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THE NEW ZEALAND

VETERINARY

NURSE

I SS U E 6 2 V O LUME 1 8 WINT E R – JUNE 2012

www.nzvna.org.nz

WSAVA Mental Stimulation for your patients Koh Samui Recognition of prior learning Review of the VNCA conference


NZVNA COUNCIL President Julie Hutt P.O. Box 19-700 Woolston, Christchurch 021 599 059 president.nzvna@gmail.com

Vice President Michelle Parkin Work 06 349 6195 027 741 8780 vicepresident.nzvna@gmail.com Treasurer Kathy Waugh 1 Taroka Close Pinehill, Albany Auckland 0632 Home 09 478 6171 Work 09 410 5169 021 843 277 k.waugh@xtra.co.nz

National Secretary Joanne Robinson 459 Barrington Street Spreydon Christchurch 8024 029 432 4975 secretary.nzvna@gmail.com COUNCIL MEMBERS Membership Secretary Anne Lascelles P.O. Box 1314 Palmerston North Home and fax 06 358 6448 vetnurse@ihug.co.nz Fiona Hastie Work 09 215 9577 021 993 045 fiona@vaj.co.nz

Lara Angevine Work 09 815 4321 ext 7352 langevine@unitec.ac.nz Heather Gudsell Work 09 524 8361 0274 792 788 Heathers_place@xtra.co.nz Hayley Langford langfords@farmside.co.nz Sarah O’Hagan 6 Sedcole Street Pahiatua Home 06 376 6101 Work 027 622 6655 sarah@vetservice.co.nz

JOURNAL EDITOR Amy Ross Home 09 636 7925 021 852 664 journal.nzvna@gmail.com COVER CREDITS Rudy, Sphynx stud. Photo courtesy of Sharyn van Aalst. PRODUCTION Printed by KM Print www.kmprint.co.nz Design by Murray Lock Graphics murray@mlgraphics.co.nz

THE NEW ZEALAND

VETERINARY

NURSE

I SSU E 62 VO LU ME 1 8 W I N T E R – J U N E 2 0 1 2

The New Zealand Veterinary Nursing Association strives to PROTECT, PROMOTE and PROVIDE the highest standard of veterinary nursing care. ISSN 1177-3553

Presidents Report by Julie Hutt .....................................................................

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Letter from the Editor by Amy Ross .........................................................

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Letter to the Editor by Catherine Smith ...................................................

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Mental Stimulation as a Stress Reliever in Patients by Stuart Greenfield .........................................................................................................

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A Safer Anaesthetic Machine Pressure Checking by Marcia Fletcher .............................................................................................................

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A Bilateral Hemimandibulectomy in a domestic cat by Amy Ross .........................................................................................................................

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Increase your word power ............................................................................

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AVNP .....................................................................................................................................

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Quiz ........................................................................................................................................

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Worldwide Volunteer Organizations ................................................

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WSAVA Congress ....................................................................................................

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Helping out on Koh Samui by Jo McGregor .........................................

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Interview with Mell Smith by Jo Robinson ...........................................

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Review of the VNCA Conference by Julie Hutt .............................

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NZVNA forms

The Qualification 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 Heathers_place@xtra.co.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.


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PRESIDENT’S REPORT We are heading into winter and I wonder where the first half of this year has gone. It is going to be a very exciting year with many changes being made for Veterinary Nursing. One I would like to talk about to you is the Targeted Review of Qualifications (TROQ). This is a review of qualifications in New Zealand in all areas to reduce the number of varying qualifications and ensure that graduate profiles, which will be set by industry, are being met. This TROQ is scheduled to take place in the latter half of 2012 for the Animal Care, Veterinary Nursing and Rural Animal Technology qualifications. Industry representatives will be involved, especially in the early part of this process, when the graduate profile is set. The Agriculture ITO, who will run this process, will be calling on industry representatives to help set graduate profiles for the qualification suite. I can see this being a challenging process, but also a very positive one for veterinary nurses in New Zealand. It will be a chance to look at our qualification against others around the world to make sure that we have a high and comparable standard of training. Employers should

then find it easier to understand what their qualified veterinary nurse is able to do in practice. I look forward to New Zealand having just one qualification delivered with different exit levels available for students, and the ability for students being able to continue their education when they are ready. Having one New Zealand suite of qualifications should also be a positive step toward eventual registration. Another issue that has been brought to our attention is that of microchipping. Veterinary nurses do not need to do a course to be able to implant microchips in a veterinary clinic, provided they are acting under the training and supervision of a veterinarian. Like vaccination certificates, even though they can implant, veterinary nurses can’t verify a microchip. This must be done by a veterinarian. At the time of writing this, I am looking forward to our upcoming conference on 19-22 June and returning to Hamilton this year. Veterinary nurses really are “the heart of practice”, so enjoy your learning and soak up all the conference has to offer from the wonderful trade stands, excel-

lent lectures and book now for the New Zealand Veterinary Nursing Association’s 20th Anniversary Dinner. I look forward to seeing you there. Julie

LETTER FROM THE EDITOR The last few months have been busy for the NZVNA council as we finalize everything for the conference and the celebrations of our 20 year anniversary. As you all know, veterinary nurses are the heart of the practice and we have an exciting line up of speakers for you. I am personally disappointed that I won’t be able to be there this year as other commitments are preventing me from attending. On top of this, we have also been organizing the veterinary nurse programme for the World Small Animal Veterinary Association (WSAVA) conference which is being held in Auckland next March. We are excited to have been invited to par4

ticipate in this conference and I strongly encourage all of you to attend this great opportunity, right on our doorstep. On a sadder note, the NZVNA would like to extend sincere condolences to Helen Schofield’s family and the staff at Franklin Zoo after her sudden and tragic passing in April. Everyone that has met Helen would testify to the fact that she was full of knowledge that she passed onto everyone she talked to, whether they were fellow veterinarians and veterinary nurses or visitors to Franklin Zoo. By looking on Franklin Zoo’s Facebook page and reading just a few of the 170 (plus) comments that are written there, you can see that

Helen was held in high regard by many, and touched an immense number of lives. Thank you to the authors of the articles that are in this issue of the journal. They include anaesthetic pressure checks and circuits, mental stimulation for our patients, a cat with fibrosarcoma of the mandible, an interview with Mell Smith – the first veterinary nurse in New Zealand to graduate with recognition of prior learning, a veterinary nurse’s experience with volunteering in Thailand and a review of the Veterinary Nurses council of Australia’s conference. Amy


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LETTER TO THE EDITOR Looking at the p.14 photo in the March edition of The New Zealand Veterinary Nurse took me back to the excitement of that meeting in 1992 in Palmerston North. I well remember, with pride, the ‘pioneering spirit’ and determination of those present. Since then, NZVNA has established itself as a most professional and respected member of the veterinary family. To not achieve legislated recognition through the registration process is a disappointment but in all other respects NZVNA has accomplished for its members all that we promoted in 1992.... and much more! Congratulations on reaching the 20 year mark! Catherine H Smith

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Mental Stimulation as a Stress Reliever in Patients

As stress lowers the patient’s immune system the susceptibility to contract disease is increased, which in turn may lead to complications such as infections and other illnesses.

by Stuart Greenfield HND Animal Welfare, BSc Applied Animal Behaviour, UK APBC Member (Association of Pet Behaviour Counsellors)

Introduction Patients within practice can be susceptible to heightened emotional states. This can often be attributable to the stress they are experiencing. This stress can have a detrimental effect on the patient’s welfare and recovery. This article looks at behavioural techniques that can be implemented in order to lower these stress levels. The effects of stress The state of stress has been documented as inhibiting the healing of a wound site in patients, which prolongs the time to recovery for the patient. As stress lowers the patient’s immune system the susceptibility to contract disease is 6


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increased, which in turn may lead to complications such as infections and other illnesses.

