Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care

Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care

Editors

Jamie M. Burkitt Creedon, DVM, DACVECCChief, Emergency and Critical Care ServiceRed Bank Veterinary Hospital, Cherry HillCherry Hill, New Jersey

Harold Davis, BA, RVT, VTS (ECC) (Anesth)Manager, Emergency and Critical Care ServiceWilliam R. Pritchard Veterinary Medical Teaching HospitalUniversity of California, DavisDavis, California

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Library of Congress Cataloging-in-Publication DataAdvanced monitoring and procedures for small animal emergency and critical care / editors, Jamie M. Burkitt Creedon, Harold Davis. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8138-1337-0 (pbk. : alk. paper) I. Creedon, Jamie M. Burkitt. II. Davis, Harold, 1958– [DNLM: 1. Emergency Treatment–veterinary. 2. Critical Care–methods. 3. Monitoring, Physiologic–veterinary. 4. Therapeutics–veterinary. SF 778] 636.089'6028–dc23 2011036425

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1 2012

To Dr. Janet Aldrich, who taught me that thinking and knowing are different, and that the former is far

more important.

To Dr. Steve Haskins, who showed me that listening is the teacher’s most important skill.

To my parents, Robbie and Mike, who taught me that caring is always worth it.

And to my husband Mike, who gives selflessly over and over and over again.

I love and thank you all.

–Jamie M. Burkitt Creedon

First and foremost this book is dedicated to my parents, Dr. Harold Davis, Sr., and Barbara Davis, and

my sister, Deborah Davis-Gillespie, for their love, support and guidance. To Thomas J. Bulgin, DVM, for giving me my start as a veterinary assistant and Gary

L. Reinhardt, DVM, and Steve C. Haskins, DVM, DACVECC, for their mentorship. To each current and

past member that I have served with on the board of directors for the Veterinary Emergency and Critical

Care Society. To the veterinary technicians and nurses that I have talked to around the world and former veterinary students of U.C. Davis: I have enjoyed sharing my knowledge and experiences with you.

Finally, to the co-founding and charter members of the Academy of Veterinary Emergency, and Critical

Care Technicians: it was an honor, pleasure, and a joy to work with you in developing the first veterinary

technician speciality academy.

