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Euthanasia, Spay/Neuter and
“The Board”
OH MY!
Dr. Solveig Evans
Gwinnett County Animal Welfare and
Enforcement
Medical Director
How to avoid “The Board”!
(In Georgia)
The letter you NEVER want to
see
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The Office of Secretary of State
Date:
Veterinarian, DVM
237 Coliseum Dr
Macon GA 31217
Respondent Email: [email protected]
Re: A dog,”Happy” owned by Angry Client
Dear Dr.Veterinarian:
The Georgia Board of Veterinary Medicine has received a formal complaint
regarding the treatment you provided to the above referenced patient.
The Board is charged to investigate every complaint received in this office. In an
attempt to further understand the complaint; please send the Board a certified
copy (form provided) of the patient’s treatment records, and copy of the financial
records, and a statement explaining the treatment you rendered, within ten (10)
days of receipt of this letter. Your statement must contain a legible translation of
the treatment notes. Each page of the patient treatment record must contain the
patient’s and treating providers’ name. Please do not send two-sided copies and
do not fold, staple, or glue any records. Do not provide records on a Disc. You
should also include a copy of this letter with any documentation you provide to
the Board.
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Please be advised that any materials you provide become a part of the
Board’s confidential investigative file and therefore will not be returned to
you. It is recommended that you retain the originals and provide our office
with duplicates. Please send the requested records to:
The Georgia Board of Veterinary Medicine
237 Coliseum Drive
Macon GA 31217
We thank you in advance for your cooperation in this matter and you will be
advised of any Board action taken as a result of this complaint. If you have any
questions you may call (478)207-2440 for assistance.
Sincerely,
GEORGIA BOARD OF VETERINARY MEDICINE
237 Coliseum Drive ● Macon, Georgia 31217 ● (478) 207-2440 ● www.sos.ga
.gov
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The Office of Secretary of State
CERTIFICATION OF RECORDS
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I hereby certify that the attached ________pages are a true and correct copy of the
(# of pages)
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complete original patient record of
____________________________________________.
(Patient Name)
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I further certify that the attached ____________ x-rays, are a true and correct
(# of x-rays)
All of the above-listed original and/or true and correct copies of patient records are
maintained under my care, custody, and control at
_______________________________________________
(Office Name and Address)
___________________________________________________________________
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Said original records are made and kept in the usual and ordinary course of business
at the above-named office.
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_________________________________
PRINTED Name of Provider
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_________________________________
PRINTED Name of Custodian of Records
_________________________________
Signature of Provider
_________________________________
Signature of Records Custodian
Sworn to and subscribed
Before me this ______ day of ________________, ______.
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__________________________________
(SEAL) NOTARY PUBLIC SIGNATURE
_________________________
MY COMMISSION EXPIRES
237 Coliseum Drive ● Macon, Georgia 31217 ● (478) 207-2440 ● www.sos.ga .gov
Georgia Code 43-50-21
General powers of board
Liberal construction of powers
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. to:
The board shall have the power
– (1) Examine and determine the qualifications and fitness
of applicants for licenses or registrations to practice
veterinary medicine and veterinary technology in this
state;
– (2) Issue, renew, refuse to renew, deny, suspend, or
revoke licenses or registrations to practice veterinary
medicine or veterinary technology in this state or
otherwise discipline licensed veterinarians and registered
veterinary technicians; and to issue, renew, deny, suspend,
or revoke veterinary faculty licenses, consistent with this
chapter and the rules and regulations adopted under this
chapter;
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– (3) Conduct investigations for the purpose of discovering
violations of this chapter or grounds for disciplining
persons licensed or registered under this chapter;
– (4) Hold hearings on all matters properly brought before
the board; and, in connection therewith, to administer
oaths, receive evidence, make the necessary
determinations, and enter orders consistent with the
findings. The board may designate one or more of its
members to serve as its hearing officer;
– (5) Appoint from its own membership one member to act
as a representative of the board at any meeting within or
outside the state where such representative is deemed
desirable;
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– (6) Bring proceedings in the courts for the enforcement of
this chapter or any regulations made pursuant to this
chapter; and
– (7) Adopt, amend, or repeal all rules necessary for its
government and all regulations necessary to carry this
chapter into effect, including without limitation the
establishment and publication of standards of
professional conduct for the practice of veterinary
medicine and veterinary technology.
• (b) The powers enumerated in subsection
• (a) of this Code section are granted for the purpose of
enabling the board to supervise effectively the practice
of veterinary medicine and veterinary technology and
are to be construed liberally to accomplish this
objective.
Georgia Rules and Regulations
Chapter 700-8
Unprofessional Conduct
Rule 700-8-.01
Unprofessional Conduct
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• Advertising - defined: Advertising shall mean any information
communicated in a manner designed to attract public
attention to the practice of the licensee or registrant.
Advertising shall include but not be limited to, a
communication, published or displayed through the use of
newspaper, internet, telephone directory, pamphlets or
handouts, radio, television, signs, billboard, window display or
any other means of medium.
– A licensee or registrant shall not make any false,
misleading or deceptive communication in any form of
advertising.
– Advertisement of prices must contain a complete
description of veterinary services included in any
advertised price and disclosure of any extra charges that
may be required to serve the consumer's needs.
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• Professional Relationships
– It shall be unprofessional conduct for a licensee or
registrant without just cause and in bad faith or for the
purpose of soliciting patronage or personal pecuniary gain
to disparage the profession or professional capabilities of
another licensee or registrant.
– It shall be unprofessional conduct to aid any person, firm,
or corporation to engage in the unauthorized practice of
veterinary medicine.
– It shall be unprofessional conduct for a licensee or
registrant to guarantee a cure or to offer his name in a
commercial setting in a testimonial as to virtues of
proprietary remedies or foods.
– Consultation by an attending veterinarian with other
veterinarians expert in the particular matter on which
consultation is sought is in the public interest and thus is
expected of the attending veterinarian when the need arises.
But such consultation is discouraged if the consulting
veterinarian employs the relationship so created to disparage
the attending veterinarian or to solicit business; such practices
are not in the public interest.
– It shall therefore be unprofessional conduct for a licensee
called as a consulting veterinarian to disparage in the
presence of the client the competence of the attending
veterinarian. The Board does, however, expect any
incompetence or negligence to be reported to it and
nothing in this rule prohibits such reports or the giving of
testimony in public or private litigation.
– It shall be unprofessional conduct for a consulting
veterinarian to assume unauthorized control of the case or
to utilize the consulting relationship to solicit business for
himself or others.
– It shall be unprofessional conduct for a licensee employed
to render professional advice by one party in negotiations
concerning the sale of an animal to accept to a fee from
the other party.
In a nut shell!
• Don’t speak poorly of other veterinarians or practices
• Don’t help non-veterinarians practice veterinary medicine
w/o a license
• Don’t guarantee a cure or offer your name as testimony for
proprietary remedies or foods
• It’s ok to consult veterinary experts but they are not allowed
to speak poorly of you (the referring veterinarian)
• A consulting veterinarian should not speak poorly about the
referring veterinarian in front of the client
– But the consulting veterinarian should report any
incompetence or negligence to the board
• The consulting veterinarian should not steal the client
• During the sale of an animal you cannot advise one party and
get paid by the other
Failure to Maintain Patient Records
– A veterinarian shall prepare and maintain a record
reflecting the care and treatment of animals treated.
