Diagnostic Sampling (Small Animals) Flashcards
(200 cards)
1
Q
Successful venipuncture requires ______ and _______
A
Proper restraint + Visualization/immobilization of the vessel
2
Q
What materials are needed for venipuncture blood sample collection?
A
- Needle + syringe
- Butterfly catheter with or without syringe or vacutainer
- Vacutainer collection system
3
Q
What makes up a vacutainer collection system?
A
- Double-pointed needle
- Plastic holder
- Blood collection tube(s) with or without anticoagulant
4
Q
A
Vacutainer Collection System
5
Q
VP collection site, method of collection, and needle gauge is chosen based on:
1.
2.
3.
4.
A
- Vessel size
- Amount of blood (sample) required
- Intended use of the sample
- VT preference
6
Q
Needle Sizes: Small Gauge
A
25 to 28 gauge
7
Q
Needle Sizes: Medium/Average Gauge
A
22 gauge
8
Q
Needle Sizes: Large Gauge
A
18 and 20 gauge
9
Q
When should you use 25-28 gauge needles?
A
- Smaller, fragile vessels
- Multiple/frequent VPs
10
Q
When should you use 22 gauge needles?
A
- VP on cats
- VP on small dogs
11
Q
When should you use 18 and 20 gauge needles?
A
- VP on large breed dogs
- VP on most farm animals
12
Q
the method of blood sample collection in which the colored-top tubes are filled in a certain order to allow for minimal contamination or “carry over” between tubes
A
Order of Draw
13
Q
Blood collected from VP must be _______ and _______.
A
placed into a specific colored-top tube + filled in order of draw
14
Q
PROCEDURE - Putting Collected Blood in Appropriate Tubes
A
- Removing the needle from the collection apparatus + the stopper from the tube
- Blood flows down the side of the blood collection tube to the “fill line” as blood is gently expelled from the collection device
- Tube’s contents are adequately mixed by gently rocking the tube back and forth a predetermined number of times
15
Q
Why is it important to NOT vigorously mix or forcefully eject collected blood samples?
A
Can cause hemolysis of sample
16
Q
the destruction of red blood cells
A
Hemolysis
17
Q
Always label blood collection tubes with:
1.
2.
3.
A
- Patient’s first + last names
- Date of collection
- Owner’s first + last names
18
Q
Give 3 examples of blood sample coagulation profiles
A
- Activated Clotting Time (ACT)
- Prothrombin Time (PT)
- Activated Partial Thromboplastin Time (APTT)
19
Q
Why is it important to break the seal of the syringe plunger before venipuncture?
A
May cause:
1. Vein to collapse
2. RBC hemolysis
20
Q
Needle is always inserted with bevel facing _____ in all VP procedures
A
up
21
Q
PROCEDURE - Venous Blood Collection (Needle + Syringe Method)
A
- Attach a 20-25 gauge needle to a 1-6 mL syringe
- Occlude the vein with a tourniquet or digital pressure
- Wipe the skin and hair on top of the vein with an alcohol-soaked cotton ball to help identify the vein
- Break the plunger seal by pulling it half way out of the syringe
- Insert the needle with the bevel facing up through the skin and into the vein at a 25º angle
- Slowly retract the syringe plunger + collect a blood sample
- Release the pressure on the vein + release the syringe plunger when a sufficient volume of blood has been collected
- Remove the needle from the vein
- Apply digital pressure to the venipuncture site as soon as the needle is removed > until hemostasis occurs
22
Q
PROCEDURE - Cephalic Venipuncture
A
- Place patient in sternal or lateral recumbency
- Grasp the leg at the metacarpus > extends the foreleg
- Occlude the vessel
- Pop the syringe plunger seal
- VT grasps the right foreleg of the patient with nondominant hand at the carpus > wipes the VP site with 70% isopropyl alcohol
- VT digitally palpates the vessel > rest thumb of nondominant hand directly against + parallel to the vessel
- Insert the needle along the vein’s long axis on the other side from your thumb
- “Flash” of blood should be noted within the needle hub > stop insertion > gently pull syringe plunger to obtain predetermined amount of blood
- Remove needle while gently aspirating
- Apply pressure to insertion areas for 30 sec > evaluate site for bleeding and/or hematoma formation for several minutes
If bleeding continues:
– Apply pressure bandage – Report clotting delay to attending vet
- Place collected blood in appropriate blood collection tubes
23
Q
A
Cephalic Vein
24
Q
Why should the cephalic vein be the last choice for diagnostic sample collection?