–Harold Davis

Contents

Contributors x

Preface xvi

SECTIONI Introduction 3

1 Triage 5Harold Davis

2 Thesmallanimalemergencyroom 11Martin D. Miller and Sean D. Smarick

3 ICUdesign 24Joris H. Robben and Julie A. Eveland-Baker

SECTIONII Cardiovascular 49

4 Catheterizationofthevenouscompartment 51Mary Tefend Campbell and Douglass K. Macintire

5 Arterialpunctureandcatheterization 69Elisa M. Mazzaferro and Cindy Hauser

6 Principlesofelectrocardiography 82Joao Orvalho

7 Electrocardiograminterpretation 89Matthew S. Mellema and Casey J. Kohen

8 Fluid-filledhemodynamicmonitoringsystems 107Jamie M. Burkitt Creedon and Marc R. Raffe

9 Directsystemicarterialbloodpressuremonitoring 122Edward Cooper and Stacey Cooper

10 Noninvasivearterialbloodpressuremonitoring 134Jill A. Williamson and Stephanie Leone

11 Centralvenouspressuremonitoring 145Rosalind S. Chow and Pamela Dilley

12 Cardiacoutputmonitoring 159Steve C. Haskins

13 Bedsideechocardiography 177Romain Pariaut

14 Pericardiocentesis 190Meredith L. Daly

15 Monitoringtissueperfusion:clinicopathologicaidsandadvancedtechniques 198Brian C. Young

16 Cardiopulmonarycerebralresuscitation 217Sean D. Smarick

17 Open-chestcardiopulmonarycerebralresuscitation 227Janelle R. Wierenga

18 Defibrillation 235Matthew S. Mellema, Craig Cornell, and Casey J. Kohen

19 Temporarycardiacpacing 245Craig Cornell

SECTIONIII Respiratory 261

20 Oxygentherapy 263Jennifer Boyle

21 PulseoximetryandCO-oximetry 274Devon A. Ayres

22 Bloodgasanalysis 286Sarah Gray and Lisa L. Powell

23 Trachealintubation 293Jeni Dohner and Rebecca S. Syring

24 Temporarytracheostomy 306F.A. (Tony) Mann and Mary M. Flanders

25 Artificialairwaymanagement 318Lila K. Sierra and Lesley G. King

26 Capnography 340Linda S. Barter

27 Mechanicalventilation 349Kate Hopper

28 Ventilatorwaveformanalysis 357Deborah Silverstein

vii

viii  Contents

29 High-frequencyventilation 374Jessica Schavone and Elizabeth Rozanski

30 Pleuralspacedrainage 378Rosemary Lombardi, Emily Savino, and Lori S. Waddell

SECTIONIV Urinaryandabdominal 393

31 Urethralcatheterization 395Janet Aldrich

32 Urinalysisinacutelyandcriticallyilldogsandcats 409David J. Polzin and Carl A. Osborne

33 Peritonealdialysis 421Diane M. Welsh and Mary Anna Labato

34 Technicalmanagementofhemodialysispatients 431Karen Poeppel and Cathy Langston

35 Peritonealevaluation 449Linda Barton and Amanda Adams

36 Specializedgastrointestinaltechniques 457Lisa Smart

37 Postoperativeperitonealdrainagetechniques 470Margo Mehl

SECTIONV Nutrition 475

38 Nutritionalrequirementsincriticalillness 477Daniel L. Chan

39 Enteraldietsforcriticallyillpatients 485Sally C. Perea

40 Assistedenteralfeeding 496Scott Campbell and Natalie Harvey

41 Parenteralnutrition 513Jennifer Larsen

SECTIONVI Analgesiaandanesthesia 523

42 Painrecognitionandmanagement 525Chiara Valtolina and Robert Goggs

43 Systemicanalgesia 540Sarah L. Haldane and Michelle Storay

44 Localanalgesia 559Vicki L. Campbell and Amy Rodriguez

45 Monitoringtheanesthetizedpatient 572Benjamin M. Brainard and Julie Denton-Schmiedt

46 Nursingcareofthelong-termanesthetizedpatient 589Yekaterina Buriko and Bridget Lyons

SECTIONVII Clinicopathologictechniques 599

47 Bloodsamplecollectionandhandling 601Lori Baden Atkins

48 In-househematologicevaluation 611Karl E. Jandrey and Carine Laporte

49 Electrolyteevaluation 637Louisa J. Rahilly

50 Acid-baseevaluation 651Steve C. Haskins

51 Osmolalityandcolloidosmoticpressure 665Elke Rudloff and Angel Rivera

52 Cytology 672Rebecca J. Greer and Timothy Koors

53 Bloodtypingandcross-matching 682Nicole M. Weinstein and Carolyn A. Sink

SECTIONVIII Infectioncontrol 693

54 Minimizingnosocomialinfection 695Amanda K. Boag and Katherine Jayne Howie

55 Careofindwellingdeviceinsertionsites 708Elana Moss Benasutti

56 Antiseptics,disinfectants,andsterilization 719Jennifer Devey and Connie M. Schmidt

57 Personnelprecautionsforpatientswithzoonoticdisease 728Megan Patterson Melcher and Christopher G. Byers

SECTIONIX Specificnursingconsiderations 743

58 Drugadministration 745Jane Quandt and Elizabeth Olmstead

59 Administrationofbiologicalproducts 759Jennifer E. Prittie

Contents  ix

60 Bloodglucosemonitoringandglycemiccontrol 776Erica L. Reineke

61 Careofthepatientwithintracranialdisease 789Marie K. Holowaychuk and Sara M. Ostenkamp

62 Careoftheenvironmentallyinjuredanimal 799Michael S. Lagutchik and Adrian Ford

63 Safehandlingandcareofpatientsexposedtoradioactiveandantineoplasticagents 814Michael S. Kent and Paul Primas

64 Medicalcharting 820Karl E. Jandrey and Sharon Fornes

65 Compassionfatigue:healingwithaheart 836Katherine Dobbs

Index 846

This book has a companion website including images and protocols from the book available at www.wiley.com/go/burkittcreedon.