The theory behind behaviour as a stress release The basic theory behind training as a stress release is that it offers the dog mental stimulation which then leads to a calmer more mentally exhausted patient. This theory has been seen in various rehoming scenarios where dogs were subjected to various types of mental stimulation (O’ Rourke-Wieneke n.d, McKinnon n.d, Schipper et al 2008). Training is not the only option out there however. There are other methods of enhancing mental stimulation by reducing emotional states. Dog Appeasing Pheromone (D.A.P Virbac) has been used in various scenarios to reduce stress levels (Mills et al 2006, Kim et al 2010, Tod et al 2005). Further to this olfactory stimulus has been shown to enhance stress relief. The use of lavender has been shown to reduce stress in dogs during transportation (Wells 2006). This principle can be taken into patient care and be used to reduce emotional states in practice, where dogs are too sensitised to undertake training or other forms of mental stimulation or enrichment. By reducing the stress level using pheromone therapy or olfactory stimuli we can further decrease stress by combining it with behavioural methods.

How can this be implemented? The use of behaviour as a stress release can be as simple as doing a five minute session of ‘Sit’ or ‘Down’ or a mixture of the two. If the patient is not capable of undertaking these tasks a simple ‘Touch’ technique can be used where the dog is rewarded for touching a target with their nose. These tasks offer the mental stimulation that can reduce the stress levels being experienced by the patient. In conjunction with this the use of a secondary technique, as discussed earlier, may be pertinent when dealing with animals of a particularly high stress level who may not respond to training as they are too sensitised.

Conclusion By using mental stimulation we can reduce the emotional stress levels of our patients, which in turn can enhance their welfare and have a positive effect on healing, the safety of the staff and the pet’s lifelong associations with the veterinary clinic. Reference List Wells, D. L (2006). Aromatherapy for travelinduced excitement in dogs. Journal of American Veterinary Medical Association. 229. 964 – 967. Tod, E et al (2005). Efficacy of dog appeasing pheromone in reducing stress and fear related

behaviour in shelter dogs. Applied Animal Behaviour Science. 93. 295 – 308. Kim, Y et al (2010). Efficacy of dog – appeasing pheromone (DAP) for ameliorating separation – related behavioural signs in hospitalized dogs. Canadian Veterinary Journal. 51. 380 – 384. Mills, D. S et al (2006). A triple blind placebocontrolled investigation into the assessment of the effect of dog Appeasing Pheromone (DAP) on anxiety related behaviour of problem dogs in the veterinary clinic. Applied animal Behaviour Science. 98. 114 – 126. Schipper, L. L et al (2008). The effect of feeding enrichment toys on the behaviour of kennelled dogs (Canis familiaris). Applied animal Behaviour Science. 114. 182 – 195. McKinnon, C (N.d). Reducing stress and increasing adoption success for shelter dogs. Found at http://vip.vetsci.usyd.edu. au/contentUpload/content_2856/CatrionaMckinnon.pdf. Accessed on 15/4/2012 O’Rorke-Wieneke, D (N.d) New trends in shelter welfare research: Can training reduce stress and increase adoption rates in shelter dogs? Found at http://vip.vetsci. usyd.edu.au/contentUpload/content_2859/ DevonO’Rorke-Wieneke.pdf. Accessed on 15/04/2012.

Why is this important? It is important to understand how the use of behavioural techniques can reduce stress in practice, as it is a simple and cost effective way to improve our patient’s welfare. We have touched on the physical benefits of reducing emotional states of stress, and the enhanced recovery of our patients. There are other benefits that make behavioural techniques a viable option when dealing with stress. For example by reducing stress we are providing the patient with more positive experiences in practice. These associations will make the patients next visits a more positive experience, as anxiety will be reduced. There is also the added benefit of reducing danger to staff dealing with a highly emotional patient. If the patient is less stressed its responses will be less likely to include aggression. This is because the dog is less fearful, and as most aggression is born of fear, the likelihood is reduced. 7


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A safer anaesthetic machine Pressure checking

by Marcia Fletcher Veterinary Technician Anaesthetist DVN (Distinction), Veterinary Technician Specialist in Anesthesia (VTS-Anes) Massey University Veterinary Teaching Hospital

Introduction I can remember being asked to help with a patient that was having a “rough” anaesthetic shortly after induction some years ago; When I arrived I saw the patient appeared light, was breathing heavily and visibly struggling. After a quick look over the anaesthesia machine I found the scavenge attached to the expiration limb of the circle system, and the expiration limb of the circle attached to the scavenge. This meant that although the patient could breathe in oxygen and anaesthetic agent, it was breathing it out directly into the scavenging system, so no steady state of anaesthetic agent could be achieved within the circuit. The patient would have remained very light and continued to struggle. This accidental set up mistake would have been picked up and corrected before the patient was anaesthetised if a circuit pressure check had been performed, and unfortunately in this case it had not. There are many MANY reasons why we should pressure check our machines and circuits. The checks we perform help ensure 8

Baby Takahe

safety for the personnel using the equipment as well as the safety of our patients. • For the personnel: maintaining a “leak free” system prevents inhalation of trace levels of anaesthetic agents that pollute our working environment. Chronic exposure to trace levels of inhalational agents has been associated with renal and hepatic disease, neurological disorders and particularly of concern for woman; reproduction issues including infertility, and there is some evidence linked to spontaneous abortions. • Preventing leaks ensures the ability to ventilate our patients with intermittent positive pressure ventilation (IPPV). With large leaks there is insufficient delivery of fresh gas (oxygen and inhalation agent) and it is impossible to maintain enough reservoir in the reservoir bag to ventilate the patient – even with the pop off valve closed. There may be sufficient leakage of anaesthetic vapour that the patient may be difficult to maintain at an appropriate plane of anaesthesia, and appear “light”. • Oxygen leaks before the vaporiser can

significantly lower the oxygen concentration within a circuit, this is detrimental to all anaesthetised patients because the insult of anaesthesia causes in every patient (to some degree): respiratory depression, hypoventilation and impaired chest wall movement. This may lead to hypoxaemia (low blood oxygenation) in susceptible individuals. Pressure checks should be performed on every component of the anaesthetic machine. This is from the oxygen’s point of entry into the machine, right down to the patient end of the breathing circuit. The checks are simple to perform, and should take around a minute to perform each (so they are not time consuming). The pressure checks can be further defined as high, intermediate and low pressure system checks, and the components included in each are listed in table 1.

The high and intermediate pressure check This check should be performed every cylinder change or once a week (whichever comes first). The pressure check for the nitrous


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Table 1: The components of the high, intermediate and low pressure systems. High pressure system Pressure: up to 2200psi

Gas cylinder Yoke hanger Yoke block High pressure hoses Pressure regulator Pressure gauge

oxide cylinder is the same as the oxygen cylinder check. To check for leaks in the high and intermediate pressure components: 1. Turn the oxygen cylinder pack valve (that is attached to the anaesthesia machine) on. Note the position of the needle on the oxygen pressure gauge (Figure 1). 2. Turn the cylinder pack valve off again. 3. Busy yourself elsewhere for 20 minutes (might be a good time for a cup of tea!...) 4. Come back and check the position of the needle on the pressure gauge in 20 minutes. If there is a leak in this system the needle would have fallen from its original position. • This type of leak will not be detrimental to the personnel in your practice (as it is only an oxygen leak), but may considerably increase your running costs, and if significant enough, may lower your percentage of oxygen entering the machine and circuit considerably (so your patient may not be breathing anywhere near 100% oxygen). Extra notes for nitrous oxide: If you use (or are thinking of using) nitrous oxide as part of your inhalational anaesthesia: Although the pressure check is the same as an oxygen cylinder, the movement of the pressure dial differs greatly when the cylinder

Figure 1: Note the position of the needle on the pressure gauge before turning the cylinder off.

