Monday, July 30, 2012
Buffetting : HR Clinic Practical Day 1
In accordance to our practical course under Non-Livestock Extra Murial Practical in year 1, we are obliged to undergo a week length, no shorter than 6 days practical in a zoo, animal shelter, as well as veterinary clinic. So for the 2nd week of July, me being the kiasu me have decided to get everything done within the 2 weeks so as practical reports can be easily compiled thereafter.
However, familial matters always come in my way. Pretty sad.
So back the clinic practical. As suggested by my buddy who also went there for her practical last year, I've decided to hit the clinic in SS17, named Healing Rooms Veterinary Clinic for a week. First impression- Thank goodness I chose the right course. Of course, I bet the clinic's staffs were the best people among the society, because of the much more nasty people they have dealt with.
Stepping into the clinic a lil later on that day was a lil unnerving, way to go with the first impression.
However, the receptionist cum vet assistant was super nice and told me I'm just on time by clicking on just passed 10am. She got me to the vets in charge, Dr VJ and Dr Prem while they told me what I need to get to for that day. Apart from me, apparently there was also another practical student on board, Cristine. I'll further elaborate, but she's taking a pre-vet course in US. So post-grad DVM program for her then.
The routine work in the clinic for the dogs boarding will be feeding them their medication as well as their food. The only dog I needed to force feed the medication was Max, a Golden Retriever because he wasn't eating much, nor allowed to due to his kidney problems. Well, being angels like all goldies do, Max was a darling. There was Gigi, a mongrel cross with an amputated forelimb, but she was only on antibiotics. Since she's a big eater, all I needed to do was hide the pills in the food. There was another mongrel on board, Grand Pa, but he was under the Malaysian Dogs Deserve Better association, and all he needed was decent food and supplements. Last but not least, we had an old Basset Hound with us, Duke and he was prep for surgery because of the tumor he had on his right forelimb. A huge mass too.
Almost forgot, there was also an in-house dog, Mc Coy, who was also the blood donor. He was on STRICT diet. Poor guy, quite hostile though.
The dogs' kennels were situated downstairs, while the cattery was situated upstairs. We had few cats boarding, but the owners came later that day to retrieve them, so I only had to attend to Junior, the in house cat, as well as the blood donor. This guy is probably the funniest and cutest cat I've ever seen before! His meows are just super adorable! They don't sound like meows at all! The sound was just too unique to explain gosh I totally should have recorded it! Very submissive, and just love it when I play with him.
So back to Clinical Husbandry:
1-Small Animal Restraining post-sedation: Intubation serves as a very important part prior to surgeries involving anesthetic agents, in most practice Isofluorene. The prep of intubation will be further explained in the Surgical Husbandry section.
a)In order to allow maximal light exposure towards the traechial canal of the animal, restrainer needs to hold the jaws of the animals by their gum, not teeth to prevent the animals from snapping the handler's fingers. A gauze can be used to allow better grasp of the animals' gum onto the fingers so as the gum wouldn't slip off and risk intubating party to perform the procedure again.
b) While doing that, restrainer needs to support the animal's back/dorsal region to prevent spinal injuries, especially animals who are sedated. Grasp the skin around the dorsal area and hold it up firmly to project the traechial canal, as well as holding the jaws to expose the canal to light.
c) Once intubated, tied the ET tube to the animal's canine jaw, if available, then around the mussel to secure the tube into place. Other wise, tie the know unto the mussel above first, then around the whole mussle.
d) Upon sedation, animals will require positional subjection so as some procedures can take place ie: exposing the side in which the tumor have subsided. While flipping the animal's body, the animals need to be folded while holding the dorsal area of the animal, and then flipped to the desirable sites. This is done to prevent and reduce the chance of the overlapping of organs, as well as the folding of vessels of the internal organ of the animals.
e) On the event of blood attainment, the best area to retrieve is via the jugular vein (around the neck area) because of the richness of the blood supply in that area. Animals of smaller size such as Miniature Pinchture, ferrets, kittens will require such sites as blood suppliers. Alternatively, larger animals can undergo blood retrieval via the cephalic vein(limbs). However, jugular vein possess higher and better quality of blood for biochemical and pathological tests.
2- Sanitary precautions: Keeping the cages and kennels sterile and free from viruses and bacteria by the previous host is very important in preventing wild spread of transmittable diseases.
a)In this clinic, the practice of Chlorox is being used, in which the ratio is from 1: 30 parts. Due to the costly nature of Chlorox, it is advisable to use them wisely. After application of Chlorox solution on the site, handlers need to wipe the site again with clean water so as to reduce the stench and alkaline concentration of the solution before housing the animals. Excess chlorox solution may burn the residing animal and cause lesions as well as dermatological repercussions. Best gauge, put head into the cage without any eye protection and feel if the air stings. If not, the cage is safe to be housed.
b) Alternatively, another solution named Trionic is also being used of the same manner and nature of that of Chlorox. However, this solution does not harm the handler, nor the animal's body as much as Chlorox do. The prep manner is to put two pumps of solution, and to be mixed with half a pail of water. The cost of this solution, however was not mentioned by the doctors.
c) There are 3 types of iodine being used by the veterinarians, 1-povidone, 2-Lugil's, 3-Tincture. Tincture as the favorite by Dr VJ among all iodine because of its effectiveness in drying the site of application, rendering the bacteria or virus subsided to drought and subsequently death. Very effective sterilizing agent.