A
Vessels need to be maintained for IVs if needed
25
Give 3 scenarios in which jugular VP would be used
1. Chemistry profiles
2. Hyperthyroid testing
3. Cushing test
26
Give 4 scenarios in which jugular VP would NOT be used
Patients with:
1. Head trauma
2. Possible heat stroke
3. Clotting abnormalities
4. Snake bites
27
PROCEDURE - Jugular Venipuncture
1. Place patient in sternal, lateral, or seated recumbency
2. Grasp underneath either side of patient's jaws > gently extend the head toward ceiling
3. Apply digital pressure at thoracic inlet > occludes vessel
4. Pop the syringe plunger seal
5. Wipe the VP site with 70% isopropyl alcohol
6. VT digitally palpates the vessel > rest thumb of nondominant hand directly against + parallel to the vessel
7. Insert the needle along the vein's long axis on the other side from your thumb
8. "Flash" of blood should be noted within the needle hub > stop insertion > gently pull syringe plunger to obtain predetermined amount of blood
9. Remove needle while gently aspirating
10. Apply pressure to insertion areas for 30 sec
11. Place collected blood in appropriate blood collection tubes
28
If patient is in sternal recumbency > jugular VP is done in the _______ direction.
cephalic
29
If patient is in lateral recumbency > jugular VP is done in ________ direction.
caudal
30
PROCEDURE - Lateral Saphenous Venipuncture DOGS
1. Place patient in lateral recumbency
2. Grasp the upper leg at the stifle > extends the hindlimb
3. Apply circumferential pressure to the stifle of the top hindleg > occludes the vessel
4. Pop the syringe plunger seal
5. VT grasps the top hindleg of the patient using nondominant hand at at the metatarsus > wipes the VP site with 70% isopropyl alcohol
6. VT digitally palpates the vessel > rest thumb of nondominant hand directly against + parallel to the vessel
7. Insert the needle along the vein's long axis on the other side from your thumb
8. "Flash" of blood should be noted within the needle hub > stop insertion > gently pull syringe plunger to obtain predetermined amount of blood
9. Remove needle while gently aspirating
10. Apply pressure to insertion areas for 30 sec > evaluate site for bleeding and/or hematoma formation for several minutes
- If bleeding continues:
– Apply pressure bandage
– Report clotting delay to attending vet
11. Place collected blood in appropriate blood collection tubes
31
PROCEDURE - Lateral Saphenous Venipuncture CATS
1. Place patient in lateral recumbency
2. Grasp the upper leg with thumb just cranial to the patella + index finger is in the patella fold on the caudal aspect of the rear leg > extends the hindlimb
3. Apply upward circumferential pressure behind + caudal to the patella > occludes the vessel
- Clipping the hair in the stifle area (just cranial to the tarsal bone) may aid in vein visualization
4. Pop the syringe plunger seal
5. VT grasps the top hindleg of the patient using nondominant hand at at the metatarsus > wipes the VP site with 70% isopropyl alcohol
6. VT digitally palpates the vessel > rest thumb of nondominant hand directly against + parallel to the vessel
7. Insert the needle along the vein's long axis on the other side from your thumb
8. "Flash" of blood should be noted within the needle hub > stop insertion > gently pull syringe plunger to obtain predetermined amount of blood
9. Remove needle while gently aspirating
10. Apply pressure to insertion areas for 30 sec > evaluate site for bleeding and/or hematoma formation for several minutes
- If bleeding continues: – Apply pressure bandage – Report clotting delay to attending vet
11. Place collected blood in appropriate blood collection tubes
32
Femoral vein is also known as the _____ vein.