Intermediate pressure system Pressure: 40-50psi

Pipeline inlets Hoses from pipeline inlets Regulators to the flowmeter Flowmeter assembly Oxygen flush valve

Low pressure system Pressure: 0-30 cm H2O

Piping from flowmeter to the vaporiser Vaporiser (out of circuit) Piping from the vaporiser to the fresh gas outlet Piping from the fresh gas outlet to the patient breathing circuit

is in use. Nitrous oxide is both a liquid and gas at room temperature. The pressure gauge and needle position is based off the pressure of the gaseous portion of nitrous oxide. This means that the needle position will remain at the “full” cylinder position until the entire liquid portion has been used up (turned into gas). If the dial is in a less than full position the cylinder is basically empty! Weighing the cylinder when it is full is the only way to accurately determine how much nitrous oxide is left in the cylinder e.g. The full cylinder weighed 4.2kg, if it now weighs 2.1kg then we can say the cylinder is half empty (or half full).

The low pressure checks There are two main types of checks for the low pressure system: The “backbar” occlusion check and the circuit check which includes both rebreathing and non-rebreathing system checks. To check the backbar of the anaesthesia machine: 1. Turn the oxygen flowmeter on to 1L/min. 2. Occlude the fresh gas outlet (also called the common gas outlet) with your thumb or hand (Figure 2). 3. The float in the oxygen flowmeter should drop down to exactly half (500ml/min) in 30 seconds if there isn’t a leak. Why does the float drop? When 1L/min of oxygen hits the occlusion (my hand) it has nowhere to exit the machine

Figure 2: Occluding the fresh gas outlet.

so it backflows creating pressure. The pressure created forces the float downwards inside the oxygen flowmeter. If there is a leak in the backbar the oxygen float would not drop (or only drop a small amount) due to the oxygen escaping through the leak and no pressure being created. A leak in the backbar may be hazardous to personnel if it incorporates, or is after the vaporiser as vapour will leak into the work environment. This type of leak is often difficult to fix, and the anaesthetic machine or vaporiser may require servicing to correct the fault. There are two common types of nonrebreathing circuit used in New Zealand veterinary practices; the “Ayres T piece” and the modified coaxial “Bain” circuit.

Figure 3: The pressure maximum indication on the Ayres T piece pop off valve. To check a non-rebreathing Ayres T piece circuit: 1. Occlude the patient end of the circuit with your thumb. 2. Close the pop-off valve (“righty tighty”). 3. Turn the oxygen flowmeter on and fill the reservoir bag until it is distended and has no creases, then turn the oxygen flowmeter off. 4. Watch the reservoir bag for crease formation, if creases appear there may be a leak. Notice I said “MAY BE”? Some pop-off valves are designed for paedi9


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atric (human) patients and have a maximum working pressure printed on them, for example, “28cm H2O pressure” (Figure 3). This means that if we fill the reservoir bag over the 30cm of water pressure limit the popoff valve will open (even in the fully closed position) to release some of this pressure. We may see this by creases forming (but not getting any larger) in the reservoir bag once we have turned the oxygen off. This can be tricky to work out whether there is a leak in the circuit of just an exceeded pressure limit on the pop-off valve. A trick I use is to squeeze the full reservoir bag close to my ear with the pop-off valve closed. If I exceed the maximum working pressure I will hear the oxygen escape out the pop-off valve and into the scavenge, or if there truly is a leak I may hear a hiss elsewhere in the tubing.

To check a non-rebreathing Bain circuit: There are two checks that need to be performed on the modified coaxial Bain circuit. Since this circuit is a “tube within a tube” we must pressure check both the outer expiratory tube and the inner fresh gas inspiratory tube. Outer tube: This check is identical to an Ayres T piece pressure check. Inner tube: 1. Turn the oxygen flowmeter on to 1L/min. 2. Occlude the inner tube with the plunger from a 3ml syringe (Figure 4). 3. The float in the oxygen flowmeter should drop down to exactly half (500ml/min) in 30 seconds if there isn’t a leak. Again, this drop is caused by the build up of pressure as the oxygen hits the occlusion (the 3ml syringe plunger).

the “Universal F circuit” and the “To-Fro” system. These systems all have an identical pressure check.

limit the amount of anaesthetic pollution in our working environment, listed below are some of the easily instigated concepts.

To check a rebreathing system: 1. Close the pop off valve. 2. Occlude the Y piece (or patient end) with your thumb. 3. Fill the reservoir bag with oxygen until it is distended and has no creases left in it. This is either done by eye, or if your anaesthetic machine has a pressure manometer incorporated, fill the reservoir bag until it has 30cm of water pressure in it (Figure 5). 4. Turn the oxygen off and either watch the reservoir bag for crease formation, or watch the pressure manometer to see if the pressure is decreasing within the circuit. 5. Open the pop off valve to allow the built up pressure out once you have finished pressure checking – do not take your thumb off the Y piece to release the pressure!

• Minimise mask or chamber inductions, both of which produce high levels of waste anaesthetic agents. • Use the lowest fresh-gas flow rates possible for the proper functioning of your vaporiser and breathing systems:

Why don’t we release the pressure by lifting our thumb? If we release our thumb soda lime (baralime) dust is picked up and deposited through the rebreathing circuit. When we then attach this circuit to a patient they will breathe in this dust. Dust inhaled into lungs is detrimental to any patient, and even more so with soda lime dust. This is because soda lime is extremely alkaline, and caustic to the lung mucosa. Not only would the patient be breathing in dust, but it would be damaging their lung tissue. Our patients are not able to wake and tell us their lungs are burning, so it’s up to us to ensure we always release pressure from a rebreathing circuit by opening the pop off valve.

Rebreathing: 30ml/kg/min with a minimum of 1L/min After 15 minutes: 10ml/kg/min with a minimum of 300ml/min Non-rebreathing: 300-500ml/kg/min with a minimum of 1L/min • Vaporiser filling should be performed at the end of the day, with limited people in the room and in a well-ventilated area. ALWAYS use the appropriate keyed filler or pouring spout to fill vaporisers. • Connect all breathing circuits to a scavenging source. Ensure the scavenging source is scavenged to the outside (not the floor!) via a passive or active scavenging system. An efficient scavenging system is capable of reducing ambient concentrations of waste gases by up to 90%! • Use activated charcoal canisters if scavenging to the outside is not feasible. • Check the cuffs on the endotracheal tubes for leaks before using them, and ensure the cuff is inflated correctly when in use. • Minimise the use of non-cuffed ET tubes, and only use in relevant species (e.g. avian species). • Keep your patient on 100% oxygen for at least 5 -10 minutes after cessation of anaesthesia and inhalational agent. This may be easier to achieve on a rebreathing circuit. Increase your oxygen flow rate to 2 - 4L/min and open the pop off valve

There are three rebreathing circuits used within New Zealand practices, The “Circle”,

Some extra tips for reducing workplace pollution Finally, there are many other ways we can

Figure 4: Occluding the inner tube of the Bain system.

Figure 5: Fill the bag until it has no creases, or until there is 30cm of water pressure in it.

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completely. This serves as a “washout” period vital to ensure the highest levels of inhalational agent are scavenged rather than being breathed into the recovery area (for us to breathe in!) • Recover all patients in a well ventilated area. Key references: Hartsfield SM. Anesthetic machines and

breathing systems. Lumb and Jones’ Veterinary Anesthesia, Thurmon JC, Tranquilli WJ and Benson GJ, Williams and Wilkins, 1996. Hartsfield SM, Cornick-Seahorn J, Cuvelliez S, Gaynor J and McGrath C. Commentary and recommendations on control of waste anesthetic gases in the workplace, Journal of the American Veterinary

Medical Association, Vol. 209, 1, 1996. Machon RG, Fletcher MC. The perioperative period: improving patient outcome. Pressure testing anaesthetic machines and patient breathing circuits. (Conference proceedings) Dec 2011.

The

NZVNA needs

YOUR HELP!