1-Drip prep: Drips are being administered intra-venously to maintain the fluid balance in the body of the animal prior, during and post surgery in result of failure to take in fluid through the normal way, via the alimentary canal. In order to secure the catheter and drip tube onto the animal's effectively, there are procedures and essential ways to conduct them.
a) 6 strips of plaster, 4 long and 2 short. In event of smaller animals or juveniles, the strips can be halved to save resources.
b) sterilizing cottons: 1 alcohol swab, 1 chlorohexidane aka HB soap; 1 tincture iodine;1 normal cotton to support the catheter to prevent skin contact onto the animal, as well as reduce irritation which will cause animal to severe the drip system.
c) cotton bandage, to wrap the drip onto the animal's site of administration, normally via forelimb. For animals with thinner forelimbs, a wooden tough depressor is used as a stretcher to support and straighten the forelimbs so as the drip do not get tangled or folded which halts fluid flow.
d) catheter; 3 way stop cock;macro fluid bags which requires 20 drops to make up to 1ml of fluid; and micro fluid bags which requires 60 drops to make up to 1ml of fluid. The difference of the fluid component prevents animals to drown from the high rate of fluid entry. 0.9% Saline(normally 1 litre); 10ml syringe to use as flusher.
2- Drip administration: (Restrainer)
a) Support and restrain the animal's head with a dominant hand, while holding the site of drip administration with the other. Restrainer needs to make sure the animals is properly restrained to prevent administrator from being susceptible to bites. Dogs should be restrained by holding the neck of the dog close to oneself's body, with the dominant below the neck and hand holding to the pectoral girdle of the opposite side. Hold the dog firm and make sure the animals is in minimal distress. Cats should be restrained by scruffing the back of the neck with the head away from oneself, but not close to the drip administrator.
b) The non dominant hand needs to contract the extended the side of the forelimb desired to be withdrawn its blood.
c) Press on the cephalic vein on the forelimb to allow the vein to be raised, due to the pressure applied by the bloodflow due to restriction. Once the vein is raised, vets will be able to identify and prick in the catheter/needle for subsequent procedure.
*note: Restrainer should not release until the administrator says to.*
Steps a, b and c can be practiced in drip administration as well as blood retrieval.
d) As needle enters, restrainer needs to hold onto the needle in the vein so that the blood pressure doesn't expel the needle, as well as allowing blood to gush out. Administrator will need to flush the saline prepared earlier to confirm the site of dripping. If no abnormal swelling, confirmed. Otherwise, relocate a new administration site immediately.
e) Tape the drip with the cotton supporting the needle of catheter to prevent skin contact and subsequently irritation, wrap with cotton bandage. Insert wooden tongue depressor if necessary.
Operation Theater notes:
1- No shoes
2- Scrubs only, mask and hair net.
3- Be extremely aware of contaminating agents
4- No touching of any sites of animal which have been sterilized other than veterinary surgeon operating.
5-Lift only surgical linen from the bottom surface, as the top is being sterilized.
6- While preparing for gauze, hold the sides of the container without contact with gauze to prevent contamination.
7- Count and REMEMBER the number of gauze taken to prevent remnants inside patients' body.
8- Be wary of patient's breathing rate on the air bag: 8 seconds/breath is the maximal isofluorene allowed
9- Take note of 5 stages of anesthesia.
10- Isofluorene count: 1 for large breed, 1/2 for smaller ones.
11- Check the conscious of patients: a) touching the eyes for blinking b) dental pulse c) movement
12- Animals may hold their breath when foreign substances enter their body. Take note, and do not panic while no breathing takes place. Re-adjust the isofluorene count to revive breathing
13- Check the time in and out of OT to assess the amount of anesthesia used.
14- Do not go over any auto-cad-ed materials to prevent contamination. Go towards instead of backwards of the equipments.
15- Hold everything including sutures, blades, or gauze by their container to prevent contamination
16- As surgery ends, wrap up with cleaning the blood stains with orange enzyme; soak used equipments to rid blood stains; stay with the patient until it regains conscious; or situate the patient in kennels thereafter.
17- Remove ET tube when patient starts coughing.
18- Turn off isofluorene when VSurgeon announces and start performing sutures.Note the time.
Quite hefty ain't it? Sorry no pictures because it was a freaking busy week. I literally worked mah arse off in the clinic.