Home visit for rabbit PTS

Re: Home visit for rabbit PTS

Andrew Chadwick — Wed, 16 Jan 2013 21:56:56 GMT

+1 for the intra renal injecton in cats - very quick and well tolerated - often better tolerated than iv in a stressed animal and thinking back I don't think I have ever had a pain reaction from doing this. That said I will still try for iv first unless I have reason to believe it is going to be unduly difficult (stressy cat, circulatory collapse etc).

To add to the rabbit discussion, a really useful tip I picked up from a nurse (isn't that where most really useful tips seem to originate!) is to shave the ear with a no 15 blade rather than using clippers - less noisy and the vein seems to stand up more especially if a warm water swab used instead of spirit (less stingy) and injecting 2ml of pento using 2 x 1ml syringes rather than 1 x 2ml makes the vein much less likely to blow (in my experience). Never thought about using it in a Basset though!

Re: Home visit for rabbit PTS

Mark Holmes — Tue, 15 Jan 2013 20:54:35 GMT

[quote user="Kate Richardson"]

Of all the methods used, I think injecting into a solid organ eg liver/kidney must be the most painful, at least with intracardiac/peritoneal/thoracic there is a potential space. As far as I am aware, pain from liver/splenic/kidney disease is caused partially by stretching of the capsule ie by swelling.

[/quote] I inject intrarenally in all but the most obese cats or shrivelled kidneys. It takes about 0.3ml pentobarbital to render a cat unconcious (and only a few seconds) and that quantity is not noticed at all. Once it is asleep I inject the rest. I have no doubt that if you injected the full dose fast it would be uncomfortable but done slowly its brilliant.

Re: Home visit for rabbit PTS

Anthony Todd — Tue, 15 Jan 2013 17:47:57 GMT

[quote user="Thomas Johnson"]then using a tourniquet (or rubber band and artery forceps) to raise the vein it was very rare to have a problem giving the pentobarbitone i/v.[/quote]

Me too, and without a nurse or sedation and often in the owner's arms. Easy peasy usually.

Re: Home visit for rabbit PTS

Thomas Johnson — Tue, 15 Jan 2013 17:43:46 GMT

[quote user="Robin Grimmer"]

I wouldn't want to do a PTS visit without a nurse or assistant, but if I had to then I would defintely sedate first.

[/quote]

In 2 of my previous jobs, both mixed practices, it wasn't practical to take a nurse on a visit out of hours so I would often euthanase cats and dogs on my own. Unless the animal was moribund I would always sedate first (adding acepromazine to the dom and torb makes the veins much easier to hit), then using a tourniquet (or rubber band and artery forceps) to raise the vein it was very rare to have a problem giving the pentobarbitone i/v.

Re: Home visit for rabbit PTS

Anthony Todd — Tue, 15 Jan 2013 14:54:28 GMT

[quote user="Gillian Mostyn"]Forgive me if I choose to ignore that particular piece of 'evidence'!!!!![/quote]

Read "Bad Pharma" and your criteria for so-called "evidence", from the best of places, might change.

Re: Home visit for rabbit PTS

Hannah Wynne Richards — Tue, 15 Jan 2013 14:26:58 GMT

I think it's an unacceptable use of An On

Wynne

Re: Home visit for rabbit PTS

Gillian Mostyn — Tue, 15 Jan 2013 12:35:20 GMT

[quote user="An On MRCVS"]

This posted by a vet on a rabbit forum.

I have spoken to Paul Flecknell, MA VetMB, PhD, DipECVAA, DipECLAM, DLAS, MRCVS- one of the UKs top rabbit vets and honoured amongst veterinary surgeons- about conscious molar clipping and whether he thinks this is acceptable and causes too much stress or damage to teeth. His reply was that he felt it WAS an acceptable practice and theoretical risks are rarely realised.

[/quote]

So an anonymous vet heard tell that another anonymous vet put something on an internet forum about having spoken to Paul Flecknell once....

Forgive me if I choose to ignore that particular piece of 'evidence'!!!!!

Re: Home visit for rabbit PTS

Anthony Dennison — Tue, 15 Jan 2013 12:04:19 GMT

[quote user="Clive Ansell"]

I often use intra renal for cat pts, done slowly and gently they don't seem to notice it. It amazes me how quickly it works, and how good perfusion must be even in old dehydrated renal failure cats with small and sclerotic kidneys.

[/quote]

After reading this thread, I did this with a very flat cat this morning. Owner sat by the cat's head, cuddling and saying goodbye while I injected into the kidneys. Much better than struggling with a vein that would have collapsed pretty quickly.

Thanks for the tips folks

Re: Home visit for rabbit PTS

An On MRCVS — Tue, 15 Jan 2013 11:51:30 GMT

[quote user="Gillian Mostyn"]

[quote user="Arlo Guthrie"]Or it could be based on the personal experience of the author(s). If the latter we don't know the quality of that experience. Could be that they've euthanased one cat between them, in 1945. Could be that they are DipEuth[/quote]

Prof Paul Flecknell is as experienced as it gets.....!!!

http://www.ncl.ac.uk/ion/staff/profile/paul.flecknell

He has been working with, and writing textbooks about, small beasties his entire distinguished career.

[/quote]

Well we dont agree with everything others say do we:

This posted by a vet on a rabbit forum.

Please dont bleat "Inappropriate use of anon account" I dont want to be named in this thread. This is not meant to be any criticism of Dr Flecknell, just to point out that there are differences of opinion all over the place.

Re: Home visit for rabbit PTS

Mark Hedberg — Tue, 15 Jan 2013 10:59:12 GMT

Not so surprising; the kidney and liver parenchyma have lots and lots of small vessels and sinuses so there's a lot of space for the injected fluid to go, so done slowly and gently it's not putting high amounts of pressure on the tissue.

Re: Home visit for rabbit PTS

Clive Ansell — Tue, 15 Jan 2013 10:49:29 GMT

Re: Home visit for rabbit PTS

Kate Richardson — Tue, 15 Jan 2013 10:29:19 GMT

Re: Home visit for rabbit PTS

Gillian Mostyn — Tue, 15 Jan 2013 10:09:57 GMT

As good as! He has been working as a named vet for his whole career so I doubt anyone else has been responsible for more animals' demise - directly and indirectly!

Re: Home visit for rabbit PTS

Mark Hedberg — Tue, 15 Jan 2013 10:07:02 GMT

Is he a DipEuth, then?

Re: Home visit for rabbit PTS

Gillian Mostyn — Tue, 15 Jan 2013 10:04:11 GMT

Prof Paul Flecknell is as experienced as it gets.....!!!

http://www.ncl.ac.uk/ion/staff/profile/paul.flecknell

He has been working with, and writing textbooks about, small beasties his entire distinguished career.

Re: Home visit for rabbit PTS

Hannah Wynne Richards — Tue, 15 Jan 2013 09:56:01 GMT

Hear hear ArloAssume painful until proven otherwise-not the other way round

Wynne

Re: Home visit for rabbit PTS

Arlo Guthrie — Tue, 15 Jan 2013 09:53:05 GMT

[quote user="David Mills"]Horse, door, bolted. More than happy to let this one lie.[/quote]

Laughed out loud - yes I had realised that.

[quote user="David Mills"]You misunderstand strengths of evidence.[/quote]

You're probably right. But would you humour me?

From my (layman's) perspective:

1. Gillian has produced documents from various respected organisations which state that intracardiac injection is painful. As you quite rightly point out, they do not reference any proof of that fact.

2. However, that doesn't mean there is no evidence. Just that it wasn't referenced. It could be based on a double blind placebo controlled randomised trial we don't know about. Or it could be based on the personal experience of the author(s). If the latter we don't know the quality of that experience. Could be that they've euthanased one cat between them, in 1945. Could be that they are DipEuth ().

3. Now, if we were talking about using this level of evidence to decide whether a treatment of marginal benefit, with known side effects should be used, I would completely see your point that this level of evidence would not be sufficient.

4. However, where common sense dictates that there is a reasonable likelihood that the injection is painful, and three organisations issue guidelines recommending it is avoided, surely it would be better to err on the side of caution, presume pain, and try and use other methods until evidence to the contrary is presented? Unless of course other methods seem to carry a risk of more pain.

Re: Home visit for rabbit PTS

vs0u — Mon, 14 Jan 2013 23:06:49 GMT

A good tip a nurse told me recently is to use the ear vein for Basset Hounds - it works!

Re: Home visit for rabbit PTS

Gillian Mostyn — Mon, 14 Jan 2013 21:03:36 GMT

[quote user="David Mills"]I apologise if she was upset by any of my comments - they certainly weren't intended to be personal - but I suspect we're both stubborn and mutually infuriating people who enjoy a good argument.[/quote]

Not at all. You are correct in your summation of my character. My only fault, in fact, is that I am just too modest!

Re: Home visit for rabbit PTS

David Mills — Mon, 14 Jan 2013 21:00:04 GMT

[quote user="Arlo Guthrie"]Er, David and Gillian, could you lay off each other?[/quote]

Horse, door, bolted. More than happy to let this one lie.

[quote user="Arlo Guthrie"]The relevant parts of the docs (ie the bits saying intracardiac injection is painful) were not specifically referenced, but does this necessarily mean they are wrong? Or just not referenced. I would have thought in this case, safer to assume that the Home office (and the RSPCA and the AVHLA) are correct and it is painful unless shown otherwise.[/quote]

You misunderstand strengths of evidence. The documents presented are, where IC injections are concerned, opinion based. There is no objective evidence that they are painful, cruel, etc., regardless of who has created the documents. This is the crux. History of science is littered with dogma that has eventually been overturned, and if EBM is to give us anything it is a critical analysis of statements regarding our practice - this is especially important where the evidence extends only to opinion, whether this is collective or individual. I dismiss the documents because they simply don't tally with my experience of giving IC injections, and therefore in the absence of stronger evidence than opinion, I shall continue.

My spat with Ms Mostyn was stimulated by the strength of her opinion, and argument with those of us who disagreed - and I was interested whence this conviction came. I apologise if she was upset by any of my comments - they certainly weren't intended to be personal - but I suspect we're both stubborn and mutually infuriating people who enjoy a good argument.

Re: Home visit for rabbit PTS

Gillian Mostyn — Mon, 14 Jan 2013 20:59:39 GMT

[quote user="Rajat"]Pentobarb into the testicles? Holy cow that's gotta hurt. Oh wait, do we have evidence for this hurting ?Maybe I should not assume.... [/quote]

Re: Home visit for rabbit PTS

Rajat — Mon, 14 Jan 2013 20:54:37 GMT

[quote user="Anthony Todd"]

[quote user="Rajat"]Sometimes you need a 26 gauge cath.[/quote]

Going to be harder to insert than a straight needle of the same bore so I don't see the advantage or the need?? 25G needles drop cats pretty quick; are rabbits different?

Ear veins are nice in pigs too [better than pentobarb into the testicle....]

[/quote]

True but its not just for the small bore that I mentioned it - it's for having an IV cath in place to inject the Euthatal through. FWIW I put one in every PTS.

Let's not open another can of worms here on whether every PTS requires one eh

Pentobarb into the testicles? Holy cow that's gotta hurt. Oh wait, do we have evidence for this hurting ?Maybe I should not assume....

Re: Home visit for rabbit PTS

Hanna Bennett — Mon, 14 Jan 2013 20:07:27 GMT

maybe it's just me, but surely it is not that hard to place a catheter? I use EMLA as required in rabbits, in cats i give s/c acp/dom/torb which gives good sedation without hypotension. Agree that owners just want quiet peaceful euthanasia, and i have had a fair few cups of tea with owners at home whilst waiting for the sedation to work pre euth, they love the opportunity to talk about the pet they are about to lose - rushing this is not in anyone's interest i find.

Re: Home visit for rabbit PTS

Gillian Mostyn — Mon, 14 Jan 2013 18:51:29 GMT

[quote user="Arlo Guthrie"]Er, David and Gillian, could you lay off each other?[/quote]

Er, Arlo, I already had! I agreed to disagree.

Re: Home visit for rabbit PTS

Anthony Todd — Mon, 14 Jan 2013 17:59:59 GMT

[quote user="Rajat"]Sometimes you need a 26 gauge cath.[/quote]

Going to be harder to insert than a straight needle of the same bore so I don't see the advantage or the need?? 25G needles drop cats pretty quick; are rabbits different?

Ear veins are nice in pigs too [better than pentobarb into the testicle....]