to granulation tissue. May appear like a tumour but it’s usually the result of a chronic inflammatory process.

Squamous

A thin, plate-like layer

Necrosis

Death of cells or tissue

Karyorrhexis

30 December 2018

Fragmentation of the nucleus of a cell; this process often precedes karyolysis

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