– These records shall contain clinical information sufficient
to justify the diagnosis and warrant treatment and shall,
if applicable, include but not limited to the following
information:
• Name, address and telephone number of the animal’s
owner
• Name of attending veterinarian and staff rendering care
• Patient identification, including name, ages, sex and
breed
• Dates of examination, treatment and custody of the
animal
• Patient history
• Presenting complaint
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• Vaccination history
• Findings from physical examination, including
temperature and weight
• Clinical lab reports, if applicable
• Medication and treatment, including frequency
• Anesthetic, including type and amount, if applicable
• Details of surgical procedure with complications and/or
abnormalities noted, if applicable
• Progress and disposition of the case
• Differential diagnosis
• X-rays, if applicable
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– All records shall be kept in readily retrievable form, shall
be recorded contemporaneously, and shall be filed
promptly following treatment
– Patient records shall be kept by a veterinarian for three
(3) years after a patients last visit notwithstanding any
other provision of law
– Copies of patient records must be made available to the
owner of the animal upon written request to the
veterinarian who treated the animal or to the
veterinarian facility where the treatment was provided.
• Such records must be made available within ten (10)
business days from request.
• The veterinarian may charge a reasonable charge for
the search, retrieval, duplication and, if applicable,
mailing of the patient records.
– Failure to keep records as required by this subparagraphs
shall constitute a failure to confirm to the minimal
standards of acceptable and prevailing veterinary medical
practice.
Failure to have an appropriate
Veterinarian/Client/Patient Relationship
– An appropriate veterinarian/client/patient relationship
will exist when:
• The veterinarian has assumed the responsibility for
making medical judgments regarding the health of the
animal(s) and the need for medical treatment, and the
client (owner or other caretaker) has agreed to follow
the instructions of the veterinarian;
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• There is sufficient knowledge of the animal(s) by the
veterinarian to initiate at least a general or preliminary
diagnosis of the medical condition of the animal(s).
– That means that the veterinarian has seen the animal
within the last twelve (12) months and is personally
acquainted with the keeping and care of the animal(s) by
virtue of an examination of the animal(s), and/or by
medically appropriate and timely visits to the premises
where the animal(s) are kept; and
• When the practicing veterinarian is readily available for
follow-up in case of adverse reactions or failure of the
regimen of therapy.
Prescription Drugs:
– After a valid veterinary/client/patient relationship has
been established, a veterinarian must make available,
upon request, at a reasonable cost, a written prescription.
– It is unlawful for a veterinarian to release, prescribe,
and/or dispense any prescription drugs without having
examined the animal and established a valid
veterinary/client/patient relationship.
Chapter 700-12
Minimum Standards
Rule 700-12-.01
Definitions
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• “Appropriately/as appropriate" for the purposes of these
rules means the expected level of care and environmental
quality in accordance with the animal species and the scope
of veterinary services being offered, as determined by the
State Board of Veterinary Medicine.
• "Clean and orderly" for the purposes of these rules means
the expected level of care and environmental quality in
accordance with the animal species and the scope of
veterinary services being offered, as determined by the State
Board of Veterinary Medicine.
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• "Good State" for the purposes of these rules
means the expected level of care and
environmental quality in accordance with the
animal species and the scope of veterinary services
being offered, as determined by the State Board of
Veterinary Medicine.
• "Proper" for the purposes of these rules means the
expected level of care and environmental quality in
accordance with the animal species and the scope
of veterinary services being offered, as determined
by the State Board of Veterinary Medicine.
• "Veterinary facility" means any premises owned or
operated by a veterinarian or his or her employer where
the practice of veterinary medicine occurs, including but
not limited to veterinary hospitals, clinics, or mobile
clinics; provided, however, that such does not include a
client's private property where a licensed veterinarian
treats the client's animals. For the purposes of these
rules, veterinary facility does not include vehicles used
for large animal ambulatory practice.
Rule 700-12-.02
Facility Standards
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• A licensed veterinarian employed at a veterinary facility is
responsible to assure that the following criteria pertaining to
facilities are met:
– Facility must maintain appropriate federal, state and local
permits.
– Facility must be appropriately secured.
– Facility must be sanitary.
– Facility must be well ventilated.
– Facility must be appropriately illuminated.
– Facility must be in a good state of repair.
– Facility walls and floors must be easily sanitized.
– Facility must have means for disposal of dead animals,
tissue, hazardous materials, medical waste which must
meet local and state requirements.
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– Facility must have exterior legible sign.
– Facility must keep grounds clean and orderly, if applicable.
– Facility must have a restroom in working order which is
maintained in a clean and orderly manner. Mobile clinics
are exempt from this requirement.
– Facility must have clean and orderly receiving area.
– Facility must have a telephone answering machine or
answering service available after business hours.
– Facility must have a holding or housing area with proper
sanitation, ventilation, lighting, size, and temperature
appropriate for the animal species.
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– Facility must have appropriate waste receptacles available.
– Facility must have effective insect and rodent control.
– Facility must store pharmaceuticals, biologicals, reagents
and lab samples in accordance with label directions or
other instructions.
– Facility must have fire extinguisher with current annual
inspection.
– Facility must post in a prominent public area a copy of the
current license issued by the Georgia State Board of
Veterinary Medicine or current online verification of
licensure from the Board website for each veterinarian and
veterinary technician working at the facility.
Rule 700-12-.03
Housing
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• A licensed veterinarian at a veterinary facility is responsible to
ensure that the following criteria pertaining to housing
animals are met:
– Each animal must be contained in a secure manner.
– Each animal must be identified as appropriate.
– Contagious animals must be isolated as appropriate.
Rule 700-12-.04
Record Keeping
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• Complete, accurate and legible records must be maintained
on all animals, or animal groups, including but not limited to,
animal owner information, animal identification, and
veterinary care.
– All records must be maintained for a minimum of 3 years
(including diagnostic imaging and other patient data).
– The veterinarian must furnish clients with an established
mailing address for obtaining medical records.
Rule 700-12-.05
Required Equipment
• A licensed veterinarian employed at a veterinary facility must
ensure that equipment is available as appropriate.
Rule 700-12-.06
Emergency Coverage
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• A licensed veterinarian employed at a veterinary facility must
ensure that emergency treatment or access to emergency
treatment to clients with an established veterinary-clientpatient relationship is provided.
• If emergency coverage is not provided, there must be
established, documented referral coverage available to cover
emergencies.
Rule 700-12-.07
Drugs and Pharmacy
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• A licensed veterinarian employed at a veterinary facility must
ensure that the following criteria pertaining to drugs and the
pharmacy are met:
– All controlled substances must be maintained in
compliance with federal and state requirements.
– All pharmaceuticals dispensed must be properly labeled in
accordance with state and federal requirements.
– Outdated pharmaceuticals must be separated, stored,
returned or disposed of in accordance with federal, state
and local requirements.
– The pharmacy must be maintained in a clean and orderly
manner.
– If utilizing controlled substances, documentation of U.S.
Drug Enforcement Administration certificates must be on
premises.
– All pharmaceuticals on the premises must be properly
labeled with drug name, concentration or activity, and
expiration date.
– A valid veterinarian-client-patient relationship must be
established before prescription medications can be
dispensed or prescriptions released.
Georgia Drugs and Narcotic Agency
http://gdna.georgia.gov
• All prescriptions must be issued for a specific patient.
(O.C.G.A. 16-13-74 and 16-13-41). Prescriptions issued for
“office use” are not valid.