Medial Saphenous Vein
33
PROCEDURE - Medial Saphenous Venipuncture for DOGS
1. Place patient in lateral recumbency
2. Grasp the upper leg at the stifle > extends the leg
3. Apply circumferential pressure to the stifle of the bottom hindleg > occludes the vessel
4. Pop the syringe plunger seal
5. VT grasps the bottom hindleg of the patient using nondominant hand at at the metatarsus > wipes the VP site with 70% isopropyl alcohol
6. VT digitally palpates the vessel > rest thumb of nondominant hand directly against + parallel to the vessel
7. Insert the needle along the vein's long axis on the other side from your thumb
8. "Flash" of blood should be noted within the needle hub > stop insertion > gently pull syringe plunger to obtain predetermined amount of blood
9. Remove needle while gently aspirating
10. Apply pressure to insertion areas for 30 sec > evaluate site for bleeding and/or hematoma formation for several minutes
-If bleeding continues: – Apply pressure bandage
- Report clotting delay to attending vet
34
PROCEDURE - Medial Saphenous Venipuncture for CATS
1. Place patient in lateral recumbency
2. Grasp the top hind leg > abduct + flex the upper leg > exposes medial surface of bottom hind leg
3. Apply pressure with the side of your abducting hand along the inguinal area of the bottom hindleg ("karate chop" fashion) > occludes the vessel
4. Pop the syringe plunger seal
5. VT grasps the bottom hindleg of the patient using nondominant hand at at the metatarsus > wipes the VP site with 70% isopropyl alcohol
6. VT digitally palpates the vessel > rest thumb of nondominant hand directly against + parallel to the vessel
7. Insert the needle along the vein's long axis on the other side from your thumb
8. "Flash" of blood should be noted within the needle hub > stop insertion > gently pull syringe plunger to obtain predetermined amount of blood
9. Remove needle while gently aspirating
10. Apply pressure to insertion areas for 30 sec > evaluate site for bleeding and/or hematoma formation for several minutes
- If bleeding continues: – Apply pressure bandage
- Report clotting delay to attending vet
35
Which species is VP of the marginal ear vein primarily used for? And what two things does it test for?
Rabbits - To test for:
1. Erythropoiesis
2. Blood glucose levels
36
PROCEDURE - Marginal Ear Venipuncture
1. Apply warmth to ear vein with a heated cloth for approx. 30 sec > dilates vessel
- Heated cloth
- Light source
- VTs hands
2. Apply 70% isopropyl alcohol to VP site
3. Slightly nick the skin + vein with a 25-gauge x 3/4" needle or lancet
4. Once blood appears on skin surface > massage pinna to obtain sufficient blood sample
5. Apply direct pressure to stop bleeding for approx. 15 sec
37
Venipuncture of the Marginal Ear Vein
38
ABG Sampling is short for _______
Arterial Blood Gas Sampling
39
ABG samples are used to assess:
1.
2.
3.
4.
1. Pulmonary function
2. Gas exchange within the lungs
3. Measurement of blood gases (O2 and CO2)
4. Blood pH
40
Give 3 examples of what ABG samples can help diagnose
1. Kidney failure
2. Heart failure
3. Diabetic ketoacidosis
41
List the 4 most common sites used to obtain an ABG sample
1. Dorsal pedal artery
2. Dorsal metatarsal artery
3. Femoral artery
4. Sublingual artery (unconcious/anesthetized patients)
42
What two kinds of needles + syringes can be used to collect an ABG sample?