Have you had an interesting case to nurse lately that you would like to share with fellow veterinary nurses? You may have had a great result, or as can often be the case in our line of work, a not so happy end of story but you know you made life for your patient more comfortable while they were in your care.

Do you have a particular interest in a certain species, or a keen focus on a specific area of veterinary work; like breeding, orthopaedic surgery, behaviour, anaesthetics, radiology, laboratory, nutrition or dentistry? Have you recently discovered a new veterinary nursing textbook or attended a continuing education event that you think others might find interesting? Or maybe you have set up a preventative health care clinic for your clients that you are proud of, and that you think other veterinary nurses might benefit from? Why not take this interest a step further, do some research, write an article (technical or otherwise) and get it published in your journal, something that would look great on your CV not to mention something for yourself and your colleagues to be very proud of. We are always on the lookout for enthusiastic veterinary nurses committed to their association, one way you can give a little bit back is by doing just that; submitting articles, stories, case studies or book reviews (or anything else you think may be worth

publishing) to the NZVNA journal editor Amy Ross or NZVNA journal liaison Fiona Hastie. We are here to help, if you’re keen to produce something but not quite sure where to start then send us an email, or pick up the phone. We’ll support and assist you to produce something worthy of publication in our wonderful journal, and sharing with the wider veterinary community. Head on over to the NZVNA stand at conference and have a chat to either of us, we really do want to hear from you! You’re not the writing type, but you love to take photos? Don’t worry we’d love to hear from you too, the NZVNA currently have a new website under construction and we would like to showcase photos of New Zealand veterinary nurses in New Zealand clinics and environments on that website. And those of you that are looking for ways to get points towards your AVNP, remember that any article that is published in the journal is eligible for points. So get in touch, all our details are in the front of this journal or on the website. We look forward to hearing from you. Thank you Amy Ross (journal editor) and Fiona Hastie (journal liaison)

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A Bilateral Hemimandibulectomy in a domestic cat This is not a very common procedure and is seen more often in dogs than cats. Often it is only one lateral half of the mandible that is removed but because of the location of the fibrosarcoma both sides needed to be removed on Ziggy.

by Amy Ross DVN – NZVNA Council Member

In July 2008 my brother-in-law took Ziggy, his nine year old, black, Domestic Medium Haired (DMH) cat to Unitec Veterinary Hospital (UVH) for boarding while he was away on holiday. I was working as a tutor for Unitec at the time and I was on the cattery admittance form as an alternative contact. This was the first time that Ziggy was seen at UVH so a health check was performed on Ziggy before he was admitted into the cattery. During the health check it was noted that Ziggy had a large chin and the staff at UVH called me to see if this was normal for him. I explained that Ziggy had always looked like he had a large chin but as it had been a couple of months since I had seen him previously I would come over to UVH to 12

have a look. When I saw Ziggy, I told Dr Angela Young, the Veterinarian on duty, that the chin appeared to have doubled in size since I had last seen Ziggy. I gave UVH permission to take radiographs of the chin as well as perform a bio-chemistry blood profile on Ziggy. I did do this without contacting the owner as I knew that he would say to go ahead with the diagnostic tests as required and did not want to disturb his long overdue holiday.

Above: Ziggy post biopsy of his chin

The next day a blood sample was taken from Ziggy’s right jugular vein. He was placed back into his cage, with no food or water, while the in-house blood tests were completed. No abnormalities were noted in the results, so Ziggy was pre-medicated with Morphine, Acetylpromazine (ACP) and Atropine, subcutaneously (SQ).


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Left: X-ray of Ziggy’s chin at the time of biopsy

owner that Ziggy was not allowed to have any food after 6:00pm the night prior to the surgery and that his water bowl needed to be removed first thing in the morning of surgery. These instructions were repeated to the owner the day before the surgery by a staff nurse who phoned to confirm that the surgery was still going ahead.

Later in the day, Ziggy was induced with Propofol intravenously (IV ) before being intubated with a 3.5 cuffed endo-tracheal (ET) tube and connected to an Ayres T-piece non-rebreathing circuit where he was maintained on 1 litre/min oxygen and 2% isoflourane. His anaesthetic was monitored by a veterinary nursing student who was under supervision at all times. He was then taken in to the x-ray room where a lateral radiograph was taken of Ziggy’s chin. Once the x-ray was developed, Angela noted bony changes to the chin as well as an increase in the soft tissue surrounding the rostal surface of the mandible. Angela consulted Dr Andrew Newington and they both agreed that a biopsy was required of the chin.

it is only one lateral half of the mandible that is removed but because of the location of the fibrosarcoma both sides needed to be removed on Ziggy. The procedure occurs by surgically removing the mandible, either in front of, or just behind the first pre-molar. Andrew explained to the owner that it would not be until he was in the surgical theatre that he would be able to determine how much of the mandible would need to be removed as it would depend on the integrity of the bone. The owner agreed to have the surgery done on Ziggy and he was booked in for surgery a week later, at the time of the consultation. A veterinary nursing student explained to the

On the morning of the surgical procedure, the owner bought Ziggy into UVH at 8:00am as instructed. The owner signed both an anaesthetic and surgical consent form. As nothing abnormal had appeared in the routine blood tests two weeks previously, it was decided that further blood tests were not required. Ziggy was then admitted into UVH where he was given a complete physical examination by one of the veterinary nursing students. Other than the size of his chin, which was looking even larger now as it had been shaved for the biopsy, no abnormalities were noted. Ziggy was then administered a pre-medication of Morphine, ACP and Atropine SQ. After the pre-medication had taken effect, Ziggy was induced with Propofol IV, intuBelow: Ziggy’s chin after being draped for surgery

I offered to phone the owner since I had given permission for the anaesthetic, blood tests and radiograph without consulting him. As a biopsy is more of an invasive procedure, I felt that it was best that he was consulted and asked for permission. After I explained the situation to the owner, he gave permission for the biopsy to be performed. This was completed straight away and Ziggy was then woken up from the anaesthetic. When the owner returned from holiday a week later, he had a consultation with Andrew explaining that the biopsy results had come back as a fibrosarcoma. Because of the bony changes involved with the mandible, the only treatment option for Ziggy was a bilateral hemimandibulectomy. This is not a very common procedure and is seen more often in dogs than cats. Often 13


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bated with a 3.5 ET tube and connected to the anaesthetic machine via an Ayres T-Piece, non-rebreathing circuit. Again his anaesthetic was maintained on 1 litre/min Oxygen and 2% isoflourane. His anaesthetic was monitored by a supervised veterinary nursing student. As well as monitoring Ziggy’s vital signs with her eyes and a stethoscope, the student also utilized an ECG machine, Doppler and Pulse Oximeter with the aid of the staff nurse that was supervising her. Before being moved into the sterile surgery, Ziggy’s chin was again shaved and given an initial prep with chlorhexidine and tincture by another student. He was then moved into the sterile surgery where his chin was given a final prep with cholrhexidine tincture before being draped with sterile plain drapes by Andrew.

Andrew elected to cut the mandible with a bone saw cranially to the first pre-molar initially. When he saw that there was no visible change to the under-lying bone he then chose to close the surgical incision with monomed suture. A fentanyl patch was placed on Ziggy’s right lateral chest. A naso-gastric tube and an Elizabethan collar (E-collar) were also placed prior to the anaesthetic being switched off and Ziggy then being maintained on 100% oxygen. When he was showing signs of waking from the anaesthetic, the ET tube was removed and Ziggy was placed back into his cage where he was continually monitored by a veterinary nursing student until he was able to lift his head.

The next morning, one of the staff nurses checked on Ziggy and discovered that throughout the night he had managed to get one of his paws stuck between his neck and the naso-gastric tube. Not only had Ziggy managed to pull out his naso-gastric tube but he had also removed all of the internal and external sutures from his surgical site.