• Only a licensed veterinarian (DVM) may authorize prescription
medications for animals. (Georgia Veterinary Practice Act
O.C.G.A 40-5-3)
Required Record Keeping for Controlled Substances
• Documentation is required every time a controlled substance
changes hands. You must have a paper trail.
• The trail is from the manufacturer, to the distributor, to the
pharmacy and/or the practitioner, and to the end user.
• State and Federal controlled substance laws require
maintenance of controlled substance records for period of 2
years from the date of each inventory.
• The GA Board of Veterinary Practice requires maintaining
records for 3 years.
• The Statute of Limitations under FDA law is 5 years, so a 5
year retention policy may be advisable
Key Details for Record Keeping
Controlled Substances
• Registrants MUST maintain the following information for all
controlled substances received:
– Date of receipt
– Drug Description
• Name, Drug strength, Dose, Quantity receive
– Name, address and DEA number of the supplier
– Name, address and DEA number of the recipient
– Name or initials of employees verifying receipt of
the drugs
Initial Inventory of Controlled Substances
• On the date of receipt and stocking of any controlled
substance, you must perform an initial inventory of the
controlled substances on hand.
• The following information must be documented:
– Date
– Documentation of whether the inventory was taken at
Opening or Close of business, or if the practice location is
open 24 hours a day, the time of the inventory
– Drug name
– Drug strength
– Dosage form
– Quantity of dosage units on hand
Inventory Count
• The initial inventory of Schedule II drugs must be maintained
on a separate form and document then the initial inventory of
Schedule III—V drugs.
• According to the DEA, after an initial inventory is taken, the
registrant shall take a new inventory of all controlled
substances on hand at least every two years
• I recommend an inventory should be done yearly
– Annual inventories should always be separate documents
that stand-alone and are maintained separately.
• Include all controlled substance dosage units in your inventory
regardless of whether they are in stock bottles, have been set
aside for destruction, are samples, or are outdated.
• You must have an exact count for Schedule II controlled
substances
• When Schedule II controlled substances are counted, they
must be hand-counted every time. No estimates!
• If you stock all schedules, you must have two annual inventory
documents; one for Schedule II and one for Schedules III—V.
Schedule II
• Substances have a high potential for abuse, but have accepted
medical uses in the United States.
• Examples are oxymorphone, meperidine (Demerol) and
pentobarbital.
• C-II substances are of particular interest to law enforcement
agencies.
• Discrepancies involving C-II agents may result in vigorous
regulatory action.
Schedule III
• Schedule III drugs, substances, or chemicals are defined as
drugs with a moderate to low potential for physical and
psychological dependence.
• C-III, IV and V substances have decreasing potential for abuse
and accepted medical uses in the United States.
• Examples of C-III substances are acetaminophen with codeine,
ketamine and the anabolic steroids.
Schedule IV
• Schedule IV drugs, substances, or chemicals are defined as
drugs with a low potential for abuse and low risk of
dependence.
• Examples are: Xanax, Tramadol, Diazepam, midazolam,
butorphanol, and phenobarbital
Logging your Inventory-Daily
• Many practitioners choose to maintain an ongoing log of all
drugs administered or dispensed. This provides an ongoing
count every day of what they have used and what they still
have on hand.
• Perpetual logs are useful and encouraged, and deter theft and
diversion, but do not replace the requirement to have a
specific annual inventory document.
• They are not required by law.
GA Board of Pharmacy Law
• Effective October 2011, the Georgia Board of Pharmacy now
requires that all Schedule II prescription drugs be sequentially
numbered and written on approved security paper.
• Keep a separate file of copies of your Schedule II
prescriptions.
Labels for Controlled Substances
• All controlled substances dispensed must bear a warning
sticker that informs the owner that it is illegal to transfer
controlled substances to anyone other than the patient for
whom it was dispensed.
• Controlled substance samples in FDA approved pre-packaged
containers are not required to be repackaged.
• Controlled substances cannot be dispensed in envelopes,
plastic bags or other unapproved containers.
Rule 700-12-.08
Surgical Standards
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• A licensed veterinarian employed at a veterinary facility must
ensure that the following criteria pertaining to surgical
standards are met if surgical procedures are performed in the
facility:
– Dose and type of anesthesia, and weight and physical
exam findings, as appropriate, must be recorded in the
patient record.
– Name of licensed veterinarian performing the surgery
must be recorded in the patient record.
– A surgery table must be used as appropriate. Such table
must have an impervious surface suitable for cleaning and
disinfecting.
– The surgical area must be clean, orderly, and well
illuminated.
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– All surgery must be performed by a licensed veterinarian
utilizing aseptic technique as appropriate for the
procedure.(e)Surgical equipment must be sterilized in the
following manner:
• Cold sterilization must be limited to instruments used in
minor or other procedures as appropriate, or limited to
those instruments that can not be sterilized otherwise.
• Surgical instruments other than those applicable to 1.
above must be sterilized utilizing autoclave, gas, or
other technique acceptable to the Board.
– Oxygen and equipment for administration must be
available as appropriate.
– Facilities and equipment for resuscitation must be readily
available as appropriate.
Rule 700-12-.09
Examination Area
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• A licensed veterinarian employed at a veterinary facility must
ensure that the following criteria pertaining to the
examination area are met:
– Area must be maintained in a clean and orderly manner.
– Impervious waste receptacle must be provided.
– Disposable towels and a sink must be readily accessible as
appropriate. A sink in a restroom is NOT considered
acceptable.
– The examination table must have an impervious surface
suitable for cleaning and disinfecting.
Rule 700-12-.10
Radiology
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• A licensed veterinarian employed at a veterinary facility must
ensure that the following criteria pertaining to radiology are
met:
– Radiological equipment must be of sufficient quality to
produce acceptable diagnostic images.
– Facility must comply with all federal, state, and local
radiological safety requirements.
– If radiological services are not offered at a facility, referral
radiological services should be made available.
Rule 700-12-.11
Patient Care
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• For hospitalized or sick animals that are maintained in a
veterinary facility, a licensed veterinarian must physically visit
the facility and see each animal daily.
• Patients recovering from anesthesia must be properly
monitored as appropriate.
Rule 700-12-.12
Renewal Statement
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• During the biennial license renewal period, each licensed
veterinarian who is employed at a veterinary facility and
providing veterinary care must state on his or her renewal
application that the facility in which he or she is employed is
in compliance with the minimum standards outlined in this
Chapter.
• Such application form must have clear instructions on how
the applicant is to complete the application subject to this
requirement.
Client Communication
Statistics
• 96% of unhappy clients never contact the business that upset
them
• For each complaint there is approximately 26 unspoken
complaints
• 95% of people that complain with return if the complaint is
resolved quickly
• For every complaint heard- 260 potential clients will hear
about your “bad” service
Nonverbal Communication
• Can account for approximately 60% of your communication
• Negative signals that you might not realize you are exhibiting
– Wrinkled forehead, clearing of throat, LACK OF EYE
CONTACT
– Scratching your head, tinkering with jewelry, rubbing your
neck, shifting weight, arms crossed, cocking head.
• Everybody does these things from time to time, but done in
excess can be a problem
Written Communication
• The written material you provide to your clients has a large
impact on the image of your practice
• Are they typeset and printed professionally
• Prepared Estimates
• Authorization for professional services
– Surgical consent
– Annual blood work
• Standardized medical discharge instructions that you can
modify per patient
– Proper restraint, food and water, elimination, exercise and
activity, medications, sutures, appointments, monitoring,
and any special instructions.
