Laura Jones
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Hi everyone! My name’s Laura and I’ll be teaching the session on nurse clinics in this course. I’m an internal medicine RVN, and a VTS in small animal medicine. I’m excited to be part of this course – there are some truly fantastic lessons (and speakers!) and I know you’ll get so much out of it. If there’s anything I can help with, please let me know!
Hello! Great question.
So in terms of whether they’re recommended in GP – I would say it depends on 1) the individual case, and 2) whether you have 24/7 nursing cover. If you’re in a clinic that doesn’t have nurses in the ward 24/7, I personally would avoid central lines. PICC’s are probably more suited to general practice, since they’re placed in a peripheral vessel like any other IV. We chatted more about this on the Q&A session, so if you haven’t yet, I’d definitely recommend checking out the recording ☺️
In terms of videos, the MILA library is fantastic:
Central Line placement -> https://youtu.be/m1AFXtlFRIA?si=N1ak_DsdoxvpJSvy
PICC placement -> https://youtu.be/fKC-em3wX-E?si=qxhG2JBKKOFp9VqF
Drum catheter (alternative to PICC) placement -> https://youtu.be/j0M-AcIXo5I?si=R-y9Pcwc3WY9sb8U
I hope this helps!
LauraReplying to [email protected] 19/11/2023 - 11:22
So far so good regarding getting them to stick. The barrier spray helps to avoid irritation. The only thing that can be annoying is if a patient stands on it and pulls it that way – but otherwise ok! Yes they are a human medical product, but can be sourced directly relatively easily ☺️
Looking forward to chatting to you all tomorrow.
If you have any Qs about the cases in last week’s lesson, or anything else – bring them with you or send them Scott’s way! Looking forward to speaking to you there!Replying to [email protected] 14/11/2023 - 10:25
YES! Only the readers, not the phone app.
But yeah, you can get ketone strips that go into the bottom of it! https://www.amazon.co.uk/FREESTYLE-Optium-B-Ketone-Test-Strips/dp/B00AJR8ZQU
(You can also order them from Veenak alongside the sensors)Replying to [email protected] 09/11/2023 - 21:18
Hey! So for some reason I only got emailed about your reply yesterday – sorry!
The link is here: https://www.breatheazy.co.uk/product/flexineb/flexineb-c2/flexineb-c2/
Expensive, but worth it. Have had a few clients buy one and then claim for it on pet insurance too.This is really interesting. Personally I am not a big fan of pill poppers in cats – I don’t think they are the cat-friendliest, and prefer to tablet by hand wherever possible. But of course that comes with a risk to us, and won’t be suitable in all cases! I never thought about the tips of the pill poppers being ingested, though!
This is a really interesting study! I’ve never used ultrasound to check placement before!
I have worked in clinics that didn’t routinely check with X-ray – but having seen some issues with them before, I now always do. I’ve had ones end up in the lungs (but initial checks felt like they were in the oesophagus) and coil up in the back of the throat instead – so we do always tend to check. It can be a bit annoying in conscious patients, but overall less risky than not checking!
We don’t do 2 views though – we tend to just do a lateral.
What does everyone else do?Replying to Katy Jones 24/10/2023 - 22:36
Hi Katy!
Great question – and to be honest there’s not one right answer, it will depend on individual clinican preference and the particular patient to some extent.
Personally, we tend to use Plasmalyte-148, or Hartmanns for our cases for the reasons you describe. I’ve also worked with people who will make custom fluids by adding saline and Hartmanns – but that’s really getting complicated!
@Scott – what do you do with these?Replying to [email protected] 24/10/2023 - 04:52
Not at all!
Honestly, we’re using them SUPER often now. They’ve replaced curves in pretty much all cases, and we also use them on our DKAs once we’ve corrected fluid/lyte/acid base issues.
We tend to get our clients to download the app, but have a reader we loan out to people who can’t use the app. However, I try to keep the reader on hand as we also use it as our blood ketone meter (you can buy ketone strips that go into the bottom of the reader which is fab!). I find that clients get on well with them – we do have a couple who should not have access to that much information though, and have tried to adjust their pet’s own insulin doses before 🤦♀️
Replying to [email protected] 24/10/2023 - 05:09
LOVE a nebuliser – my fave for cats is the BreathEzy one as it’s really quiet. I’ve had a couple of chronic rhinitis cases buy their own, but I’ve also worked in clinics where we loaned them out on a deposit system 🙂
Hi Jodie!
We use the same dose, crushed with water and administered via a urinary catheter. I can’t say I’ve appreciated a significant different in onset of effect if I’m honest.
There’s a paper published in the American Journal of Veterinary Research, I’ll link it below for you:“Objective: To determine the pharmacokinetics and efficacy of trazodone following rectal administration of a single dose to healthy dogs.
Animals: 6 healthy adult dogs.
Procedures: Each dog received a single dose of trazodone (approx 8 mg/kg) per rectum. Trazodone tablets were crushed into a powder, mixed with 5 mL of tap water, and injected into the rectum via a red rubber catheter. Sedation scores were assigned, and blood samples were collected for determination of plasma trazodone concentration at predetermined times before and after drug administration. Pharmacokinetic parameters were estimated by noncompartmental analysis.
Results: Plasma trazodone concentration remained below the detection limit for 1 dog even though it became moderately sedate. Median (interquartile [25th to 75th percentile] range [IQR]) maximum plasma trazodone concentration and volume of distribution and clearance corrected for bioavailability were 1.00 μg/mL (0.66 to 1.40 μg/mL), 10.3 L/kg (7.37 to 14.4 L/kg), and 639 mL/kg/h (594 to 719 mL/kg/h), respectively. Median time to maximum plasma trazodone concentration and elimination half-life were 15 minutes (range, 15 to 30 minutes) and 12 hours (IQR, 7.99 to 12.7 hours), respectively. All dogs became mildly or moderately sedate, and the extent of sedation was maximal at a median of 30 minutes (IQR, 30 to 60 minutes) after trazodone administration. No adverse effects were observed.
Conclusions and clinical relevance: Rectal administration of trazodone may be a viable option for sedation and treatment of anxiety in dogs for which administration of sedatives and anxiolytics by other routes is contraindicated. Further research is necessary to better elucidate the pharmacokinetics and efficacy of trazodone following rectal administration and determine optimal dosing.”
LOVE some pre-visit anxiolytics – we tend to do gabapentin for cats and trazodone for dogs. In really severe cases we’ll use them together. Also a fan of rectal trazodone in dogs that are really challenging to medicate – we’ll do this in patients recovering from GA/sedation where we expect a difficult recovery, for example. Anyone else doing this?
Scott – this is super interesting! I have never seen this done. I am going to get my geek on and read all about it though!
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