Transcription
Veterinary Medicine for Assistants 101. I'm Bianca. Hey, I work at a low-cost animal medical center and I created this PowerPoint as a means to have something to go back on, just besides paper. But also, like, hearing the sound of a person talking sometimes, it's easier to retain information than like reading a bunch of slides. So here we go.
So one of the first things to know that's really helpful is understanding the scope of practice. So like, what is the difference between a veterinarian and an RVT, and they're not on-the-job training technician versus an assistant? So a veterinarian is a DVM, a Doctor of Veterinary Medicine. Veterinarians attended an undergraduate college and then were accepted into a veterinary school, a four-year school. They after they graduate, they sit for an exam, they take state boards, and they are given a license from the state to practice veterinary medicine. The main things that veterinarians do that no one else can do legally is to perform surgery, to diagnose patients, and to prescribe medications. So veterinarians look at all the pieces of diagnostics to fit into a puzzle to determine what is wrong with the patient and what actions need to be taken to fix that patient, whether that be medication, surgery, or both. So those are really the main things that veterinarians should be spending their time doing: diagnosing, prescribing, surgerizing.
RVTs, that stands for Registered Veterinary Technician. So these are people that have attended a veterinary technology school, which the program itself is a two-year program, and there's usually about a year of prereqs, so it's around three years total. Once they finish school, they take a State Board Exam, and they are licensed by the state to be a registered veterinary tech. In the state of Louisiana, which is where we live, there are currently no requirements to hold a license as an RVT. Other states, there are rules and regulations as to what a person is limited to do if they don't hold an RVT license. Louisiana is currently not one of those states. There are lots of potential legislations out there for different states that allow on-the-job trained technicians to do things just as much as RVTs can do. In the future, this will be a position that is only doable with an RVT license. Currently, Louisiana is not one of those states. So anything that an RVT can do, anybody else in the hospital can do.
So that brings us to OJT's. So OJT's is short for like, on-the-job trained. These are either like technicians or assistants. So on-the-job trained staff are people who have no formal education in veterinary medicine and they've learned by working under experienced and educated veterinary professionals. There are amazing on-the-job training technicians out there. Even though I am an RVT, I was an OJT first. I was an on-the-job training veterinary technician for years before I went to veterinary technology school. Some of the best technicians I've ever met have been on-the-job trained. Skill has no educational limit, but it's important to be, even if you don't have formal education, it's important to be as knowledgeable as you can be on the things that you do, and not just know how to do things, but why we do things. And the job-trained techs and assistants play a very vital role in the hospital. Just because they lack formal education does not make their position any less important.
So working with animals is awesome. Like, everybody at one point in their lives was like, "I want to work with animals." Like, I mean, it's dope, it really is. It's the coolest. But even though it's cool, and the majority of our patients are very happy to spend time with us, it can come with risks. And because of this, we always want to use the most safe and humane handling techniques, both safe for us as handlers and safe for the patients. So 99.9% of the animals that we see come through the door are not truly aggressive. But it seems that way when you're working with dogs that are biting, or cats that are scratching and hissing, or dogs that are growling or snapping or snarling. But in reality, these are not the patients that are aggressive. The main reasons that patients growl, snap, bite, scratch, hiss are because of pain and fear.
So fear is that primary motivator that you see with these cats and dogs that are labeled as like "will bite" or "cautions." This is a little organization called Fear Free that you can see in a little corner, that's their logo. They offer online trainings for veterinary professionals about canine behavior and fear behavior and restraint techniques, and not just physical restraint, but chemical restraint and tips and tricks. And it's about $300 and something bucks for their Level 1 class. So it's kind of pricey, especially if you're like on a technician budget. But it's definitely worth it if you were ever interested or had a little extra money or like wanted to treat yourself. I recommend everybody take a Fear Free course.
So how do we know if our patient is afraid? A lot of people that think of an aggressive or fearful dog, or a dog that is potentially has the potential to bite, everybody thinks of like the big grand gestures, right? Like the raised hackles, the growl, the head pulled low, like all these big, huge, glaring warning signs. But before we ever get there, and some dogs never get to that point of demonstrating with body language their fear, before we ever get to the big grand gestures of snapping, growling, snarling, we have little tiny micro signs, like subtle signs of body language that to other dogs are very like, well-spoken language of like, "Hey, I'm uncomfortable." In the dog world, like other dogs see it, they're like, "I got you. I understand you're communicating perfectly." But we as people, we just tend to overlook these things because they seem so small.