Email Rules
• Consider the purpose of your message
• Keep it short and simple
• Consider legal ramifications
– You can’t ever truly delete and email
• Protect your reputation
– Can be forwarded with your address attached
• Save the email and copy it to the client record
Verbal Communication
• Low, deep tone = more authoritative
• Timing- short pauses can accentuate your point
• Atmosphere
• 60% failure of communication
• Succinctness is critical
• Speaking too much is as bad as not enough
• Keep in mind that we typically only recall 25% of what was
heard from the last few days
• The human brain can process more than 500 words per
minute while the average speech rate is 120-150 words per
minute.
• Speaking to slowly can cause you to lose your listeners
attention, think about what you say before you do.
Communication Skills
• Look For Clues
– If you know how to read nonverbal clues you might be able
to tell what the client in thinking or feeling
• Which may contradict what they are saying
– Pay attention to tone, facial expression, posture
• This may help you clarify the situation before a
misunderstanding occurs
• Show Your Empathy
– Empathetic listening is a process of actively responding to
what clients are saying, either verbally or nonverbally
• Acknowledge that the owner may be feeling nervous
about their pet’s condition
• Make statements to help clients feel accepted
• Speak quietly and slowly in times of sadness
– Offer tissue if you notice them starting to get
emotional
• There are three types of statements you can make to help
clients feel accepted:
– Non-judgmental statements
» You were placed in a very difficult situation
– Normalizing statements
» It’s very common for pet owners to miss these
masses
– Self-disclosing statements
» My cat has behavioral issues too.
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• Ask Open Ended Questions
– . It helps to solidifying client bonds and increase the feeling
of a partnership in veterinary care
– This will help not only to obtain an accurate history but
also to assess clients’ understanding preferences, and
goals for diagnostics and treatments
• Begin with what or how
• Avoid why which can sound accusatory
– Rule of thumb: Ask, don’t tell. In presenting the diagnosis,
ask what the client knows about the disease rather than
jumping into a description.
• This shows the client you value their knowledge and
helps in deciding where to begin your client educations
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– Closed ended questions begin with:
• When, is, did, who, and where
– Results in 1 word answers
• Repeat After Them=Reflective Listening
– Repeating what clients say or imply
• Shows interest in their thoughts and feelings
• Shows empathy and clarifies their understanding
• You may start these responses with standard phrases
such as “So, you’re saying that…” and “It sounds like…”
– Reflective listening can also be communicated
nonverbally, with nods and smiles
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• If you want a pet owner to expound without your input,
try repeating the client’s last word or phrase.
– If a client says, “Fluffy has just been acting crazy,”
you may respond with a simple, “Crazy?”
– The pet owner will instinctively elaborate for you.
• Good communicators can assess reactions by interpreting
body language
– If you aren’t getting appropriate responses, change your
approach.
– Is you language to complicated, is the client distracted
How to improve your skills
• Video tape your interactions in rooms, so you can review
them later to critique yourself
• People want them to appreciate them, listen to them, help
them, use their name, be creative, be honest
• Ask questions, react positively with gestures, facial
expressions and voice tone
• Use simple answers and avoid jargon
• Remain objective
• Remember clients are usually angry with you, they are angry
with the situation
• It is ok to say, “I don’t know, but I will find the information for
you”.
• Try to be aware of client emotional state
• Listening carefully
• Talking is considered active and dominant
• Listening is more passive and respectful
Records
• Keep complete, accurate and legible record
– Write all records within 24 hours of the visit of the pet
– If it is not in record it was not done
– Time and date stamp in computer or paper record then
initialed
– Never erase, white out or cover mistakes.
• Cross out and correct notation with initials
– Standard and approved abbreviations and notations are
acceptable
– Do not disclose the record to anyone without the clients
approval
• Exception would be law enforcement
Humane Euthanasia
AVMA Guidelines
Georgia Law
HSUS Reference Manual
AVMA Definitions
• Euthanasia is derived from the Greek terms:
– eu meaning good and thanatos meaning death.
• The term is usually used to describe ending the life of an
individual animal in a way that minimizes or eliminates pain
and distress.
• A good death is tantamount to the humane termination of an
animal’s life.
• In the context of these Guidelines, the veterinarian’s prima
facie duty in carrying out euthanasia includes, but is not
limited to:
– his or her humane disposition to induce death in a manner
that is in accord with an animal’s interest and/or because it
is a matter of welfare, and
– the use of humane techniques to induce the most rapid
and painless and distress-free death possible.
– These conditions, while separate, are not mutually
exclusive and are codependent.
.
• While recommendations are made, it is important for those
utilizing these recommendations to understand that, in some
instances, agents and methods of euthanasia identified as
appropriate for a particular species may not be available or
may become less than an ideal choice due to differences in
circumstances.
• Conversely, when settings are atypical, methods normally not
considered appropriate may become the method of choice.
• Under such conditions, the humaneness (or perceived lack
thereof) of the method used to bring about the death of an
animal may be distinguished from the intent or outcome
associated with an act of killing.
.
• Following this reasoning, it may still be an act of euthanasia to
kill an animal in a manner that is not perfectly humane or that
would not be considered appropriate in other contexts.
– For example, due to lack of control over free-ranging
wildlife and the stress associated with close human
contact, use of a firearm may be the most appropriate
means of euthanasia.
– Also, shooting a suffering animal that is in extremis,
instead of catching and transporting it to a clinic to
euthanize it using a method normally considered to be
appropriate (eg, barbiturates), is consistent with one
interpretation of a good death.
• The former method promotes the animal’s overall interests by
ending its misery quickly, even though the latter technique
may be considered to be more acceptable under normal
conditions.
• Neither of these examples, however, absolves the individual
from her or his responsibility to ensure that recommended
methods and agents of euthanasia are preferentially used.
Accepted Methods in Companion Animals
• Noninhaled Agents
– Barbiturates and barbituric acid derivatives
• Intravenous injection of a barbituric acid derivative (eg,
pentobarbital, pentobarbital combination product) is
the preferred method for euthanasia of dogs, cats, and
other small companion animals.
– Nonbarbiturate anesthetic overdose—
• Injectable anesthetic overdose (eg, combination of
ketamine and xylazine given IV, IP or IM or propofol
given IV)
Acceptable with Conditions Methods
• Noninhaled Agents
– Barbiturates and barbituric acid derivatives (alternate
routes of administration)
• The IP route is not practical for medium or large dogs
due to the volume of agent that must be administered
and a prolonged time to death.
.
• Inhaled Agents
– Inhaled anesthetics
• Overdoses of inhaled anesthetics administered via
chamber (eg, isoflurane, sevoflurane) are acceptable
with conditions for euthanasia of small mammals and
some other species < 7 kg because most vertebrates
display aversion behavior to inhaled anesthetics
– Inhaled anesthetics may also be used to anesthetize small
fractious animals prior to administration of an injectable
euthanasia agent.
Physical Methods
– Gunshot
• Gunshot should only be performed by highly skilled
personnel trained in the use of firearms (eg, animal
control and law enforcement officers, properly trained
veterinarians) and only in jurisdictions that allow for
legal firearm use.
– Penetrating captive bolt
• Use of a penetrating captive bolt by trained personnel
in a controlled laboratory setting has been described as
an effective and humane method of euthanasia for
rabbits and dogs.