Below: First surgical incision

The owner came into UVH that afternoon to visit Ziggy. Andrew spoke with him, explaining that they would need to keep Ziggy in overnight, just in case he did manage to remove his sutures again. When he was able to go home the next day, he would be on antibiotics and pain relief. Because of the type of surgery and the interference of the surgical wound by Ziggy, he would be on antibiotics for 6 weeks.

The owner was contacted and after verbal permission was given over the phone, Ziggy was given another anaesthetic so that his surgical wound could be re-sutured. It was decided that instead of sutures, skin staples would be used to close the wound. Prior to being woken from this anaesthetic, all four of Ziggy’s paws were wrapped with vetrap and his E-collar was placed back on – this time slightly tighter, in the hopes that he would not be able to remove his sutures again.

I know from past experience of having to call in to my brother in laws house to medicate Ziggy that the owner would have difficulty with administering the medication. Though I knew that Ziggy and my two cats did not get on, I offered to take Ziggy to my house for the six weeks that he would be on medication, much to the relief of the owner. Once this had been decided on, Andrew asked if I would mind taking Ziggy home that night so that I could keep an eye on him to ensure he did not interfere with his surgical site again. I had no problems with this and I borrowed a collapsible crate from UVH. The crate was set up in our spare room so that we could keep the door closed and our own cats separate from Ziggy. Before placing Ziggy into the crate, I did decide to remove the vetrap bandages from all of Ziggy’s paws as he was thrashing around and shaking his paws. I crossed my fingers that Ziggy would leave his surgical site alone, but I believe that I made the right call at the time Left: Ziggy’s mandible after his chin was surgically removed 14


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Left: Ziggy hiding under the bed so that I couldn’t medicate him

temperature in the room would be warmer and after awhile placed Ziggy back into his crate before turning out the light and climbing back into bed where I barely slept for the rest of the night. The next morning I took Ziggy back into UVH for a recheck. I explained to the staff about Ziggy’s decreased body temperature and how I thought he had died in the night. His temperature was taken during the consultation and it was 38.5°C. Ziggy had not interfered with his staples either and Andrew was happy with how the wound was looking and Ziggy’s demeanour. I was provided with Ziggy’s Clavulox drops, Metacam oral for cats and Baytril 50mg tablets. I also took home some Hills a/d diet to make into a slurry for Ziggy to easily lick at and ingest. I was also given instructions to bring Ziggy in for weekly vet checks, unless I had any concerns about his mandible and the wound, then I was to bring him in straight away.

Above: Ziggy 4 weeks post surgery as Ziggy did calm down as soon as the last bandage was removed. I decided to sleep in the spare bed that evening so that I could keep an ear out for Ziggy, in case he did start interfering with his surgical wound. At 3:00am I woke up, thinking that I could not hear any noise from Ziggy, who was in the crate right next to the bed, so I got up and turned the light on. When I looked into the crate, I could not see Ziggy breathing and when I touched his chest to feel for a heart rate he was cold to the touch. With tears streaming down my face, I started to pat Ziggy, thinking that he had died during the night. I was trying to work out how I would tell my brother in law

that his beloved cat had died. I must admit that I did decide I would take Ziggy’s body into UVH and get the staff to call the owner to inform him of what had happened as I did not think that I would be able to call the owner myself. While I was doing this, Ziggy started to move under my hand. I was ecstatic when I realized that he was actually still alive and that he was hypothermic. This was probably due to the two anaesthetics that he had received in the last 48 hours. I forced Ziggy to stand up and I patted him all over his body, quite roughly, to help stimulate him and encourage blood flow. After a couple of minutes Ziggy started to walk around and purr. I did not have a thermometer at home so I was unable to monitor Ziggy’s core body temperature. So I adjusted the temperature on the column heater so that the ambient

Initially Ziggy was interested in the Hills a/d diet but after a couple of days he would not eat it. I offered him some jellymeat which he only half heartedly licked at. I contacted the owner, who was visiting on a regular basis, to find out what food Ziggy normally ate and he said that he would bring some of his food around that evening. When the owner turned up, he not only had the jellymeat and biscuits that Ziggy normally ate but he had also bought some beef mince with him – as you can probably guess, Ziggy turned his nose up at everything but the beef mince. When I took Ziggy into UVH for his staples to be removed 12 days post surgery, Andrew noted that a small amount of bone was visible. It was decided that this would be rechecked in a week’s time and there was a chance that Ziggy would require further surgery to correct this. Thankfully at the next revisit, the skin had grown over the small amount of bone and further surgery would not be required. Medicating Ziggy twice daily was not a problem until about the third week. By this stage he was sick of the regular pilling and every time I entered the room he would run into the far corner, under the queen size bed, where I could not easily reach him. If I sat quietly in the room, on most occasions, 15


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Above: Ziggy today

he would come out for some attention and after I had patted and cuddled him for awhile I could then medicate him without too many problems. But there was the odd day where I would have to climb under the bed to get anywhere near him. Not too long after this started happening, my husband was diagnosed with pneumonia and I developed a bad cold. It was at this point where I started to appreciate how a lot of our clients struggle with medicating their pets, even for short periods of time, if their pet is not being cooperative. I have to admit that there was the odd day where I cheated and hid Ziggy’s medication in his food, which thankfully he ate with no problems. This is probably due to the fact that he was still eating beef mince at this stage. At the end of the six week period, Andrew was very happy with how Ziggy’s mandible had healed and that he would no longer need to be on any medication. With this news, Ziggy was able to go home with his owner. The owner quickly discovered how much Ziggy was hypersalivating – if we visited and Ziggy wanted to sit on our laps we had to have a towel between our legs and Ziggy or 16

we would end up with wet legs. Ziggy had also started to groom a lot more than he had prior to the surgery so his fur was constantly wet due to the hypersalivation. It has now been four years since Ziggy had his bilateral hemimandibulectomy. His excess salivation has calmed down though he does still drool a lot. He is also happily eating both jellymeat and cat biscuits, though he does need his biscuits to be in a deeper

Above: Ziggy’s mandible 4 years on

bowl so that he can easily get his face into it to pick up the biscuits otherwise they end up scattered all over the floor. At first glance a lot of people are not aware that Ziggy has had part of his jaw removed and if they were not told, or asked ‘what is different about this cat’, a lot of people would never guess.


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Increase your

word power

Word definitions sourced from the Dictionary of Veterinary Nursing, second edition D.R Lane and S. Guthrie and http://www.thefreedictionary.com

Inhalational agents Volatile anaesthetics used for the purpose of general anaesthesia, usually administered by endotracheal tube or face mask. IPPV Intermittent Positive Pressure Ventilation; A technique used in anaesthesia to ensure adequate ventilation of the lungs. Anaesthetised patients may be ventilated if necessary by squeezing the reservoir bag or by using mechanical ventilators. Hypoxemia Less than normal oxygen tension in the circulating blood. Nitrous Oxide Anaesthetic gas used in circuits mainly for its analgesic properties; it has a diluting effect on oxygen as a carrier gas. Cannot be used in closed anaesthetic circuits. Pressure manometer An instrument used to measure the pressure exerted by liquids and gases. Pressure is exerted on one end of a U-shaped tube partially filled with liquid; the liquid is displaced upwards on the other side of the tube by a distance proportional to the pressure difference on each side of the tube. Hemimandibulectomy Removal of one half of the lower jaw. Procedure used in the treatment of jaw neoplasia. Hypersalivation Excessive secretion of saliva. Fibrosarcoma Malignant tumour of fibrous connective tissue. Biopsy Taking living tissue from the body, usually for microscopic examination for the purpose of diagnosis or assessing cancer after tumour removal. Naso-gastric tube A fine tube inserted into the stomach through the nose, used for oral fluid administration.

