Veterinary Technician | November 2009 by davidpsu

The Complete Journal for the Veterinary Health Care Team

Vol. 30 No. 11 | November 2009

CE Credit from Alfred State College, SUNY

A Blessing in Disguise A Talk with Julie Shaw, RVT

T Fine Art of The Arterial Lines A Perioperative Hypotension Care in the Golden Years: Understanding Canine Cognitive Dysfunction Visit us at www.VetTechJournal.com

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Editor’sLetter

Vol. 30 No. 11

November 2009 EDITOR IN CHIEF Marianne Tear, MS, LVT

EDITORIAL STAFF Tracey L. Giannouris, MA, Executive Editor 267-685-2447 | tgiannouris@vetlearn.com Paul Basilio, Associate Editor 267-685-2421 | pbasilio@vetlearn.com Allyson Corcoran, Editorial Assistant 267-685-2490 | acorcoran@vetlearn.com VETERINARY ADVISER Dorothy Normile, VMD, Chief Medical Officer SALES AND MARKETING Boyd Shearon, Account Manager 913-322-1643 | 215-287-7871 | bshearon@vetlearn.com Joanne Carson, National Account Manager 267-685-2410 | 609-238-6147 | jcarson@vetlearn.com Russell Johns Associates, LLC Classified Advertising Market Showcase 800-237-9851 | vettech@rja-ads.com DESIGN Michelle Taylor, Senior Art Director 267-685-2474 | mtaylor@vetlearn.com David Beagin, Art Director 267-685-2461 | dbeagin@vetlearn.com Bethany Wakeley, Production Artist Stephaney Weber, Production Artist OPERATIONS Marissa DiCindio, Director 267-685-2405 | mdicindio@vetlearn.com Christine Polcino, Traffic Manager 267-685-2419 | cpolcino@vetlearn.com CUSTOMER SERVICE 800-426-9119, option 2 | info@vetlearn.com PUBLISHED BY

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Our Mission VETERINARY TECHNICIAN is designed to support and actively promote the professional status and value of veterinary technicians and assistants in their own eyes, in the eyes of their colleagues and employers, and within veterinary medicine as a whole. Indexing: VETERINARY TECHNICIAN ® is included in the international indexing coverage of Index Veterinarius (CAB International), Focus On: Veterinary Science and Medicine (ISI), SciSearch (ISI), and Research Alert (ISI). Article retrieval systems include The Genuine Article (ISI) and The Copyright Clearance Center, Inc. Yearly author and subject indexes for VETERINARY TECHNICIAN are published in December on our website.

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Looking Inward Writing this column each month has made me look closely at myself and discover what I find important in life; but looking inward is not always easy. Sometimes I find things that I don’t like and should strive to change. I guess it is part of the natural growing process, but honestly, I thought I was done growing years ago. One of the biggest things I have discovered is that I am not an inwardly patient person. I want and expect immediate results from myself. I can tolerate slower outcomes from other people, but not from myself. This discovery—or more correctly, this epiphany—came during National Veterinary Technician Week. The Michigan Association of Veterinary Technicians hosted its annual fall conference to kick off the celebration. The theme was the human–animal bond, and we asked Management Matters columnist Katherine Dobbs, RVT, CVPM, PHR, to speak about bonding clients to the practice. Katherine is a phenomenal speaker, and I used my presidential authority to make sure I moderated her talks. Typically, when given the choice between clinical presentations and practice management presentations, I choose the clinical ones because I can apply the technical aspects of the presentations immediately. While some effort is required to become proficient with the new techniques, they usually do not involve relearning behaviors or habits. In terms of client relations, I have to completely change the way I act and perceive situations. This is not for the weak or impatient. Perhaps one of the reasons I was drawn to emergency medicine is that there are no long-term client interactions. After the client leaves, does it matter if the practice connected with the client or if the client felt that his or her needs were met? The pet’s immediate concerns are usually resolved—for better or worse—and then the client leaves. But were things handled in a way that made a positive impression? Does the client realize the technical skill that was involved in helping his or her pet? Or is the client upset because nobody took the time to explain what was happening as it happened? Clients in emergency clinics are often scared, stressed, and feel helpless. Yes, we took the best care of the animal, but did we remember how overwhelmed the client probably felt during the process? So, now comes the hard part; I need to try to understand things from the client’s perspective more often. Don’t get me wrong; I can be an understanding, sympathetic, and empathetic person—for a short time, and if I have a vested interest. Otherwise, I feel overwhelmed by emotion and start “circling the drain” of compassion fatigue. I need to begin evaluating my response to situations and try to see it from the other party’s point of view, and then I can start the slow process of changing habits. Wish me luck!

Glenn Triest

The Complete Journal for the Veterinary Health Care Team

Marianne Tear, MS, LVT Editor in Chief Veterinary Technician | NOVEMBER 2009

EditorialBoard Our Mission VETERINARY TECHNICIAN is designed to support and actively promote the professional status and value of veterinary technicians and assistants in their own eyes, in the eyes of their colleagues and employers, and within veterinary medicine as a whole.

Glenn Triest

EDITOR IN CHIEF

Elaine Anthony, MA, CVT St. Petersburg College

Kimberly A. Baldwin, LVT, VTS (ECC) Cornell University

Marianne Tear, MS, LVT Program Director Veterinary Technology Program Baker College of Clinton Township, MI

Andrea Battaglia, LVT Cornell University

Tracy Blais, BS, CVT, MEd

SECTION EDITORS

Mount Ida College

BEHAVIOR Julie Shaw, RVT

David Bolette, RVT, LATg University of Pittsburgh

Animal Behavior Clinic Purdue University

Susan Bryant, CVT, VTS (Anesthesia) Tufts Cummings School of Veterinary Medicine

DENTISTRY Jeanne R. Perrone, CVT, VTS (Dentistry)

Mary Tefend Campbell, LVT, VTS (ECC)

Tampa Bay Veterinary Specialists

Mindy A. Cohan, VMD

EQUINE DeeAnn Wilfong, BS, CVT

Fort Washington Veterinary Hospital

Littleton Large Animal Clinic Littleton, CO

Elizabeth Davis, DVM, PhD, DACVIM

NUTRITION Ann Wortinger, BIS, LVT, VTS (ECC, SAIM) Wayne State University

Kansas State University

Harold Davis, BA, RVT, VTS (ECC, Anesthesia) University of California, Davis

DeeAnn Wilfong

Katherine Dobbs, RVT, CVPM, PHR interFace Veterinary HR Systems, LLC Appleton, WI

Jeanne R. Perrone

Joseph A. Impellizeri, DVM, DACVIM Wappingers Falls, NY

Tara Lang, BS, RVT Critter Communications, LLC Cape Girardeau, MO Julie Shaw

Donna Letavish, CVT

Marianne Tear Ann Wortinger

Peter Olson

Michigan State University

Heidi Lobprise, DVM, DAVDC Pfizer Animal Health

Alfred State College (CE Accreditation)

Melvin C. Chambliss, DVM Program Director

Douglas J. Pierson, VMD, MPS Kathleen M. Bliss, LVT, MALS Kelly Collins, LVT Tracey M. Martin, LVT

Laura McLain Madsen, DVM Central Valley Veterinary Hospital Salt Lake City, UT

Rosandra (Rose) Manduca, DVM Miami Dade College

Betty A. Marcucci, MA, VMD VCA Burbank Veterinary Hospital

Trisha McLaughlin, CVT Newtown Veterinary Hospital Newtown, PA

Kathryn E. Michel, DVM, MS, DACVN University of Pennsylvania

Christopher Norkus, BS, CVT, VTS (ECC, Anesthesia) Ross University School of Veterinary Medicine Basseterre, St. Kitts, West Indies

Jody Nugent-Deal, RVT University of California, Davis

Kristina Palmer-Holtry, RVT University of California, Davis

Karl M. Peter, DVM Foothill College

Ann Rashmir-Raven, DVM, MS, DACVS Mississippi State University

Virginia T. Rentko, VMD, DACVIM Medway, MA

Nancy Shaffran, CVT, VTS (ECC) Margi Sirois, EdD, MS, RVT Penn Foster College

P. Alleice Summers, MS, DVM Cedar Valley College

Any statements, claims, or product endorsements made in VETERINARY TECHNICIAN are solely the opinions of our authors and advertisers and do not necessarily reflect the views of the Publisher or Editorial Board. VETERINARY TECHNICIAN® (ISSN 8750-8990) is published monthly by Veterinary Learning Systems, a division of MediMedia USA, 780 Township Line Road, Yardley, PA 19067. Copyright ©2009 Veterinary Learning Systems. All rights reserved. Canada Post international publications mail product (Canadian distribution) sales agreement number 40014103. Return undeliverable Canadian addresses to MediMedia, PO Box 7224, Windsor, ON N9A 0B1. Printed in USA. No part of this issue may be reproduced in any form without written permission from the publisher. Periodicals postage paid at Morrisville, PA, and at additional mailing offices. Subscription rate: $49 for one year, $88 for two years, $126 for three years. Canadian and Mexican rates: $55 for one year, $102 for two years, $142 for three years. Foreign rate: $129 for one year, $219 for two years, $349 for three years. (All checks must be payable to Veterinary Learning Systems in US funds drawn on a US branch of a US bank.) Selected back issues are available for $8 each (plus postage). Reprints are available for all VETERINARY TECHNICIAN articles; call 800-426-9119. POSTMASTER : Send address changes to Veterinary Technician, Veterinary Learning Systems, 780 Township Line Road, Yardley, PA 19067.

NOVEMBER 2009 | Veterinary Technician

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Contents

November 2009

The Complete Journal for the Veterinary Health Care Team

Volume 30, Issue 11

A Blessing in Disguise Julie Shaw, RVT, did not always know how to communicate with dogs. After immersing herself in the world of animal behavior, she now teaches behavior techniques to students and clients and is proud to say she has the best job in the world. ©2009 Peter Olson

COLUMNS 12 Peer Reviewed Perioperative Hypotension

CE ARTICLE

The Fine Art of Arterial Lines Heidi Reuss-Lamky, LVT, VTS (Anesthesia) Blood pressure assessment can be a crucial component of patient care and has become part of the routine diagnostic workup for geriatric patients and patients with renal insufﬁciency, cardiac disease, vision loss, or endocrine disorders.

Christopher L. Norkus, BS, CVT, VTS (ECC, Anesthesia)

30 Peer Reviewed Care in the Golden Years: Understanding Canine Cognitive Dysfunction Kristen White, CVT, and Lisa Garrison, LVT

The peer-reviewed CE articles contained in VETERINARY TECHNICIAN meet the standards set by Alfred State College for 1.0 credit hour. Documentation will be issued by Alfred State College, a State University of New York (SUNY) College of Technology.

34 Management Matters

Tech News

Katherine Dobbs, RVT, CVPM, PHR

Web Community Offers Expert Advice .................................................18

DEPARTMENTS

When the Appointment Schedule Goes Out the Window

Editor’s Letter ............................................. 1

Final View Hungry Like the German Shorthaired Pointer

40 4

NOVEMBER 2009 | Veterinary Technician

Editorial Board ........................................... 2 State News ............................................ 6 Tech Tips ..............................................29 Product Forum .....................................33 Advertisers Index ............................... 35 Market Showcase ..................................36 Classiﬁed Advertising ...........................37 www.VetTechJournal.com

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CanadianNews

Western Veterinary College Affected by Isotope Shortage A shortage of medical isotopes, which are used in medical imaging, has caused the University of Saskatchewan’s Veterinary Hospital to delay the opening of a new $500,000 diagnostic suite. The shortage is due to operational problems

at the Chalk River nuclear plant in Ontario. The plant is one of the biggest suppliers of isotopes for medical use in Canada. Human medical providers get precedence over veterinarians, which

causes delays and further exacerbates the problem for the college. Until the shortage is rectiﬁed, the hospital will be relying on other imaging techniques, such as magnetic resonance imaging and radiography. VT

BC SPCA Launches Satellite Adoption Program The British Columbia Society for the Prevention of Cruelty to Animals (BC SPCA) has partnered with Bosley’s Pet Food Plus to open 17 SPCA satellite adoption sites, which will be located in Bosley’s stores in Lower Mainland, Victoria, and Nanaimo. The adoption program is already underway at the Bosley’s in Richmond and will begin adoption operations in other store locations as soon as enclosures for housing the animals are available. In addition to providing space in its stores for the on-site adoption of SPCA animals, Bosley’s donated $20,000 to the satellite adoption program to help purchase enclosures and other equipment to expand the operation. Mary Prantner, director of retail operations for Bosley’s, says the partnership ﬁts with the chain’s philosophy. “We always urge our customers to adopt their pets from a rescue organization or to buy from a reputable breeder to avoid supporting puppy and kitten mills,” she says.

In addition to creating adoption locations in pet food supply retailers, the BC SPCA is looking to the veterinary community to help expand its network of satellite adoption sites. Dr. John Anderson of Anderson Animal Hospital in Vancouver has signed on as the ﬁrst veterinarian in Vancouver to host a BC SPCA satellite adoption centre. Dr. Anderson has donated the cost of the enclosures and will house two to four SPCA cats each week. He is also providing free spay/neuter operations, vaccinations, and dental surgery for the incoming cats. “As someone who is dedicated to animal welfare, I am thrilled to help the BC SPCA,” he says. “This is a small thing we can do that will make a big difference for animals in need.” To learn more about the SPCA’s satellite adoption, visit spca.bc.ca. Veterinary clinics interested in becoming an SPCA satellite adoption site are invited to call the BC SPCA at 604-681-7271. VT

Continuing Education DECEMBER 2009 Northern Alberta Institute of Technology lo o gy South h Learning Centre—Edmonton, AB, Dec. 1, 7:00 PM too 9:00 PM. Dr. Brian Skorobohach, DVM, DACVO, will lead a discussion about canine and feline corneal r eal disease. rn The lecture is free to all RAHTs and countss for 2 hours of CE credit. Registration deadline is N Nov. ov. 20. For more ov information, contact Dr. Lisa Collis at 780-475-9225 75 92 9225 2 or drcollis@telus.net. For more CE opportunities, visit www.caahtt-acttsa.ca and the Conference Calendar at www.VetTechJournal.com.