1. 22 or 25 gauge needle + 1 or 3 mL syringe + lithium or sodium heparin
2. ABG self-filling syringe coated with lithium heparin
43
PROCEDURE - Arterial Blood Collection
1. Coat dead space of a syringe (with attached needle) with heparin > expel excess heparin from the syringe
2. Use appropriate restraint
3. VT digitally palpates the target vessel with nondominant hand
4. Site is clipped and/or surgically prepped
5. Using palpating fingers to guide > insert needle with heparinized syringe bevel side up + parallel to the artery + at 45º angle
6. Flash of blood should be noted within the needle hub
7. Fill syringe
- If ABG self-filling syringe > syringe will automatically fill to a predetermined volume set prior to venipuncture
- If lithium heparin-coated syringe + needle > VT gently pulls syringe plunger to obtain 1-1.5 mL sample
8. Remove needle gently + apply pressure to insertion areas for 1 min > monitor for hematoma formation
9. Expel all air from the collection syringe + place rubber stopper on end of the needle
10. Sample placed in ice water bath during transport to lab for immediate analysis OR sample can stay in ice water bath for several hours before analysis
44
What are 2 important things to avoid doing when collecting an ABG sample? Why?
1. Introducing air
2. Applying excessive negative pressure
Both affect PaO2 measurements
45
The medial saphenous vein can be easily confused with the _______.
femoral artery
46
_____ is the preferred artery for arterial catheter placement.
Dorsal Metatarsal Artery
47
What 2 scenarios would you use arterial catheter placement?
1. Collection of multiple blood samples
2. Continuous measurement of arterial BP
48
PROCEDURE - Arterial Catheter Placement
1. Place patient in lateral recumbency + extend hock
2. Site is clipped + aseptically prepped
3. Flush a 20-22 gauge over-the-needle (OTN) catheter with heparinized normal saline
4. Palpate the artery
5. Using needle's beveled edge > make a relief hole in dermis for insertion
7. Palpate needle tip + artery simultaneously with fingers of opposite hand
8. Insert the catheter steeply until it penetrates the upper artery wall > then move it flat against the skin surface + parallel to the artery's long axis
9. Flash of blood should be seen within the needle hub > then carefully advance the catheter into the artery to its full length
10. Replace needle with a T-connector + stopcock
11. Wrapping adhesive tape around the hub to secure catheter > Cover the insertion site with a 2"x2" piece of gauze > Apply roll gauze followed by tape
12. Flush catheter every 2 hours with heparinized saline OR attach to a continuous flush system
13. Check toes for warmth every 2-4 hours
-If toes are cool > remove catheter
14. Perform catheter care every 48 hours
49
_____ mL needed for most quantitative urinalyses
7-10 mL
50
_____ mL needed for strip-based urinalyses
< 7 mL
51
What temperature should samples be for urinalysis if they have been refrigerated?
Room temperature
52
List 4 methods of urine sample collection
1. Voided collection
2. Manual bladder expression
3. Cystocentesis
4. Urinary catheterization
53
method of urine sample collection in which the sample is gathered as or after the patient excretes the urine and is used for routine urinalysis
Voided Collection
54
Voided urine sample collections are NOT acceptable for ______.
Cultures
55
method of urine sample collection in which the sample is gathered by applying pressure directly to the bladder and is used in animals that have difficulty voiding due to neurological deficits
Manual Bladder Expression
56
Manual bladder expression sample collections are NOT acceptable for ______.
Cultures
57
Do NOT use manual bladder expression for ______. Why?
Urinary blockages > may result in urethral or vesicular rupture
58
PROCEDURE - Manual Bladder Expression
1. Place patient in standing or lateral recumbency
2. VT places hands on either side of the caudal abdomen
3. Isolate the bladder between the palmar surfaces of the fingers
4. Gently and continuously apply pressure to express the urine
- If method does not work with moderate compression > MUST use a different method
59
method of urine sample collection in which the sample is gathered by placing a needle through the abdominal wall to draw urine directly from the bladder and is used to obtain sterile urine samples for analysis or culture and sensitivity testing
Cystocentesis
60
Give 4 scenarios in which cystocentesis would be used
1. Urinalysis
2. Culture and sensitivity testing
3. Aid in localization of hematuria, pyuria, bacteriuria
4. Relieve distended bladder if catheter cannot be placed
61
blood cells in the urine
Hematuria
62
pus in the urine
Pyuria
63
Give 4 scenarios in which cystocentesis is NOT used
Patients with:
1. Recent abdominal surgery or trauma
2. Suspected bleeding disorders
3. Pyometra
4. Suspected caudal abdominal or bladder tumor
64
uterine infection
pyometra
65
Why is it important to remove most but not ALL urine during a cystocentesis?
