Euthanasia in Small Animal Practice

Why do we euthanize our pets?

To use humane techniques to induce the most rapid and painless and distress-free death possible. Or Painless killing to relieve suffering

When is euthanasia the correct decision?

Uncontrollable pain/suffering

Terminal/progressive illness

Age related cognitive dysfunction/senility

Unable to treat condition

Quality of life concerns

What is the most important factor for veterinary surgeons when determining if euthanasia is the correct choice?

Quality of life concerns

What are possible time frames for deciding to euthanize the animal?

Acute trauma→ sudden, Behavioral problems/aggression, Infectious disease (public health concerns), overpopulation, owner request

How to have the end of life discussion with owners, what should we try to accomodate?

Quiet room, be open and honest, prepare client - warning shot, BE CLEAR (no euphemisms, ‘put to sleep’), allow time, actively listen, display empathy

Important features of an informed consent form

Owner’s details and signature, Vet signature, Discussion about aftercare before the euthanasia, Discuss cost of all involved.

If you must discuss euthanasia over the phone, make sure that

You are somewhere quiet and not disturbed

Ask if free to talk

NEVER leave a message

Record the conversation and if possible, have a witness

Come to see you to discuss/be with pet

If a message is required, maybe say

I have an update, it is urgent. Please call back as soon as possible.

How can we best prepare the room for the euthanasia process?

Quiet room, Bood double appointment if possible, Tissues, Comfortable space for client and animal, Get assistance if required, Equipment required, Let colleagues know euthanasia in progress - something on consult door to note

What equipment do you need for euthanasia?

Catheters, pentobarbital, stethoscope

Options for aftercare include

Cremation or burial at home

What types of cremation are offered?

Routine or Private

What does it mean if an owner requests Routine cremation?

No ashes back

What does it mean if an owner requests Private cremation?

Ashes back, increased cost

What must you verify when an owner requests a burial at home?

Must be deep enough, must not be near a water supply

Check local legislation

What makes a ‘good’ euthanasia?

Rapid process

Pain free

Minimal distress and fear for the animal (and owner)

Reliable

Irreversible

Safe (for staff and owners)

What is important to us and the owners for their pet

What should we be sure to tell the client to best prepare them for this process?

Explain step by step

Is sedation required?

IV catheter

If unwell patient, may need to have on oxygen etc

Warn owner of possible changes

Ask owner if they are ready to proceed

What is the euthanasia process?

Place catheter in cephalic or saphenous vein

Pentobarbital Na 200mg/mL (Schedule 3)

80mg/kg in debilitated animals

120-160 mg/kg in younger, fitter animals

Rapid IV injection

Overdose of anesthetic → respiratory and cardiac arrest

Where can we inject pentobarbital?

IV: Cephalic, Lateral saphenous, Dorsal pedal vein, Lateral/marginal ear vein (rabbits)

Intra organ (*sedate if injecting into an organ*)

Changes that we can see during the euthanasia process

Potential nausea, sleepy/drowsy animal

The pentobarbitone may cause increase/hitch in breathing, will suddenly lose consciousness, loss of bladder and bowel control, potential fluid from nostrils/mouth, twitching is possible, eyes stay open

What is needed for intracardiac injection euthanasia?

Needle size: 1-1.5"in needle 19-21g

Right lateral recumbency

Palpate or auscultate for the apex beat

Insert needle at 45 -90 degree angle

Flash of bright red blood

Inject quickly and smoothly

Immediate

May likely be upsetting for owners

What is needed for intrahepatic injection euthanasia?

Needle size: 1-1.5in needle 21g

Lateral recumbency

Palpate and localise the xiphoid process

Insert needle on either side of the xiphoid process

Rapid action (~2min)

What is needed for intrarenal injection euthanasia?

Needle size: 5/8 inch 21g or 23g

Painful

Rapid acting (~1min)

Cats and small mammals only

What is needed for intraperitoneal injection euthanasia?

Needle size: 5/8in 21g

Lower left quadrant

15-20 degree with bevel upwards

Slow acting (>5min)

Potential for mis-injection into fat, viscera, or subcutaneous space

What is needed for inhalation euthanasia?

Isoflurane/Sevoflurane

Pungent odor - patients may hold their breath

Distress noted with some agents

Slow acting (5-15min)

Consider for personnel health and safety

Smaller animals <7kg

What do you need to confirm a successful euthanasia procedure

No audible heartbeat

Pale mucus membranes

Apnea

Pupils fixed and dilated

No palpebral/corneal reflex

Offer owner time with their pet

Ask if they would like collar, paw print, etc

Offer more quiet exit from practice

What should be done once the owner has left?

Remove catheter and collar

Place in bag - labelled for routine or private cremation!

Ensure all paperwork is filled in correctly

Seal the bag and label with patient ID

Place bagged body in practice chill/freezer

If heavy or giant breed, may need special uplift/help

If owner is taking the euthanized patient home, what should you advise them of?

Rigor mortis, may ‘leak’ urine feces and fluids, confirm death, wrap body in blanket, place in bed/box/vehicle for owner

Advise on burial (deep hole 1M, a distance from water supply, consider risk to wildlife)

If owner requests a home visit, what should you do?

Take a colleague, take a consent form for signature, take extra of everything, arrive respectfully, Additional cost is usually incurred (make sure o is aware of this!)

If you experience problems with clients when you recommend euthanasia, be sure to

Get support

Get a more senior colleague to speak to the client

Speak to another member of the family if possible

Phone governing body for advice

When can you euthanize a patient without owner consent?

If you feel the animal’s welfare is SEVERELY compromised

If it is an emergency first aid situation, or welfare is compromised