NOVEMBER 2009 | Veterinary Technician

BC SPCA transfer driver Lynda Little delivers 4-month-old Clyde to Bosley’s Pet Food Plus in Richmond, BC. Clyde is the first cat to be placed for adoption through the new satellite adoption agreement between the BC SPCA and Bosley’s.

JANUARY 2010 Ontario Ontt rio On oV Veterinary eterr Medical Association 2010 Conference and and Trade Sho Show—Westin o Harbour Castle, Toronto, ON, Jan. 28 to 30. Thiss 3-day conference will include CE, wet labs, master classes, and an nd clinical pearls. For more information, call 800-670-1702 02 or visit ovma.org. FEBRUARY FEB 2010 Western Veterinary ry Conference—Mandalay Bay, Las Vegas, Nevada, US, S, Feb. 14 to 18. Enjoy comprehensive continuing education n pr programs for veterinarians and veterinary technicians. technician anss O an On Feb. 17, a technician fair will offer the latest specialty training, industry, and professional in aacademia, c ca associations. ci Speak with representatives, ask questions, meet other technicians, and enjoy light refreshments. For more information, visit www.wvc.org. VT www.VetTechJournal.com

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Cover Story

A Blessing in Disguise Despite her years as a veterinary technician, Julie Shaw, Allyson Corcoran Editorial Assistant RVT, did not always know how to communicate with dogs. The ﬁrst time she used the clicker training method, she scared the dog away and threw the clicker down in frustration. However, determined to succeed, she did more research and picked up the clicker again. Soon, Julie was surprised to ﬁnd the dog was trying to communicate with her. “The dog started talking back to me,” Julie explains. “He started offering behaviors, hoping that I would click him. It was two-way communication and it opened up a whole new realm. I thought, ‘Oh my gosh, these animals are incredibly smart. I have completely underestimated them.’” This communication breakthrough reignited Julie’s passion for veterinary medicine, inspiring her to delve further into the world of animal behavior. 8

NOVEMBER 2009 | Veterinary Technician

www.VetTechJournal.com

Cover Story

An Unexpected Journey

The Technician’s Role

Julie did not try clicker training on a whim. After her son Dylan was born premature, Julie learned he was diagnosed with cerebral palsy. “When I found out Dylan had cerebral palsy, I could not ﬁx that,” she says. “I could not cure it, and I felt helpless. What could I do? I thought, ‘Let’s get him a service dog.’” When Dylan was 2 years old, Julie contacted service dog organizations to ﬁnd a dog for her son. After she was rejected by countless organizations that didn’t think Dylan needed a service dog, Julie decided to train one herself. She diligently studied the art of clicker training, and almost 15 years later, she has successfully trained two wonderful service dogs—Faith and Hero—for Dylan.

After years in the behavior ﬁeld, Julie has come to realize why behavior is important. Today, clients are more aware of behavior problems and training issues. Therefore, more clients want help and turn to their veterinarian, so clinics need to be prepared. Julie admits that the technician’s role in behavioral treatment can be tricky because there is a ﬁne line between preventive measures and a diagnosis. She emphasizes that communication between the veterinarian and the technician is the most important aspect of behavioral treatment. “I heard Dr. Luescher once say that without a technician, you can add an hour onto the treatment, diagnosis, or consultation of a behavior problem,” explains Julie. “I have my role, and he has his role, and it is a team effort. Once veterinarians have made the diagnosis, ruled out health problems, and decided which medication to prescribe, they turn it over to the technician. The technicians are the eyes and the ears of the veterinarians when it comes to treating behavior problems.”

The Best Job in the World Julie’s response to Dylan’s unique situation eventually led Julie to her current position as senior animal behavior technologist in the Department of Veterinary Clinical Sciences at the Purdue University School of Veterinary Medicine. While training Faith, Julie was in constant contact with behaviorists at the university and was particularly close with one of the technicians. When the technician decided to retire, she encouraged Julie to take her position. At the time, Julie was interested in behavior but wasn’t sure she could leave private practice and all of the animals she helped on a daily basis. “It wasn’t until a mentor of mine said, ‘If you take the job, you’ll be teaching the teachers,’” says Julie. “And that was all it took.” Ten years later, Julie, who now teaches behavior techniques to clients, veterinary students, and veterinary technology students, is proud to say, “I have the best job in the world!”

What Technicians Want When a behavior case is referred to their department, Julie, Purdue behavior professor Andrew Luescher, DVM, PhD, and veterinary residents work together to develop a treatment plan. Julie explains that this is when she becomes an advocate for the client. “My job is to listen and say, ‘This client has three young children, so the treatment plan is going to be very difﬁcult for her to do,’ and then we modify it,” she explains. “I feel respected when I am able to give my opinion and it is valued. When I ﬁrst started, Dr. Luescher turned to me and asked, ‘What do you think?’ I stood there completely stunned and thought, ‘You want to know what I think? I love this place!’” Julie realizes that the respect she gets at work is exactly what technicians everywhere want. “We want to feel valued, respected, and appreciated.” www.VetTechJournal.com

S TAY I N G F O C U S E D

And the Award Goes to… ecently, Julie received the Western Veterinary Conference Continuing Educator of the Year award for technicians. Julie is honored to receive the award but admits, “The real reward will be when I see one of my students lecturing, and I can see my influences on them when they receive the award.”

Julie receives the award from Willie M. Reed, DVM, PhD, DACVP, DACPV, dean of Purdue University School of Veterinary Medicine.

Veterinary Technician | NOVEMBER 2009

Cover Story

Life Outside of Private Practice Because Julie works in a university, she can focus on her interest in behavior. Currently, she is working on a textbook, Companion Animal Behavior for Veterinary Technicians and Nurses, which should be available in 2010 from Blackwell Publishing. In the book, Julie and her colleagues clearly deﬁne the role of the technician in treating animal behavioral issues. Julie is also involved with the Karen Pryor Academy for Animal Training & Behavior, which advocates force-free training. At the academy, she is proud to have established the Faith Scholarship in honor of her son’s ﬁrst service dog. The scholarship, which is for veterinary technicians who are interested in behavior, covers almost half of the academy tuition. “By creating that scholarship in Faith’s name, it feels like she’s still here and still giving to the veterinary profession,” Julie explains. “I’m really proud of that.” Despite not working in private practice for years, Julie will always remember how exhausting the days were. “I never want to forget what it’s like to be in practice,” she says. “I would step out of bed at 5:00 AM and think, ‘I will not sit down again until 8:00 PM.’ I remember eating while

standing up, trying to keep track of the six CBCs I was running, and answering phone calls. Private practice technicians are absolutely amazing—just amazing.”

Watch and Learn If a technician is interested in learning more about behavior, Julie explains that many routes are available: 1. Join the Society of Veterinary Behavior Technicians. “It’s where technicians in the same ‘boat’ can meet and learn about continuing education [CE], books to read, and how to start heading in that direction,” Julie explains. 2. Start freelancing. Julie suggests that experienced technicians can start making home behavior modiﬁcation visits. After a veterinarian has made a diagnosis and formed a treatment plan, a technician can go to the client’s home, apply the behavior modiﬁcation techniques, and write a follow-up report for the veterinarian. “It is no different than when a diabetic animal comes in and the veterinarian says, ‘Here’s my treatment plan, now go do this,’” she says, If a technician’s clinic does not handle a lot of behavior cases, Julie suggests that the technician freelance at other clinics in the area.

PERSONAL INTEREST

Having Faith and a Hero s a determined mother and veterinary technician who wanted to help her son Dylan live life to the fullest, Julie expertly trained two golden retriever service dogs. When Dylan was a toddler, Julie clicker trained Faith to help Dylan with everyday activities, such as bracing when Dylan would stand up or walk. Every night, Faith retrieved a bottle of water for Dylan, tucked him in, took back the water bottle, and then turn out the light. After Faith died of lymphosarcoma, Julie trained another service dog—Hero. By the time Dylan met Hero, Dylan was high functioning, so Hero’s role was a bit different than Faith’s. Hero helped Dylan

NOVEMBER 2009 | Veterinary Technician

pick up things, walk, and retrieve crutches. Hero is now semiretired because Dylan is partly walking on his own. Despite all the benefits of having a service dog, Julie jokes that there are some downsides. Recently, Hero g has been involved in some night-

Three-year-old Dylan sits with Faith, his first service ddog.

time shenanigans. When everyone in is bed, Hero will open the refrigerator door, steal food, slip through the doggy door, and have a feast in the backyard. “I will hear the doggy door and look outside, and he will be sitting there with a loaf of bread in his mouth, looking completely in innocent; but this is what happens w when you have a service dog! More ttraining is definitely in order.” Along with Dylan, Julie also has tw two wonderful daughters—Taylor aand Skylar. Despite some hardships, Julie is g grateful for her situation. “If my son d didn’t have cerebral palsy, I wouldn’t b be here,” she explains. “How can I not cconsider that a huge blessing?”

www.VetTechJournal.com

Cover Story

3. Shadow a diplomate. Julie says it is beneficial for a technician to find a board-certified behaviorist in the area and shadow him or her on consultations. 4. Apply to the Academy of Veterinary Behavior Technicians. After recording hours spent addressing animal behavior, technicians can apply to the academy to earn their specialization and further their studies in behavior.

Pushing Forward In the future, Julie would like to see more technicians have access to CE about the proper way to conduct and present research, such as gathering case histories and writing retrospective studies. “Technicians are on the front line, and research is one thing we don’t learn about in school,” she says. Julie would also like to see more technician programs include behavior courses. She says that learning about behavior should not be a choice and that technicians should at least be taught the minimum, such as how animals think and learn, as well as how to handle animals in a nonstressful way. “I want a pediatrician who knows how to make my child more comfortable during an appointment, and I

want him to care if my child is stressed,” she explains. “I also want the same thing for my pet.” To help technicians explore their interests, Julie hopes that internships will become a staple of the future. She would like to see programs that are similar to residencies for veterinarians. “We need to have technicians asking for it, and we need some funding,” she says. “That’s one of the things I’m very excited about. At my job, I want to have a technician intern that works beside me, teaches classes, and does everything I do.” Julie also hopes to see more technicians specializing and the creation of more specialties. With all her hopes for the future, Julie is aware that she will not see changes in the blink of an eye. “Change doesn’t happen quickly,” she explains. “I’ve learned over the years that change is gradual. We need to appreciate the small wins. We need to push ourselves forward. Most important, we have to respect ourselves and what we can do.” VT

VITAL STATISTICS J U L I E S H A W

Photos courtesy of Julie Shaw, RVT

Current Employment Senior animal behavior technologist, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN

Education Dylan picking up Faith ass a puppy. Dylan sits with Hero for a picture taken earlier thiss year.

www.VetTechJournal.com

Associate’s degree in Applied Science, Purdue University, West Lafayette, IN (1983)

Professional Organizations National Association of Veterinary Technicians in America; Society of Veterinary Behavior Technicians; Academy of Veterinary Behavior Technicians Veterinary Technician | NOVEMBER 2009

Peer Reviewed

Perioperative Hypotension H

ypotension is a frequent phenomenon observed during human and vet1–3 erinary anesthesia. Unfortunately, in the past, blood pressure (BP) was not routinely monitored in veterinary patients under anesthesia, and the presence of perioperative hypotension was likely overlooked.4 In 1995, the American College of Veterinary Anesthesiologists (ACVA) published recommendations for regular monitoring of multiple physiologic parameters, including BP, in patients undergoing general anesthesia.5 Additionally, with the increasing availability of BP monitoring devices and education regarding their use, veterinarians and veterinary technicians are now more aware of the risk of perioperative hypotension and, therefore, seek effective strategies for treating it.

Christopher L. Norkus, BS, CVT, VTS (ECC, Anesthesia)

NOVEMBER 2009 | Veterinary Technician

Components of Blood Pressure BP is the pressure exerted by circulating blood on the walls of blood vessels and is composed of systolic and diastolic pressures. The systolic pressure occurs at the end of the cardiac cycle when the ventricles are contracting and represents a peak pressure in the arteries. Diastolic pressure is the minimum pressure in the arteries, occurring at the beginning of each cardiac cycle when the ventricles are completely ﬁlled with blood. Arterial BP is the mathematical product of systemic vascular resistance (SVR) and cardiac output (CO)6: BP = SVR × CO SVR refers to the degree of dilation (vasodilation) or constriction (vasoconstriction) of systemic blood vessels. CO is the volume of blood being pumped by the heart in a www.VetTechJournal.com

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given minute. CO is the product of stroke volume (SV) and heart rate (HR).6 SV is the volume of blood being pumped from the heart, whereas HR is the number of times the heart pumps per minute: CO = SV × HR SV is composed of cardiac preload, cardiac contractility, and cardiac afterload.6 Cardiac preload is the blood volume returning to the heart, whereas afterload is the resistance the heart pumps against for blood to leave the heart. Factors that increase afterload typically decrease SV. Cardiac contractility is the strength of the heart’s contraction (Figure 1).