So fearful dogs exhibit a bunch of displays of body language. Even like very innocent things, like a hunched body and lowered head. Like we can physically see those are signs of discomfort. But then there are things like yawning and lip licking. Yawning and lip licking are appeasement gestures that dogs use when they're scared to let other dogs know that they're not a threat. It's just a submissive appeasement body language, and it says like, "Please don't hurt me because I'm not gonna hurt you, and I'm scared that you're about to hurt me." You also get things like crescent moon eyes. So if you look at our little brindled boy in the top right corner, he's kind of looking to the side, and you see the whites, the sclera of his eyes, they make that crescent moon shape. So you'll see that a lot in nervous dogs where their eyes get big, and they'll look from side to side, and you'll be able to see the sclera of the eye in that crescent moon shape. Pulled back ears. So even happy dogs will sometimes have pulled back ears. So again, it's hard to tell. Even things like wagging of the tail. A wagging tail does not necessarily mean that we're a happy dog. It means that we're a dog that is alert. It doesn't always mean I'm ready to play. Also, like the wrinkled forehead. Somebody once described this to me as like the Justin Timberlake look. But you'll see like the wrinkled forehead or like the pulled up eyebrows. But these are just small, tiny things that dogs do that in the dog world is like big, glaringly obvious. And to people, we just like consistently overlook it. And then when the dog is lunging and biting, it's like, "Whoa, that came out of nowhere." But in reality, it didn't. Our dog and our patient has been telling us for like the last five minutes, "Yo, bro, I'm uncomfortable," and we've just kind of been oblivious to it.
So lucky for us, it's a lot easier to look at a cat and judge if it's fearful. Their body language to human beings is less subtle than fearful dog body language can be. Typically, if a cat is comfortable, it's very obvious. Versus if they are a little nervous, you'll typically get the flat ears or maybe a little raised fur on the back. They won't really move. They'll kind of stay in one spot. They'll stay really low. Maybe they'll be pushed to the back of their kennel. They're not coming to the front. But the difference between cats and dogs is is that a fearful dog only has one offensive weapon, and that would be either teeth versus their dog's paws, which their nails are pretty blunt. And dogs usually use their paws for defense, not offense. Versus cats who have five offensive weapons and zero defensive weapons. So a cat, and the cat's mouth and all four paws will do some some damage, right? They don't have any defense. Cats are offense all the way. So handling nervous, fearful, painful cats is a little tricky because every end of this cat can do some damage.
Alright, let's discuss the approach. So how we approach our patients is really important because it really like sets the mood for how the rest of this patient is going to be for the remainder of their visit. Anytime we're approaching an animal, we always want to use slow, confident movements. We never want to move fast around a patient that we're just meeting, and we never want to kind of nervously like do that thing where you're like, "You go, but then you're a little nervous that you pull back, and then you go again." And like, they can kind of feel that, and they're like, "Whoa, why are you nervous? Why are you freaking out? Should I freak out because you're freaking me out?" Kind of a thing. You also want to try to avoid like leaning over a patient. It's really uncomfortable. Like imagine like a giant person just like hovering over you, and you don't know them, and you're in a space that you've never been in before. Like, it just can be super nerve-wracking to have some stranger in a strange space like hover over you. So we don't want to like loom over patients or stand over them. That also goes for like reaching out for patients. Sometimes in appointments, we don't really have a lot of time. I mean, unfortunately, scheduled every 15 minutes, so we don't have this huge amount of time to like become best friends with our patients and wait for them to get comfortable and then let them come to us. But what I like to do is when I go into an exam room and I'm about to get my patient history, I don't really go for the patient first. I will acknowledge the owner and speak to the owner and start getting my history, and then maybe sitting on the floor or opening a carrier and allowing the patient time to hear my voice and get used to me in the room before I immediately start reaching for them to do things to them. It just gives them a moment to read the situation and see that everything is for the most part pretty cool.
