Euthanasia protocol

RE: Euthanasia protocol

Minnie — Sun, 10 Nov 2019 22:27:46 GMT

[quote user="vetbl.locum"]

PS What are peoples thoughts on practices lightning a candle in waiting room during the euth consult?

[/quote]

trialed it for a few days only at one place I worked (trial ceased at clients request). Its a bit much in my mind- and I said as much before we tried it, has real potential to upset rather than comfort. From those in the waiting room 'some things you would rather not know about' because to them it brings brings back sad memories of previous animals they have had pts or reminds them that the one they have with them will be needing an appointment for the same in the future. And for the client needing the pts appt for their beloved pet - most times they really don't want attention drawing to their grief, their priority is to be there for their pets last moments, perhaps to spend a little time by themselves and then to get the hell out of there and grieve in peace. Some will be appreciative of a strangers' show of sympathy that is true but most will not. We are lucky in that there are a couple of doors in the practice that people can use to leave by and avoid the waiting room.

RE: Euthanasia protocol

bob lehner — Fri, 08 Nov 2019 22:09:47 GMT

[quote user="Anthony Dennison"]

[quote user="Julian Earl"]Might it be very useful for neonatal puppies/kittens? Not even a catheter, just the needle-hub intra-rectally? I have never used this technique but wish I had known about it. Yet another thing one was not taught at university but should know on day one? [/quote]

The technique that was described here (I'm really sorry, I can't remember her name. Dutch vet who did work in Mozambique for a while now does OOH in the UK... just can't think of the name but want to credit her!!) was using some drip tubing inserted up the anus, then instill into the rectum using that.

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Mariette Asselbergs - she used to write some interesting stuff on here - but vanished a while back. I think she said doctors in Mozambique used rectal pentobarb on children with rabies to control convulsions.

RE: Euthanasia protocol

Anthony Dennison — Fri, 08 Nov 2019 17:54:59 GMT

RE: Euthanasia protocol

Julian Earl — Fri, 08 Nov 2019 14:16:10 GMT

Might it be very useful for neonatal puppies/kittens? Not even a catheter, just the needle-hub intra-rectally? I have never used this technique but wish I had known about it. Yet another thing one was not taught at university but should know on day one?

Thanks, even though I am not in practice now it is still useful to learn.

What about lambs, piglets? can it even be adapted to sedate a difficult [a.k.a.] a needle-shy horse for euthanasia as well? 200mls per rectum via the catheter. Could be done over a stable door perhaps? No broken arms over the door if the horse squats then.

RE: Euthanasia protocol

Anthony Dennison — Fri, 08 Nov 2019 11:26:21 GMT

[quote user="Sarah Keir"]

I read, a good few years ago, about a vet who give pento per rectum through a urinary catheter and said it works well - never tried but for those no vein ones...

[/quote]

I read that on here too. I've used it once. Did take an age but did work, dog had no BP anyway, and was peaceful. Not something that can be done in the middle of a busy consulting block.

I also almost always go intrarenal in cats. Much less stressful for them. Minimal handling, fuss from the owner.

RE: Euthanasia protocol

Sarah Keir — Thu, 07 Nov 2019 19:10:48 GMT

premed - usually starved for a GA, sedation for euthanasia - sometimes been fed a large last meal!!

RE: Euthanasia protocol

Clive Ansell — Thu, 07 Nov 2019 18:48:57 GMT

I don't think I have every seen a cat vomit when given Medetomidine and Butophanol as a premed?

RE: Euthanasia protocol

Rob Loxley — Thu, 07 Nov 2019 18:03:49 GMT

[quote user="Kate Richardson"]Avoids the vomiting with medetomidine which is not what owners want to see prior to euthanasia[/quote]

My number 1 issue with medetomidine in cats in this situation

RE: Euthanasia protocol

Iain Richards — Thu, 07 Nov 2019 17:33:42 GMT

Oops - sorry Sarah, I'll blame Arlo's tech that woudn't let me quote the whole post.

RE: Euthanasia protocol

Bob Russell — Thu, 07 Nov 2019 15:55:35 GMT

I have no problem with euthanasia being carried out in the same room a puppy or kitten had the first vaccination and many encounters between. The pet and owner tend to be in a familiar environment.

It is a practical, matter of fact procedure carried out gently and sympathetically.

We will do everything we can to find a quiet time and I will chat with owners before, explain during and chat after if I feel it is appropriate. Many of the patients are familiar and there are often stories to retell. My ideal is to have owners leave the room with a bit of a smile on their faces and happy memories.

As a minimum I want them leaving with the belief they have done the right thing.

Clearly with some owners this is not appropriate and they leave quickly or are given a bit of quiet time to themselves.

Sometimes we use the room next door because it has an electric table (to save backs!).

This really is a bit of an art and gauging owners takes experience and time.

I am not a believer in protocols in this situation.