What Constitutes Perioperative Hypotension? Methods for measuring BP currently include indirect means via ultrasonic Doppler and oscillometric techniques as well as direct means via arterial catheterization. In dogs and cats, hypotension is deﬁned as a systolic BP <80 mm Hg or a mean arterial pressure (MAP) <60 mm Hg.7 MAP is commonly estimated using the following formula: MAP = Diastolic pressure + / × (Systolic pressure – Diastolic pressure) The Doppler method tends to underestimate systolic BP in cats by about 10 to 14 mm Hg.8

Why Measure Blood Pressure During Anesthesia? Innumerable reasons exist for measuring BP during the perioperative period. First, most anesthetic agents have negative cardiovascular effects.9–14 With this in mind, insufﬁcient monitoring of physiologic status introduces unsettling guesswork into the use of anesthesia. For example, because pulse strength is merely the difference between the systolic and diastolic pressures, patients can have strong pulses and appear clinically normal but still have perioperative hypotension.15 Renal autoregulation and splanchnic perfusion are compromised if MAP <60 mm Hg.16 Decreased delivery of oxygen to tissue due to perioperative hypotension can easily result in necrosis and organ failure after anesthesia. In more severe cases in which cardiac and cerebral perfusion is compromised, acute cardiac arrest and death can rapidly ensue. It is well documented that the occurrence of hypotension is correlated with mortality in the intensive care unit, perioperatively and postoperatively.17–19 In humans undergoing non-cardiac surgery, a perioperative hypotension episode was a signiﬁcant predictor of 1-year mortality, suggesting that hypotensive episodes may affect outcomes over longer time periods than previously appreciated.19

Etiology Factors affecting any of the components of circulation can lead to changes in BP and, in turn, hypotension. The www.VetTechJournal.com

Figure 1. Flow chart of blood pressure components.

causes of hypotension are generally broken into three categories: decreased preload, decreased cardiac function, and decreased vascular resistance. Common causes of decreased preload include hypovolemia and decreased venous return. Hemorrhage, gastrointestinal losses and dehydration, polyuria, hypoadrenocorticism, effusion or third spacing of ﬂuid, burns, heatstroke, and the use of many prescription drugs (e.g., diuretics, ACE inhibitors) are all recognized causes of hypovolemia.20 Causes of decreased venous return include patient positioning, pericardial tamponade, severe pneumothorax, positive pressure ventilation, gastric dilatation and volvulus, and caval syndrome of heartworm disease.20 The numerous causes of decreased cardiac function include cardiomyopathy, valvular disease, bradyarrhythmias, tachyarrhythmias, electrolyte and acid–base abnormalities, severe hypoxia, and the use of many prescription drugs and anesthetic agents (e.g., β blockers, inhalant anesthetics).20 Patients presenting with decreased vascular tone commonly have sepsis or systemic inﬂammatory response syndrome (SIRS), anaphylaxis, dramatic neurogenic insult, electrolyte and acid–base abnorVeterinary Technician | NOVEMBER 2009

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Pharmacological Management of Perioperative Hypotension

Dopamine — a short-acting injectable agent that must be administered by constant-rate infusion (CRI). Because this drug has α- and β-adrenergic agonist properties, it can be useful for improving inotropy (β1 effect), HR (β1 effect), and SVR (α1 effect). A potential adverse effect of dopamine is cardiac arrhythmia. Therefore, the drug should be discontinued if cardiac arrhythmia, hypertension, or tachycardia results. It should be used extremely carefully, if at all, in patients with cardiac arrhythmias or heart disease. In patients that have been premedicated with acepromazine, the effects of dopamine may be partially negated via α1 antagonism.32 A dose range of 3–20 μg/kg/min has been proposed. Doses of 5–10 μg/kg/min result in predominantly β effects. Doses >10 μg/kg/min have a stronger α1 effect.33 The author typically begins drug therapy with this agent at a dose of 7 μg/kg/min and then adjust the dose accordingly to the lowest effective dose. Data suggest that dopamine alone is generally effective and often more effective than dobutamine, ephedrine, or dopamine and dobutamine combined.34–36

Phenylephrine — another short-acting injectable agent that must be administered by CRI. Because this drug has solid α1-adrenergic agonist effects, it is very useful for improving SVR caused by inhalant-induced vasodilation without altering inotropy or chronotropy. Because the drug has strong vasoconstrictive effects, it should be used only for the short term (<10 minutes) to avoid risk of decreased renal and splanchnic blood flow. A dose of 0.5–1.0 μg/kg/ min has been proposed.38 This drug is also preferred for managing phenothiazine-induced hypotension.

Dobutamine — a short-acting injectable agent that must be administered by CRI. Because this drug has β-adrenergic agonist properties, it is most useful for improving inotropy (β1 effect).33 This agent may increase, decrease, or maintain HR. After using this agent, some clinicians have reported the occurrence of bradycardia that required anticholinergic therapy.37 Dobutamine may be a safer option for patients with cardiac disease. This drug should be discontinued if cardiac arrhythmia, hypertension, or tachycardia results. A dose of 2–10 μg/kg/min, titrated to effect, has been suggested.33

Vasopressin — an injectable agent that has recently gained popularity in human and veterinary critical care for its vasoconstrictive properties during cardiac arrest and refractory hypotension. It has also been used to improve SVR in humans under anesthesia that are refractory to other drugs.39 Use of this drug in veterinary anesthesia has been limited but may become popular in the near future. A dose of 0.01–0.06 U/kg/h has been suggested.40 A helpful review of the use of this drug in veterinary medicine can be found in the April 2009 issue of Journal of Veterinary Emergency & Critical Care.

NOVEMBER 2009 | Veterinary Technician

Ephedrine — a long-lasting injectable agent that is typically administered as a bolus. Because this agent has β1and α1-adrenergic agonist effects, it can improve SVR and cardiac contractility.33 A slow bolus of 0.03–0.07 mg/kg IV, titrated to effect, has been suggested.33 Unfortunately, the effects of this agent are often short lived.34 Adverse effects such as cardiac arrhythmias occur with some frequency. This drug is likely most appropriate for short anesthetic procedures in routine cases involving healthy patients.

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malities, or severe hypoxia or are receiving prescription drugs or anesthetic agents (e.g., β blockers, calcium channel blockers, acepromazine, propofol).20

Management Treatment of perioperative hypotension is as much of an art as it is a science. However, treatment generally includes initial minimization of the causes of hypotension (e.g., stopping blood loss, minimizing or discontinuing hypotensive drugs) and then management of the hypotension itself (e.g., administering fluids and drugs). If a hypotensive reading occurs while monitoring BP, the anesthetist should recognize this as an anesthetic emergency and address it immediately. The anesthetist should quickly confirm that hypotension exists and that the reading is not false. This may include changing Doppler locations, ensuring proper cuff size, or evaluating other physiologic parameters, such as mucous membrane color, capillary refill time, HR, electrocardiogram rhythm, the end tidal carbon dioxide (ETCO2) level, saturation of peripheral oxygen (SpO2), blood gas levels, and plasma lactate level. After confirming the presence of perioperative hypotension, the anesthetist should evaluate the patient’s ventilation and temperature and ensure that they are adequate. Simultaneously, the anesthetist should begin to reduce the use of drugs that may cause hypotension. In many incidences, this means immediate reduction of the inhalant anesthetic. In some cases of severe hypotension, it may be necessary to discontinue the use of the inhalant until safer BP readings are obtained. However, if the hypotension is not severe and surgery will begin momentarily, a patient’s BP will sometimes improve once surgical stimulation begins. If the above steps fail to correct hypotension by the next measurement, further steps must be initiated. If the patient has bradycardia and hypotension, the decrease in HR may be affecting CO enough to also decrease BP. Therefore, patients with bradycardia can be treated with either atropine (0.02–0.04 mg/ kg IV) or glycopyrrolate (0.005–0.01 mg/kg IV) until the HR returns to normal. 21 Because of the slower onset of glycopyrrolate, it is inappropriate for use in life-threatening emergencies. One exception to this is if the patient was given an α2 adrenergic agonist (e.g., dexmedetomidine) as part of the anesthesia. In these cases, rather than giving the patient an anticholinergic, the most effective strategy is drug reversal with atipamezole. This should resolve the problem by improving CO, if the cause of hypotension was bradycardia. If these steps are not effective or only partially www.VetTechJournal.com

NOVEMBER 2009

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improve the problem, the anesthetist should proceed to the next treatment. At this point, an intravenous fluid bolus is given to correct potential hypovolemia and to maximize cardiac preload. This step aims to correct problems such as subclinical dehydration and decreases in venous return resulting from patient position or the use of anesthetic drugs. A bolus of a balanced crystalloid (e.g., 0.9% sodium chloride, lactated Ringer’s solution, Normosol-R) is typically administered rapidly at 5–10 mL/kg IV. If this fails to improve BP, cardiac preload has not fully been restored to normal or the problem is not due to decreased cardiac preload. At this point, some anesthetists administer a second crystalloid bolus (5–10 mL/kg IV) or a colloid (e.g., hetastarch) at 2.5–5 mL/ kg IV in cats and 5–10 mL/kg IV in dogs. Another option is to slowly administer 7% hypertonic saline at 4 mL/kg IV over 5–15 minutes.22 This technique is very useful for rapidly correcting hypovolemia specifically due to surgical hemorrhage once surgical homeostasis has been obtained. Patients experiencing significant intraoperative hemorrhage will likely require intraoperative administration of blood products. Patients that have not responded to treatment of their abnormal HR and to maximization of cardiac preload likely have inadequate SVR, cardiac contractility, or both. Some routine patients, many geriatric patients, and most critically ill patients do not tolerate the vasodilatory and negative inotropic properties of inhalant anesthetics. Therefore, the anesthetist may choose to further decrease or to eliminate the use of the inhalant drug. The minimum alveolar concentration (MAC) of an anesthetic agent is the lowest administered end tidal concentration of drug that produces no gross motor response in 50% of the patients exposed to a painful stimulus.23 Anesthetists should remember that the MAC of sevoflurane in oxygen is 2.36% in dogs and 2.58% in cats.24,25 The MAC of isoflurane in oxygen is 1.28% in dogs and 1.6% in cats.26 Inhalation requirements can be dramatically reduced

Glossary Chronotropy—affecting a time or rate, as in heart rate Hypovolemia—abnormally decreased volume of circulating fluid (plasma volume) in the body Inotropy—the force of cardiac muscle contraction (contractility) Splanchnic—pertaining to the viscera (including the mesenteric, splenic, and hepatic beds)

NOVEMBER 2009 | Veterinary Technician

by cardiovascular-sparing options such as a bolus or a constant-rate infusion (CRI) of an opioid (e.g., fentanyl, hydromorphone) alone or in conjunction with a benzodiazepine (e.g., diazepam, midazolam) or with ketamine.27–30 Combinations of morphine, lidocaine, and ketamine (MLK) have been widely used and can signiﬁcantly decrease MAC and improve analgesia during inhalant anesthesia.30 To reduce MAC, the author generally prefers to administer intermittent intravenous boluses of hydromorphone (0.1 mg/kg IV) as needed with or without midazolam (0.1 mg/ kg IV) as needed or fentanyl (0.003–0.04 mg/kg/h CRI) with or without midazolam (0.1–0.5 mg/kg/h CRI). In some cases, anesthesia can be maintained in critically ill patients with little or no inhalant. In very unstable cases, the use of nondepolarizing muscle relaxants (e.g., atracurium, pancuronium, vecuronium) along with opioid administration may help to avoid the use of an inhalant. In most patients with perioperative hypotension, the above techniques can improve BP. Patients that do not respond to these techniques likely have a signiﬁcant decrease in cardiac function and/or a decrease in vascular tone. In these cases, a pharmacologic aid is used to improve SVR and inotropy (see Pharmacologic Management of Systemic Vascular Resistance).

Prevention Prevention of perioperative hypotension involves initial stabilization of a patient’s disease state as much as possible before administration of anesthesia. Patient monitoring is crucial to preventing perioperative hypotension. All patients undergoing anesthesia, regardless of age, the procedure, or health status, should have their BP monitored at regular intervals. In these patients, an IV catheter should be placed and a balanced crystalloid administered perioperatively. For healthy patients under anesthesia that are not at risk for volume overload (e.g., heart failure, anuria), fluid rates are typically 10–20 mL/kg/h for the first hour and 10 mL/ kg/h thereafter. In patients that are at risk for fluid overload, a central venous catheter should be placed (e.g., in the jugular vein) and central venous pressure (CVP) monitored during anesthesia to assess cardiac preload status and to direct fluid therapy. A starting fluid rate for these cases is often 2.5–5 ml/kg/h but should be adjusted according to individual needs. A balanced anesthesia technique allows the use of multiple drugs in small quantities to avoid large doses of a single agent. This helps avoid adverse effects seen with the dependence on a single drug, especially limiting the pronounced cardiac depression that can be observed with the use of VT inhalant anesthetics.31 www.VetTechJournal.com