Removing all volume risks contact between needle + bladder wall > damage to bladder
66
During a cystocentesis, insert the needle _______ of the bladder instead of ______.
During a cystocentesis, insert the needle [cranial to the trigone region] of the bladder instead of [the apex].
67
Why should you NEVER redirect the needle once in the abdominal cavity during a cystocentesis?
May result in accidental viscera laceration
68
Give 3 possible complications of a cystocentesis
1. Bladder laceration
2. Bowel laceration
3. Peritonitis (as a result of prior)
69
Give 2 contraindications for cystocentesis
1. Inadequate urine volume in bladder
2. Patient resists restraint + abdominal palpation
70
What size neddle + syringe are needed for a cystocentesis?
1. 22-gauge x 1-1.5 in needle
2. 12 mL or larger syringe
71
Preferred restraint(s) for ventrolateral cystocentesis
1. Standing recumbency
2. Lateral recumbency
72
Preferred restraint(s) for ventral cystocentesis
1. Dorsal recumbency
73
PROCEDURE - Ventrolateral Cystocentesis
1. Place patient in standing or lateral recumbency
2. Palpate abdomen to determine size + location of bladder
3. Hold the syringe with the needle in one hand + stabilize the bladder from below with the free hand
- Press bladder dorsally + caudally to immobilize it against the pelvis
4. Wipe insertion site with alcohol
5. Insert needle caudomedially into abdominal cavity + bladder > 45º angle to bladder wall + toward cranial trigonal region
6. Aspirate urine in the syringe until desired sample volume is obtained
7. Stop aspiration or release negative pressure on the plunger of syringe BEFORE withdrawing the needle
74
PROCEDURE - Ventral Cystocentesis
1. Place patient in dorsal recumbency
- May take 2 assistants for large breeds or deep-chested dogs
2. Palpate abdomen to determine size + location of bladder
3. Hold the syringe with the needle in one hand + stabilize the bladder from below with the free hand
- Press bladder dorsally + caudally to immobilize it against the pelvis
4. Wipe insertion site with alcohol
5. Insert needle on midline into abdominal cavity > 45º angle to bladder wall + directed caudally
6. Aspirate urine in the syringe until desired sample volume is obtained
7. Stop aspiration or release negative pressure on the plunger of syringe BEFORE withdrawing the needle
75
method of urine sample collection in which the sample is gathered by placing a tube directly into the urethra
Urinary Catheterization
76
List 4 possible complications of urinary catheterization
1. Urethral inflammation
2. Bacterial UTI
3. Urethral and bladder irritation
4. Trauma
77
What 2 scenarios would indwelling urinary catheters be used?
Patients that have:
1. Recently had urethral calculi removed
2. Neurologic impairment/traumatic conditions interfering with normal urination
78
having normal blood pressure
Normotensive
79
having a normal volume of blood in the body
Normovolemic
80
A normotensive, normovolemic patient with intact renal function has a urinary output of _____ per _____ per hour.
1-2 mL of urine per kg of body weight
81
PROCEDURE - Indwelling Urinary Catheter Placement and Removal
1. Gently rinse prepuce or vulva twice with warm antimicrobial solution + water > dry
2. Missing step?
2. Connect catheter with sterile gloves to IV extension tubing OR Collection system
3. Collection bag acts as urine reservoir > measure + empty periodically
4. Detach catheter with sterile gloves
- Remove as soon as possible
- If required on long term basis > place a new catheter every 4-5 days
82
If urine in reservoir bag is NOT adequate:
1.