If you go into a room and a patient is immediately avoiding you, they want to be invisible. Don't acknowledge them. If I feel that when I walk into a room and either a patient is unbelievably nervous, or if I try to make contact with a patient and I can tell that he is just like five steps away from completely losing it, I will make the decision to do everything at once. Meaning, instead of handling him to get his TPR, to get his heartworm test, or to get his fecal, and then letting him go, and then getting him again later for the doctor to come in and do their exam and their vaccines. For patients that I feel are like teetering on the edge of like completely losing it, I will just wait to get all my samples until the doctor comes in the room. Then, in one fell swoop, it will be a TPR, fecal, a heartworm test, and vaccines. That way, this patient only has to deal with one set of human contact, and then they don't have to worry about it anymore. Because once you wind patients up, sometimes it's it's hard to get them to come back down. So learning how to read a patient during the approach is a skill that takes time. But once you get used to it and learn and see and become experienced, it's gonna be a lot easier for you to wait a little extra time to get everything done at once.
Whenever we're taking a patient from a client, example for like drop-offs or like for surgeries, I try to have people avoid standing over a dog and then putting a leash on them from the front. Again, this goes back to like not leaning over a patient or hovering over a patient. It's uncomfortable and jarring. So when you apply the leash, kind of stand to the side of the dog and then loop it from the side, so you're not coming to their face. It just makes them more comfortable. And for little dogs, if I'm taking a small dog from a client, I have them pick up their small dog and hand them to me, but first, because being picked up and handed to a person that you don't know with outstretched arms is terrifying for some animals. So when the owner puts them, but first, and so they're handing the dog to you with their backside, all the dog sees is their owner, and it's more comfortable for them to be handled that way. It's not scary as opposed to like being handed to some giant stranger. And I just briefly talked about the carrier. I always like to open the carrier and give the patient a few seconds to decide if they want to come out or not. And if they don't want to come out, if they're in a soft carrier, I like to just unzip it and take them out from the top instead of dragging them out. Hard carriers can be very cumbersome and take a lot of time to undo. But if it's a snap-top carrier versus a twisty screw-top, you'll know what I'm talking about when you experience it. If it's a snap-top, I'll pop the snaps and let them out. But if it's a screw-top, unfortunately, it just takes too much time in a 15-minute appointment slot. So I slide them out. But what you never, ever, ever, ever, ever should be doing with a patient in a carrier that won't come out, it's flipping the carrier upside down and shaking the cat out. This is a bad habit that I've seen a lot of people in different practices use. I hate it. It's horrifying. It should never be used in practice. Like, you are just making that animal completely terrified. It's terrifying to be hung upside down and shaken out of a carrier. That is just not something to ever have in your toolbox. And if it's something that you do have in your toolbox, please erase it from your memory.
Also, treats are your friends. So especially for dogs, a little treat encouragement, using some snacks will always work out better if they're food-motivated. Now, some patients will not be food-motivated. Some patients don't give a about food. But treats are really using to your advantage. You can get animals to do a lot with some treats. But always ask the owner before you give a treat because some dogs have food allergies. And always ask an owner if they have a peanut allergy if you're planning to use peanut butter with your patients. I've heard horror stories of like people using peanut butter on a puppy for vaccines and like not telling the client and then returning the the puppy back to the client and then the puppy licks the client's face and now their client's like breaking out in hives. So always ask if it's okay to give something before you give it.
Restraints. So this is something that is gonna be taking a lot of your time. This is one of the things that you're gonna be doing the most working in the veterinary hospital as an assistant is restraining animals. It is for some people, it comes easy. For some people, it takes a lot of time and finesse to get right. But there are three main types of restraint. So the first type of restraint is psychological. So this is like soothing voices, petting, scratching, just things that you would do to like make a dog comfortable, like talking to them sweetly, not using any loud voices, scratching by the night behind the ears, scratching the base of the tail, just letting them be comfortable and be reassured. This is not something that you can just use alone, but it's great to use in conjunction with the next form of restraint, which is physical.