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References 1. Redondo JI, Rubio M, Soler G, et al. Normal values and incidence of cardiorespiratory complications in dogs during general anesthesia. A review of 1281 cases. J Vet Med A Physiol Pathol Clin Med 2007;54(9):470-477. 2. Bijker J, van Klei W, Kappen TH, et al. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology 2007;107(2):213-220. 3. Gaynor JS, Dunlop CI, Wagner AE, et al. Complications and mortality associated with anesthesia in dogs and cats. JAAHA 1999;35:13-17. 4. Wagner AE, Hellyer PW. Observations of private veterinary practices in Colorado, with an emphasis on anesthesia. J Vet Med Educ 2002;29:176-182. 5. Diplomates of the ACVA. Suggestions for monitoring anesthetized veterinary patients. JAVMA 1995;206(7):936-937. 6. Tranquilli WJ, Thurmon JC, Grimm KA. In: Lumb & Jones’ Veterinary Anesthesia & Analgesia. 4th ed. Ames, IA: BlackwellWiley; 2007: 79-81. 7. Ettinger SJ, Feldman EC. In: Textbook of Veterinary Internal Medicine. 6th ed. St. Louis: Elsevier Saunders; 2005;480. 8. Grandy JL, Dunlop CI, Hodgson DS, et al. Evaluation of the Doppler ultrasonic method of measuring systolic arterial blood pressure in cats. Am J Vet Res 1992;53:1166-1169. 9. Todd MM, Drummond JC. A comparison of the cerebrovascular and metabolic effects of halothane and isoflurane in the cat. Anesthesiology 1984;60:276-282. 10. Mutoh T, Nishimura R, Kim HY, et al. Cardiopulmonary effects of sevoflurane, compared with halothane, enflurane and isoflurane, in dogs. Am J Vet Res 1997;58:885-890. 11. Ebert TJ, Harkin CP, Muzi M. Cardiovascular response to sevoflurane: a review. Anesth Analg 1995;81(Suppl):11-22. 12. Coulter DB, Whelan SC, Wilson RC, et al. Determination of blood pressure by indirect methods in dogs given acetylpromazine maleate. Cornell Vet 1981;71:75-84. 13. Doi M, Ikeda K. Respiratory effects of sevoflurane. Anesth Analg 1987;66:241. 14. Ilkiw JE, Pascoe PJ, Haskins SC, Patz JD. Cardiovascular and respiratory effects of propofol administration in hypovolemic dogs. Am J Vet Res 1992;53:2323-2327. 15. Cole S, Otto C, Hughes D. Cardiopulmonary cerebral resuscitation in small animals—a clinical practice review. Part II. JVECC 2003;3(1):13-23. 16. Stoelting RK. Kidneys. In: Pharmacology and Physiology in Anesthetic Practice. Philadelphia: JB Lippincott; 1987:761-799. 17. Silverstein DC, Wininger FA, Shofer FS, et al. Relationship between Doppler blood pressure and survival or response to treatment in critically ill cats: 83 cases (2003-2004). JAVMA 2008;232(6):893-897. 18. Simpson KE, McCann TM, Bommer NX, et al. Retrospective analysis of selected predictors of mortality within a veterinary intensive care unit. J Feline Med Surg 2007;9(5):364-368. 19. Monk TG, Saini V, Weldon BC, et al. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg 2005;100(1):4-10. 20. Ettinger SJ, Feldman EC. In: Textbook of Veterinary Internal Medicine. 6th ed. St. Louis: Elsevier Saunders; 2005:482. 21. Tranquilli WJ, Thurmon JC, Grimm KA. In: Lumb & Jones’ Veterinary Anesthesia & Analgesia. 4th ed. Ames, IA: Blackwell Wiley; 2007:205-206. 22. Tranquilli WJ, Thurmon JC, Grimm KA. In: Lumb & Jones’ Veterinary Anesthesia & Analgesia. 4th ed. Ames, IA: Blackwell Wiley; 2007:971. 23. Tranquilli WJ, Thurmon JC, Grimm KA. In: Lumb & Jones’

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24.

25. 26. 27.

28.

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31. 32.

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34.

35.

36.

37. 38.

39.

40.

Veterinary Anesthesia & Analgesia. 4th ed. Ames, IA: Blackwell Wiley; 2007:13. Kazama T, Ikeda K. Comparison of MAC and the rate of rise of alveolar concentration of sevoflurane with halothane and isoflurane in the dog. Anesthesiology 1988;68:435. Doi M, Yunoki H, Ikeda K. The minimum alveolar concentration of sevoflurane in cats. J Anesthesia 1988;2:113. Steffey EP, Howland D. Isoflurane potency in the dogs and cat. Am J Vet Res 1977;38:1833-1836. Hellyer PW, Mama KR, Shafford HL, et al. Effects of diazepam and flumazenil on minimum alveolar concentrations for dogs anesthetized with isoflurane or a combination of isoflurane and fentanyl. Am J Vet Res 2001;62(4):555-560. Mednes GM, Selmi AL. Use of a combination of propofol and fentanyl, alfentanil, or sufentanil for total intravenous anesthesia in cats. JAVMA 2003;223(11):1608-1613. Liehmann L, Mosing M, Auer U. A comparison of cardiorespiratory variables during isoflurane–fentanyl and propofol–fentanyl anesthesia for surgery in injured cats. Vet Anaesth Analg 2006;33(3):158-168. Muir WW, Wiese AJ, March PA. Effects of morphine, lidocaine, and ketamine on MAC in isoflurane dogs. Am J Vet Res 2003;64:1155-1160. Norkus C. Balancing act: combining inhalant anesthetics and injectable drugs. Vet Tech 2006;12:770-780. Monteiro ER, Teixeira Neto FJ, Castro VB, et al. Effects of acepromazine on the cardiovascular actions of dopamine in anesthetized dogs. Vet Anaesth Analg 2007;(2):312-21. Tranquilli WJ, Thurmon JC, Grimm KA. Lumb & Jones’ Veterinary Anesthesia & Analgesia. 4th ed. Ames, IA: Blackwell Wiley; 2007:975. Chen HC, Sinclair MD, Dyson DH. Use of ephedrine and dopamine in dogs for the management of hypotension in routine clinical cases under isoflurane anesthesia. Vet Anaesth Analg 2007;34(5):301-311. Rosati M, Dyson DH, Sinclair MD, et al. Response of hypotensive dogs to dopamine hydrochloride and dobutamine hydrochloride during deep isoflurane anesthesia. Am J Vet Res 2007;68(5):483494. Dyson DH, Sinclair MD. Impact of dopamine or dobutamine infusions on cardiovascular variables after rapid blood loss and volume replacement during isoflurane-induced anesthesia in dogs. Am J Vet Res 2006;67(7):1121-1130. Hofmeister EH, Keenan K, Egger CM. Dobutamine-induced bradycardia in a dog. Vet Anaesth Analg 2005;32(2):107-111. Tranquilli WJ, Thurmon JC, Grimm KA. In: Lumb & Jones’ Veterinary Anesthesia & Analgesia. 4th ed. Ames, IA: Blackwell Wiley; 2007:973. Wheeler AH, Turchiano J, Tobias JD. A case of refractory intraoperative hypotension treated with vasopressin infusion. J Clin Anesth 2008;20(2):139-142. Tranquilli WJ, Thurmon JC, Grimm KA. In: Lumb & Jones’ Veterinary Anesthesia & Analgesia. 4th ed. Ames, IA: Blackwell Wiley. 2007:982.

ABOUT THE AUTHOR

Christopher Norkus, BS, CVT, VTS (ECC, ANESTHESIA) Chris is a member of the VETERINARY TECHNICIAN Editorial Board and currently is a veterinary student at Ross University School of Veterinary Medicine in Basseterre, St. Kitts, West Indies

Veterinary Technician | NOVEMBER 2009

TechNews

Web Community Offers Expert Advice SAN FRANCISCO—In the vast and shifting world of direct-to-pet-owner Web sites, well-intentioned but misinformed advice can lead owners down the wrong path for veterinary care. This misinformation can result in confrontations in the examination room, loss of clientele, and substandard care for the pets caught in the middle. To combat this, Web sites that offer expert veterinary advice about pets and pet ownership are attempting to sift through the online “noise” to bring owners rational, evidence-based responses for popular questions about animal care. DogTime.com, a “hubsite” of more than 450 pet publishing partners and 360 animal care blogs, was launched to provide a Web-based community where dog owners can interact and share stories about the challenges and rewards of caring for a dog, including advice on when to seek veterinary care, the importance of wellness, and how others have dealt with caring for a dog with a chronic illness. “It’s like going to the dog park to the millionth power,” said Simon Tonner, vice president of marketing for DogTime Media. “There are many people out there who are passionate about their pets and are eager to share advice and relate their experiences.” DogTime has assembled a panel of veterinarians to offer authoritative answers for pet owners—something that is lacking in most online pet communities. Owners with questions regarding pre-adoption concerns, the needs of puppies, nutrition, geriatric care, and more receive answers from licensed veterinary professionals who take care to acknowledge that their advice is no substitute for a trip to the dog’s veterinarian. According to Tonner, the site is always looking for more veterinary experts to answer owners’ questions. 18

NOVEMBER 2009 | Veterinary Technician

DogTime recently launched a campaign to help link dogs in shelters with potential owners across the country. Members of the community at Facebook.com can install the “Save a Dog” application on their profile page and “virtually foster” a dog. People who visit participating profile pages will see pictures of dogs that are up for adoption, read their stories, and search for other adoptable dogs in the area. “People can type in their zip code, enter their age or breed preference, and have access to more than 70,000 animals that are living in shelters across the country,” Tonner said. “The rescue community has been enthusiastic about this. It’s a new way for volunteers and organizations to receive additional exposure for their dogs and increase the chances of adoption. We are on track for 1 million Save a Dog users by early next year.” DogTime also features a pet insurance center, which presents a side-byside comparison grid of more than 40 pet insurance policies. The grid includes the benefits, approximate cost, and restrictions of each plan, allowing consumers to compare the options. “We have a section of the site where owners can ask an insurance expert,” Tonner said. “When people look at the grid, they can get a general idea of what the main points are, but some people will have questions specific to their pets, such as breed restrictions and preexisting conditions.” The open nature of the Internet lends itself to multifaceted discussions that can benefit both veterinarians and dog owners. “When our experts offer their opinion or advice, the community will offer their input and begin an open discussion,” Tonner said. “That is the beauty of the open forum. It creates a dialogue that provides value for everyone.” VT www.VetTechJournal.com

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MometamaxÂŽ /TIC 3USPENSION IS INDICATED FOR THE TREATMENT OF OTITIS EXTERNA IN DOGS CAUSED BY SUSCEPTIBLE STRAINS OF YEAST Malassezia pachydermatis) AND BACTERIA Pseudomonas SPP ;INCLUDING P. aeruginosa= COAGULASE POSITIVE STAPHYLOCOCCI Enterococcus faecalis, Proteus mirabilis AND BETA HEMOLYTIC STREPTOCOCCI #OMPONENTS MAY CAUSE LOCAL HYPERSENSITIVITY OR OTOTOXICITY &OR SIDE EFFECTS AND WARNINGS PLEASE SEE ACCOMPANYING BRIEF SUMMARY OF 0RODUCT )NFORMATION See Page 18 for Product Information Summary

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1. Reeder CJ, GrifďŹ n CE, Polissar NL, et al. Comparative adrenocortical suppression in dogs with otitis externa following topical otic administration of four different glucocorticoid-containing medications. Vet Therap. 2008;9:111-121. 2. Rubin J, Walker RD, Blickenstaff K, Bodies-Jones S, Zhao S., Antimicrobial resistance and genetic characterization of ďŹ&#x201A;uoroquinolone resistance of Pseudomonas aeruginosa isolated from canine infections., Vet microbiol. 2008 Mar 4; [Epub ahead of print] SPAH-MO-96a

CE Article #1

The Fine Art of

Arterial Lines T

he measurement of blood pressure is becoming increasingly commonplace in veterinary practices. Blood pressure assessment can be a crucial component of patient care during anesthesia, surgery, and the triage phase of nursing care (e.g., blood loss, trauma), as well as during procedures such as chemotherapy. In addition, blood pressure assessment has become part of the routine diagnostic workup for geriatric patients and patients with renal insufficiency, cardiac disease, vision loss (e.g., retinal detachment), or endocrine disorders (e.g., hyperthyroidism, diabetic ketoacidosis).1,2

Heidi Reuss-Lamky, LVT, VTS (Anesthesia)

Indirect Versus Direct Measurement There are two techniques for measuring blood pressure: indirect, noninvasive methods via Doppler or oscillometric devices, and direct, invasive methods. Indirect blood pressure measurement methods have many caveats. Results may vary greatly based on the cuff size and fit, cuff positioning, patient movement, presence of limb edema or significant arrhythmias, patient size, and operator experience.1,3,4 Furthermore, external methods of measuring blood pressure can be less accurate when the results may be most important, such as in hypotensive patients, patients with small vessel sizes, or those with vasoconstriction.5 Additionally, “white coat” phenomenon, which has been well documented in human and veterinary patients, can result in inaccurate blood pressure assessments.3 Although the heart rate can be reliably and reproducibly measured by noninvasive methods, there is greater variability when diastolic and systolic pressures and mean arterial pressure (MAP) are indirectly measured compared with telemetrically acquired direct blood pressure readings within a given (3- to 4-minute) time frame in a conscious dog. 3 In one informal head-tohead study, readings from oscillometric devices ranged 10% to 30% lower than direct, telemetric recordings. 3 Experienced personnel using a Doppler device to record systolic pressures obtained readings that were 18% to 20

NOVEMBER 2009 | Veterinary Technician

nearly 28% lower than the reference measurements. The results of this study included the following: • In normal dogs, “spot” blood pressure measurements may not reﬂect the patient’s physiologic or pathologic state as accurately as time-averaged blood pressure readings over longer intervals. • Although blood pressure trends were accurately predicted by the indirect oscillometric methods tested, each one provided unique values that were not consistently comparable with the validated standard. • Compared with the reference measurements, there were wide deviations in recorded blood pressure values when trained, experienced personnel in a clinical setting used oscillometric or Doppler techniques.3 The inability to accurately gauge blood pressure in veterinary patients using currently available indirect methods led the American College of Veterinary Internal Medicine (ACVIM) Consensus Panel to proclaim that, “for the diagnosis of systemic hypertension, the indirect device used should be one that is commonly employed or designed for veterinary use and has been previously validated in conscious animals in the species of interest. However, no indirect device has met these criteria for use in conscious dogs or cats.” 4 Therefore, direct arterial blood pressure (DABP) monitoring, which has been proven to be the most accurate method of measuring blood pressure in human and veterinary patients, is considered the “gold standard.”