2.
3.
4.
1. Palpate bladder for distention
2. Inspect urinary catheter for obstructions or kinks
3. Gently compress bladder > determine whether urine can flow through catheter
4. Flush small volume of sterile 0.9% saline solution to (attempt) to relieve obstruction
83
Urethral catheter sizes are _____ sizes.
French (Fr) sizes
84
Urethral catheters are measured to the ______ portion of the bladder.
caudal
85
Use ______ urethral catheter sizes for male and female feline patients of all weights.
3.5-Fr
86
Canine Urethral Catheter Size:
Male < 9kg
3.5-Fr
87
Canine Urethral Catheter Size:
Male 9-23kg
5- or 8-Fr
88
Canine Urethral Catheter Size:
Male > 23kg
10- or 12-Fr
89
Canine Urethral Catheter Size:
Female < 9kg
5-Fr
90
Canine Urethral Catheter Size:
Female 9-23kg
8- or 12-Fr
91
Canine Urethral Catheter Size:
Female > 23kg
10- or 12-Fr
92
rigid catheter for sample collection and emptying the bladder
Polypropylene Catheter
93
flexible catheter used for indwelling catheters
Foley Catheter
94
PROCEDURE - Urinary Catheterization for Male Dogs
1. Place patient in lateral recumbency + retract the upper leg
2. Clip hairs around preputial orifice > flush the prepuce with dilute antiseptic solution > rinse with warm sterile saline solution or water
3. VA retracts prepuce > exposes glans (tip) of penis > wash glans of penis with antiseptic solution > rinse with warm saline solution or water
4. Aseptically open catheter packaging
5. To distal tip of catheter > apply sterile water-soluble lubricant OR sterile lidocaine ointment
6. Insert + gently advance the catheter into the urethra
7. Urine should flow into catheter as it enters the neck of the bladder > advance catheter 1 cm further OR to predetermined measurement
8. Attach sterile syringe to catheter
9. Slowly aspirate urine from bladder
10. Discard first few mL of urine suctioned from catheter
11. Store collected urine in sterile + capped tube
12. Catheter may be withdrawn or remain in the bladder
95
To guide urinary catheter around curve of ischial arch (os penis) >
apply digital pressure on the perineum externally
OR
pressing the catheter with index finger placed in rectum
96
PROCEDURE - Urinary Catheterization for Female Dogs
1. Place dog in standing, lateral, or sternal recumbency
2. Clip hairs around vulvar areas > flush the vulvar + perineal areas with dilute antiseptic solution > rinse with warm sterile saline solution or water
3. Instill 1.0 mL of sterile 2% lidocaine jelly into the ventral vaginal floor
4. Apply sterile lubricant to the tip of the catheter
5. Wearing sterile gloves > insert the catheter into the urethral papilla
6. Advance until urine is seen in catheter OR at premeasured length
7. Attach sterile syringe to catheter > apply gentle negative pressure to obtain sample
8. Store collected urine in sterile + capped tube
9. Catheter may be withdrawn or remain in the bladder
97
PROCEDURE - Guiding Urinary Catheter in Female Canines (Speculum + Light Source)
1. Gently insert speculum of choice vertically into vagina > then straightened to horizontal when pelvic canal is entered (2-4 cm inside the vagina) – Avoid the clitoral fossa
2. Using light aid > locate urethral papilla + urethral orifice
3. Insert lubricated catheter
98
PROCEDURE - Guiding Urinary Catheter in Female Canines (Blind Technique)
1. Placed lubricated finger into vagina > slide 2-5cm along ventral floor > until urethral papilla + external urethral orifice are located
2. Introduce lubricated catheter into the vagina > use the finger in the vestibule to guide catheter into urethral orifice
3. Palpate catheter within the urethral orifice > to acknowledge proper placement
- NOT in cranial vestibule
99
characterized as having reduced alertness and responsiveness
Obtunded
100
characterized as having high levels of potassium in the blood
Hyperkalemic
101
Male cats with obstructions for long periods of time are often ______ + _______.