RE: Euthanasia protocol

Joyce Whitehead — Thu, 07 Nov 2019 15:40:54 GMT

I saw it recommended for chickens too and have tried it once in a small one that didn’t have visible veins, it worked well, quietly slipped away in a kennel.

RE: Euthanasia protocol

Sarah Keir — Thu, 07 Nov 2019 15:14:19 GMT

I read, a good few years ago, about a vet who give pento per rectum through a urinary catheter and said it works well - never tried but for those no vein ones...

RE: Euthanasia protocol

Sarah Keir — Thu, 07 Nov 2019 15:11:08 GMT

[quote user="Iain Richards"]

[quote user="Sarah Keir"]I don't want special rooms, cannulae, candles, comfy chairs, routine sedation.[/quote]

It was a specific design in our new (2002) build and one of the best things we did. It has a door straight to the carpark, flotex carpet floor, and, until the scanner arrived, no vetty kit. It means cleints can go there, away from the bustel and stay there without clogging up a consulting room. Some folk like to sit on the floor with their dogs.

[/quote]

Hi Iain, Please can you edit your post as it was actually Michael W who doesn't want these things - I actually do! Thanks!

RE: Euthanasia protocol

George Cooper — Thu, 07 Nov 2019 14:51:13 GMT

There is one other route of administration that can be utilised if the situation is appropriate - and that is sub-cutaneous. Many vets will query this, thinking that it must be painful. I can assure you that it most definitely is not.

This arose from a case where a fairly hyper, and "difficult to reach" client (in the 'hello? This is what will happen' sense.) announced in the final moments that she really - but REALLY wished that the cat and she could be at home quietly on the sofa as the cat slipped peacefully away, and not all-of-a-sudden as had happened with her previous cat(s) with the kidney system. This particular cat was her "last" of her little colony that she had bred and nurtured, and as such I understood completely her point and request.

A fair few years ago I had employed the s/c route in a couple of instances where alternates did not exist,, and found it slow, peaceful, non painful and dignified. This was in the days before effective cat sedation techniques. And so with this client I explained what we would do, and how she'd need to jump in the car and head for her sofa promptly. And that is what happened. Four ml s/c for a sizeable oriental, no reaction whatsoever from it and off she went. When she popped in to settle up a couple of days later, her appreciation was emotional. She had got home, made a cuppa, and settled down with the cat. Within 5 minutes or so the cat relaxed and slept, and took about another five to die - in her arms, in her home as she had wished and with no "alien bodies" present.

It isn't a technique that I would choose as a routine, simply because there are unpredictable effects and timing issues, and the owner has to arrange burial - all without supervision. However - in certain cases it could rove to be useful, and worth knowing about.

RE: Euthanasia protocol

Kate Richardson — Thu, 07 Nov 2019 13:47:20 GMT

[quote user="Beats"] domitor IM [trick is to apply tourniquet as soon as sleep, usually about 30secs to 2 minutes, before peripheral vasoconstriction occurs,[/quote]

You shouldn't get peripheral vasoconstriction if you use low doses of Domitor- 0.01-0.2mls per kg and it's generally very effective in majority of cats (excepting the ones with already collapsed veins due to shock etc)

RE: Euthanasia protocol

Beats — Thu, 07 Nov 2019 13:43:45 GMT

[quote user="Iain Richards"]It was a specific design in our new (2002) build and one of the best things we did. It has a door straight to the carpark, flotex carpet floor, and, until the scanner arrived, no vetty kit. It means cleints can go there, away from the bustel and stay there without clogging up a consulting room. Some folk like to sit on the floor with their dogs.[/quote]

Another advantage of a separate room not generally used for consults is some clients visibly shudder on returning to the consult room where their last pet was euthanased. I've had the odd one that I know has attended a different vet clinic for years before returning simply as they found visiting again too traumatic - of course that can count for the whole clinic, but I think stepping back into the same room can be especially poignant [equally I've had new clients for same reason]. Occassional client over the years has requested a different consulting room from the one their last pet was euthanased in, or made comment that they have ended up in the same one (in a negative, to them, sense). We have 4 consult rooms, but when busy have to use the ultrasound room or prep room for consults also. An extra room would be amazing, but is, for us, unrealistic.

I'm in the "make-it-quick" camp. I do most myself without an extra body. I love my tourniquet. I've never really got into intra-renal in cats - did a bit as new graduate. Generally I find that if a cat is resistant to me giving in cephalic, then it's also resistant to me grabbing a left-kidney to inject (I may simply have poor technique); so cats get big dose (0.5-1ml, as much as goes in) domitor IM [trick is to apply tourniquet as soon as sleep, usually about 30secs to 2 minutes, before peripheral vasoconstriction occurs, then give pento once sleepy enough before vomiting starts - don't have long! I don't always manage this and on occasions will start to vomit as giving which isn't ideal, but I at least always warn will vomit if sedate]. I'll try Kate's 0.5ml alfaxan IM and see if that solves the occasional vomiting euthanasia cat.