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Congratulations to the following veterinary nurses who have successfully completed the Accredited Veterinary Nursing Program (AVNP) for 2011. Great job! Laura Sladen Steph Mann Emma Smith Lara Angevine Heather Gudsell Fiona Hastie Helen Ryan Alice Gasner Yvonne Haren Karen O’Dea Amanda Peach

Natalie Smith Sonya Watts Catherine Rice Rebecca Stewart Kaycee Polkinghorne Louise Kennard Rebecca Sharp Shontelle White Jo O’Leary Karen O’Dea Danielle Horsley

Our AVNP is gaining momentum! Continuing professional development helps keep you up-to-date with the latest and greatest information, stimulates your brain, and gets you excited about working to implement positive change in the work-place. If you’re not already enrolled in the Accredited Veterinary Nursing Program for 2012, you can contact the membership secretary, Anne Lascelles at vetnurse@ihug.co.nz, or check out our web-link for more information: http://www.nzvna.org.nz/cpd-scheme Take a look at what’s on offer. There’s something here for just about everyone, and courses are being added throughout the year. We’d also like to extend our thanks to the great CPD providers who are part of the AVNP. Join today and keep on the cutting edge of veterinary nursing! 18


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Q uiz – M ental stimulation as a stress reliever 1.

Patients within practice are ____________ to heightened emotional states a. Prone b. Ignorant c. Incapable d. Susceptible

2. Stress can effect a patients welfare and recovery a. True b. False 3.

The healing of a wound site in a patient can be inhibited by a. Strain b. Stress c. Stimulation d. Excitement

4. A lowered immune system may lead to a. Infections b. Complications c. Other illnesses d. All of the above 5. Mental stimulation in patients leads to a. A calmer patient b. An excited patient c. An uncontrollable patient d. A patient that does require further hospitalization 6.

D.A.P (Virbac) stands for a. Dog Activity Pheromone b. Dog Assuaging Pheromone c. Dog Appeasing Pheromone

7.

Which herb has been shown to reduce stress while transporting dogs? a. Mint b. Catnip c. Lavender d. Rosemary

8.

What sense is stimulated by the use of D.A.P? a. Touch b. Olfaction c. Gustation d. Visual Perception

12. A simple behavioural command that you can use is: a. Sit b. Stay c. Heel d. Come

9.

The use of behavioural techniques within practice is a. Difficult but cost effective b. Simple and cost effective c. Simple but time consuming d. Difficult and time consuming

13. If a patient is not able to undertake these simple tasks for you a. Behavioural techniques will not work for them b. You should get another staff member to try c. You could try a simple ‘touch’ technique d. You could try a different command

10. If a patient is less stressed, its responses are less likely to include a. Fear b. Obedience c. Aggression d. Unpredictability 11. The use of behaviour as a stress relief only needs to be as long as a. 2 minutes b. 5 minutes c. 8 minutes d. 10 minutes

14. The ‘touch’ technique involves a. The patient touching something with their nose b. You giving the patient a pat on the head c. Getting the patient out of the cage d. None of the above 15 By reducing a patients emotional stress levels, we enhance a. Staff safety b. Our patients olfactory stimulus c. Our patients excitement levels d. Our patients fear and aggression

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Worldwide volunteer organisations 2012 Over the past few years, the New Zealand Veterinary Nurse Journal has featured articles from veterinary nurses that have assisted at volunteer organisations around the world. From the feedback that we have received about these articles, we understand that many of you are interested in volunteering your time to assist. There are many animal related volunteer organisations worldwide and while the NZVNA are not in a position to endorse any of them, the following have been recommended to us by veterinarians and veterinary nurses that have volunteered and enjoyed their experience. www.worldvets.org South Pacific Animal Welfare www.spaw.org.nz spaw.enquiry@gmail.com The Esther Honey Foundation www.estherhoney.org www.greenvolunteers.com www.animal-job.co.uk www.thegreatproject.com www.orangutan.org.au Volunteering with Sunbears Donna Barlow Back_of_beyond.volunteers@xtra.co.nz Dog and Cat Rescue Samui www.samuidog.org Bali Street Dog Fund www.balistreetdogs.org.au Vets and Vet Nurses in the Wild Safari Angela Younger wildlifepgm@winnetthouse.com Hoedspruit Endangered Species Centre www.hesc.co.za Kiwi Care Team KiwiCareTeam@gmail.com 20


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New nationwide rewards programme for the profession New Zealand veterinary clinics are now able to join NZ’s fastest-growing customer rewards programme – AA Smartfuel. AA Smartfuel provides fuel discounts to customers who shop at selected retailers and service providers. With already more than 940,000 users, the target is to achieve 1 million registered card-holders in the first year. AA Smartfuel has teamed up with Animal Health Incentives Ltd to provide the profession with channel exclusivity to this exciting rewards scheme. Animal Health Incentives Ltd has launched the VetSign® brand, which will be promoted nationwide. Participating veterinary clinics will display the VetSign® logo to signal they are an AA Smartfuel service provider.

Customers simply swipe their AA Smartfuel card at participating retailers to earn cents per litre discounts on their next fuel purchase. The AA Smartfuel programme is free to join, and available to everyone.

Other benefits include: • The programme is simple for clinics to administer and manage • It has a proven ability to lift sales & average transaction value • There’s flexibility for each clinic to manage their own promotional activity • Each clinic can view sales information in real time through the AA Smartfuel system

Importantly, VetSign® AA Smartfuel provides clinics with a way to ‘value-add’ their services – and attract new clients – without having to discount.

VetSign® has the support of a number of industry suppliers, who will provide participating clinics with regular promotional offers and additional marketing support.

Each clinic can choose to make their own promotional offers (e.g bring in your pet for a dental this month and you’ll earn cents per litre).

The nationwide launch of VetSign® began in early April. Clinics who want to sign up, or find out more, can email info@vetsign.co.nz or visit www.vetsign.co.nz

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WSAVA Congress

The World Small Animal Veterinary Association (WSAVA) is an organization that represents over 70,000 individual veterinarians around the world who are involved with the care of domesticated small animals. Each year the WSAVA congress is held in a different part of the world and in 2013, New Zealand is lucky enough to be hosting this amazing conference in Auckland. Each year the conference attracts many veterinarians and veterinary nurses/technicians from countries around the world. The NZVNA feels privileged to have been invited to not only attend lectures by world

renowned veterinarians and veterinary nurses/ technicians, but to also hold our very own veterinary nursing stream over two days.

In 2013 we’ve secured Nancy Shaffran as our keynote speaker for the WSAVA congress (check out her profile below). For those of you that have not yet had the opportunity to hear Nancy speak, she is not only captivating – she has the room on the edge of their seats and in tears as they listen to her experiences, also getting you really thinking and being involved with her in participation throughout her lectures.

NZVNA Keynote Speaker at WSAVA 2013 – Nancy Shaffran CVT, VTS (ECC) Nancy is a professional veterinary educator with an extensive background in critical care and pain management. She is a charter member and a Past President of the Academy of Veterinary Emergency and Critical Care Technicians. After 12 years at the University of Pennsylvania Veterinary Hospital, as Supervisor of the Intensive Care Unit she spent 5 years as director of Education and Staff Relations at Cardiopet’s Veterinary Referral Center followed by 7 years as a senior specialist on the Sedation and Pain Management team at Pfizer Animal Health. Nancy has given over 2000 lectures to technicians and veterinarians around the world; she has authored over 20 journal and book chapter publications. The focus of Nancy’s career has been on the ethics and appropriate management of pain in companion animals. Nancy has received numerous awards including Speaker of the Year from the North American Veterinary Conference, the Jack Mara Memorial Lecture Award and was most recently the 2011 technician of the Year for Pennsylvania. She has held seats on the Board of Directors for the International Veterinary Academy of Pain Management and the Veterinary Emergency and Critical Care Society. Nancy currently works as a lecturer and private consultant striving to help improve pain management in veterinary practice. 22