Considerations The use of arterial catheters for DABP monitoring has many advantages in critically ill or high-risk anesthetic patients requiring frequent blood pressure measurements over time. It is also extremely helpful in assessing the progress of ﬂuid resuscitation therapy and inotropic or pressor therapy in patients with hypovolemic or septic shock.5,6 Furthermore, using arterial catheters for periodic assessment of blood gases can be beneﬁcial in patients with respiratory disease or acid–base disorders.7 However, artewww.VetTechJournal.com

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Glossary

Figure 1. The supplies needed to place an arterial catheter are similar to those needed to place an intravenous catheter. Inset: Special arterial catheters, such as this one manufactured by Arrow International, contain a flexible guidewire that assists in passing the catheter into the arterial vessel.

rial catheters must be used prudently in relatively healthy patients because of the possibility of severe hemorrhage if the catheter is dislodged, chewed, or pulled out. It is strongly advised that all patients with arterial catheters be closely observed at all times.5 A number of arteries can serve as placement sites for an arterial catheter. The dorsal pedal/metatarsal arteries are the most commonly used and easiest to maintain on a longterm basis. Other sites used in veterinary patients include the radial, brachial, palmar, femoral, auricular, coccygeal (tail), and sublingual (ventral tongue) arteries. Radial and brachial arterial catheters are more technically challenging to place. Palmar, femoral, and brachial catheters are best reserved for unconscious patients, as any change in the patient’s position can cause catheter maintenance problems.8 In addition to the dangers of excessive motion, coccygeal arterial catheters can prove problematic if the patient experiences diarrhea. The sublingual artery should be used only in unconscious patients, and hematoma formation is common once the catheter is removed. The femoral artery can be used in smaller patients (e.g., cats, small dogs), and the auricular artery—located on the midline of the dorsal surface of the pinna—can be used in larger dogs with pendulous pinnae (e.g., basset hound, beagle).5 It may be beneﬁcial to position an empty 20-mL syringe case on the ventral surface of the pinna and beneath the cannulated artery to provide a steady surface to which the auricular catheter can be securely taped. Another consideration in selecting the site for an arterial catheter is to avoid compromise of the circulation distal to the placement site (e.g., end arteries or other areas with known deﬁciencies in collateral circulation). Other areas www.VetTechJournal.com

Arteriovenous fistula—abnormal passage or communication between an artery and a vein Cannula—a tube for insertion into a duct or cavity; during insertion, its lumen is usually occupied by a trocar DABP—direct (invasive) arterial blood pressure Embolism—sudden blocking of an artery by a clot or foreign material that has been transported by the blood current Hypotensive—marked by low blood pressure or serving to reduce blood pressure Inotropic—affecting the force of muscular contractions Pseudoaneurysm—dilatation and tortuosity of a vessel, giving the appearance of an aneurysm Suppurative—forming or discharging pus Telemetry—taking measurements at a distance from the subject; radio transmission of measurable evidence of phenomena that are under investigation Thromboarteritis—thrombosis (formation or presence of a clot) associated with arteritis (inflammation of an artery) “White coat” phenomenon—also known as whitecoat hypertension or white-coat effect; phenomenon in which patients exhibit elevated blood pressure in a clinical setting but not at home; this is believed to be due to patient anxiety in clinical settings

that are not suitable for catheter placement include those that are infected or that have sustained trauma proximal to the proposed insertion site.7

Preparation and Catheter Placement Arterial catheter placement requires the same supplies as peripheral IV access: clippers, alcohol and antiseptic scrub, adhesive tape and sterile dressing materials, heparinized saline solution, 1% to 2% lidocaine (without epinephrine), a Luer-Lok T-set preﬁlled with heparinized saline solution, and a 20- to 24-gauge over-the-needle catheter (Figure 1). Although the length of the arterial catheter partly depends on personal preference, longer lengths should be selected for long-term use. The 20-gauge, 1.5-inch QuickFlash Radial Artery Catheterization Set (Arrow International; Reading, PA) contains a ﬂexible guidewire that is fed into the artery before insertion of the catheter, thereby assisting Veterinary Technician | NOVEMBER 2009

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passage of the catheter into the artery. Various sizes of Argon arterial catheters are also manufactured by Maxxim Medical (Argon Division; Athens, TX). The dorsal pedal artery is catheterized as follows: the patient is placed in lateral recumbency, with the limb to be catheterized in the down position. The hair is clipped and the area prepared as for IV catheterization, using a full surgical scrub. An assistant may stabilize the limb, but it is essential to not apply pressure around the hock. The dorsal pedal artery is carefully palpated and identified along its entire course (Figure 2). This artery usually passes between metatarsals II and III (Figure 3), and the optimal site for catheterization is the most distal point where it can still be palpated. The greatest difficulties encountered while placing an arterial catheter are due to arterial spasms or the inability to pass the guidewire or catheter through the artery. When arterial spasms are suspected, further attempts to catheterize the artery should be abandoned and an alternative site selected.7 Injecting a small bleb of 1% to 2% lidocaine over the artery at the planned catheter insertion site can help to prevent arterial spasm during placement. The catheter should be placed percutaneously at a 10˚ to 20˚ angle, just distal to where the artery can be palpated, with the technician always mindful that the artery is located very superficially. The catheter and needle stylet are inserted slowly (in 1-mm increments) into the artery until a blood flash is observed in the end of the catheter (Figure 4). If difficulty is encountered while the catheter is fed into the artery, it can be repositioned slightly and fed again. If the catheter will not feed, but an arterial pulse is still palpable, the catheter can be left in the vessel and a second catheter inserted proximal to the original site. This technique may prevent hematoma formation, which can make additional attempts to catheterize the same vessel extremely difficult or impossible.9 Unless the patient is extremely hypotensive, pulsatile blood flow from the catheter should be noted once the needle stylet has been removed. When the catheter has been successfully advanced into the artery, it can be secured firmly in place with adhesive tape and catheter bandaging materials. The Luer-Lok T-set prefilled with heparinized saline solution is then attached snugly, and the catheter is flushed with 1 to 1.5 mL of the solution, with the technician ensuring that no air bubbles are in the line. The catheter should be clearly labeled as an arterial catheter. It can then be connected to a pressure transducer and continuous-flush mechanism if being used for DABP monitoring, or it can remain capped to a closed, Luer-Lok T-set. www.VetTechJournal.com Veterinary Technician | NOVEMBER 2009

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Figure 2. Step 1: Clip the area surrounding the dorsal pedal artery, just distal to the hock. Step 2: Apply a full surgical scrub over the clipped region. Step 3: Palpate the artery and identify as much of its route of travel as possible. Step 4: Approach the artery at a 10°–20° angle. Note: Sterile gloves should be worn when placing arterial lines.

Once an arterial catheter has been placed, the utmost care must be used to maintain it on a long-term basis. It should be treated like any other catheter, including the use of aseptic technique and daily bandage changes. The heparinized saline bag should be changed every 24 hours, and the high-pressure tubing associated with the transducer should be replaced every 72 hours.1 A routine three-syringe technique is used to obtain blood samples from the arterial catheter, with the technician first drawing 2.5 mL of arterial blood into a 3-mL syringe containing 0.5 mL of heparinized saline solution. The arterial blood sample is then collected into a syringe that can be heparinized or nonheparinized. Finally, the catheter is flushed with heparinized saline solution and reattached to the blood pressure transducer and either a flush system pressurized to 150 mm Hg that continuously flushes the catheter with heparinized saline solution (1000 24

NOVEMBER 2009 | Veterinary Technician

U of heparin per L of 0.9% sodium chloride), or a closed, Luer-Lok T-set that is ﬂushed at least once every 1 to 4 hours with 1 to 3 mL of heparinized saline solution. The blood that was ﬁrst acquired from the arterial catheter can be returned to the patient through a peripheral IV catheter

Angle of catheterization (10˚–20˚)

Hock

Medial

Optimal route for catheterization

Lateral

II III IV V

Left metatarsus (lateral view)

Courtesy of Dr. Matthew Beal

Arterial Catheters

Figure 3. Dorsal pedal arterial anatomy—left hindlimb. www.VetTechJournal.com

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if desired. Arterial catheters should never be used to administer drugs or fluid therapy.9 Arterial catheters used for DABP measurements must be connected to a continuous-flush system and a pressure transducer that has been placed at the level of the right atrium or sternum via the shortest possible length of noncompliant extension tubing. The most accurate measurements possible can be ensured by eliminating all air bubbles from the entire system. Once the transducer is attached to the monitor, the transducer must be “zeroed” at the level of the heart. This is typically accomplished by opening a three-way stopcock on the transducer so that the pressure is equilibrated with the atmosphere to establish a zero reference point. After this, the monitor will display a series of waveforms and the patient’s real-time systolic and diastolic pressures as well as MAP. The rate of inaccuracy associated with DABP measurements is reportedly 2% to 4%, with 1% to 2% of the inaccuracy arising from the transducer and another 1% to 2% from the amplifier.5 Not all brands of anesthetic monitors can measure DABP. The instruction manual should be consulted to determine the capabilities of a monitor, the type of transducer kit and other equipment it may require, and the correct assembly and operation.

Waveform Interpretations It is important to thoroughly understand the DABP waveform. When used in conjunction with electrocardiography, the DABP waveform can provide valuable information regarding the effects of arterial perfusion on the major organ systems. For example, a state of poor perfusion exists when cardiac arrhythmias (e.g., intermittent ventricular premature contractions) are associated with a dampened waveform appearance in conjunction with an abnormal MAP. Evaluation of the waveform is essential for assessing cardiac function, particularly as it relates to left ventricular ejection (Figure 5). Peak ejection occurs during the highest point on the waveform and is associated with systole. The downstroke of the waveform is associated with a drop in pressure. Midway through the downstroke, a notch, called the dicrotic notch, may be visible, indicating closure of the aortic valve. The dicrotic notch also represents the beginning of diastole. The remainder of the waveform’s downstroke represents blood ﬂow into the arterial tree, with the lowest point representing diastole. A thorough knowledge of the potential problems associated with arterial catheters and their waveform indications can simplify the troubleshooting process and ensure continuous DABP monitoring. One common problem involves waveform dampening or loss. This may be associated with www.VetTechJournal.com

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CE Article #1

Figure 4. Step 5: Keeping the course of the artery in mind, slowly (in 1-mm increments) advance the catheter beneath the skin and into the artery until a blood flash is noted in the catheter hub. Step 6: After the flash of blood is noted, deploy the guidewire and then slowly advance the catheter into the artery. Step 7: Securely attach a Luer-Lok (preferably) T-set and flush the catheter with heparinized saline. Then bandage the catheter using aseptic technique. Step 8: To avoid confusion, the catheter should always be clearly labeled as an arterial line. Note: Sterile gloves should be worn when placing arterial lines.

air bubbles, blood clots, excessive blood, or kinks in the catheter or tubing.9 Arterial spasm may also cause waveform dampening or loss. The MAP is generally correct during arterial spasm, even without a good tracing. In all cases of waveform dampening or loss it is important to ensure that the line is not clamped off, and then the line and catheter should be flushed. If the catheter has migrated against the vessel wall, changing the patient’s position may resolve the problem.1 Sometimes the line is flowing and can be aspirated, but the waveform is not visible. In these cases, the cable attachment to the monitor should be confirmed, as should the “on” position of the stopcock. In the event of a sudden change in pressure, it is essential to ensure that the transducer has not moved and is still at the level of the heart and that no one is leaning on the patient’s line or a major blood vessel. More important, a sudden change in pressure can indicate that cardiac arrest has occurred or is imminent, so the patient’s pulse and end26

NOVEMBER 2009 | Veterinary Technician

tidal CO2 production should be assessed immediately to make sure this is not the case. Inaccurate readings (i.e., lower systolic and higher diastolic values) may occur when the waveform is dampened. Furthermore, inaccurately low readings may occur in patients with severe peripheral vasoconstriction (e.g., due to severe hypovolemia or high-dose pressor agents).5 Reﬂections of the waveform from a peripheral catheter may amplify the systolic pressure, resulting in falsely elevated systolic values. Although less common in veterinary medicine, this phenomenon occurs routinely in geriatric human patients when arteries are noncompliant.5 When the accuracy of DABP measurements is questioned, it is not necessary to spend a great deal of time troubleshooting the system. Instead, assess the patient’s cardiovascular status (e.g., respiration, pulse quality, mucous membrane color, etc.) and combine those ﬁndings with the indirect blood pressure readings to help ensure timely intervention during a potential www.VetTechJournal.com

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Systolic p. Dicrotic notch

Dicrotic notch

Pulse pressure MAP = Diastolic + 1/3 Pulse pressure (S-D)

Diastolic p.

Vasodilation

Vasoconstriction

Figure 5. Peak ejection occurs during the highest point on the waveform and is associated with systole. Midway through the downstroke, the dicrotic notch may be visible and indicates closure of the aortic valve and the beginning of diastole.

Figure 6. The effects of vasodilation and vasoconstriction are readily visible on the direct arterial blood pressure waveform.

cardiovascular crisis. Although indirect blood pressure and DABP measurements may differ, the patient’s clinical management may be affected by large disparities.

or inotropic agents (Figure 6). Furthermore, evaluation of the pressure waveform permits clinicians to determine when cardiac arrhythmias may be causing poor pressures or when pulse deﬁcits become detrimental to the patient, allowing timely institution of interventional drugs. Although a thorough understanding of the regional anatomy and an advanced skill level are necessary to place arterial catheters, they can help to provide clinicians with accurate, aggressive monitoring of numerous hemodynamic parameters and help guide resuscitation efforts. VT

Precautions and Complications There are many drawbacks associated with arterial cannulation. Although arterial catheters can be used to provide critical information, their use may be impractical in relatively healthy, mobile, conscious patients. Around-the-clock supervision is imperative for managing all patients with an arterial line. The use of arterial catheters increases the risk of iatrogenic hemorrhage (possibly leading to exsanguination), infection, thromboembolism, and hematoma formation.2,5,9 Air bubbles that are flushed into the artery of a distal extremity eventually enter the small capillaries of the foot. The presence of large air bubbles can result in an air embolism, possibly leading to tissue necrosis. Moreover, frequent administration of heparin can lead to iatrogenic coagulation abnormalities, especially in small patients.4 In humans, other reported complications (rare) include temporary or permanent occlusion of the artery, abscessation, cellulitis, nerve paralysis, suppurative thromboarteritis, arteriovenous fistula, and pseudoaneurysm. There is an increased risk of infection and sepsis when an arterial catheter is left in place for longer than 96 hours. Sepsis is also more prevalent in the presence of local inflammation. Caregivers may be a source of contamination, contributing to infection rates while monitoring the system and flushing the infusion lines.10

Conclusion Arterial cannulation is generally considered a safe technique associated with only a small number of serious complications. When used for assessing blood pressure and blood gases, arterial catheterization can be invaluable for managing critically ill patients, high-risk anesthesia patients, and trauma victims as well as for providing objective information on acid–base status and pulmonary function. Arterial catheterization can also help to guide volume replacement and monitor patients with hypovolemic or septic shock during the administration of pressor www.VetTechJournal.com

References 1. Tefend M. Blood pressure monitoring: what you may not know. Proc ACVIM 2003. 2. Durham E. Arterial blood pressure measurement. Vet Tech 2005;26(5):325-338. 3. Cowgill L. Accuracy of methods for blood pressure measurement. Proc ACVIM 2006:658-659. 4. Atkins C, Brown S, Bagley R, et al. Guidelines for the identifcation, evaluation, and management of systemic hypertension in dogs and cats. JVIM 2007;21(3):542-558. 5. Waddell L. Blood pressure monitoring for the critically ill. Proc WVC 2004. 6. Macintire DK, Dobratz KJ, Haskins SC, Saxon WD. Monitoring critical patients. In: Manual of Small Animal Emergency and Critical Care Medicine. Baltimore/Philadelphia: Lippincott Williams & Wilkins; 2004:73-74. 7. Tegtmeyer K, Brady G, Lai S, et al. Videos in clinical medicine: placement of an arterial line. N Engl J Med 2006;354(15):e13. 8. Beal MW. Vascular access in the trauma patient. Proc Mich Vet Conf 2007. 9. Mazzaferro E. Arterial catheterization. Proc IVECCS. 2004. 10. Scheer B, Perel A, Pfeiffer UJ. Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anesthesia and intensive care medicine. Crit Care 2002;6(3):198-204.

