Cytopoint injection

RE: Cytopoint injection

David Scarff — Tue, 16 Aug 2022 14:52:45 GMT

Agree totally - I have seen anaphylaxis after vaccination, and never after Cytopoint.! But all these considerations are important to work through, however rare they are. If we are dispensing ofr prescribing the product we are responsible for it, even when it has left the building.

RE: Cytopoint injection

Julian Earl — Tue, 16 Aug 2022 14:49:03 GMT

[quote userid="3169" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/30380/cytopoint-injection/238710#238710"]As it is with antibiotics, every vaccine we use and yet we don't worry. We are happy giving a booster or probably a Cytopoint at 6.50 [/quote]

Surely Anaphylaxisrequires a veterinary diagnosisprior to treatment ...? Dos it not?? Ihave no exprience whatsoever with Cytopoint so this dicusion is interesting abut a supposedly wonderful new Non-cortisone based therapy for ~Hypersensitivities? Thanks

RE: Cytopoint injection

Michael Woodhouse — Tue, 16 Aug 2022 14:25:05 GMT

[quote userid="2116" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/30380/cytopoint-injection/238709#238709"]And as a 'natural' prduct anaphylaxis is a risk - do we send adrenaline injection too!?[/quote]

As it is with antibiotics, every vaccine we use and yet we don't worry. We are happy giving a booster or probably a Cytopoint at 6.50 and locking the doors at 7.00 and putting the phones through to the OOH provider in many cases. If something reacted then they would either attend the practice or their OOH facility.

I really feel we are scraping the barrel for excuses.

RE: Cytopoint injection

David Scarff — Tue, 16 Aug 2022 14:16:16 GMT

I would also be concerned that the product is fragile and doesn't bear much shaking. And as a 'natural' prduct anaphylaxis is a risk - do we send adrenaline injection too!?

RE: Cytopoint injection

Stephen Courtney — Tue, 16 Aug 2022 06:49:16 GMT

This is the advice I got from VDS on this subject - just for interest

To be honest I think if clients are trained and sensible, I have no personal issue with this, but you need to document your warnings etc, and apparently even then a judge might find in favour of some idiot who injected themselves while pregnant

To summarise:

After a chat with their advisers there are 3 issues regarding written Rx:

cold chain security - cannot be guaranteed
Pregnant and risk of self injection is potentially significant
Also nerve growth factor issues in all humans are a big concern (though I don't understand these, they are potentially serious)

VDS said that if a written Rx is provided the client should be advised re health and safety advice and risks and this should be documented eg a signed disclaimer - however they did say that signed disclaimers don't guarantee you can't lose a court case but at least shows you have thought things through - obviously this is a much bigger deal than simply writing a prescription- which is something I hadn't thought of at all

In addition injecting for the client ie giving a drug they bring to the surgery - makes us responsible for storage, handling and efficacy and so on, and as we cannot verify storage conditions it leaves us in a difficult spot

Finally regarding the legality of refusing to provide a prescription we cannot be forced to do so by the client but they advise that we document in each case why the request is refused - it is not illegal for us to refuse but we need to be able to show why

They also felt that a blanket ban was potentially going to leave us on shakey ground with the RCVS as there are situations where the risks are much lower - eg my ex RVN client who is well past child bearing age.

We aren't the only practice to make this decision but there are many that do write the prescriptions and clients are free to seek out another vet obviously

Given the overall number of requests like this are low the impact is likely to be minimal but the odd client is likely to kick off

RE: Cytopoint injection

Stephen Courtney — Tue, 16 Aug 2022 06:44:51 GMT

I completely agree that nurses should be allowed to vaccinate - certainly boosters, and if a pup or kitten has been seen by a vet already, these too. Human nurses do, and I've certainly noticed a difference in quality of process compared to when it's given by a doctor!

Pretending the vaccine process requires a vet to be giving it is ridiculous and clients feel the same way. It's protectionism and it's unhelpful especially given the staffing shortage which is unlikely to go away any time soon.

However I do like having a scattering of vaccines between all the actually sick ones / worried owner with non- specific signs type cases as it gives me a breather

If I have a list full of seriously unwell animals it's exhausting and I would miss the routine vaccinations badly.

Though to be honest if I'm having a day like that, the vaccine cases are " in for booster but for the last 6 months ...."

Sometimes you just can't win

RE: Cytopoint injection

Clive Ansell — Mon, 15 Aug 2022 21:15:49 GMT

[quote userid="8958" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/30380/cytopoint-injection/238680#238680"]

Clive Ansell said:
The main part of the vaccinaton consultation is assessing that the animal is fit for vaccination, not the actual injection which a chimpanzee could do given enough bananas

Now you say this in the same post

Clive Ansell said:
I've been saying that for 26 years, though nobody else was on side.

In fact I have worked in one pracitce where RVN's gave routine booster vaccinations.

Neil

[/quote]

RVN's are perfectly capable of assessing whether an animal is fit for vaccination or not - - - - they are trained. If they were unsure they could ask the MRCVS already on premises of course.

Don't underestimate the abilty of RVN's

RE: Cytopoint injection

Neil Wheadon — Mon, 15 Aug 2022 20:42:23 GMT

Can't resist

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/30380/cytopoint-injection/238679#238679"]The main part of the vaccinaton consultation is assessing that the animal is fit for vaccination, not the actual injection which a chimpanzee could do given enough bananas[/quote]

Now you say this in the same post

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/30380/cytopoint-injection/238679#238679"]

I've been saying that for 26 years, though nobody else was on side.

In fact I have worked in one pracitce where RVN's gave routine booster vaccinations.

[/quote]

Neil

RE: Cytopoint injection

Clive Ansell — Mon, 15 Aug 2022 20:36:53 GMT

[quote userid="8958" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/30380/cytopoint-injection/238666#238666"]Personally in the practices I locum in, I have seen 2 cases where home injection was 'allowed' by the practice, both to trusted clients[/quote]

None of the practices I locum for routinely allow for owners to inject animals at home, other than insulin.

There are exceptions, and these are assessed on a case by case basis. Last one I dealt with was a chap that works away from home all week and can only attend the practice on weekends, but since the practice has now closed saturday morning surgeries we have allowed him to inject monthly Cytopoint at home.

I guess it depends on the case, the situation and the ability of the client. We have to be sure it is safe, they are capable, and that medicines are stored, used and discarded as per legislation. As the prescribing MRCVS, it is ones own head on the VMD or RCVS chopping block if anything ever goes mammaries up.

I don't think we can really compare insulin to other drugs, given that it is usually injected twice every day coming to the surgery would not be possible or practical. having to attend once a month for Cytopoint, Librela, Zycortal is not unreasonable.

[quote userid="8958" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/30380/cytopoint-injection/238666#238666"]It's a small step to 'at home vaccinations' then isn't it? It's the same logic[/quote]

No.

The main part of the vaccinaton consultation is assessing that the animal is fit for vaccination, not the actual injection which a chimpanzee could do given enough bananas,

[quote userid="3169" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/30380/cytopoint-injection/238670#238670"]Have a few savage farm dogs on the books where I do a detailed appraisal of the animals existence and need for vaccination and let the owner do it when I'm gone as I need my fingers for work.....[/quote]

I've had similar cases recently, aggressive dogs that I cannot get within 10 metres of. Owners inject and give KC vaccine in my (fairly distant) presence, I sign the certificate and get to keep my face and fingers. Again on a case by case basis.

[quote userid="3169" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/30380/cytopoint-injection/238670#238670"]Personally I'm all for nurse vaccinations, but I realise it's unpopular. Would insist on an MRCVS on site.[/quote]

I've been saying that for 26 years, though nobody else was on side.

In fact I have worked in one pracitce where RVN's gave routine booster vaccinations. They received complaints from other practices and met resistance from the RCVS. They no longer do it. A shame, because it worked really well. We're stuck in the dark ages I'm afraid.

RE: Cytopoint injection

Michael Woodhouse — Mon, 15 Aug 2022 11:34:26 GMT

Yes, but if you want to pay for a consult and a prescription then I will happily prescribe it for you to give at home, but I suspect it will cost you vastly more.

Have a few savage farm dogs on the books where I do a detailed appraisal of the animals existence and need for vaccination and let the owner do it when I'm gone as I need my fingers for work.....

Personally I'm all for nurse vaccinations, but I realise it's unpopular. Would insist on an MRCVS on site.

RE: Cytopoint injection

Neil Wheadon — Mon, 15 Aug 2022 10:01:26 GMT

[quote userid="3169" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/30380/cytopoint-injection/238663#238663"]With the caveats I set out above (demo to me 1st etc) then if the seller of the medicine can maintain the cold chain to the door then I don't see a particular issue.[/quote]

It's a small step to 'at home vaccinations' then isn't it? It's the same logic

There needs to be a line drawn.

Personally in the practices I locum in, I have seen 2 cases where home injection was 'allowed' by the practice, both to trusted clients

Neil

RE: Cytopoint injection

Michael Woodhouse — Mon, 15 Aug 2022 08:05:36 GMT

With the caveats I set out above (demo to me 1st etc) then if the seller of the medicine can maintain the cold chain to the door then I don't see a particular issue. You can order farm animal vaccines to your door, I assume they deliver things like insulin?

I don't see it's really any different to them coming into the practice for the first injection then taking the next 5 home with them.

RE: Cytopoint injection

Stephen Courtney — Mon, 15 Aug 2022 07:46:11 GMT

You misunderstand - must have been unclear , apologies

The issue is written prescriptions for home injection

RE: Cytopoint injection

Michael Woodhouse — Sun, 14 Aug 2022 20:25:58 GMT

[quote userid="4256" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/30380/cytopoint-injection/238656#238656"]potential risks eg to pregnant people if accidentally self injected[/quote]

Been doing this 16 years now and never managed to inject myself with a full dose of anything.

If you lay awake worrying about pregnant women then I presume you don't therefore prescribe prednisolone, carbergoline, thiamazole etc ?

It muct be really limiting in practice, especially as the profession becomes female dominant, you as the guy must be BUSY.

RE: Cytopoint injection

Stephen Courtney — Sun, 14 Aug 2022 20:05:08 GMT

How would you feel about the same request for Librela or Solensia? We have just had this discussion at our practice and the decision was taken that we would NOT write prescriptions for these products on health and safety grounds given the potential risks eg to pregnant people if accidentally self injected

RE: Cytopoint injection

Dinu Catilina — Sun, 07 Aug 2022 13:11:08 GMT

Same as Michael. Insuline must also be kept cold.

I think we might overstate the consequences of an incorrect SC injection in pets.

RE: Cytopoint injection

Miriam Lodewyks — Sun, 07 Aug 2022 11:31:06 GMT

Can’t see it being an issue but we prefer our clients to bring the dog so our nurses inject them.

Cold-chain maintenance would be my main concern.

RE: Cytopoint injection

Michael Woodhouse — Sat, 06 Aug 2022 09:58:10 GMT

I can't see a sensible reason not to let them administer it at home, the consequences of accidental self administered insulin could be much greater than a theoretical risk from Cytopoint. Have a few clients who do it themselves.

Equally I will often send owners home with Amoxycillin LA injections for cats as I find the compliance much better than tablets/oral. Maybe I just come at this with a farm vet hat on.

My wife recently had a caesarean and she was sent home with a box of anti clotting injections to give herself.

I'd want to see every 6 month and get the owner to do the first one in front of me.