UNACCEPTABLE Methods
• With the exception of IM delivery of select injectable
anesthetics:
• SC, IM, intrapulmonary, and intrathecal routes of
administration are unacceptable for administration of
injectable euthanasia agents because of the limited
information available regarding their effectiveness and high
probability of pain associated with injection in awake
animals.
• Household chemicals, disinfectants, cleaning agents, and
pesticides are not acceptable for administration as euthanasia
agents.
• Other unacceptable approaches to euthanasia include
hypothermia and drowning.
Dangerous or Fractious Animals
• Animals that are unable to be safely and humanely
restrained should be sedated by means of drugs delivered
orally or remotely (eg, darts, pole syringes) before
administration of euthanasia agents.
• Doing so will assist in relieving anxiety and pain for the
animal, in addition to reducing safety risks for personnel.
• There is a variety of pre-euthanasia drugs that can be
administered PO, SC, or IM, alone or in combination, to
render animals unconscious with minimal handling in
preparation for euthanasia
FETUSES AND NEONATES
• Scientific data indicate that mammalian embryos and fetuses
are in a state of unconsciousness throughout pregnancy and
birth.
– For dogs and cats, this is in part due to moderate
neurologic immaturity
• Euthanasia of dogs, cats, and other mammals in mid- or lateterm pregnancy should be conducted via an injection of a
barbiturate or barbituric acid derivative (eg, sodium
pentobarbital) as previously described.
– Fetuses should be left undisturbed in the uterus for 15 to
20 minutes after the bitch or queen has been confirmed
dead.
.
• During ovariohysterectomy of pregnant dogs and cats and
small mammals with altricial (requiring
nourishment)neonates, ligation of the uterine blood vessels
with retention of the fetuses inside the uterus will result in
death of the fetuses.
– The uterus should not be opened for, at least 1 hour or
longer.
• In the case of caesarian section in late-term pregnancy, IP
injection of pentobarbital is recommended for fetuses that
must be euthanized for congenital deformities or illness and
that have been removed from the uterus (creating the
potential that successful breathing may have occurred).
Animal Control, Sheltering, and Rescue
Facilities
• The preferred method of euthanasia in these facilities is
injection of a barbiturate or barbituric acid derivative with
appropriate animal handling.
• When euthanizing animals that are well socialized without
pre-euthanasia sedation or anesthesia, appropriate handling
usually involves two trained people.
– One individual restrains the animal and the other
administers the euthanasia agent.
• When euthanizing distressed, dangerous, or fractious animals,
a sedative or anesthetic should be administered prior to
attempting euthanasia.
• When the necessary restraint can be performed, a preeuthanasia sedative or anesthetic can be delivered IM or PO.
• After administration of the sedative or anesthetic, the animal
is released so that it can return to a comfortable low-stress
location (eg, dimly lighted cage or area) while the drug takes
effect.
• Once the drug has taken effect safe euthanasia agents can be
administered
Humane Society of the United
States
Euthanasia Manual
Criteria to Evaluate Acceptable Methods of
Euthanasia
• Ability to induce loss of consciousness and death with a
minimum of pain and distress
• Time requires to induce loss of consciousness
• Reliability
• Safety of personnel
• Irreversibility
• Compatibility with intended animal use and purpose
• Documented emotional effect on observers or operators
• Compatibility with subsequent evaluation examinations, or
use of tissue
•
•
•
•
Drug availability and human abuse potential
Compatibility with species, age, and health status
Ability to maintain equipment in proper working order
Safety for predators or scavengers should the animal’s
remains be consumed
• Legal requirements
• Environmental impact of the method or disposition of the
animal’s remains
Topics to Consider
•
•
•
•
Sodium Pentobarbital
Pre-Euthanasia Drugs
Verification of death
Unacceptable methods
Sodium Pentobarbital
• Why?: When used in high doses it works to quickly and
completely depresses the animal’s central nervous system,
resulting in death.
– When introduced into the bloodstream, it moves rapidly to
the heart and then into the brain, where is quickly and
painlessly depresses all vital life functions.
– The animal loses consciousness within seconds and results
in clinical death within minutes.
• Stages of anesthesia that each animal undergoes once the
drug has been administered
– Stage I: Voluntary Excitement aka Induction
– Stage II: Involuntary Excitement aka Delirium
– Stage III: Surgical Anesthesia
– Stage IV: Medullary Paralysis aka Irreversible anesthesia
Acceptable Routes of Administration
• Intravenous (IV)
• Intraperitoneal (IP)
– Requires 3 times more drug than IV dosage
– When performed properly, completely painless and can be
more humane than IV in some circumstances
– Used for kittens, puppies, birds, reptiles, small mammals
and small wildlife
– Proper location:
• On linea alba, just below umbilicus
– Landmarks:
» Linea alba, xyphoid, hip joints
» AVOID lower abdomen, muscles, spleen and
liver
.
• Intracardiac
– Excruciatingly painful in a conscious animal
– NEVER administered unless full UNCONSCIOUS
– Fastest most efficient delivery of drugs
• Compromised veins
• Compromised circulatory system
• Sodium Pentobarbital has already been administered IV
or IP and has not effectively resulted in death
– Procedure:
• Determine if pet unconscious after administration of
pre-euthanasia medications
– Palpebral reflex
– Toe pinch reflex-checking for deep pain.
.
• Palpate area where heart beat is felt most prominently
• Reference area having animal in lateral recumbancy,
bending elbow to 45-degree angle and the heart should
be directly behind the elbow
• Longer needle is necessary
• Insert at 90-degree angle, aspirate to confirm location,
inject, leave needle and syringe in place until the heart
has stopped
– If blood is not easily aspirated or if only a quick flash
of bright red blood is observed, then the needle
may be in the heart muscle
» This would be considered an IM injection
which is NOT an acceptable route of
administration
Methods NOT Acceptable
• Intraperitoneal
– Adult dogs and puppies over 5 weeks of age
– Late term pregnancy
• Intravenous
– Jugular vein in companion animals
• Intramuscular, subcutaneous, intrathoracic, intrapulmonary,
intrahepatic, intrarenal, intrasplenic, intrathecal or any other
nonvascular injection site
Where Permitted by Law
• Oral administration can be useful in very difficult or fractious
animals
• Goal:
– Not to fully complete the euthanasia process but simply
get the animal to ingest enough drug to render it fully
unconscious for direct injection of additional sodium
pentobarbital or at least manageable to gain control of the
animal
• Bitter taste
• High dosages of 3 times IV dose
Georgia Law
• Code of Georgia Annotated
• §4-11-5.1 Substances and procedures for euthanasia of dogs
and cats by animal shelters
• Who can perform:
– Licensed veterinarian or physician
– Lay person properly trained in the proper and humane use
of a method of euthanasia under the supervision of a
licensed veterinarian or physician (does not require
veterinarian to be present)
• Who may possess:
– Veterinary clinics
– Animal shelters or other facilities which are operated for
the collection and care of stray, neglected, abandoned, or
unwanted animals
• Method:
– Sodium pentobarbital or a derivative of sodium
pentobarbital
– Any substance which is clinically proven to be as humane
as sodium pentobarbital and which has been officially
recognized as such by the AVMA
.
• *Georgia adopted a law outlawing the use of gas
chambers beginning December 31, 2010
• Emergency Euthanasia:
– In cases of extraordinary circumstances where the dog or
cat poses an extreme risk or danger to the veterinarian,
physician, or lay person performing euthanasia, such
person shall be allowed the use of any other substance or
procedure that is humane to perform euthanasia on such
dangerous dog or cat.