ABOUT THE AUTHOR

Heidi Reuss-Lamky, LVT, VTS (Anesthesia) Heidi works at Oakland Veterinary Referral Services in Bloomfield Hills, MI, and St. Francis Animal Hospital in Macomb, MI.

Veterinary Technician | NOVEMBER 2009

CE Article #1

Article #1 FREE CE Test The article you have read qualifies for 1.0 credit hour. To receive credit from Alfred State College, choose the best answer to each of the following questions. Take the test online at www.VetTechJournal.com. 1. Which statement regarding arterial catheter site selection is incorrect? a. Infected areas should be avoided. b. The circulation can be compromised distal to the placement site. c. End arteries may cause maintenance problems due to excess motion. d. Areas with trauma proximal to the insertion site should be avoided. 2. Long-term maintenance of arterial catheters may include___________. a. daily bandage changes b. a continuous-flush system pressurized to 150 mm Hg c. high-pressure tubing changes every 72 hours d. all of the above 3. Obtaining the most accurate DABP measurements involves ___________. a. using the shortest length possible of compliant extension tubing b. eliminating all air bubbles in the entire setup c. ensuring that the transducer is placed at the level of the arterial catheter d. flushing the arterial catheter once every 1 to 4 hours 4. When troubleshooting DABP monitoring, waveform dampening may be due to ___________. a. arterial spasms b. reflections from the arterial catheter c. an impending cardiac arrest d. noncompliant arteries 5. Which of the following is not a complication associated with arterial cannulation? a. iatrogenic hemorrhage

b. severe vasoconstriction c. tissue necrosis d. thromboembolism 6. Arterial catheters may be used for ___________. a. administering blood and/or plasma transfusions b. small-volume (<20 mL) colloid fluid boluses c. administering vasopressor drugs d. assessing pulmonary function 7. DABP monitoring may be especially beneficial for managing patients ___________. a. in septic shock b. with vision loss (e.g., retinal detachment) c. with hyperthyroidism d. in the triage phase of nursing care 8. When indirect blood pressure monitoring devices are used, the most accurate measurement is ___________. a. diastolic pressure b. heart rate c. MAP d. systolic pressure 9. The dicrotic notch is associated with ___________. a. a drop in pressure b. the beginning of systole c. closure of the aortic valve d. cardiac arrhythmias 10. The best site for long-term measurement of DABP is the ___________ artery. a. palmar b. auricular c. radial or brachial d. dorsal pedal

Take this CE test for FREE! Go to www.VetTechJournal.com. 28

NOVEMBER 2009 | Veterinary Technician

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TechTips

Each published Tip of the Month contributor receives a surprise gift in addition to $50.

After appointments, owners often struggle with their anxious dog while they try to pay the bill. To make the check-out process easier, we attached a doorknob to the counter in the lobby. The doorknob acts as a handy leash holder, freeing clients to take care of other things. The staff at Companion Animal Hospital Traverse City, MI

Ingenuity We had difﬁculty keeping track of drug dosage charts from manufacturers. We tried keeping them in a drawer but kept losing them. Now we keep the charts in plastic sleeves in a three-ring binder that stays in the pharmacy. This way, the charts are protected, organized in alphabetical order, and always in one location. Chris Hartman, LVT Aiken, SC

the dog’s hair, we place a wide piece of Elastoplast (Beiersdorf AG) tape across the top of the head, which holds the hair away from the dog’s eyes. For dogs with a lot of loose skin, such as bulldogs, we clip hemostats to the ends of the tape and secure them to the dog’s collar. This holds the loose skin back, giving the surgeon a better view during surgery. Anne Thoman Mt Brydges, ON, Canada

Courtesy of Anne Thoman

We bought a number of inexpensive baby T-shirts at a local dollar store. We keep a supply of the T-shirts with our bandaging materials so we can add them when extra protection is needed for an abdominal bandage or wound. Heather Riggs, CVT Provo, UT

When bilateral cherry eye surgery is performed, the hair on the top of the dog’s head often gets in the way. Instead of shaving or clipping www.VetTechJournal.com

We use S hooks for many things around the ofﬁce, such as organizing anesthesia bags, attaching a medication bag to a patient’s cage, or hanging IV ﬂuids in a pinch. We also use them to organize e-collars or to hang up bath mats to dry. The hooks are inexpensive and can be purchased at most hardware stores. Heather Thiele, CVT Shreveport, LA

Courtesy of Matthew Steiner

Courtesy of the staff at Companion Animal Hospital

TIP of the MONTH

Injectable medications that come in glass bottles are often expensive. To keep the bottles from breaking if dropped, we wrap them in thick plastic tubing purchased from a hardware store. Matthew Steiner Salem, OR We were constantly looking for our left and right radiograph markers. To prevent losing them, we used a string to permanently attach them to the Bucky tray. Kim Kraemer Winnipeg, MB, Canada When we see new clients, we give them a folder that includes our hours, ﬁnancial policies, and staff information; a pen and a loop leash imprinted with our clinic’s name; and breed-speciﬁc brochures for the client’s pet. In addition, we offer the clients a brief clinic tour and the opportunity to meet the staff. Rosanna Gestwicki Kalamazoo, MI

To stay organized, our clinic keeps a 3-way stopcock, some IV line, and catheter tip syringes in a packet that is kept by the suction unit. Now we are always prepared to do ear cleanings and ﬂushes. The technicians at Rocklin Road Animal Hospital Rocklin, CA Veterinary Technician | NOVEMBER 2009

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Care in the Golden Years:

Understanding Canine Cognitive Dysfunction

anine cognitive dysfunction syndrome (CDS) is a neurodegenerative disorder in senior pets that is characterized by increased brain pathology and cognitive decline. Aging affects all the body’s systems and can directly or indirectly affect behavior. Physical manifestations of aging in dogs are progressive and generally irreversible. When the clinical changes are mild, pet owners tend to neglect them or to regard them as normal functions of the aging process.1 The brains of senior dogs have been found to have neuropathologic lesions similar to those in humans diagnosed with dementia,2 such as cerebrocortical and basal ganglia atrophy, an increase in ventricular size, widening of the sulci, narrowing and retraction of the gyri, leptomeningeal thickening in the cerebral hemisphere (although not in the cerebellum), meningeal calciﬁcation, demyelination, an increase in the size and number of glial cells, and a reduction in neurons.3

Kristen White, CVT, and Lisa Garrison, LVT

Antioxidant mechanisms that protect against oxidative damage can be overwhelmed in the brains of senior dogs, which can lead to cellular damage and increased production of β-amyloid, a neurotoxic peptide that is the main constituent of amyloid plaques found in the brains of humans with Alzheimer’s disease.1 Studies show that greater β-amyloid accumulation corresponds with greater cognitive impairment.4 The brain is also susceptible to the effect of reactive oxygen species, known as free radicals. Free radicals originate primarily during mitochondrial aerobic metabolism, particularly during electron transport and respiration in aged mitochondria.5 Free radicals have been associated with mutations in DNA, damage to lipids and protein, and physiologic decline of cellular function. The diagnosis of CDS begins with a complete physical examination by the veterinarian. The examination should include appropriate laboratory tests to rule out any underlying metabolic problems that may be treatable, such as hypertension, diabetes,

Memory function studies in geriatric dogs have shown that impaired animals cannot recall an object after encountering it ﬁve to 10 times.

NOVEMBER 2009 | Veterinary Technician

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Photo courtesy of Candace Parave

Cushing’s disease, and thyroid disease.2 Recommended tests include a CBC, urinalysis, a serum biochemistry profile, and endocrine screening tests. Additional diagnostics, such as radiography, fecal testing, organ function tests, water intake measurement, and ultrasonography, may also be performed to rule out underlying problems.6 Once underlying medical problems have been ruled out or controlled, the next step in addressing a behavioral problem is to obtain a complete behavioral history from the owner.2 Each clinic typically has a behavioral history form on file, and many veterinary organizations offer free samples or guidelines for creating an appropriate form. The aging process does not affect all cognitive abilities equally, and some signs may not be present on examination. Age-impaired dogs may have trouble completing certain discrimination tests, lack curiosity around novel objects, or display impairment during memory testing.3 In addition to clinicians obtaining a behavior history, they can perform several neuropsychologic tests that rely on quantitative measurement rather than subjective behavioral health questionnaires. The Toronto General Testing Apparatus (TGTA) is designed to assess a dog’s ability to recall objects based on similarities and differences, using a food reward when the dog selects the correct object. The TGTA is typically used in research settings because it requires a great deal of time to test the animal and the device is cost-prohibitive for general practitioners.3 A curiosity test has proven more suitable for use in private practice. The curiosity test requires approximately 10 minutes, and a selection of dog toys, to evaluate the amount of exploratory behavior that a dog exhibits. These tests classify geriatric dogs as unimpaired, impaired, or severely impaired.3 Memory function studies in geriatric dogs have shown that impaired animals cannot recall an object after encountering it five to 10 times.3 The acronym DISHA (disorientation, interaction alterations, sleep–wake cycle alterations, housesoiling, and activity changes) is used to describe clinical signs of CDS.3 In addition, numerous other signs of CDS have been reported, including spatial disorientation, altered learning and memory, increased or decreased activity, altered social relationships, increased restlessness or anxiety, change in appetite, excessive vocalization, and decreased perception or responsiveness.

A recent study concluded that 62% of dogs 11 to 16 years of age demonstrated at least one behavioral change associated with CDS.2 The study also demonstrated that the increase in signs was directly correlated with the increase in the age of the dog. Veterinarians surveyed for the study reported that 7% of clients with dogs aged 11 to 16 years reported behavioral changes in their pet without being prompted.2 This study demonstrates the beneﬁt of administering a behavioral questionnaire to owners of senior dogs at each wellness examination to allow early diagnosis, intervention, and treatment.

Treatment Options Several treatment options are available for managing CDS. Selegiline hydrochloride, also called l-deprenyl hydrochloride (Anipryl, Pﬁzer Animal Health), is approved in North America for treatment of clinical signs associated with CDS.4 Selegiline is an irreversible and selective inhibitor of monoamine oxidase B (MAO-B), which enhances dopamine levels and other catecholamines in the cortex and hippocampus.7 One study reported that 69% to 75% of dogs showed improvement in at least one clinical sign after 1 month of selegiline therapy.8 The recommended dose of selegiline is 0.5 to 1 mg/kg PO q24h in the morning. Results can be seen in as little as 2 weeks or as long as 2 months.4 Selegiline should not be used with selective serotonin reuptake inhibitors (SSRIs; e.g., ﬂuoxetine) or tricyclic antidepressants (e.g., amitriptyline). A washout period of at least 14 days is needed before tran-

The aging process does not affect all cognitive abilities equally, and some signs may not be present on examination.

www.VetTechJournal.com

Veterinary Technician | NOVEMBER 2009

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sitioning a dog to selegiline if the dog is receiving an SSRI or a tricyclic antidepressant.7 s-Adenosylmethionine (SAMe) is a nutraceutical that has primarily been studied for its antidepressant effects in humans. In veterinary medicine, it has been used in cases of liver disease but has now been found to effectively treat cognitive decline in animals.9 SAMe does not appear to have any adverse interactions with other medications, so it can be used as an adjunctive therapy.6 Nutritional and dietary supplements are also used in treating CDS. Antioxidants (e.g., vitamin E) and mitochondrial cofactors (e.g., lipoic acid and fatty acids) work together to slow damage of free radicals and protect cell membranes.4 Some prescription diets also contain antioxidants, lipoic acid, carnitine, omega-3 fatty acids, and other nutrients to combat brain aging and age-related behavioral changes.9 Behavioral and environmental modification may also be necessary.2 For example, if a dog exhibits inappropriate soiling, the owner may have to accompany it outside and provide positive reinforcement—similar to housebreaking a puppy. Confinement is a type of environmental modification that keeps the dog out of certain areas of the house that may be targets of inappropriate soiling. Environmental enrichment is important for senior dogs. Food puzzles and obedience refresher courses are a form of valuable mental stimulation. If a dog is physically able, it can be beneficial to provide lengthy, daily walks as well. *

References 1. Bowen J, Heath S. Behavior Problems in Small Animals: Practical Advice for the Veterinary Team. Philadelphia: Elsevier; 2005. 2. Horwitz DF. Behavior problems in senior dogs. Proc ACVC 2001. 3. Landsberg G, Hunthausen W, Ackerman L. Handbook of Behavior Problems of the Dog and Cat. 2nd ed. Philadelphia: Saunders; 2003. 4. Hoskins JD. Geriatrics & Gerontology of the Dog and Cat. Philadelphia: Elsevier Health Sciences; 2004. 5. Ikeda-Douglas C, Zicker S, Estrada J, et al. Prior experience, antioxidants, and mitochondrial cofactors improve cognitive function in aged beagles. Vet Ther 2004;5(1):5-16. 6. Landsberg GM, Hunthasuen W, Ackerman L. The effects of aging on the behavior of senior pets. In: Handbook of Behavior Problems of the Dog and Cat. 2nd ed. Philadelphia: Saunders; 2003:269-304. 7. Manufacturer’s information. Pﬁzer Animal Health. Accessed March 2009 at http://www.cdsindogs.com/PDF/CDSInDogs/ANIPRYL.pdf. 8. Pﬁzer Animal Health. CDSindogs.com. Accessed Oct. 2009. 9. Cotman C, Head E, Muggenburg B, et al. Brain aging in the canine: a diet enriched in antioxidants reduces cognitive dysfunction. Neurobiol Aging. 2002;23(5):809-818.