WSAVA 2013 really is an opportunity that shouldn’t be missed, to have the world on our doorstep, we as veterinary nurses have the chance to showcase what veterinary nursing is like in little old Aotearoa. The NZVNA will show you something special, so make the time now and get there!


be there:

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biggest ever veterinary event in New Zealand

The World Small Animal Veterinary Association Congress is coming to Auckland, 6th to 9th March, 2013. It will include a veterinary nurse stream. The veterinary nurse stream features two days jam packed with presentations from leading international experts. This is a once in a lifetime opportunity for New Zealand vet nurses. Make your plans to come to WSAVA 2013. Full programme and early bird registration on www.wsava2013.org

www.wsava2013.org

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Helping out on

Koh Samui by Jo McGregor Part-time vet nurse at Marshall and Pringle Pet Med Kaiapoi. Cert in Animal Science in Technology, a Cert in Canine Behaviour and a B.Sc. in Zoology & Psychology

Last September, in order to have a reprieve from the Christchurch aftershocks we went on a family holiday to Thailand. An entire month was spent on the island of Koh Samui, which is a beautiful tropical island in the South of Thailand, approximately 25 kilometres across, with many beautiful beaches, thousands of coconut palms, 25,000 inhabitants and several hundred bungalow resorts and hotels. There are hundreds of stray or soi dogs (‘soi’ in Thai means street) begging for food. Most of the soi dogs live in small packs and remain within their territory. In an effort to curtail the number of soi dogs, the government in the past has carried out mass poisonings and the problem was solved for a time, although upsetting countless tourists at the same time as they witnessed dead and dying dogs everywhere. Until April 1999, there was no vet on the island and medical treatment for any animal was impossible. Countless sick or injured dogs and cats no doubt died in horrible circumstances. German tourist Brigitte Gomm and her husband founded the Dog Rescue Centre Samui (DRCS) in April 1999 and opened up a small clinic at the end of Chaweng Road. They now have many permanent staff, and a second large compound and clinic at the bottom of the island in Ban Taling Ngam, where they take in dogs that are too old or sick to be returned to the streets. Volunteers from all over the world head to Koh Samui to help out with veterinary care. DRCS’s aims are to desex and deworm all dogs and cats, and to treat all dogs suffering from mange. They aim to treat all stray dogs and cats in the event of injury or sickness and give them somewhere to rest. Another goal of course, is to educate the people of Koh Samui concerning the keeping of their own animals. They aim to inject all dogs and cats against rabies and thanks to DRCS, Koh Samui is the only rabies-free area in the whole of Thailand.

Left: Dog with mange behind market Opposite, above: Local soi puppy Opposite, below: Cat Zone at Chaweng DRCS centre 24


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In order to make my holiday ‘a holiday with a purpose’ I contacted Jo Robinson from Provet before I left, who generously supplied me with a suitcase full of veterinary products to donate to DRCS. On visiting for the first time I was welcomed by Brigitte, who then quickly gave me a job! When I mentioned we were based at Fisherman’s Village she gave me boxes of ‘tick prevention’ vials, and suggested that I de-tick every dog I meet while out and about. I was at first a bit apprehensive at the thought of approaching stray dogs but soon discovered that they love ‘farangs’ (foreigners) as we feed them and love them while the locals completely ignore them. As we were there for a month we got to know many of the locals and their dogs, I was able to recognise their resting spots and which hotel they preferred to hang out at and am happy to report that 98% of the dogs at Fisherman’s Village are tick-free (for that month anyway!). I was able to text DRCS about a dog I spotted that lived at the back of the local food market, it had severe mange - and its mate was pregnant. The next day I met an English vet there who injected it with Ivomec and would do so for the next few weeks, monitor the bitch and then get her spayed. Another morning I discovered an emaciated and dehydrated dog lying on a pile of rubble, and within an hour DRCS had collected him and taken him to their vet clinic. I medicated the big friendly dog over the road from our apartment twice a day for a suspected blood parasite infestation - sadly treatment was too little too late and he died within a few days of meeting him. Buddhism prevents the act of euthanasia (who knows how they get away with mass poisoning) and I guess this was the hardest thing for me to deal with - the DRCS shelter housed some seriously miserable dogs and cats. Very few of the local staff at the shelter speak English but it was fun to take my children there anyway to cuddle all the cats and watch them cook up a storm of rice and meat for all their four legged guests. Vets and veterinary students wishing to gain practical experience are welcome any time check out their website - www.samuidog.org - but if getting to Koh Samui is not an option - you can donate, sponsor or even adopt a pet from here. As of November 2011 they have about 350 dogs and 130 cats in their shelter. I will be returning to Koh Samui for sure. Left: Amy with kitten 26


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I N T E R V I E W with

Mell Smith Interviewed by Jo Robinson BAM Provet

In the past it was not necessary for veterinary nurses to have a formal qualification; and it was not until the late 1990’s that it become standard for veterinary nurses to be qualified. Throughout New Zealand, there are large numbers of hugely experienced and valued staff members, who have not had the opportunity to train and become qualified veterinary nurses. For a Veterinary Clinic to achieve Best Practice accreditation, it is a requirement for their veterinary nurses either to be qualified or enrolled in an approved training program. Mell Smith was a staff member that fell into this category. Although hugely experienced, and employed as a veterinary nurse for 16 years, she was unqualified. Mell works for a busy small animal veterinary clinic in Christchurch and is the veterinary nursing manager. She manages four veterinary nurses and her role involves surgical nursing, rosters, inventory control, hospitalized patients and administration. Otago Polytechnic offers recognition of prior learning/experience, through assessment of prior learning (APL). On comple-

tion a candidate will be awarded with the National Certificate in Veterinary Nursing. The candidate is required to present evidence of competency in theory and practical skills required of a graduate in the National Certificate of Veterinary Nursing. Evidence is gathered by face to face conversations, visits by an assessor to the veterinary clinic work place to view the candidate performing their day to day job, video clips of set tasks as they happen in the veterinary clinic, attestations from veterinary supervisors and some written tasks. Candidates are guided through the process by a qualified work place assessor, experienced in veterinary nurse education. The whole process for Mell took around 18 months to complete, (this could be longer or shorter depending on what works for each candidate). This option of obtaining the National Certificate in Veterinary Nursing is not easy, and it takes time and effort to gather evidence of prior learning, but is a great option for people like Mell. Rather than returning to Left: Mell at her graduation with Emma Riddle who has just completed her diploma in veterinary nursing

study she was able to instead showcase the knowledge she had built up over her years as a veterinary nurse in practice. This option of gaining a veterinary nursing qualification is available to people who have worked in companion animal veterinary practice for a minimum of eight years. The process starts with an initial scoping visit to meet and speak with the candidate. From this a plan is put into place to ensure the candidate meets the evidence and requirements for the qualification. In Mell’s case it was decided that all unit standards could be accessed via the APL process except Anatomy and Physiology. For this unit standard, Mell enrolled in the Otago Polytechnic, School of Veterinary Nursing distance program to complete as a normal enrolled student. This style of learning suited Mell as it fitted in well around her busy work schedule and family life. Mell’s employer was also very encouraging and supportive of her and her studies. Mell is the first veterinary nurse, in New Zealand, to complete her National Certificate in veterinary nursing by recognition of prior learning. We warmly congratulate Mell and wish her all the best in her future veterinary nursing career. 27


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Review of the VNCA conference by Julie Hutt NCVN, CAT

I have recently returned from the Veterinary Nurses Council of Australia (VNCA) Conference which was held on the Gold Coast, Australia. I was very excited and had been looking forward to it for some time. To be able to attend and participate in the conference was made possible by the support of Hill’s Pet Nutrition, who generously supports the veterinary nurse profession each year and continues to invest in programs to enhance both knowledge and skills. On the Tuesday evening before conference those of us who arrived early were welcomed by the VNCA Executive and members of the Divisional Committees. This get together and registration was an enjoyable evening