So physical restraint. This is the primary mode of restraint that we use. So this is using our bodies, our hands, muzzles, leashes, towels, things that we use to keep a patient safe and restrained during exams or procedures. Pair this with psychological restraint, it gets you far. And then the last form of restraint is chemical restraint. So chemical restraint is restraint in the forms of things like sedatives and tranquilizers, which should really always be used anytime you have like a painful patient. Sometimes you'll wherever you may be in practice, wherever practice that you may work at, you may come across a veterinarian who asks you to do something painful on a patient, and it just slips their mind, like clipping a deep wound or or putting on like a bandage or a splint or something like that. Or like in any kind of anything that it can be super painful. Always advocate for your patient and say, "You know, this patient's really painful, can we give him something, a little sedative, a little opioid, a little something to take the edge off?" Like, chemical restraint is your friend. And never be afraid to bring it up to your doctors to ask, like, "Can I get a little Dexdomitor up in here? Can I get a little buprenorphine for this cat?" Because pain control or sedation is gonna be your friend when it's you who has to handle the painful animal. And when it comes to fractious animals, like animals who are so fearful that they are dangerous, always never be afraid to say, "Like, I'm very uncomfortable handling this big dog that is lunging at me. I would prefer if we would give it some of that good good so he can calm down a little." Like, chemical restraint is amazing. It's excellent. We have a wide availability of options for chemical restraint. Use it to your advantage. It's easier for you, it's better for your patient. Imagine if you were so terrified going somewhere, but then somebody gave you some Valium, eased your anxiety. I have to take Valium to go to the dentist. Like, think of it that way. Like, it's easier for everyone involved.
Alright, physical restraint. The thing that you're gonna be doing most with every patient that comes in the door. So the goal to get physical restraint right is to rely on the technique and not the strength behind the grip. Okay? You're working smarter, not harder. It truly is about technique. It doesn't matter how strong somebody is or how big somebody is. A very tiny, meek, and mild person could have better restraint on a 50-pound wild dog than some buff dude because it's not about how tough you are. Because rough handling will always provoke retaliation. If you hold on to that patient tight or hard, and they start to struggle, and your response is that you hold them harder, their fight or flight is gonna kick in, and they are going to just immediately respond to either try to bite or to get away. They don't understand why they're being held. You can't explain to them, like, "Bro, if you just calm down for like five minutes, it'll all be over." So the technique is is what's important. Anytime you have a painful patient, put a muzzle on him, even if he's sweet, because the second that you start manipulating the wound or the break, they could just turn around and snap because it hurts.
Towels and blankets for fractious or nervous cats or dogs. It's great, especially for cats. They love to be alone in small, dark spaces. If you got a bad cat, or a cat that's nervous, or any cat in general, pop a towel over its head, wrap them up a little bit. They feel so much more secure. Scruffing is a controversial subject. My personal practice, I try to avoid scruffing if necessary. However, if you're inexperienced with animal handling, learning how to safely restrain a cat without scruffing takes a lot of skill and finesse. So if you have to scruff in order to get a good hold, that's not a problem. The head hug is the primary method of restraint for dogs. This is the restraint move that you're gonna do for most of your procedures, like even for holding for an exam, for holding for a temperature, for holding for a fecal, for holding for vaccines, for venipuncture. Like, this is pretty much your primary go-to dog restraint technique. So how it works, you can see in this little picture here, but please see me or somebody experienced for a demonstration if you need, if you want like more hands-on. What you're gonna do is you're gonna place the patient close to your body from one side. So either the patient's left side will be against your body, or the patient's right side will be against your body, depending on how you want to hold him. With one arm, you're going to head hug. So basically, you're gonna wrap your arm around that patient's head, and your elbow is going to be what's going to keep that patient still, not the strength of the grip of the head hug. We're not doing a chokehold here. No pressure is on our patient's neck at all. We, when we're holding our patient, we're keeping our elbow high, so we're creating less space for our patient to be able to move. The closer the patient is to your body and the higher your elbow is, the less space that patient is allowed to have with movement. If you're doing a head hug and you drop your elbow all the way down, I want you to just look at this dude in this picture, and I want you to imagine if his elbow was all the way down. That patient has so much room to move his head, to turn around, to get loose. Keep the elbow high, the body close. If you're on the floor with a patient, like a big dog, and you're doing the head hug, but their back end is starting to like get away, or their back feet to push, take the leg that's closest to their backside. So if we're, if our patient's on his right side, and we're holding with our right elbow, we're gonna take our left leg and put it behind the patient with a knee bent, so that way when that patient's backing up, they're backing up into your leg, and they're not getting any leverage to escape. Or you can do this restraint on the floor in front of a wall. So if your patient's trying to back up, they really can't because there's a wall behind them. They're not gonna get any leverage to go anywhere. This is kind of difficult to explain in words, but I will happily go through this with a dog with you a million, eighty thousand times, would you just grab a dog and just go at it. So please, this is something that everybody needs to get good at, and it takes technique, not strength.