Standards of Care for Early Spay
and Neuter
Early Neuters vs. Testicular Cancer
• Neutering will totally prevent testicular cancer.
• Testicular tumors account for 90% of all cancers originating
from the male reproductive system.
• Most tumors are contained to the testicles, but may spread in
10-20% of the cases.
• Especially prevalent in older dogs, testicular tumors are the
second most common tumor in male dogs.
• Sertoli cell tumors, interstitial (Leydig) cell tumors, and
seminomas are the three most common tumors.
– Seminomas (42%) and interstitial cell tumors (50%) are
most common with sertoli cell tumors being the least
common (8%).
.
• About one third of dogs that develop a tumor will have more
that one of these types of tumors present.
• Other types of testicular tumors (i.e. embryonal carcinoma,
lipoma, fibroma, hemangioma, chondroma, teratoma) can
occur, but are rare.
• Male dogs that have one or both testicles cryptorchid are
much more likely to develop a tumor than dogs with normal
(scrotal) testicles.
– Undescended testicles are at increased risk to develop
malignant behaving tumors (seminomas and Sertoli cell
tumors).
• Tumors of normal descended, or scrotal, testicles are usually
benign.
• Testicular tumors can spread to regional lymph nodes, liver
and lungs.
• Neutering by four months will take care of all these concerns!
Testicular Tumor
Early Spay vs Mammary Cancer
• Early Spays (by four to five months of age) = 98% Decrease In
Mammary Cancer
• Mammary tumors are the most common tumors of female
dogs, accounting for half of all tumors, and are the third most
common tumor for cats.
• They are malignant about 50% of the time in dogs and 80% of
the time in cats.
• The risk of mammary tumors rises quickly with every heat
cycle.
• Spaying by four months can prevent not only mammary
cancer but uterine, cervical, and ovarian tumors as well.
• While the latter are not so frequent as mammary tumors,
they are still very serious when they occur.
• Once a mammary tumor spreads to the lungs or bones, the
cancer will be fatal.
• An unspayed dog is approximately 4 times more likely to
develop mammary tumors than a dog spayed after only two
heats
– 12 times more likely than a dog spayed before her first
year (by 6 -8 months of age)
• An unspayed cat is 7 times more likely than a spayed cat to
develop mammary tumors.
AVMA Policy Statement on
Pediatric Spay/Neuter
• The AVMA supports the concept of pediatric spay/neuter in
dogs and cats in an effort to reduce the number of unwanted
animals of these species. Just as for other veterinary medical
and surgical procedures, veterinarians should use their best
medical judgment in deciding at what age spay/neuter should
be performed on individual animals.
Making Sense of the Studies on Early
Spay/Neuter in Golden Retrievers
•
• The Golden Retriever study from UC Davis has gotten a lot of
publicity, and being used to raise concerns about early
spay/neuter.
• What does it really say, and is it fair to extrapolate this to all
early spay/neuter?
• This study is specific to Golden Retrievers and some issues to
which the breed is prone. The number of affected patients is
small and the authors themselves warn the information
cannot be extrapolated to other breeds.
• The database used was from the University of California's
small animal hospital, a hospital staffed mostly by board
certified veterinary specialists.
•
•
•
Abstract
In contrast to European countries, the overwhelming majority of dogs in the U.S. are
neutered (including spaying), usually done before one year of age. Given the importance of
gonadal hormones in growth and development, this cultural contrast invites an analysis of
the multiple organ systems that may be adversely affected by neutering. Using a single breedspecific dataset, the objective was to examine the variables of gender and age at the time of
neutering versus leaving dogs gonadally intact, on all diseases occurring with sufficient
frequency for statistical analyses. Given its popularity and vulnerability to various cancers and
joint disorders, the Golden Retriever was chosen for this study. Veterinary hospital records of
759 client-owned, intact and neutered female and male dogs, 1–8 years old, were examined
for diagnoses of hip dysplasia (HD), cranial cruciate ligament tear (CCL), lymphosarcoma
(LSA), hemangiosarcoma (HSA), and mast cell tumor (MCT). Patients were classified as intact,
or neutered early (,12 mo) or late ($12 mo). Statistical analyses involved survival analyses and
incidence rate comparisons. Outcomes at the 5 percent level of significance are reported. Of
early-neutered males, 10 percent were diagnosed with HD, double the occurrence in intact
males. There were no cases of CCL diagnosed in intact males or females, but in earlyneutered males and females the occurrences were 5 percent and 8 percent, respectively.
Almost 10 percent of early-neutered males were diagnosed with LSA, 3 times more than
intact males. The percentage of HSA cases in late-neutered females (about 8 percent) was 4
times more than intact and early-neutered females. There were no cases of MCT in intact
females, but the occurrence was nearly 6 percent in late-neutered females. The results have
health implications for Golden Retriever companion and service dogs, and for oncologists
using dogs as models of cancers that occur in humans.
• There may be socioeconomic variables that can skew the
findings. For example, the majority of dogs will never see the
inside of a specialty referral center, either because their
owners can't afford the service or it is impractical for them to
make the travel, or maybe the dogs were just plain healthy
and didn't need specialty services.
• When the data is carefully reviewed, there are several
categories where spayed or neutered dogs actually scored
better than intact Goldens.
• The authors made this generalization from their study: “For all
five diseases analyzed in the present study, the disease rates
in males and/or females were significantly increased when
neutering was performed early and or late.”
• This generalization is much too broad and conflicts with the
data reported.
• Every breed is predisposed to its own unique list of medical
conditions, so studies within a single breed cannot be
extrapolated to other breeds.
• The number of dogs affected in each category was fewer than
20, with some in single digits.
• Compare this to the millions of companion animals at risk of
euthanasia in shelters, or those impacted by mammary
cancers, pyometra (infection of the uterus), or puppies, and
sometimes mothers, lost to difficult deliveries.
• There are other recent studies that show the benefits of early
spay/neuter that cover a much larger sampling.
• A 2013 study from the University of Georgia shows that
neutered and spayed dogs live 14% and 23% longer,
respectively, than intact dogs.
• The Georgia study looked at more than 70,000 dogs and 185
different breeds, thereby lending it more validity.
• Those results were backed up by an even more recent study
from Banfield that shows neutered dogs live 18% longer and
spayed females live 23% longer
• According to the Georgia study, spayed and neutered dogs are
dramatically less likely to die from infectious disease, trauma,
vascular disease, and degenerative disease than intact dogs.
• The UC Davis study fails to mention or compare the protective
effect preventing mammary cancer by spaying dogs before
their first heat.
What is the earliest you can spay/neuter kittens and
puppies?
•
• For puppies and kittens in a shelter situation, they may be
spayed or neutered as early as eight weeks.
– Approximately 2 pounds
• One of the main reasons for altering them at this age is so
they can find loving permanent homes as quickly as possible.
• Shelters have an obligation, and are often required by law, to
spay or neuter every pet before it is adopted.
• Veterinarians attending to shelter kittens and puppies are
quite experienced in pediatric surgery ensuring their safe
care.
• Even though youngsters in this group may have been
vaccinated one or more times, and may already be spayed or
neutered, the new adopted family will still need to take them
to their veterinarian for a general health exam and finish up
their vaccination series, which typically concludes around 12
weeks or so for kittens, and around 16 weeks for puppies.
• What can be said for sure is that spaying or neutering is
recommended by the age of 4 to 5 months.
• This will prevent accidental litters, avoid any heat cycles, and
markedly reduce the likelihood of mammary cancer.