ABOUT THE AUTHORS

Kristen White, CVT Kristen is affiliated with the Animal and Bird Hospital of Clearwater, FL.

Lisa Garrison, LVT Lisa is a teacher in the veterinary technology program at Delaware Technical and Community College.

Through early diagnosis and intervention, CDS in senior dogs can be better managed. By educating clients about this illness, including its signs and treatment options, technicians can help to preserve the human–animal bond. VT

The brains of senior dogs have been found to have neuropathologic lesions similar to those in humans diagnosed with dementia. 32

She’s Not Your Average Client. Feral cat protocols available at alleycat.org/Veterinarian.

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FeLV/FIV Treatment

Veterinary practitioners can now access information on coinfection with vector-borne pathogens in dogs at www.cvbd.org. The CVBD Digest contains relevant ﬁndings from the Canine Vector-Borne Disease Symposia and can aid practitioners in what can be a difﬁcult clinical diagnosis. This information can increase understanding of the complex interaction of different infectious agents and the canine immune system.

ProLabs Animal Health has released a treatment aid for FeLV and FIV. Lymphocyte T-Cell Immunomodulator (LTCI) is the ﬁrst USDA-approved treatment for these viruses. LTCI is a potent regulator of CD-4 lymphocyte production and function, and it increases IL-2 production in animals, which is known to stimulate cytotoxic T-cell responses against viruses.

800-367-6359

www.prolabsanimalhealth.com

www.cvbd.com

Virbac Animal Health EPS, Inc.

Liquid Diet

Medical Labels Medi-Dose has introduced butterﬂy labels in six new colors (bright blue, red, green, yellow, orange, and white) to call attention to medications requiring special handling. The labels can be printed with a regular laser printer, and their unique hourglass design provides practitioners ample area for medication identiﬁcation without covering important markings on the item being labeled.

800-523-8966

www.virbacvet.com

AVMA Accredited

Sample Collection IDEXX Reference Laboratories has updated the sample collection protocol for its Cardiopet proBNP test. The previous protocol required that samples be shipped frozen. The new protocol uses a proprietary sample tube that allows transport at room temperature. With next-day results and expert feedback from board-certiﬁed specialists, Cardiopet proBNP is a simple blood test that helps veterinarians diagnose or rule out cardiac disease.

www.idexx.com

PRN Pharmacal

Ethylene Glycol Test The React Ethylene Glycol Test Kit is a diagnostic tool designed to detect the presence of ethylene glycol in the blood of dogs and cats. React is ﬁve times faster than the current standard and is also effective for the diagnosis of ethylene glycol poisoning in cats, something no other test kit on the market currently offers. The test is simple and provides results in <6 minutes. In the test, an enzymecatalyzed reaction with ethylene glycol–contaminated blood causes a solution to change color.

800-874-9764

800-338-3659

www.medidose.com

IDEXX Reference Laboratories

888-433-9987

Rebound Liquid Diet provides fortiﬁed, balanced nutrition for critical care, debilitated, and recovering canine and feline patients. The liquid diet is designed to be palatable and versatile. It contains amino acids, essential vitamins, prebiotics, insoluble ﬁber, omega fatty acids, and a high energy density for compromised patients. Rebound has one formulation for cats and dogs, is lactose free, and comes in an 8-oz carton.

www.prnpharmacal.com

Veterinary Technology Degrees • Associate’s degree

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St. Petersburg College Excellence in education since 1927

Veterinary Technician | NOVEMBER 2009

ManagementMatters

When the

Appointment Schedule

Goes Out the Window

NOVEMBER 2009 | Veterinary Technician

and even on your new client paperwork and Web site that states, “Our goal is to respect your scheduled appointment time. However, if another pet needs our immediate attention, we hope you will understand. We appreciate your patience as we strive to take care of all our animal friends in a timely manner.” Even if clients don’t see this sign until after they have yelled at the receptionist, it may make a difference in how they react in the future. That is the proactive approach, but you also need to be very active in handling the reality of an appointment schedule gone haywire. As mentioned, you and your team will continue to work as hard and as fast as you can to get to each patient that needs your services. However, clients are often thinking only of their own schedule. The more communication you have with clients who are waiting, the better—even if you y have to deliver bad news. Doo not leave clients not lea lea eave ve ccli lien li ents en ts in in limbo liimb mbo bo because beca beca be caus aus usee this thi th his is will wil w illl only il o ly on

Most practices beneﬁt from keeping an emergency slot open in both the morning and afternoon, just in case an emergency does arrive.

hen you get to work in the morning and see that every slot on the appointment schedule is full, you may groan and think, Wow, we’re going to be busy today. You also know that any “hiccups” during the day, such as a client running late, an emergency case, or a client who decides to bring more than one pet for a single-pet slot, could make you fall behind. Conversely, when you arrive in the morning and see an appointment schedule with many openings, you know better than to be lulled into a false sense of security. The days that look to be the best can easily turn into the worst as phone calls and clients start pouring in unexpectedly. To help yourself and your team make it through the tough days, you must first believe that you will survive them. Begin each day by checking your attitude at the door, so to speak. When you look at the appointment schedule and imagine the myriad things that could go wrong, it’s easyy too on n’t’t let your good mood start to slip away. However, that won’t help anyone—least of all you. It is important to remember ber that no matter what happens, the day will eventually en end nd nd and you will likely be alive at the end of it. There are a few ways to protect the appointment schededule from too much disruption. Most practices benefit from keeping an emergency slot open in both the morning and afternoon, just in case an emergency does arrive or circumstances complicate the schedule. This may help to even out the workload for the team, but often the person most affected by any glitch in the appointment schedule is a client. When clients become angry, upset, or impatient, it can compound the staff’s problems. To minimize the negative effects of schedule disruptions on your clients, you can take proactive and active measures. To those of us in the veterinary field, it seems like common sense that a client should understand if appointments run late, particularly if it’s because a pet presented because of an unexpected crisis. Yet these days, everyone is very busy and may have set aside only the bare minimum of time for a pet’s appointment. It may be helpful to have a friendly sign in your lobby, at the front desk,

Katherine Dobbs, RVT, CVPM, PHR

www.VetTechJournal.com

ManagementMatters

Be Honest Always be truthful about why appointments are running late. If you tell a client that an emergency arrived when, in reality, no emergencies have presented, the client may ask someone else on the staff about the poor pet that needed help. It would be unfortunate for the client to discover your white lie. If you are simply running late, tell the client. If a client is told that an emergency arrived earlier and requires the doctor’s care, he or she will often understand, but don’t misuse client trust by fibbing about the off-kilter appointment schedule.

compound the problem and spoil their mood even more. If appointments begin to run late, the receptionist should be told and should mention it when other clients arrive. People need to be given a fair and honest expectation of how long their wait will be. At this point, you may also be able to offer alternatives to waiting. For instance, is it possible for the pet to be left at the practice while the client goes to his or her next errand, or would the client rather reschedule for another time or day? If the client agrees to wait, keep him or her updated. The front desk should stay in touch with the technicians who are assisting the doctor(s) so that clients can be

updated on how the situation is progressing. If the receptionist has updated a client a few times, it is advisable to have the technician come out to apologize and give a projected time frame. When the patient is ﬁnally seen, the veterinarian should also apologize to the client for the wait. The more people who show they care about the client’s situation, the better the client will feel at the end of the visit. The most important thing is to keep calm, continue communicating, and maintain a positive attitude. Becoming frazzled only adds to the problem and can contribute to inefﬁciencies. If you keep smiling, give genuine apologies and accurate updates, you should survive until the end of your shift! VT

ABOUT THE AUTHOR

Katherine Dobbs, RVT, CVPM, PHR Katherine is the president of interFace Veterinary HR Systems, LLC. She is a compassion fatigue specialist and presents workshops and lectures on the topic. Contact her at ManagementMatters@sbcglobal.net.

AdvertisersIndex Want Free Information About These Products and Services? Send an email to productinfo@VetTechJournal.com. Abbott Animal Health AlphaTRAK Blood Glucose Monitoring System ................................... Inside back cover

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Alley Cat Allies Feral Cat Protocols .................................................................................................... 32

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IDEXX Laboratories Preanesthetic Evaluation ............................................................................................ 3

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Veterinary Technician | NOVEMBER 2009

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Publisher’s Disclaimer: Advertising appearing in this issue does not necessarily reflect the opinions of nor constitute or imply endorsement or recommendation by the Publisher. The Publisher is not responsible for any statements or data made by the Advertiser.

Contact Your Market Showcase Advertising Specialists vettech@rja-ads.com or call 800-237-9851

WhereTechsConnect.com is your answer!

Veterinary Technician’s Market Showcase Advertising section delivers your product or service to thousands of potential buyers and responders each issue. Every ad is also featured on vetclassifieds.com for even greater marketing exposure. e-mail: vettech@rja-ads.com www.VetTechJournal.com 36 NOVEMBER 2009 | Veterinary Technician

Veterinary Technician | AUGUST 2009 36 www.VetTechJournal.com

ClassiﬁedAdvertising TECHNICIANS WANTED ALABAMA

TECHNICIANS WANTED ALABAMA

The Auburn University Small Animal Teaching Hospital is seeking applicants for a licensed veterinary technician. The successful candidate will enter a new position responsible solely for neurology, joining an existing team of experienced technicians and a boarded neurologist. Desire to instruct and ability to function independently with confidence are necessities. Find a full job description, requirements, and application instructions at www.auemployment.com. Refer to requisition # 23193.

Auburn University Critical Care Program is a busy, high-quality Emergency/Critical Care facility at a teaching hospital seeking applicants for nursing positions to care for critically ill animals. Various shifts are available, including day, night, weekend and overnights. Applicants with advanced skills, good communication skills, and a positive attitude are encouraged to apply. Opportunities for growth abound, with VTS certification encouraged. Expand your skills working with ACVECC diplomates and residents in a state of the art facility with a challenging caseload! Excellent benefits package and shift differential available.

Auburn University is an Affirmative Action/Equal Opportunity Employer.

TECHNICIAN - ANESTHESIA

CALIFORNIA – Opening for a registered veterinary technician in El Centro, California. The applicant must have a current California license and should be bi-lingual (Spanish). Fax resume to: 760-353-6451.

CALIFORNIA – RVT or experienced veterinary technician needed for busy two-doctor small animal clinic. Well-equipped, competitive salary and medical benefits. No evenings, one Saturday morning a month. Standiford Veterinary Center, 1409 Standiford Avenue #4, Modesto, CA 95350. 209-577-3481, Fax: 209-577-0317, Attention: Linda Lattig.

For more information, contact Stephanie Pitzer (sjp0006@auburn.edu) Apply online on our website: www.auemployment.com . Refer to Requisition # 23174. Auburn University is an Affirmative Action/Equal Opportunity Employer.

ALABAMA

Do you enjoy problem solving and independent decision making? Then come to the “Loveliest Village on the Plains:” Auburn, Alabama. The Auburn University Small Animal Teaching Hospital is seeking applicants for an anesthesia technician. The successful candidate will enter a new position responsible solely for anesthesia and peri-operative pain management, joining an existing team of an experienced anesthetist and boarded anesthesiologist. Desire to instruct and ability to function independently with confidence are necessities. Find a full job description, requirements, and application instructions at www.auemployment.com. Refer to requisition # 23156. U.S. News and World Report ranked Auburn as the #2 Best Place to Live for 2009. Auburn is blessed with four seasons, great public schools, friendly people, and many recreational activities. The cost of living is well below the national average and housing is very affordable. Traffic is non-existent, but Atlanta is a convenient 90 mile trip via interstate highway.You can’t imagine a better quality of life for a family.

For additional information, contact Jacob Johnson at 334-844-0801. Auburn University is an Affirmative Action/Equal Opportunity Employer.

