clinical test 2

What does mean Occlude

It’s the holding off of the vessels to prevent Venus return

Proximal

Towards the body

Distal

Away from the body

Medial

• Towards the midline of the body

• move toward the body

Lateral

• Away from the midline of the body

• away from the body

deep

• Away from the surface of the body; further inside.

superficial

• Closer to the surface of the body; more external.

How to prep a syringe

• Open syringe properly, which is by the plunger side

• Do not touch the tip

• If no needle on the syringe do not place it on a table

• Throw out if the tip touched the table or. If the hub of the needle touches anything

• Gently twist the needle in a clockwise manor ( this will prevent air flow into the syringe)

• Be sure to move the plunger to break the seal

• Bigger the syringe size the larger the suction that is created

How to hold a syringe

• Hold it low on the barrel

• Hold it with at least two fingers in the barrel

• last 2-3 fingers work on the plunger

Indication for venipuncture

diagnostic tests

How to choose the vessel

Depends on the amount of blood you want and what the patient will allow

What do you need for supplies for a blood draw

• needle/ syringe

• 70% alcohol

• Restrained

• Blood tubes

• Pressure bandages

• And other optional things Like tourniquet, vacutainer, butterfly catheter, clippers, gloves

How to choose syringe size

Should be chosen based on the volume of the sample, the size of the vine and the risk of back pressure

How to chose a needle gauge

It should be chosen asked on the comfort and size of the patient and vein health, while focusing on maintaining the structure of the sample.

General Principles of blood draws

• reduce stress

• Collection site should be free of disease and debris

• Always have bevel up for the needle

• Distal to proximal ( start low)

What must the resstrainer do with the tourniquet before venipunture exist the vessel

the restraint must remove the tourniquet before the needle exist the vessel

Lavender top tube

EDTA tube

EDTA

A chelating agent used as an anticoagulant in blood collection tubes to prevent clotting.

Light blue top tube

Sodium citrate tube

Sodium citrate

is an anticoagulant used in blood collection, primarily for coagulation testing. It binds calcium ions to prevent clotting.

green top tube

Lithium Heparin tube

Lithium heparin tube

A type of blood collection tube that contains lithium heparin as an anticoagulant, commonly used for plasma testing.

tiger top tube or red/ yellow tube

serum separator

Serum separator

A tube containing a gel that separates serum from clotted blood during centrifugation.

Red top or white top tube

Non additive

Gray top tube

Sodium fluoride/potassium oxalate

What to do when transferring blood into a tube

if you are using a 20 g needle or bigger you can puncture the vacuum tube stopper with the needle

What to do when transferring blood if you are using a needle smaller than a 20g needle

• Detach needle from syringe

• remove stopper from collection tube

• Gently transfer blood into tube along the side

Serum tubes need to do what before being spun

Needs to clot before centrifugation

Anticoagulants tubes need to have what

• You must have proper anticoagulant blood ratio for blood volume

• Tube must be gently inverted multiple times

Canine cephalic venipuncture when and why

• Avoid using cephalon vein for blood draws

• Save cephalon veins for IVC placement

Cephalic vein blood draw

• Sternal recumbency

• This is the front leg vein

• Leg is extended and held off by the restrainer

• Vessel needs to be approached at a 15-30 degree angle

• Must release tourniquet before needle is removed from vessel

What angle is used for the Cephalic vein

• Vessel needs to be approached at a 15-30 degree angle

where is the Cephalic vein located

this is the front leg vein

Canine lateral Saphenous vein

• Always use your thumb of non-dominant hand to stabilize the vessel

• Try flexing or extending the hock to allow the vessel to be more obvious to you

• Vessel is superficial and very wiggly

• Patient should be in lateral recumbency (or standing restraint

• The restrained can extend the stifle and compress the vein by grasping the animals distal thigh or proximal tibia ( level of the stifle)

• Lower angle 15-20 degrees

what is the angle for lateral Saphenous vein

• Lower angle 15-20 degrees

lateral Saphenous vein is located where

the hind leg

Canine jugular vein

• It’s all about the restraint/positioning

• Head should not be flexed too much

• Jugular vein runs in the jugular furrow

• Jugs have a thicker vessel wall than peripheral veins ( need to give a little umph to get in)