• Early age surgery is safe with fewer post-surgery concerns, is
less stressful on the patient, provides a quicker recover time,
and is generally less expensive than later age spay/neuter.
• Although there are always variations, cats can have their first
heat as early as 4 months old
• Dogs can have their first heat as early as 5 to 6 months old
• With 50% of litters being accidents, you can see how
unwanted litters can add up quickly.
• Pregnancy at an early age can be tough physically, but can
also start a cycle of babies having babies.
• Cats can have up to 3 litters a year with an average of 4 kittens
– Many people don’t know that the new mom can become
pregnant again while still nursing a litter!
• Dogs can have up to 2 litters a year with an average of 4
puppies
AVMA Support
• The AVMA supports the concept of pediatric spay/neuter in
dogs and cats in an effort to reduce the number of unwanted
animals of these species.
• Just as for other veterinary medical and surgical procedures,
veterinarians should use their best medical judgment in
deciding at what age spay/neuter should be performed on
individual animals.
PetSmart Charities study
• PetSmart Charities shows us how people’s attitudes toward
spay/neuter are based on incorrect assumptions.
• The study uncovered a real problem among unaltered cats,
showing that 19% of the feline population has had at least
one litter.
• Furthermore, the research shows that 59% of these litters
were unintentional “accidents” — a full 10% increase from
when this survey was first conducted in 2009!
• The main reason respondents chose not to spay/neuter their
recently acquired pet, the study shows, was that they
believed their pet to be too young.
• More specifically, it was shown that 72% of recent adopters
estimated that pets needed to be 6 months of age or older, or
simply didn’t know when the operation was safe.
• Furthermore, 81% of potential adopters thought 6 months
was the earliest age possible, or didn’t know when
spaying/neutering was safe.
Bad Behavior
• Spaying/neutering early helps eliminate annoying behaviors
like spraying, roaming, yowling, and fighting. Not to mention
stopping heat cycles.
• Spaying and neutering early stops many unwanted behaviors
from even starting in both cats and dogs.
• For example, female cats can go into heat up to ten times in a
year, and the heat cycle can last up to 2 weeks.
• That means that for 20 weeks a year you could be dealing
with the thrashing, the howling, the flirting, and the escape
attempts that go along with having an intact female cat!
• Male cats and dogs that have not been fixed have a strong
desire to mark their territory by spraying strong-smelling
urine.
• They constantly roam in search of mates, which makes them
more likely to get hit by a car, and they are likely to get in
fights with other males to compete for mates.
• Female dogs can also become aggressive during their heat
cycles, which can pose a risk to other animals and small
children.
• Taking away the desire to breed at an early age, however,
does not take away your pet's beloved personality.
• Your male cat or dog’s sense of manliness won’t disappear
either.
• Animals have no concept of their sexual identity, so Spike isn’t
going to suffer any kind of identity crisis once he’s neutered.
• By eliminating the sexual drive that can cause a dog to bolt
from the house or yard, neutering helps protect dogs from
injuries and diseases associated with roaming in search of a
mate.
• Neutering decreases roaming, one study found, in 90 percent
of male dogs.
– On the loose, a dog may be hit by a car, harmed by an act
of cruelty, or infected with a disease transmitted by
another animal.
– He can also be seriously wounded in a dog fight - always
less likely if a dog has been neutered since neutering
reduces aggressiveness toward other male dogs
Help stop teenage pregnancy! Early-age
neutering in cats.
Joyce A1, Yates D.
PRACTICAL RELEVANCE:
• Neutering kittens at an early age, typically between 6 and 14
weeks, has received increasing attention and gained
prominence in recent years, particularly in the United States
and in shelter medicine in the UK. However, in private practice
it has yet to be generally endorsed.
GLOBAL IMPORTANCE:
• Among many of the animal welfare charities, early neutering
is seen as a crucial step in conquering and controlling cat
overpopulation.
CLINICAL CHALLENGES:
• Physiological differences between kittens and adult cats are
very important to consider before undertaking elective early
neutering. Increased sensitivity to drugs, prolongation of
effects and a limited capacity for cardiovascular compensation
are the principal anaesthetic concerns in kittens.
EVIDENCE BASE:
• The optimal age for neutering, traditionally deemed to be
between 5 and 8 months, is now questioned, as short- and
longer-term studies demonstrate no significant behavioral and
physical advantages conferred by traditional-age neutering.
• Furthermore, a number of safe anesthetic and surgical
protocols have been documented that produce lower
morbidity and similar mortality rates in early-age neuters
compared with traditional-age neuters.
Effect of age at gonadectomy on the probability
of dogs becoming overweight
Lefebvre SL1, Yang M, Wang M, Elliott DA, Buff PR, Lund EM.
OBJECTIVE:
• To determine whether gonadectomy or age at gonadectomy
was associated with the risk that dogs would subsequently
become overweight.
DESIGN:
• Retrospective cohort study.
ANIMALS:
• 1,930 dogs gonadectomized between 1998 and 2001 at ≤ 6
months of age (n = 782), > 6 months to ≤ 1 year of age (861),
or > 1 to ≤ 5 years of age (287) and 1,669 sexually intact dogs.
PROCEDURES:
• Dogs were followed-up through medical records for ≥ 10 years
or until a diagnosis of overweight (defined as overweight,
obese, or having a body condition score ≥ 4/5) was recorded.
Information extracted included age at study entry, sex, breed,
breed-size category, hospital visit frequency, and diagnosis
(yes or no) of overweight or diseases that might affect body
condition. Relative risk of a diagnosis of overweight was
assessed among age groups of gonadectomized dogs and
between gonadectomized and sexually intact dogs.
RESULTS:
• No difference was detected among dogs grouped according to
age at gonadectomy with respect to the risk of being
overweight. This risk was significantly greater in
gonadectomized dogs than in sexually intact dogs, but only
during the first 2 years after gonadectomy. Sexually intact
male dogs were approximately 40% less likely to have this
diagnosis (hazard ratio, 0.61; 95% confidence interval, 0.52 to
0.72) than were sexually intact female dogs; no difference in
risk between the sexes was evident for gonadectomized dogs.
CONCLUSIONS AND CLINICAL RELEVANCE:
• Gonadectomized dogs had a greater risk of being overweight
than did sexually intact dogs, but this risk was not influenced
by age at gonadectomy. Opportunities exist for veterinarians
to provide counseling during the first years after gonadectomy
to help dogs maintain a healthy weight.
Pedicle ties provide a rapid and safe method for
feline ovariohysterectomy.
Miller KP1, Rekers W2, Ellis K3, Ellingsen K2, Milovancev M4.
J Feline Med Surg. 2015 Mar 13.
OBJECTIVES:
• The specific objectives of the present study were to evaluate
the rate of hemorrhage-related complications across a large
number of feline pedicle tie (PT) procedures, and evaluate for
a difference in surgical time between traditional pedicle
double ligation (PDL) and PT procedures.
. RESULTS:
• Six of 2136 (0.281%) cats experienced a hemorrhage-related
complication associated with the ovarian pedicle. Five of the
six ovarian pedicle hemorrhage-related complications were
recognized and corrected intraoperatively, with the remaining
hemorrhagic event being detected postoperatively. Surgical
times were significantly shorter in PT kittens compared with
PDL kittens (4.7 ± 0.1 mins vs 6.7 ± 0.1 mins) and PT adult cats
compared with PDL adult cats (5.0 ± 0.2 mins vs 7.0 ± 0.2
mins).