Okay, lateral recumbency is just a fancy way to say like, lying on your side. So there are a lot of like, medical directional terms in veterinary medicine, and that over time you'll come to understand how they relate to like the real world. So lateral means side, recumbency means laying down. So whenever we have a patient in lateral recumbency, we have them laying on one side of their body, either on the ground or on the table. Whenever we're restraining for lateral recumbency, the two, the things that the most important things is you want to have your hands restraining the front and back leg that are on the ground. So if your patient is in right lateral recumbency, meaning they're laying on their right side, you want to be holding onto their right back and front leg. If you're holding onto the top leg, they're gonna be able to use the bottom leg, the leg that's closest to the floor, to just get up. Those are the legs that have leverage. So if you see in these photos, these people are restraining the dogs, holding the leg that's closest to the floor. For the little dogs, it's easy to get them into lateral recumbency. You can kind of just pick them up and place them there, and then your hands are gonna go over the patient and hold on to their bottom front and back leg. For larger dogs, there's a little technique that you can do to get here. So if you can get a patient to like lay on their belly and then kind of roll them over onto their side, this is good for like really well-behaved patients. The majority of your patients are not gonna be like, "Oh, I'm gonna lay down and I was gonna let you roll me over." Like, most the time they're like, "Yo, bro, what are you doing?" But there is a technique where you, if you look at the girl in this first picture, she's kneeling on the ground, and she has the dog at whatever side she wants recumbent. So it's on this picture, this dog's left side, this little tiny curly dog, his left side is against her legs. And while he's standing up, you're gonna grab the left front and back legs, so the legs that are closest to you. And now with those legs, you're gonna take those legs and slowly slide the patient against your thighs and roll them on to the floor. So they've transitioned from their left side on your thighs to now you've slowly rolled them to their left side is now on the floor, and you're holding their left front and back leg. You know what, I'm probably gonna make some videos, so stay tuned, there will be videos for this too. But also, please come see me if you want to practice this.
Okay, so with cats, less is more. I mean, for pretty much every patient, like less is more because this is again about technique, not strength. But cats don't really like to be with that much. I say in this PowerPoint, I'm gonna say in this PowerPoint. So towels are your friend, like I mentioned earlier. Cats like to be covered, they like to be in dark spaces. I love towels. There's also a spray called Feliway that we sometimes have in the back that is a feline facial pheromone, and in studies, it is shown effective to help slightly minimize stress that cats experience. But it doesn't always work. But I like to, on my really bad cats, spray a towel with some Feliway before I wrap them up. So wrapping a cat in a burrito or covering a cat's face is really helpful to ease stress for the cat. And kind of like, remember we talked about cats having five offensive weapons? So by wrapping them in a towel, you're kind of like protecting yourself from all the claws. There's a couple of examples here at the bottom. The first one is like a kitty burrito with the leg out. So this is good if you're gonna be doing like cephalic, like front leg venipuncture, or holding for somebody like putting in an IV catheter, where you wrap the whole cat in a towel and then you hold the towel behind the cat's neck, like similar to a scruff, or you could even hold the scruff if necessary, and then just have one foot out. So they're the rest of their three feet are contained in the towel. So even if they wanted to kick, they can't because that towel is wrapped around them. And the second picture is a cat for an exam that doesn't need a leg out. It's just a cat wrapped in a towel. This is if you have to like look at the face, or you're examining their ears, eyes, or mouth. So now the entire cat is just wrapped really tightly in a burrito and is being held in that wrap. So the, the doctor can examine the face without fear of a four limbs coming at them with with claws. And then this last photo is for like a back leg for doing like back leg blood. Which is, I like to do for fractious cats. If I have a cat that's a real, real bad, I'm gonna pull blood from a back leg. So they can be covered, their face with a towel, they don't need to look at me, I don't need to be in their face, they feel more secure. And this technique is, is she's just holding the cat next to her, karate chopping that back leg. Whenever you need to get blood from that back leg, you're gonna karate chop it. But this hold can also be done scruffing a cat as well. So all these three techniques can be used with towels, without a scruff, if you have a compliant cat, and all these techniques can be used with a scruff if you just have a real bad cat.