Obtunded
Hyperkalemic
102
_____ is also known as a silicone tomcat catheter.
3.5-Fr polypropylene catheter
103
Type of urinary catheter used for male cats
3.5-Fr polypropylene
104
PROCEDURE - Urinary Catheterization for Male Cats
1. Evaluate + monitor patient prior to giving anesthetic agents > sedate or anesthetize the patient
2. Place in lateral or dorsal recumbency + hind legs drawn cranially
3. VA retracts prepuce > exposes glans (tip) of penis > wash glans of penis with antiseptic solution > rinse with warm saline solution or water
4. Clip hairs around preputial orifice > flush the prepuce with dilute antiseptic solution > rinse with warm sterile saline solution or water
5. Extend the penis dorsally + parallel to the vertebral column
6. Wearing sterile gloves > palpate to check for distal urethral plug or calculus
- If there is an obstruction> gently massage tip of penis with thumb + forefinger > dislodge any urethral plugs
- If there no obstruction OR the massage is unsuccessful > proceed with catheterization
7. Pass a lubricated 3.5 Fr polypropylene catheter into urethra
8. Urine should flow into catheter as it enters the neck of the bladder > advance catheter 1 cm further OR to predetermined measurement
9. Attach sterile syringe to catheter
10. Slowly aspirate urine from bladder
11. Discard first few mL of urine suctioned from catheter
12. Store collected urine in sterile + capped tube
13. Catheter may be withdrawn or remain in the bladder
14. Using an Elizabethan collar is recommended > prevent removal of catheter + urine reservoir
105
Fecal samples are used in gross and microscopic examinations to look for:
1.
2.
3.
4.
1. Mucus
2. Blood
3. Intestinal parasites
4. Ova
106
a procedure performed to diagnose or treat pleural filling defects by aspirating air and fluid compressing the lungs in the pleural cavity and thus allowing them to re-expand
Thoracocentesis
107
What are 5 signs of pleural filling defects?
1. Tachypnea
2. Respiratory distress
3. Open mouth breathing
4. Diminished breath sounds > determined via chest auscultation
5. Cyanosis
108
short shallow breaths
Tachypnea
109
Give 2 indications for thoracocentesis
1. Pneumothorax
2. Pleural effusion
110
Give 3 contraindications for thoracocentesis
1. Diaphragmatic hernia
2. Presence of pleural masses
3. Presence of a disease causing fragile lung tissue
111
What materials are needed for a thoracocentesis?
1. Sterile gloves
2. 18- to 20-gauge, 2-5" OTN catheter
3. IV extension tubing
4. Three-way stopcock
5. Syringe
6. #15 scalpel
7. Lidocaine 2%
8. Clippers
9. Antiseptic scrub and solution
10. Vacutainer blood tubes
- Lavender-top EDTA
- Red-top clot tubes
11. Culture transport media
112
Use the ____ to ____ intercostal space when performing a thoracocentesis.
7th to 8th
113
When performing a thoracocentesis to aspirate AIR > enter the ______ thorax.
dorsal thorax
114
When performing a thoracocentesis to aspirate FLUID > enter the ______ thorax.
ventral thorax
115
PROCEDURE - Thoracocentesis
1. Place animal in standing, sternal, or lateral recumbency
2. Shave + aseptically prepare several inch diameter around target insertion site at 7th to 8th intercostal space
3. Inject 1-2 mL lidocaine into + around target insertion site
4. Wearing surgeon's gloves > assemble equipment
- Attach stopcock to syringe
- Attach extension tubing to stopcock
- Add additional extension tube to free port of stopcock > place distal end into a bowl to collect pleural fluid
5. Insert needle in the caudal aspect of intercostal space + cranial to rib
6. