Weekend inpatient care

RE: Weekend inpatient care

Aine Seavers — Sat, 26 Nov 2016 02:19:34 GMT

How often does a catheter block relative to problem bladder with no catheter ?How can you trust an owner not to burst a bladder or make it so sore from improper manipulation or simply just not being to empty any of it? If we are looking for complication rate and risk being a RCVS issue, then the stats would surely be in favour of leaving the catheter in to give the cat a fighting chance. I take paralysed Dachs in Mon to Sat for owners who can't afford surgery or handle the 6 weeks medical care-the dogs go home on weekends as the owners have to do some of work in getting the dogs well. If they need to see the a/h vet they know they will have to pay full price for that as not covered in my community minded approach to helping keep their uninsured pet alive by providing very heavily subsided nursing care and vet vigilance for the majority of the week. Makes the owners very appreciative of the care the pet is getting given at the vet clinic as well- these owners would be no different.

RE: Weekend inpatient care

Rob Loxley — Fri, 25 Nov 2016 18:23:40 GMT

[quote user="Bob Russell"]A cat with a full, uncomfortable bladder (perhaps with an owner squeezing it several times a day) or one with a catheter that might create trouble but probably will not? I know which I would prefer!!![/quote]

No right answer but I think if you can explain how to manually express the bladder which is not easy for clients IME, then I'm sure you can explain how to watch for complications with a catheter. I'd equally send it home with the catheter in place in this situation.

RE: Weekend inpatient care

Bob Russell — Fri, 25 Nov 2016 12:50:22 GMT

[quote user="Robin Grimmer"]

Anon - I've been 'dropped in it' a few times locuming. I would do exactly the same . I wouldn't send a cat home with a catheter and I think the rcvs would take a dim view of it should anything go wrong. In fact , it's just the sort of thing I could imagine reading in the vds newsletter!

[/quote]

Not sure why it would be unacceptable under the circumstances. I would only consider it if I had a degree of confidence in the sense of the owner. I would only do it if I was available at the end of the phone. Nowadays owners can usually take photos if they are looking at something they are not sure about!

A cat with a full, uncomfortable bladder (perhaps with an owner squeezing it several times a day) or one with a catheter that might create trouble but probably will not? I know which I would prefer!!!

The alternative is PTS so my preference would be for the cat to go home with catheter but I do understand why some would be reluctant.

Written care sheet to remove elements of doubt!

RE: Weekend inpatient care

Robin Grimmer — Fri, 25 Nov 2016 12:06:16 GMT

RE: Weekend inpatient care

Martin Atkinson — Fri, 25 Nov 2016 11:52:22 GMT

[quote user="An On MRCVS"]This is such a contrast to my previous locum, no credit allowed.[/quote]You get rather cynical after a while and that is my approach. That said someone rocked up shortly before closing last night with a moribund cat she reckoned she'd found by the side of the road. The drama and crocodile tears, the fact this was an adolescent cat which was totally emaciated with no evidence of injury, made me think this was a cock and bull story and she was the owner. Nonetheless, despite my cynicism we put it in on a drip and into our heated kennel so I'm not such a hard man after all. But a few minutes later it started doing the death wails and agonal breathing so we bumped it - saved worrying about what to do with it overnight. Maybe that was Karma.

RE: Weekend inpatient care

An On MRCVS — Fri, 25 Nov 2016 11:30:03 GMT

This is such a contrast to my previous locum, no credit allowed. I saw a Staffie their that needed enucleation due to ruptured ulcer. Client not registered, turned up with no money. Told either pts or must pay up front for the op. Next day the mother paid in full over the phone, had the op and was fine.

RE: Weekend inpatient care

An On MRCVS — Fri, 25 Nov 2016 11:25:19 GMT

I agree with Martin. My conscience is clear, we've done a lot for this cat and at this stage 2 weeks post injury I do think it's worth giving longer. There isn't a local pdsa and this was all agreed with the boss who I am locuming for (sole charge). All I am concerned about now is doing the best for this cat and not falling foul of rcvs obligations. I'm not happy about sending the cat home with a catheter, it might get blocked or whatever. So I will pull the catheter before going home and show them how to feel and express the bladder. If he can't urinate over the weekend then they need to go to the ooh clinic. Their responsibility, not mine. The boss was quite happy to send the cat home last weekend and it couldn't pee then either!

RE: Weekend inpatient care

Aine Seavers — Fri, 25 Nov 2016 10:20:51 GMT

Fully inform the owner, get it signed and offer them to take home in a crate with a buster collar and an open catheter-it is hard to bite it off and if it does then they need to be advised that will need an op. Those tail injuries and bladder nerve damage, we used to hospitalise in the PDSA for 42 days and it is amazing how many came good so 2 weeks is early. Why has it not gone to the PDSA full time if funds are an issue-or if not alms correct-they have done well with it on el cheapo thus far so now they need to come to the party and organise either to take the cat home for the weekend or have it hospitalised elsewhere for the 50hrs and pay for that part of the treatment.

RE: Weekend inpatient care

Martin Atkinson — Thu, 24 Nov 2016 12:20:29 GMT

This thread is about responsibility not the standard of care this cat is already having which sounds excellent. You have more than fulfilled your part of the bargain towards both the cat, the owner and your employer so the owner has to accept that they pay for gold standard care or take the consequences if they don't. It is their decision not yours and you should feel free to dissociate yourself from it. I know that is difficult as we are a caring profession but at some point you have to learn to do so otherwise you'll end up tearing your hair out and wracked with guilt.

Alternatively if you are not in a hurry to leave over the weekend and there is free accommodation you could contact your employer and if he wants to pay you £300/day just to squeeze a cat's bladder 3-4 times a day why not suggest that? It was his choice to treat this cat on a budget.

RE: Weekend inpatient care

An On MRCVS — Thu, 24 Nov 2016 11:50:25 GMT

I'm always completely honest by the level of in patient care, but the cat was in all last week as well before I was here. I have left the catheter dripping I prefer that way. The current recommendation is not to give antibiotics until the catheter is removed.

As I said , the cat was sent home last weekend and couldn't urinate which probably hasn't done it's bladder much good. I don't think these owners would be up to dealing with a catheter. And the cat gets quite fractious when you do anything round the rear end.

RE: Weekend inpatient care

Neil Wheadon — Thu, 24 Nov 2016 11:47:21 GMT

Playing Devils Advocate

You have been employed till Saturday. After that it is the practice owner to put in place measures to look after patients till he/she returns on Monday. In this as in other cases the triage and OOH cover is the vet at Vets Now's responsibility (I also worked for Vets Now for 9 years)

You are therefore caught with a long term case.

1) Talk to the client and explain, it is their responsibility not yours. Your responsibility ends when Vets Now take over (though admit we don't think that way do we?)

2) I would send a cat home with a catheter, but depends on the catheter, some as you say do snap at the hub, but is this any worse at home than in the surgery when no-one is looking at the cat? I would suggest the cat is better at home. If they need to call Vets Now, the onus is on them, not you

Good Luck

Neil

RE: Weekend inpatient care

Bob Russell — Thu, 24 Nov 2016 11:40:23 GMT

You are limited in your options but owners can be educated to watch a catheterised cat. Far from ideal but may be the only affordable option if you consider the cat has a fair chance of recovery.

Check the cat on the Saturday, leave the catheter dripping rather than collecting in a bag. Buster collar and lots of puppy pads. Stacks of pain relief and antibiotic cover. I would give them my mobile number should they have a worry but let them know if it needs to be seen it has to be by the emergency service. I usually 'go away for the weekend'!

This way the owners have a familiar voice at the end of the phone, you can advise checking/emergency euthanasia if things go badly. The cat then has a chance!

Clearly not ideal but not unacceptable welfare wise IMO but the owners need to be aware that things may still go pear shaped.

A balancing act between doing right for the cat, keeping the cost down and sleeping with a clear conscience!

Poor prognosis or bad owners then euthanasia a real option but a shame considering what the cat has been through!

Not a bad idea to put it all in writing for the owner to take away with them!

RE: Weekend inpatient care

An On MRCVS — Thu, 24 Nov 2016 11:36:53 GMT

Hi Neil,

The cat is 2 weeks post injury tomorrow. So yes still early days, I normally give them a month. During the week it's not a problem as the cat can stay here. There is a nurse who lives above who can do checks but I don't live close enough to come in. We've been expressing the bladder twice daily and now it's catheterised. It's the weekend after 12 pm that's the problem. I will probably keep the catheter in til last minute and then send home for the weekend. Not ideal. But I'm not sending him home with a catheter. He might get to it and bite the end off or something .

RE: Weekend inpatient care

Neil Wheadon — Thu, 24 Nov 2016 11:26:31 GMT

Tricky, consider

1) Tail pulls can take time, when was the RTA? If you have catheterised, that will help

2) What are you doing OOH at present, it's Thursday? The most important thing is tell the owner the standard of care the cat is receiving overnight. - See recent VDS case where owner not aware and complications occurred as wasn't told that in fact the cat/dog was left alone

3) Is there any harm in leaving the catheter in and draining last thing and sending the cat home at night? The worse that will happen is the cat will pull it out.

4) Personally I'd manage till Saturday, then hand the case over, however you are the vet in charge. If you feel the cat needs euthanasia, document it, justify it and do it, that's why you're an MRCVS

Neil (a locum)