Okay, this right here is a technique that is best with visuals, but I'm gonna explain it here anyway, but I will also make a video or an in-person demonstration. This is a technique that is done with two people and can only be done if the cat is in a hard carrier. But this is a great technique to do and to have in your little toolbox when you need to get a fractious cat out of the carrier. So the only thing you're gonna need is a towel and another human being. So what's gonna happen is you're going to either unscrew or unsnap the carrier, but do not take the lid off yet. After you unscrew and unsnap the carrier, you are going to come from the back of the carrier, like facing the back of the carrier, like this guy is here. This gentleman is standing behind the carrier, and then the second person is going to slowly lift the lid, but not all the way. This is the only picture that I could find of somebody trying to do this. This carrier lid is too high up. This cat could jump right out of here if it wanted to. You're barely going to lift the lid, and you're going to use the towel. Actually, don't even know why I included this picture because there's so many things that I want to do differently. So this lid is gonna be lifted lower, and your hands, this dude's hands are like kind of inside of the carrier. Don't you want your hands outside of the carrier with the towel taut because you're gonna slide in that little space that you're being given from the top and the bottom piece of the carrier, you're gonna slide that towel completely to the front. So now you have like a blanket covering your cat. And then once that towel is completely covering your cat, you are gonna have the person holding the lid lift it a little higher, and you're gonna take your forearms and place them quickly inside the carrier on both sides of the cat, still holding above the towel. So now your forearms resting on top of the cat that's being held in with a towel, and you're gonna use your forearms to kind of scoop up the cat. So you're gonna take your forearms and bring them closer together underneath the cat. So now the cat is basically wrapped once in a towel, and you're gonna lift that cat up and place them on the table. And then somebody else or you will grab this cat's scruff and will wrap him up more. This is also a good technique if the cat can't be touched. So from here, now we have our cat, and we can give it whatever injectables that we need, and then we can place it back in the carrier and let the drugs do their thing. This is also something that I'm gonna need to make a video for. And the more that I look at this picture, and I've done this PowerPoint for like three years, the more that I look at it as a picture, the more I hate it. There, this, this technique could be done way more better. But this kind of gets you a little flavor of what we're talking about.
So we kind of talked about how scruffing is not like the ideal go-to method. It's definitely important. It's definitely a skill to have, especially if you feel that you cannot safely restrain the cat other ways and you're the most comfortable with scruff, by all means do it because it's safer for the cat and it's safer for you. But scruffing can cause like a little bit of a stress response. But what scruffing is, is just basically you're holding the cat by the skin on the back of their neck. And when you're holding them, you're also going to hold their back legs and extend the cat along your forearm. So this way, the back legs can't kick. And as long as the person who's working on the cat doesn't put any body parts of theirs near the front legs, they're not going to get scratched. This is a technique that can be used for IV catheters, for blood draws, even just exams if you have a really, really bad cat. But for the most part, cats can be examined without a stress. But it takes a lot of finesse to be able to restrain a cat for things like venipuncture without scruffing. If you don't have a lot of, if you don't have like a lot of finesse, I mean, it is holding a cat for blood draws without scruffing takes a lot of, it takes a lot of skill. So I never fault anybody for scruffing.
Muzzles are our friends. When in doubt, if you have any concerns at all, if you have any little suspicions, a little feeling, a little inkling, your spidey senses are tingling, and you think this dog or cat is gonna bite, go for the muzzle. Putting on a muzzle is similar to like how we discussed putting on a leash, especially for muzzles, because you don't want to stand over a dog and come directly from the front of their face to put a muzzle on. Firstly, the dog is already nervous, you think he's gonna bite already, and now you're gonna like approach his face. It's nerve-wracking, it's uncomfortable. You want to come from behind. So you're gonna stand behind the patient with the muzzle outstretched and then bring it in front of their face and clip. That way, they are not aware until the muzzle is practically over their face what's happening. If I'm in the room with a client, I always let the client know, like, "Hey, I'm gonna put a muzzle on. It's not painful, it doesn't hurt, it's gonna, it's just a little insurance to make sure that he's not gonna bite." Same deal with cats. I always let owners know that the muzzle is not painful and it does not mean that their dog is bad. Sometimes I call it a party hat. I say, "You know, we're gonna have to put a party hat on Mickey because he's a little uncomfortable."
There are different types of muzzles for dogs and cats. So cat muzzles are cool because they cover the whole face. I have said in a million times that cats love small dark spaces, they love having their face covered. Cat muzzles cover not only their face to prevent from biting or their mouth, but they also cover their eyes, so they don't get to see. So a lot of times when you put a cat muzzle on, they're like, "Oh yeah, hell yeah," because like, it's a whole, "I can't see you, you can't see me" thing. And then for dog muzzles, the thicker part of the muzzle is going to be at the bottom, and the less thick, though the thinner strap goes over the top.
So we've already talked about restraint, but now we're gonna go a little in in more depth with that and talk about restraint specifically for venipuncture. So when, so venipuncture is anytime we're inserting a needle into a vein. So when we are restraining for a venipuncture, the most important thing to remember is that we don't want this vein to move. Any part of the dog can move except for the vein. There are a couple of primary blood draw sites that we use. So the cephalic vein is in the front leg. The lateral saphenous is on the outside back leg. This is typically a dog-only blood draw area. And then the medial, oh my god, I wrote medical, Jesus, it's medial saphenous. Medial saphenous is the vein on the inner thigh. This can be used for both dogs and cats. You typically see this more in cats. And then the jugular is in the neck. This is the best choice for blood draws of large quantities because it's very big and you can fill up, if you need to fill up a full syringe, you can do it much more quicker on a jug than on a front leg. There are contraindications for jug sticks, most notably if your patient is like a hemophiliac, has or has gotten into rat poison because rat poison makes your blood not clot, or if he's got like hemophilic anemia, anything that is compromising your patient's ability to clot, you shouldn't use a jug stick. For this, it's more of a technician note, but it's also important to like, it's nice to have in your brain because sometimes people are doing a million and eight things and somebody's like, "Hey, that dog on the table, I need somebody to do a blood draw on it." And so a technician drawing blood may not know the history on this patient. So if you could be like, "Oh, you know, I overheard this dog potentially got into rat poison, don't do jug sticks." You know what I mean? Just like tiny things like that. It's not important or in your objective to know, but it's just a nice little thing to keep in your brain.
So to restrain for cephalic venipuncture. So cephalic is that vein in the front leg. You're basically gonna do a head hug, but have a little extra spin on it. So you're gonna head hug your patient, and then the side that your patient isn't touching you is gonna be the leg that's used. So if you're holding your patient and his right side is against you, you are gonna have your technician draw blood from that left leg. So his right side is against you, and you're going to head hug again with that, with that elbow up high, close to your body. And then the arm that isn't doing the head hug, it's gonna reach around that patient, and you're gonna grab that dog's leg, the leg that's gonna have the blood drawn or the IV catheter put in. And but you're gonna grab it behind the elbow. So you don't want to grab it above the elbow. You almost want the palm of your hand to be cupping the elbow of that patient because if you go below that elbow, that patient can then bend the elbow and pull the leg away from you, which is not what we want. So almost cupping that elbow, hitting right at the elbow or above with the palm of the hand. You want your thumb to be towards the inside of the patient, towards the midline. So you're gonna take your thumb and grip the medial side of that leg, and then twist your hand so that thumb is pulling the vein taut. The idea here is to make a tourniquet. So if you, if you've ever gotten blood drawn from a doctor, or you've seen anybody getting blood drawn, or you've ever shot heroin, or saw anybody shoot heroin, you have a tourniquet that's tied around your arm that's taut, that pulls that vein back so you can, it, you're rolling the vein so you can see it, or it's more pronounced. And that's the idea here is that you, as the restrainer, are using your hand as a tourniquet. This one takes a little finesse. Sometimes people in my experience see it and they immediately visualize and they got it and they understand what's going on. But for the majority of people, it's like, takes a little bit of time for them to really understand where the hand placement is and how they should be gripping and how to roll. So this is something that not just a video will help you with. This is something that you're gonna need to practice a lot and have somebody walk you through and then you demonstrate for them what you're doing so they can kind of fine-tune.