Contributors

Amanda Adams, LVT, VTS (ECC)Critical Care/Dialysis TechnicianVCA Veterinary Specialty Center of SeattleSeattle, Washington

Janet Aldrich, DVM, DACVECCFormerly Clinical VeterinarianVeterinary Medical Teaching HospitalUniversity of CaliforniaDavis, California

Lori Baden Atkins, AAS, LVT, VTS (ECC)Small Animal ICU/ER CoordinatorVeterinary Medical Teaching HospitalTexas A&M UniversityCollege Station, Texas

Devon A. Ayres, RVT, BSIntensive Care Unit TechnicianVeterinary Specialty HospitalSan Diego, California

Linda S. Barter, MVSc, BSc (Vet), PhD, DACVAAssistant Professor of Veterinary AnesthesiologyUniversity of CaliforniaDavis, California

Linda Barton, DVM, DACVECCStaff VeterinarianDepartment of Critical CareVCA Veterinary Specialty CenterLynnwood, Washington

Elana Moss Benasutti, CVTCritical Care NurseIntensive Care UnitMatthew J. Ryan Veterinary HospitalUniversity of PennsylvaniaPhiladelphia, Pennsylvania

Amanda K. Boag, MA, VetMB, DACVIM, DACVECC, FHEA, MRCVSClinical DirectorVets NowScotland, United Kingdom

Jennifer Boyle, RVT, VTS (ECC)CE Relationships ManagerVeterinary Information NetworkDavis, CA

Benjamin M. Brainard, VMD, DACVA, DACVECCAssociate Professor, Critical CareDepartment of Small Animal Medicine and SurgeryCollege of Veterinary MedicineUniversity of GeorgiaAthens, Georgia

Yekaterina Buriko, DVM, DACVECCStaff DoctorAnimal Medical CenterNew York, New York

Jamie M. Burkitt Creedon, DVM, DACVECCChief, Emergency and Critical Care ServiceRed Bank Veterinary Hospital, Cherry HillCherry Hill, New Jersey

Christopher G. Byers, DVM, DACVECC, DACVIM Faculty Internist / CriticalistMidWest Veterinary Specialty HospitalOmaha, Nebraska

Mary Tefend Campbell, CVT, VTS (ECC)Nursing ManagerCarriage Hills Referral HospitalMontgomery, Alabama

Scott Campbell, BVSc (Hons), MACVSc, DACVNSenior Lecturer in Clinical NutritionClinical Nutrition Support ServiceSchool of Veterinary ScienceUniversity of QueenslandBrisbane, Australia

Vicki L. Campbell, DVM, DACVA, DACVECCAssistant ProfessorClinical Care UnitDepartment of Clinical SciencesColorado State UniversityFort Collins, Colorado

x

Contributors  xi

Daniel L. Chan, DVM, DACVECC, DACVN, FHEA, MRCVSSenior Lecturer in Emergency and Critical CareClinical NutritionistDepartment of Veterinary Clinical SciencesThe Royal Veterinary CollegeUniversity of LondonHertfordshire, United Kingdom

Rosalind S. Chow, VMD, DACVECCCriticalistVeterinary Medical and Surgical GroupVentura, California

Monica C. Clare, VMD, DACVECCDirector of the ICUIntensive Care UnitVeterinary Specialty HospitalSan Diego, California

Edward Cooper, VMD, MS, DACVECCAssistant Professor, Small Animal Emergency and Critical CareDepartment of Veterinary Clinical SciencesOhio State UniversityColumbus, Ohio

Stacey Cooper, RVT, VTS (ECC)Veterinary Medical CenterOhio State UniversityColumbus, Ohio

Craig Cornell, BA, RVT, VTS (ECC) (Anesthesia)Department of Small Animal AnesthesiaUniversity of CaliforniaDavis, California