In answer to original post, I think a "policy" sounds awful. I think allowing each vet to act as they see best works best. You'll really annoy a vet by telling them that the way they find doing euthanasias is best is "no longer practice policy"... My main objection would be that finding a nurse is not always expedient and I wouldn't like awkward delays during a euthanasia.

RE: Euthanasia protocol

Iain Richards — Thu, 07 Nov 2019 11:52:58 GMT

[quote user="Michael Woodhouse"]I don't want special rooms, cannulae, candles, comfy chairs, routine sedation.[/quote]

RE: Euthanasia protocol

Lucy Fleming — Thu, 07 Nov 2019 11:03:07 GMT

I tend to agree with Michael that most people, once they have decided, want things to proceed smoothly and efficiently. I don't think that necessarily precludes using sedation or cannulae if that's what you prefer or find helpful. We do have an electric candle at our reception desk but in the daylight you can't really tell if it's on or not. One client was mortally offended by it when it appeared, for some reason. We're lucky enough to have multiple consulting rooms so rarely need to hurry anyone out, and can use the other door in our consulting rooms to show them out a separate exit if the waiting room is busy.

I can see how a general practice policy might be helpful, but this is a situation where retaining some flexibility is important, IMO

RE: Euthanasia protocol

Thomas Johnson — Thu, 07 Nov 2019 09:42:00 GMT

[quote user="Sarah Keir"]

[quote user="Michael Woodhouse"]

with minimal fuss. I don't want special rooms, cannulae, candles, comfy chairs, routine sedation.

[/quote]

But some clients do and we are a service industry, servicing clients needs. Though they may be some difference with 'down south'/fur babies rather than up in the far north

[/quote]

I agree. We have a separate euthanasia room, it has a small sofa in it and a fold down rather than a fixed table, and no computer. It means clients don't have to wait in the waiting room if they don't want to. There is considerable variation in what people want with euthanasia, but what is always the case is that they don't want their pet stressed, in pain or suffering. As long as they are fairly calm I prefer not to sedate, but if you can tell that they are going to struggle I would much rather sedate than have to have them forcibly held by the nurse, I also think it's quite reasonable if they appear calm but start to struggle to stop and sedate them before continuing.

I find that most clients, once the decision is made, want the euthanasia done quickly, but not rushed. What I find very variable is what they want to do afterwards, some clients want to go straight away, others like to stay for a while, and having a separate euthanasia room means that you can let them have as much time as they want.

RE: Euthanasia protocol

Sarah Keir — Thu, 07 Nov 2019 09:23:59 GMT

[quote user="Michael Woodhouse"]

with minimal fuss. I don't want special rooms, cannulae, candles, comfy chairs, routine sedation.

[/quote]

But some clients do and we are a service industry, servicing clients needs. Though they may be some difference with 'down south'/fur babies rather than up in the far north

RE: Euthanasia protocol

Thomas Johnson — Thu, 07 Nov 2019 08:30:49 GMT

[quote user="Evelyn Barbour-Hill"]But always try to avoid having other people in the waiting room. That's horrid.[/quote]

I agree it's not ideal, and we will always try and book euthanasias at a time when there are no other appointments, but if a mid-morning appointment unexpectedly turns into a euthanasia appointment and there are several vets consulting it's unavoidable, and clients pop in to pick up medication or bring their dog in to be weighed throughout the day.

RE: Euthanasia protocol

Michael Woodhouse — Wed, 06 Nov 2019 22:13:55 GMT

[quote user="Julian Earl"]What do others feel about intra-renal and/or intracardiac in cats and dogs?[/quote]

Always do cats intra renal. No pain. Easy. Fast. Would only go IV if I already had access. Tell owner "little injection into belly as they don't like us injecting veins". Owner cuddles head.

Intracardiac only in heavily sedated animals. Out of choice med/butorphanol +/- ketamine. On visits xylazine only. Big doses.

Yet I would use intra-cardiac as a routine in a baby lamb and I'm not sure how I feel about the double standards.

I know some people like to make it a big thing, but I want it over as quickly as possible with minimal fuss. I don't want special rooms, cannulae, candles, comfy chairs, routine sedation.

RE: Euthanasia protocol

Nicola Cole — Wed, 06 Nov 2019 22:03:57 GMT

[quote user="vetbl.locum"]

Any thoughts on RCVS view on i/p injection for euth following recent case? Would VDS be able to defend you if there was a complaint.

[/quote]

If that’s the case that you linked to later than I’m not sure I see why that would alter RCVS view on I/p injection. The link was to a case regarding intra-cardiac injection....

RE: Euthanasia protocol

Kate Richardson — Wed, 06 Nov 2019 21:57:58 GMT

[quote user="Sarah Wheadon"]

Sorry, I was just wondering if you had a nicely sedated cat with a decently visible vein

[/quote]

Yes, beautifully sedated with a lovely vein

RE: Euthanasia protocol

Sarah Wheadon — Wed, 06 Nov 2019 21:52:23 GMT

Sorry, I was just wondering if you had a nicely sedated cat with a decently visible vein