Yeah, saphenous vein venipuncture restraint. So remember that there's two different saphenous veins. The medial saphenous, which is in this little cat, and the lateral saphenous, which is this dog pictured. So this will usually be done in lateral recumbency. However, in big dogs, you can do a back leg with them standing up. But for the most part, we're talking lateral recumbency here. So we're gonna place them in lateral recumbency. And for cats, for that medial saphenous, the, the leg that is on the table is gonna be the leg that is being having blood drawn. So for a cat, you're gonna lay them down in lateral recumbency and you're gonna scruff them usually, or wrap them in a towel and extend their body. And the person who is getting the blood is going to hold on to the bottom of that leg that's getting blood drawn. And for this, you're not gonna roll like we do for the front leg. For this, you're gonna actually karate chop. So if you see the restrainer here, she's got her hand on the cat's belly, and it's a her pinky side is is pressing into the very top of that cat's leg. Her, she's like basically karate chopping as a form of a tourniquet to make that vein more pronounced. For the, um, so that was for medial saphenous. For a lateral saphenous, that's gonna be on our dog patient. So you can either have your patient stand up and roll off, but it's usually very difficult to hold for a back leg and also roll off at the same time because you have an elbow at the patient's head, you got a 60-pound lab, your arm can't really reach their back leg and still hold their head effectively. So typically a third person would be rolling off the back leg, or sometimes the technician themselves is rolling off the back leg. But ideally, to get a good roll on a lateral saphenous, you're gonna have your patient laying down in lateral recumbency. But we're gonna break a rule. So if you go back to the PowerPoint where we're discussing how to hold for lateral recumbency, the rule is you are always holding the two legs that are closest to the floor. We break that rule when we're rolling off for a vein and lateral, lateral saphenous vein. So you're gonna hold on to the patient's front bottom leg, but we're not drawing from the patient's back bottom leg, we're drawing from the patient's top bottom leg. So instead of holding on to the bottom front and back leg, you're gonna hold on to the bottom front leg and then the top back leg. And it's kind of same deal, you're gonna grip it and roll a little bit to make that vein more pronounced. This hold makes it a little bit more difficult, and your patient's gonna have a little bit more wiggle room to escape if they wanted to. But as long as you keep a good grip on that bottom top leg, you should be okay.
Jugular vein venipuncture. So if you need a large quantity of blood, the jug is where it's at. So typically this is done on a table. For smaller patients, it's done on the floor. For big dogs, it can be done with a patient either sitting up or laying on lateral recumbency. So for small animals, well, for cats, I like to keep their bottom legs extended, like if you see in this first picture. So this cat's kind of like pulled up to the end of the table, and their legs are kind of stretched out so that way you can't get scratched because you got a restrainer holding their front legs. I would typically wrap this cat in a towel because if you see in this picture, this cat's back feet are free to just scratch away. So I would wrap this cat in a towel. But you're gonna be holding their head upright. So you're gonna be holding in a way that makes their neck extend. You, as their restrainer, don't have to hold off on a vein. The, the person drawing the blood will roll their own vein. It's a thoracic inlet. And then for if you got a patient in lateral recumbency, you're just gonna lay them down, and the, either somebody will hold their head if it's a bigger patient, or you can hold their head. Usually I have a third party hold. So I have somebody restraining in lateral recumbency, so you've got a hand on each bottom leg, and then somebody else is holding the head up while the third person is drawing the blood. And I actually don't know why I don't have a picture of a little dog on a table. The little dog is gonna be similar to this first cat here, except you don't need to extend their legs off the table. They can just stand at the end of the table. I'm not worried about getting scratched by a dog, you don't really need, so they don't need to be extended like a cat does.
Hospital cleanliness is one of the most important things to maintain when it comes to a veterinary hospital or any hospital in general. We see numerous patients, sometimes up to 100, come through that door, especially on surgery days, and it is absolutely imperative that we clean up behind every single one. We have patients with communicable diseases, viruses, bacteria, yeast, internal parasites, you name it, they got it, and they can transfer it to another patient if we are not careful. Anytime a patient has left an exam table, that table needs to be cleaned with Rescue. Rescue is a veterinary-grade disinfectant that at different concentrations kills different things. It is made in spray bottles. So the concentrated Rescue is put into a gallon jug, which is then poured out into spray bottles for use. It absolutely is imperative that every single time a patient leaves an exam table, that exam table is cleaned, sprayed with Rescue, and cleaned. No patient should ever be placed on a table that has not been previously cleaned from the patient beforehand. Anything that we use restraint-wise, towels, muzzles, anything like that, that has touched a patient, once a patient is gone, those things immediately get put in the dirty clothes, and so they do not get used at another patient. Any surfaces that have been contaminated with blood, urine, or feces, this includes countertops, the floor, the wall, anything that has ever contaminated with blood, urine, or feces needs to be immediately cleaned with Rescue. These are hard, fast, unbreakable rules. These are things that can never, ever, ever be compromised. Patient health should never be compromised, and when we have an unclean hospital, we are compromising our patient health. So making sure that surfaces are cleaned, that we are washing our hands or sanitary our hands between handling patients, these are bare minimum standards of what we should be doing in a veterinary hospital.