CONCLUSIONS AND RELEVANCE:
• This study demonstrates that the PT technique is associated
with a very low risk of hemorrhage-related complications and
is significantly faster than double ligating the ovarian pedicle
in kittens and adult cats. Use of the PT technique has the
potential to be of significant economic benefit in institutions
performing large numbers of feline ovariohysterectomies.
Guidelines for Preoperative Care
• Patient transport
– Proper confinement and security of enclosures
– Environmental temperature regulation
• Heating and cooling, proper ventilation
– Verification of identity of patients
• Name bands, collars, microchip
– Continuous monitoring
• Patient selection
– Owned animals should be 4 months of age to allow for
development of immunity
– Shelter animals can be as young as 6 weeks of age
– Physical examination
– Staffing, economics
• Client communication
– Client confirmation of patient’s health
– Acknowledgement of risk of infections disease exposure
– Acknowledgement of risk of anesthesia and surgery
including death
– Authorization for surgery
– Recommendation of ongoing health care at full-service
veterinary clinic
– Client contact information
– Description of fees
– Other vaccines as per AAFP, AAHA recommendations
• Record keeping
– Comply with state and local practice acts and guidelines
– Medical record
• Vaccination
– Rabies should be required
• Withholding of food but not water
– Pediatric-feed 2-4 hours prior to surgery and should not be
withheld for more than 4 hours after surgery
– Juvenile and adults should have food withheld for a
minimum of 4 hours but more than 6 is not warranted
• Physical examination
– Verification of sex and reproductive status
– Body weight
• Patient housing
– Identification
– Adequate temperature and ventilation
– Housing properly cleaned and disinfected
– Littermates may be house together
– Feral animals should be housed in traps
• Infections disease control
– Proper cleaning of equipment in direct contact with
patients
– Anesthesia breathing circuits should be cleaned weekly
– Staff hygiene
• Equipment
– Properly maintained
– Scavenger system-active and passive
• Charcoal canisters changed every 8 hours or
determined by weight of canister
Guidelines for Anesthetic Procedures
• Perioperative and intraoperative thermoregulation
– Limit direct contact with cold surfaces
– Limit body cavity exposure
– Protected contact with external heat sources
• Avoid heating pads, heat lamps, blow dryers, drying
cages and hot water containers
– Minimize hair removal and moistening of skin in pediatric
patients
• Oxygen supplementation and ventilation
– Mask-2-5 liters/minute
.
• Fluid therapy
– When needed subcutaneous or intravenous
– Should be warmed
• Monitoring
– Pulse quality, rate and rhythm
– Respiratory rate and pattern
– Jaw tone
• Moderately relaxed is indicative of a surgical plane of
anesthesia
– Eye position and pupil size
• Moderate ventral strabismus of both eyes is indicative
of a surgical plane of anesthesia
– Palpebral reflex
• Mildly sluggish or slow is indicative of a surgical plane
of anesthesia.
• Anesthetic protocol
– Multimodal
• Provision of analgesia or a lack of pain
• Stress reduction
• Immobility or muscle relaxation
• Safe, controlled reversible depression of
CNS=unconsciousness
.
• Administration of analgesics
– Alpha-2 adrenoceptor agonist
– NSAIDS
– Local anesthetics
– Opiods
• Anticholinergic agents
– Not recommended as part of routine protocol
• Induction and maintenance of anesthesia with inhalant
anesthetics
– Mask administration of inhalant anesthetics for induction
or maintenance of anesthesia should be minimized
–
hi
• Mask induction should be avoided
– High degree of stress
– Loss of consciousness is poorly controlled
– Severe sympathomimetic effects and bronchial
irritation
– Increased risk of aspiration of gastric contents
– Expense
• Mask maintenance should be used only for short
periods of time
• Preparation for emergencies
– Crash cart
– Emergency drug charts which contain volumes of drugs per
body weight
– Staff training for CPR
• Accurate drug calculation and administration
– Dosing chart based on weight
– Keep in mind to account for health status for dosing
administration
• High-risk patients
– Based on history and physical examination
– Brachycephalic
– Geriatric
• Intubation
– Does not necessarily need to be part of protocol, but
should be available if needed.
Guidelines for Surgical Care
• Operating-area environment
– Dedicated area
– Scheduled cleaning and disinfection policy in place
– Traffic limited
• Surgical-pack preparation
– Separate sterile instruments for each patient
– Cleaned and sterilized by steam, gas or plasma
• Indicator strip
• Double wrapped packs
• Patient preparation
– Bladder expression
– Skin
• Hair removal and skin disinfected
– Draping
• Required for all abdominal procedures and castrations
– Exception is pediatric castration
• Surgeon preparation
– Surgical attire
– Surgical caps and masks
• Required
– Surgical hand and arm scrub
• Required
• Approved waterless surgical prep agents are acceptable
alternatives to traditional scrub techniques
– Surgical gowns
• Recommended but not required
– Surgical gloves
• Sterile single use gloves are required for all surgeries
except for routine cat castration
• Suture materials
– Sutures or surgical clips
• Surgical procedures
– Acceptable
• Female-ventral midline, flank, laparoscopic
– Ovariohysterectomy and ovariectomy
» Closure must incorporate the external rectus
fascia
• Male-prescrotal, scrotal
• Interrupted or continuous suture pattern for abdominal
closure
• Scrotal incisions for pediatric castrations can be
sutured, glued or left open for second intention
healing.
• Identification of neutered animals
– Unilateral ear tipping for feral cats
– Tattoo
• Directly to the surgical incision after SQ closure
• Cutaneous incision other than surgical incision
• Intradermal injection of tattoo ink
• Tattoo gun with sterile needle for each patient
• Use of antimicrobials
– Routine perioperative usage is not recommended
– Specific indications acceptable
Guidelines for Postoperative Care
• Patient transport within the clinic
– Safe delivery to and from the recovery area
• Minimize stress, maintain thermoregulation and airway
• Recovery
– Minimize complications
– Continuous direct observation
– Pediatric patients best recovered with littermates
• Analgesia
– If not administered prior to during surgery
• Anesthetic reversal
– At veterinarians discretion
• Thermoregulation
– As previously described
• Kennel environment
– Under supervision water and food should be offered as
soon as patients are ambulatory
– Encourage urination and defecation once ambulatory
• Release
– Evaluate immediately prior to release
– Provide written post operative instructions for owner
Anesthesia Protocols
Humane Alliance a program of the ASPCA
• Feline single injection protocol
– Dexdomitor, Telazol, Morphine
– Previously Dexdomitor, Morphine, Ketamine
• Maintenance
– Oxygen 1.5%, Isoflurane max 1-2% via mask
• Anecdotal research indicates that Iso levels greater
than 2% can cause laryngospasm in “masked” cats
• Pain Management
– NSAID
• Meloxicam if over 4 months of age
• Buprenorphine transmucosal if under 4 months of age
• Local anesthetic
– Splash linea block
• Bupivacaine
• Reversal if needed
– Naloxone, Antiseden
• Canine
– Premed
• Acepromazine, Morphine
– Induction
• Ketamine, Diazepam/Midazolam
– Maintenance
• Isoflurane/Oxygen via endotracheal tube
– Pain Management
• Meloxicam
• Local anesthetic
– Testicular block
• Lidocaine or Bupivacaine
– Splash linea block
• Lidocaine/Sterile water
• Reversal if needed
– Naloxone
Questions:
[email protected]
[email protected]