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and a chance to catch up with friends and colleagues as well as meet new people. Conference started with the Opening Ceremony at 8am on the Wednesday. It was the start of an inspiring conference; “Vet Nursing Unleashed”. The VNCA run their own conference with an incredible amount of support from industry. There were three streams running over the three days with workshop sessions being run at the same time. We were really spoilt for choice. For the 400 plus delegates attending it would have been almost impossible for them not to have gained a wealth of knowledge. This year’s key note speaker, Craig Cornell, has worked in the Department of Small Animal Anaesthesia at the Veterinary

Above: Julie Hutt and Lara Angevine at the Hills Pet Nutrition trade stand presentation


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Medical Teaching Hospital, University of California, Davis since 1984. He has experience anaesthetizing patients for a wide range of diagnostic and therapeutic procedures, but also has a particular interest in cardiovascular anesthesia. Craig was also involved in the development of the first technician specialist certification organizations AVECCT and AVTA. He spoke on an assortment of stimulating topics. These were just some of the interesting topics that I enjoyed. 1. “Paediatric Anaesthesia”; because very young patients have such different physiology and needs than the more mature patients. What do you need to look for in the preanaesthetic evaluation, and how to actually anaesthetize paediatric patients? 2. “Understanding Inhalational Anaesthetics”; with a detailed look at the properties and use of inhalational anesthetic drugs. E.g. how these drugs affect the patient with particular emphasis on the cardiovascular and respiratory systems. 3. “Understanding your Anaesthetic Equipment”; how the anaesthetic machine works, how to use it safely, and how to troubleshoot problems.

4. “Cardiovascular Monitoring”; how monitoring equipment commonly used in practice, combined with an understanding of physiology allows us to recognize problems, determine their severity, suggest therapy of the problem and monitor the effectiveness of therapy. 5. “ Respir ator y Monitor ing ”; how monitoring equipment commonly used in practice, combined with an understanding of physiology allows us to recognize problems, determine their severity, suggest therapy of the problem and monitor the effectiveness of therapy. 6. “Ventilatory Care”; when positive pressure ventilation should be used, how to adjust the setting on a ventilator, and how to monitor the patient to determine if ventilation is adequate. Other notable speakers were Dr Philip Judge, Anita Parkin, Mimi Dona, Trish Farry, Hayley Squance, to name but a few. The workshops are an enjoyable hands-on added extra and covered a wide variety of topics. For example, Wildlife Husbandry and Care, Pain Management, Practical Bandaging from equine to feline, Behavioral

Based Interviewing, ECG – case based interpretations, and IV Catheterisation. On the first day I attended a discussion forum on Vet Nurse Registration, an interesting and informative meeting. It helped me understand where veterinary nursing is heading in Australia and that Western Australia (WA) already have registration, so to work in WA you must hold current registration. This is excellent for the employer; they know that the veterinary nurse they want to employ is qualified and also the general public knows that the veterinary nurse dealing with their pet has the knowledge and skills to do so. A talk that I did particularly enjoy was by Cath Atkin on the “Rehabilitation of Marine Mammals”. This is something I know very little about and most probably will never get the chance to do, but found very interesting

Below: Clockwise, starting at top left - Julie Hutt and Lara Angevine, Jo Robinson and Julie Hutt, the Hills Pet Nutrition Australia team, the VNCA council members

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to see what is happening in this field. Cath Atkin works at The Sea World Research and Rescue Foundation, in association with National Parks and Wildlife authorities and community volunteers. They are involved in the rescue and rehabilitation of many marine mammal species across Australia. The process of decision-making to determine the appropriate course of intervention and treatment involved is determined through assessment of a number of factors, primarily the animal’s health, age, social dependence, natural distribution and disease risks. The health and safety of all personnel, the general public and the animals must be the highest priority at all times. In Queensland, the most common mammal species requiring specialized care due to stranding, entanglement or injury are the Inshore and Offshore Pacific Bottlenose Dolphin and the New Zealand Fur Seal. The conference ended with the VNCA Gala Dinner on Friday in the Grand Ballroom, a superb three course meal and drinks followed by dancing to the music of a live band. I want to thank the VNCA for a wonderful conference and for the friendships that we have made. It is quite refreshing to realise that the problems facing veterinary nurses are fairly similar throughout New Zealand and Australia. We are also lucky that in both Australia and New Zealand industry are very 30

supportive of the veterinary nursing profession. Industries were very well represented and the veterinary nurses made the most of catching up on the latest information and new gadgets on offer; I must add that I was one of them. Many exciting competitions were run and some delegates received wonderful prizes. As with all things good...it had to come to an end. I wish to sincerely thank Hill’s Pet Nutrition New Zealand Ltd for their generosity in sponsoring me. I especially wish

to thank Jo Hatcher, Gill Montgomery and the Australian veterinary nurses who made us feel very special while attending an extremely well run and informative conference. Above: Julie and Lara trying to work out how to fit a car into their luggage if they win it. Below: Hayley Squance presenting at the VNCA conference.


ProSkills Online Courses

Flexible online training for you and your practice Technical Topics

Customer Service and Personal Effectiveness Topics

Management and Human Resources Topics

When you see this symbol it means you can log on and off as you like. Forums, movies, animations, interactive content, and image galleries give you a broad spectrum of interactive learning materials. When you see this symbol it means you can enjoy pre-recorded lectures of around 45-60 minutes. They are presented on a specific area by noted industry professionals. Your 3 day access allows you to review the material as often as you wish during that time. Cardiopulmonary Cerebral Resuscitation

CPCR is an online course designed specifically for those wishing to gain exceptional knowledge to achieve optimal resuscitation techniques and understanding. The course makes extensive use of rich media, including images, video demonstrations and animations, to engage and teach practical skills. Covering areas ranging from task allocation, drug use and administration through to the latest cardiac massage techniques. Be prepared for the next arrest!

The Essentials of Pathology

This course will give you a comprehensive introduction to basic in-house veterinary pathology procedure. On-going assessment ensures you understand as you go. Topics covered include the use of the microscope and refractometer, understanding blood collection and storage, PCV and TPP, making blood smears, recognising normal and abnormal red blood cells, recognising white blood cells, performing differential white cell counts, understanding common biochemical and electrolyte tests, biopsies, skin, urine and faecal tests.

Understanding Preventative Health: Diseases, Parasites and Nutrition

Answering the curly questions from your clients like “Why isn’t this treatment working?” or “How did my cat catch this?” can be very challenging for the veterinary nurse. This course thoroughly explores the conditions we work hard to prevent. It covers the basis of disease, viral and parasitic conditions, how they are spread and the effects they have on pets as well as people. It looks at basic nutrition and the diets we can recommend to our clients.

Succeeding with Difficult Clients

Difficult clients can be a challenging and often emotional experience. However maintaining your poise and succeeding with difficult clients is truly rewarding. This online course covers the anatomy of difficult clients, understanding anger styles and the impact of body language and tone, personal skills and emotional intelligence, simple skills to manage the ‘difficult client’ experience and using practice standards to prevent common complaints.

Professional Telephone Techniques

Professional Telephone Techniques is vital for all veterinary personnel. Statistics show that over 80% of all new clients first make contact by phone. Topics covered in this course include understanding the importance of the telephone, telephone communication, placing calls on-hold and message taking, phone management, handling client complaints and your practice standards.

Human Resource Essentials

In this course you will walk you through a series of checklists and exercises so you can “audit” yourself and assess the areas you implement well and areas that you may need to improve in your practice. You will focus on your skills and attributes as a manager or supervisor of staff.

Want to get a taste of our courses? Take this FREE COURSE: Head to Toe: The Patient Examination (self-paced) Whether performing triage, in-patient or pre-consultation examinations; whether new to the industry or an experienced nurse, this media rich course will engage, teach and renew your patient examination skills.

For the full suite of programs visit: www.provetlearning.com.au/ProSkills



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