Feline medial saphenous vein

• Medial side of the leg in the cat

• Restrainer will hold off the leg In karate chop

• Use thumb to stabilize

• Do not let go of leg

• Bevel up

• Vessel is extremely superficial ( lower angle of approach 10 degrees) place needle right on top of vessel and advance

• The angle is flatter of an approach

• This vessel is extremely prone to hematoma formation

• Tourniquet is remove med prior to coming out of vessel

• Apply pressure, hold off for 60-90 seconds

What angle needs to be used for the Feline medial saphenous vein

• lower angle of approach 10 degrees

• vessel is very superficial

Feline jugular

vein is located in the neck area of cats, generally used for venipuncture and requires careful positioning to avoid complications. It has a significant depth and a larger diameter compared to peripheral veins.

Arterial blood sampling

• Used to assess pulmonary function by testing blood gases

• Deeper stick

• Blood cherry red ( this is oxygenated blood)

• Dorsal pedal vessel

• Arterial blood used for blood gas analyze

• be careful to not use this vein for regular blood draws

• much further down the front leg

Complications of venipuncture to the patient

• Tissue trauma ( avoid seeking and finding to much)

• Sepsis ( maintain asepsis)

• Phlebitis (aseptic technique always)

• Bleeding from site

• Hematoma ( apply direct pressure to site upon removal of your needle and be sure to release occlusion before removing needle)

Complications of venipunture to the sample

• Hemolysis ( avoid seeking and finding/avoid shaking sample/ don’t go through the rubber stopper of the tube)

• Sample dilution ( if you don’t have correct amount added to the tube)

• Clot formation ( if it takes too long to draw sample)

For blood tubes need to fill them to what

• To the line or the amount that is indicated on the tube

• Don’t want to overfill or under fill

• Should always be 9 parts blood 1 part additive

Pressure bandages

Should not be on longer than 5 minutes

Gray top tube ( sodium fluoride/potassium oxalate) are used for what

Used for the best BG monitoring

Lavender top tubes good for what tests

CBC

Light blue top ( sodium citrate) good for what tests

Coagulation tests

Green top ( lithium heparin) are good for what tests

For chemistry good for electrolytes panels specifically

Red/yellow top tubes ( serum separator) are good for what tests

Chem

Red top ( non-additive) tubes are good for

• Urine

• Drug testing

• The drug can become stuck in the additive which will create a false result, which is why a non-additive tube should be used

When using a 22g needle can it be put through a rubber stopper

No the size is too small can cause hemolysis

Muscles used for IM injections

• Lumbar epaxial

• Quadriceps

• Triceps

• Caudal thigh ( semimembranosus/semitendinosus)

• Caudal thigh should be avoided

Why is the caudal thigh avoided for IM injections

Due to the sciatic nerves proximity

Lumbar epaxail muscles location

• Muscle group on either side of the spine

• Caudal to the 13th rib to iliac crest on pelvis

What technique is used to find the lumbar expaxial

• The three finger technique is used

• Thumb on the pelvis middle finger on dorsal spinous process off spine and index finger is where the needle is inserted

Triceps muscle group location

Located caudal to humerus

What technique is used for the triceps muscle group

• Left thumb placed on humerus to isolate muscle belly

• Insert needle caudal to humerus and direct needle cranially to reach the triceps muscle group.

Quadriceps muscle group technique

• Place thumb on lateral femur to isolate quadriceps muscle belly

• Insert need cranially to the femur and direct needle cranially

Caudal thigh muscle group IM injections

• Non-dominate thumb in the groove just caudal to the femur to isolate muscle belly

• Direct needle caudally

Topical adminsteration

• Can be applied anywhere with hairless skin

• Apply to clean skin if possible

• Wear gloves

• Use e-collar to prevent licking

For topical adminsteration what sometimes needs to happen

• The area may need to be shaved and cleaned first

  • Medications like

    • Fentanyl transdermal patch, spot on flea and tick control

• Topical anesthetics, nitroglycerin ointment antibiotic and cortisone creams/ointments

Oral administration

This is the most common type of administeration it comes in many forms

What do tablets and capsules need to have on them for oral administeration

• They need to be lubricated to prevent the pill from sticking to the esophagus

• Can be done with canned food baby food, butter etc.