FLORIDA Veterinary Technicians/Nurses We are a state-of-the-art small animal emergency/critical care and referral hospital located in West Palm Beach. Fueled by a dedicated team of professionals, our practice specializes in emergency/critical care, surgery, internal medicine, oncology, neurology, cardiology, radiology, and ophthalmology. We have a place for you, whatever your interests may be! Qualities required in our technicians and nurses include: • Clinical and interpersonal skills • Desire to directly assist with case management • Self-motivated and team-oriented New graduates welcome! Excellent compensation adds to our quality working environment. Additional benefits include medical and dental insurance, 401(k), paid vacation, uniform reimbursement, CE, and discounted services for your pets! Please call Jennifer at Palm Beach Veterinary Specialists: 561-434-5700; and/or send your resume, Attn: Jennifer: Fax: 561-296-2888; Email: careers@palmbeachvetspecialists.com

HAVE A POSITION TO FILL? Contact us for an ad quote. Trish O’Brien vettech@rja-ads.com 800-237-9851, x237 www.VetTechJournal.com

FLORIDA – Miami Veterinary Specialists is a state-of-the-art referral practice that provides highquality, cutting-edge veterinary medicine. We are always seeking highly enthusiastic, self-motivated, experienced team players to join our fast-growing technician staff. New graduates welcome. Work to your fullest capability assisting our onsite board-certified specialists in: Ultrasonography • Computed Tomography (CT Scans) • Endoscopy • Fluoroscopy • Dermatology • Oncologic Surgery • Neurologic Surgery • Orthopedic Surgery • Soft Tissue Surgery • Internal Medicine • 24-hour Emergency Care • and much more Specialized duties include: patient monitoring (including anesthesia), ICU and critical care, surgical prep, sterility assistance, specialized diagnostics and treatments, and digital radiography. The ability to think and handle responsibility is a must! Our benefits package includes a 401(k), CE, paid vacation, medical/dental insurance, pet discounts, and more. Interested veterinary technicians, please apply in person: Miami Veterinary Specialists, 8601 Sunset Drive, Miami, FL 33143; or fax resume to 305-665-2821, Attn: Brad For more information, call 305-665-2820 or visit www.mvshospital.com

Place Your Ad Where It Will Get Noticed: Contact Trish O'Brien at vettech@rja-ads.com or call 800-237-9851, ext. 237

Veterinary Technician | NOVEMBER 2009

ClassiﬁedAdvertising TECHNICIANS WANTED

TECHNICIANS WANTED

TECHNICIANS WANTED NEW JERSEY – Full-time veterinary technician needed for busy practice in Allendale, New Jersey. At least 3 years experience necessary. Must be a self-motivated, reliable, team player and have strong communication skills. Evenings and some Saturdays a must. Please call Jennifer at 201-327-1045.

NEW JERSEY – Technical supervisors wanted. We have immediate placement, and future opportunities for growing specialty and ER/Trauma hospital in New Jersey. Looking for candidates who have good communication, management, training and technical skills to ﬁll our weekend, training and other management positions. Check out why we are becoming the employer of choice by going to: www.northstarvets.com for more details on position and how to apply.

FLORIDA Coral Springs Animal Hospital is always accepting applications from enthusiastic, motivated, compassionate, dedicated, quality-minded CVTs and similarly experienced technicians without a degree. New graduates are encouraged to apply. We practice professional, excellent veterinary medicine and surgery with the highest degree of ethics and integrity at our general/specialty/emergency/critical care facility, which is open 24/7. We are looking for individuals who want to utilize their veterinary nursing skills to the fullest. Technicians with the desire to work at a premium facility that has a great record of retaining excellent veterinary professionals are encouraged to apply. Salary is commensurate with experience but will range from $32,000–$44,000+ plus shift pay differentials. We also have a generous benefits package that includes health and dental insurance, paid vacation, paid sick or personal days, paid holidays, CE, uniform allowance, retirement plan with employer matching, bonuses, and discounted pet care. Drug-free workplace. Flexible scheduling. Please visit us and take a virtual tour of our brand-new 39,000–sq. ft. state-of-the-art facility at www.coralspringsanimalhosp.com. Please send resume to: Coral Springs Animal Hospital 2160 North University Drive Coral Springs, FL 33071 Attn: Shayne Gardner, Hospital Manager Phone 954-753-1800 • Fax 954-343-0238

VETERINARY TECHNICIAN POSITION The Veterinary Specialty Center Emergency and Critical Care Services is in partnership with a state-of-the-art multi-specialty referral hospital located in the northern suburbs of the Chicago area. We are searching for talented, caring and experienced veterinary technicians. Our team-oriented approach to patient care offers the highest possible quality of care to our patients. Our creative business plan provides for an excellent work environment with outstanding compensation, profit sharing and benefits.

Send resume attention Evelyn Feekin Email: efeekin@vetspecialty.com or fax 847-459-1848

PENNSYLVANIA

In Print…Online…Bases Covered Veterinary Technician Classifieds

www.vetclassifieds.com Contact us today for more information Trish O’Brien: 800-237-9851, x237 www.vettech@rja-ads.com

Gwynedd Veterinary Hospital and Emergency Service is a busy 24-hour medical care and referral facility with a 16-doctor and 30-technician team providing comprehensive care and ER services, located 45 minutes northwest of Philadelphia. We have two board-certified specialists on our staff who regularly perform endoscopy, ultrasound, and orthopedic surgery. Our clients appreciate the excellent patient care delivery that we offer, including digital radiography, in-house coagulation testing, multilumen catheterization, capnography, and TPN. Salary is commensurate with experience. Your colleagues are talented and focused on quality patient care using the latest techniques and medications. We offer a flexible schedule and excellent benefits. Please fax resume to 215-699-7754, Attn: Cindy Lorenz E-mail: gwyneddvethosp@comcast.net Visit our website at www.gwyneddvethospital.com

It All Begins Here at DCCCD Cedar Valley College is currently accepting applications for the Director, Veterinary Technology position: Requirements: Doctor of Veterinary Medicine, D.V.M.., plus three years teaching experience and administrative responsibility or comparable experience. Ability to utilize computer technology to access data, maintain records, generate reports and communicate with others. Requires technical communication skills to deal with veterinary technology faculty and other health professionals and individuals from diverse socio-economic backgrounds. Official transcript will be required. Salary: $51,876 - $90,783 Annually, depending on education and experience (Comprehensive benefits package) APPLICATION REQUIREMENTS: Official DCCCD Application for Employment (www.jobs.dcccd.edu ) Resume, Unofficial copy of graduate transcripts. Deadline for all applications (electronic/non-electronic) and other required documents is Open Until Filled. Resume and unofficial transcripts may be faxed to 972-860-8279, emailed to CVCHR@dcccd.edu , delivered in person or mailed to: Cedar Valley College, Human Resources, 3030 North Dallas Ave., Lancaster, TX 75134. Please include position number (030909051) on all documents submitted. For complete job description information and online application please visit our website at: www.dcccd.edu/Business+Community/jobs.htm To send supplemental information email apply@dcccd.edu. Employment opportunities are offered by the Dallas County Community College District without regard to race, color, age, national origin, religion, sex, disability or sexual orientation.

Looking to hire a technician? You have come to the right place. Veterinary Technician Classifieds...Your audience awaits you. Trish O’Brien 800-237-9851, x237 • vettech@rja-ads.com 38

NOVEMBER 2009 | Veterinary Technician

www.VetTechJournal.com

ClassiﬁedAdvertising TECHNICIANS WANTED UTAH – We are seeking skilled veterinary technicians with a perfect mix of technical and client service capabilities for a high-energy practice in the quaint 9th and 9th district in beautiful Salt Lake City. Our brand-new, state-of-the-art, AAHAaccredited facility is now open. Full-time positions are now available with very competitive wages, great benefits, and team-based work environment. Commitment to excellent patient care and client service a must! Highly motivated technicians who thrive in a fast-paced, challenging, and rewarding position may fax resumes with an intro letter to 801-328-9158 or e-mail info@upcvet.com www.uvhdc.com

VIRGINIA – Licensed veterinary technician. We are growing! Full-time position available for a personable, energetic, and motivated individual. 6,400 square foot facility, multi-doctor practice (6), digital x-ray, and all new inhouse lab equipment. We strive to practice high caliber medicine in a personalized and compassionate environment. Practice associated with two full-time groomers and a professional trainer. Centrally located between Richmond and Washington, D.C. If you are interested in joining our team, contact us with resume and references - attention Ashley, White Oak Animal Hospital, 10 Walsh Lane, Fredericksburg, VA 22405, or call: (540) 374-0462, or email: woah@woahvets.com. Licensed Veterinary Technician Seeking a highly-motivated, self-starting technician that possesses a great attitude and the desire to be highly compensated. The Veterinary Emergency Center, centrally located in Richmond, VA, provides 24 hour emergency, critical care and specialty referral services. To date our location offers board certified specialists in emergency/ critical care internal medicine, radiology, cardiology, surgery, dermatology and ophthalmology as well as providing I-131 treatment for hyperthyroid cats. Our AAHA-accredited hospital is seeking an energetic, goal oriented technician to join our team for a full time or part time position. The VEC offers a skillbased pay scale in which technicians are encouraged and supported to reach the highest skill/ pay level possible. Starting compensation is $16-18/hr DOE, with additional compensation for supervisory responsibilities or VTS certification. In addition to providing a challenging learning environment, the VEC offers an excellent benefits package. Please send resumes to our patient services manager Emily Cox, LVT via mail 3312 W. Cary St., Richmond, VA 23221 Fax 804-353-9271 or E-mail: emilycoxvec@gmail.com

TECHNICIANS WANTED VIRGINIA – Part-time/full-time LVT wanted. We are looking for a full-time or part-time licensed veterinary technician to join our growing AAHA practice. We are a four doctor, two LVT practice with great clients and a welltrained, highly committed staff. Your duties will include providing nursing care, taking radiographs, dentals, monitoring anesthesia and assisting in surgeries. You will also be responsible for collecting and processing laboratory specimens and giving routine vaccines. We offer highly competitive benefits including paid vacation, continuing education and insurance. Salary will be commensurate with your skills and experience, and new graduates are welcome. Please contact Sherry Meier, Office Manager, at Independent Hill Veterinary Clinic, 13444 Dumfries Road, Manassas, VA 20112, 703-791-2083, or via email: kirby13444@aol.com. (Your best bet is to call.) VIRGINIA – LVT needed for a three-doctor, small animal practice near Williamsburg. Located near beaches, mountains, and historic areas. Spacious, well-equipped, AAHAhospital emphasizing client education, preventative medicine, behavioral counseling, and geriatric care. We are looking for an individual who will work well with our motivated, compassionate and team-oriented staff. Excellent opportunity with competitive salary and benefits. Will aid with travel expenses. Please send resume to Dale Sprenkel, P.O. Box 1222, Williamsburg, VA 23187 or e-mail jmoon@ noahsark.hrcoxmail.com

Place your ad in print and receive free internet exposure on www.vetclassifieds.com Contact: Trish O'Brien at vettech@rja-ads.com 800-237-9851, ext. 237

TECHNICIANS WANTED Internal Medicine Technician - VA Veterinary Emergency Center (VEC) a 24 hour emergency/critical care hospital and referral center, has an opening in our established internal medicine department. Experience is preferred. The internal medicine department enjoys the ability to collaborate with board certified specialist in radiology, surgery, cardiology and critical care. LVT starting salaries range from $16 -$20 per hour based on experience level and technical ability. LVTs with pertinent specialty certification and/or supervisory experience are additionally compensated. Full-time employees will enjoy our generous benefits package: Vacation/sick pay; CE/licensing/ professional membership dues; full medical/dental, short & long term disability/life insurance; profit sharing and incentive bonuses; uniform allowance; discounts off of specialty pet care. A positive attitude and the ability to work well as a team member are essential. We encourage and support all our staff to achieve the highest skill level and salary possible. Please send resumes to our patient services manager Emily Cox via mail 3312 W. Cary St., Richmond, VA 23221 Fax 804-353-9271 or E-mail: emilycoxvec@gmail.com.

CONTINUING EDUCATION

Mid-South Regional Conference November 13, 14, 15, 2009 Harrah’s Casino and Convention Center (formerly the Grand Casino and Convention Center) Tunica, Mississippi. Conference will feature topics on Ophthalmology, Dermatology, Oncology, Orthopedics, Infectious Diseases and Immunology, Spay/Neuter Techniques, Practice Management and VLE principals. Technician Track, November 14, 2009 Physical Therapy/Rehab, Emergency/Critical Care, Spay/Neuter & Shelter Med Topics, Parasitology. For more information and registration form, contact: Lee Hughes, Executive Director Memphis/Shelby County Veterinary Medical Association 901-754-1615 Lmhughes@bellsouth.net

Place Your Ad Where It Will Get Noticed: Contact Trish O'Brien at vettech@rja-ads.com or call 800-237-9851, ext. 237 www.VetTechJournal.com

Veterinary Technician | NOVEMBER 2009

FinalView

Hungry Like the German Shorthaired Pointer Submitted by Kerry Kornish, LVT, Woodside Animal Hospital, Port Orchard, WA

n 11-year-old, 65-lb (29.5-kg), spayed German shorthaired pointer presented to our clinic with a 4-day history of anorexia. Because of the dog’s history, the owners suspected inappropriate ingestion. In addition, a 3 × 3-foot piece of carpet had been torn up, but the remnants were never found. Radiographs revealed a large amount of foreign material in the gastric lumen. The outlines of carpet strands were easily identiﬁed on the images. The owners opted for a laparotomy because they were familiar with the procedure, which had been used to treat their other dog after it ate a rubber mat. During surgery, approximately 4 lb of carpet ﬁbers, about the size of a large melon or basketball, were removed from the stomach and proximal duodenum. The dog recovered well, and the owners were instructed to keep a close eye on their dogs’ carpet consumption. VT

Do You Have a Unique Case to Share? Send us your interesting case with clinical images—radiographs and/or high-resolution photographs that help tell the story. Provide a 100- to 300-word description of what the images are showing, how the case was treated, and the animal’s recovery. We pay $75 per published case. Send submissions by e-mail to editor@VetTechJournal.com, or mail to VLS/Veterinary Technician, 780 Township Line Road, Yardley, PA 19067. 40

NOVEMBER 2009 | Veterinary Technician

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If accuracy, speed, and small sample size are important to you... Your source for inside information. Calibrated specifically for dogs and cats, the AlphaTRAK Meter requires just 0.3 µL of blood per capillary sample. Convenient and accurate in-clinic or home use, results are available within 15 seconds.

Accuracy — The AlphaTRAK System has been demonstrated to produce results equivalent to those from a reference laboratory. You get the accuracy your practice demands.1 Speed — Time is money. The AlphaTRAK Meter gives you readings within 15 seconds, leaving you extra time to care for more patients. Sample Size — A small sample size of 0.3 µL allows you to obtain enough blood from the patient without the need for a needle and syringe.

...then the AlphaTRAK® Blood Glucose Monitoring System is for your practice.

To learn more about the AlphaTRAK System or for training tools contact Abbott Animal Health Customer Service at 888-299-7416 or visit us at www.AlphaTRAKmeter.com.

Data on file.

Andis_USE.qxp:Bayer Advantage Ad_USE

1/13/09

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