Meredith L. Daly, VMD, DACVECCBluepearl Veterinary PartnersNew York, New York

Harold Davis, BA, RVT, VTS (ECC) (Anesthesia)Manager, Emergency and Critical Care ServiceWilliam R. Pritchard Veterinary Medical Teaching HospitalUniversity of CaliforniaDavis, California

Julie Denton-Schmiedt, CVT, BALarge and Small Animal Anesthesia Veterinary TechnicianHull, Georgia

Jennifer Devey, DVM, DACVECCDepartment Head, Emergency and CriticalCare ServiceDirector of EducationLauderdale Veterinary SpecialistsFort Lauderdale, Florida

Pamela Dilley, RVT, CCRAVeterinary Medical and Surgical GroupVentura, California

Katherine Dobbs, RVT, CVPM, PHRinterFace Veterinary HR Systems, LLCAppleton, Wisconsin

Jeni Dohner, CVT, VTS (ECC)Emergency ServiceMatthew J. Ryan Veterinary HospitalSchool of Veterinary MedicineUniversity of PennsylvaniaPhiladelphia, Pennsylvania

Julie A. Eveland-Baker RVT, VTS (ECC)Shift Supervisor, Small Animal Intensive Care UnitVeterinary Medical Teaching HospitalUniversity of CaliforniaDavis, California

Mary M. Flanders, RVT, VTS (ECC)Veterinary Medical Teaching HospitalUniversity of MissouriColumbia, Missouri

Daniel J. Fletcher, PhD, DVM, DACVECCAssistant Professor of Emergency and Critical CareDepartment of Clinical SciencesCollege of Veterinary MedicineCornell UniversityIthaca, New York

Adrian Ford, BS, LVT, VTS (ECC)Chief Operations Officer, Hospital AdministratorEmergency Pet Center HospitalsEmergency Pet Clinic INCSan Antonio, Texas

Sharon Fornes, RVT, VTS (Anesthesia)Program DirectorVeterinary TechnologyCarrington College CaliforniaSan Leandro, California

xii  Contributors

Robert Goggs, BVSc, DACVECC, MRCVSWellcome Trust Research Training FellowSchool of Physiology and PharmacologyUniversity of BristolBristol, United Kingdom

Sarah Gray, DVM, DACVECCCriticalistVeterinary Medical and Surgical GroupVentura, California

Rebecca J. Greer, DVM, MS, DACVECCStaff CriticalistVeterinary Specialty ServicesManchester, Missouri

Sarah L. Haldane, BVSc, BAnSc, MACVSc, DACVECCSenior LecturerDepartment of Emergency and Critical CareUniversity of MelbourneMelbourne, Victoria, Australia

Natalie Harvey, BApSc (VT)Nutrition TechnicianClinical Nutrition Support ServiceSchool of Veterinary ScienceUniversity of QueenslandBrisbane, Australia

Steve C. Haskins, DVM, MS, DACVA, DACVECCProfessor EmeritusUniversity of CaliforniaDavis, California

Cindy Hauser, MBA, CVT, VTS (ECC)Wheat Ridge Animal HospitalWheat Ridge, Colorado

Marie K. Holowaychuk, DVM, DACVECCAssistant Professor, Emergency and Critical Care MedicineDepartment of Clinical StudiesOntario Veterinary CollegeUniversity of GuelphGuelph, Ontario, Canada

Kate Hopper, BVSc, PhD, DACVECCAssistant Professor, Small Animal Emergency and Critical CareDepartment of Veterinary Surgical and Radiological SciencesUniversity of CaliforniaDavis, California

Katherine Jayne Howie, VN, VTS (ECC)Senior Veterinary NurseVets‐Now FarnhamFarnham, United Kingdom

Karl E. Jandrey, DVM, MAS, DACVECCAssistant Professor of Clinical Small Animal Emergency and Critical CareDepartment of Surgical and Radiological SciencesWilliam R. Pritchard Veterinary Medical Teaching HospitalUniversity of CaliforniaDavis, California

