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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
A John Wiley & Sons, Inc., Publication
This edition first published 2012 © 2012 by John Wiley & Sons, Inc.
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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