Pill popper/piller

Is used to pill animals. Especially cats

Why should dry pilling be avoided

• When dry pilled they can get stuck to the esophagus causing strictures

• Pills should always be followed with 3mls of water

How to give liquid medication

• Given in the pouch just caudal to comissure of the lip ( pull laterally with the thumb)

• This allows the mouth the remain closed

• The head needs to be kept in a neutral position

• Pull the limp laterally ( away from ) and given small amounts at a time

Nasal administration

Medications absorbed through the nasal mucosa

What are different types of nasal administration

• Respiratory vaccines and local anesthetics

• Nasal cannulas to administer oxygen and humidified air

• Nasoesophageal nasogastric tubes ( provides nutritional support)

Ophthalmic application

• These are medications applied to the eye topically

• Available as liquids or ointments

• The eye needs to be clean

• Solutions need to be applied before ointments

• Never touch the eye with the applicator

• For ointments open and close the eye after application

• Need to wait 5 minutes between eye medications

What should be applied to the eye first ointment or drops

Drops need to be applied first

How long should you wait in between eye medication

5 minutes

Where should drops in the eye be applied

Given at 12 o’clock position onto the sclera for best distribution

Optic application

• Liquids instilled into the ear canal to medicate or clean the ear

• Clean ear prior to medicating

• Obtain samples before cleaning

• Otoscopic exam beforehand to make sure tympanic membrane is intact

• Start with the least infected ear first

What needs to be seen before cleaning the ear

The tympanic membrane is intact

How to clean an ear

• Instill ear cleaner, massage the base of the ear and wipe out external ear canal with cotton ball

• do not put the whole applicator into the ear

Intradermal injections

Used for skin testing ( allergy, Tb testing) and local anesthetics

Subcutaneous injections

Used for Vaccines, insulin, allergy injections

angle for IV injections

15 -30 degrees

Angle for sq injections

30-45 degrees

What is the angle for IM injections

90 degree angle

What is the preferred site for SQ injections

• The dorsolateral region from the neck to the hips

• stay distal in case a problem arises

Should SQ be used in dehydrated or critically ill

No it should not be used

What happens with absorption in obese anaimls

Absorption is slower

What needle is used for SQ

• 22 gauge for up to 60 pounds

• Over 60 pounds 20 gauge is used

What size needle is used for SQ fluids

18 gauge

What is the amount that should be avoided for max ml in sq fluids

More than 250ml per site

What is the amount max volume for dogs for IM

3-5 max

What is the amount max for cats for IM injections

1-2mls

When a jug stick should not be used

• When the pet has a clotting issue

• If there is head trauma

What needs to be done for dogs or cats when they are hospitalized

Need to make sure they are clean, dry, comfortable, secure housing, has minimum stress, has ID of neckband and cage cards, exercise if allowed, clean water and food

What are the psychological needs of dogs and cats when hospitalized

• Need to be socialization to maintain appetite, temperature, and mentation

• Do things like pet them snuggle, and be extra positive during meditation time

What needs to monitored when they are hospitalized

• Vials and elimination

• Level on consciousness

• Monitor weight daily on the same scale

• Monitor body temperature rectally for hypo- or hyperthermia

• Monitor pulse by palpation and heart by auscultation

• Monitor and measure urine production

Things that need to be monitored

• GI tract

• Feces, vomit, saliva

• Nervous system

• LOC, gait, head tilt, eyes

• The integumentary system integrity

• Alopecia parasites, edema, icterus, ecchymosis, and petechia

• Nutritional support

• To prevent malnutrition

What are signs of pain

• Anorexia

• Mydriasis

• Frequent repositioning

• Tachypnea

• Tachycardia

• Ptyalism

• Crying

• Growling

• Restlessness

• Partially closed eyes

• Third eyelid protrusion

• Reluctance to lie down

• Pale mucous membrane

• Whimpering

• Yipping when moved or touched

How to control pain

• Determine location and severity of pain

• Eliminate the cause and factors contributing to pain

• Make patient as comfortable as possible

• Medication for analgesia

Patients may need respiratory support

Improve or maintain pulmonary function and tissue oxygenation

How is respiratory support given

• Oxygen mask

• Tracheostomy tube

• Oxygen cage

• Nasal insufflations tube

• Endotracheal tube

• Ventilator

Nebulization

• Humidifying inspired gases

• Promotes mobilization of mucous layer

• Aids in removal of secretions from small airways to bronchi

• This gets the gunk out helps make coughs more productive ( mucus and bacteria)