Michael S. Kent, DVM, DACVIM (Oncology), DACVR (Radiation Oncology), MASAssistant ProfessorDepartment of Surgical and Radiological SciencesSchool of Veterinary MedicineUniversity of CaliforniaDavis, California

Lesley G. King, MVB, DACVECC, DACVIMDepartment of Clinical StudiesMatthew J. Ryan Veterinary HospitalSchool of Veterinary MedicineUniversity of PennsylvaniaPhiladelphia, Pennsylvania

Casey J. Kohen, BAResearch Assistant, Mellema LabSchool of Veterinary MedicineUniversity of CaliforniaDavis, California

Timothy Koors, DVMResidentVeterinary Specialty ServicesManchester, Missouri

Mary Anna Labato, DVM, ACVIMClinical ProfessorSection Head, Small Animal MedicineCummings School of Veterinary MedicineTufts UniversityNorth Grafton, Massachusetts

Michael S. Lagutchik, DVM, MS, DACVECCMedical DirectorEmergency Pet Center HospitalsSan Antonio, Texas

Contributors  xiii

Cathy Langston, DVM, DACVIMStaff Veterinarian, Head of Nephrology, Urology, and Hemodialysis UnitDepartment of Renal Medicine and HemodialysisAnimal Medical CenterNew York, New York

Carine Laporte, VMDSchool of Veterinary MedicineUniversity of PennsylvaniaPhiladelphia, Pennsylvania

Jennifer Larsen, DVM, PhD, DACVNAssistant Professor of Clinical NutritionDepartment of Molecular BiosciencesSchool of Veterinary MedicineUniversity of CaliforniaDavis, California

Stephanie Leone, BS, RVTEmergency Service ManagerPet Emergency & Specialty CenterLa Mesa, California

Rosemary Lombardi, CVT, VTS (ECC)Director of NursingMatthew J. Ryan Veterinary HospitalSchool of Veterinary MedicineUniversity of PennsylvaniaPhiladelphia, Pennsylvania

Bridget Lyons, BA, CVTICU Nurse, VHD CandidateIntensive Care UnitUniversity of Pennsylvania School of Veterinary MedicinePhiladelphia, Pennsylvania

Elisa M. Mazzaferro, MS, DVM, PhD, DACVECCDirector of Emergency ServicesWheat Ridge Animal HospitalWheat Ridge, Colorado

Douglass K. Macintire, DVM, MS, DACVECCProfessor of Acute Medicine and Critical CareDepartment of Clinical SciencesCollege of Veterinary MedicineAuburn UniversityAuburn, Alabama

F. A. (Tony) Mann, DVM, MS, DACVS, DACVECCDirector of Small Animal Emergency and Critical Care ServicesSmall Animal Soft Tissue Surgery Service ChiefVeterinary Medical Teaching HospitalUniversity of MissouriColumbia, Missouri

Margo Mehl, DVM, DACVSSan Francisco Veterinary SpecialistsSan Francisco, California

Megan Patterson Melcher, RVTICU TechnicianVCA Veterinary Referral AssociatesGaithersburg, Maryland

Matthew S. Mellema, DVM, PhD, DACVECCAssistant Professor, Small Animal Emergency and Critical CareSchool of Veterinary MedicineUniversity of CalifroniaDavis, California

Martin D. MillerOperations ManagerAVETSMonroeville, Pennsylvania

Elizabeth Olmstead, CVT, BSBlood Donor Supervisor, ICU TechnicianDepartment of Small Animal MedicineCollege of Veterinary MedicineUniversity of MinnesotaSt. Paul, Minnesota

Joao Orvalho, DVM, DACVIM (Cardiology)Veterinary Medical CenterSchool of Veterinary MedicineUniversity of CaliforniaSan Diego, California

Carl A. Osborne, DVM, PhD, DACVIMProfessor of Veterinary Internal MedicineCollege of Veterinary MedicineUniversity of MinnesotaSt. Paul, Minnesota

Sara M. OstenkampVeterinary TechnicianICU DepartmentNorth Carolina State UniversityRaleigh, North Carolina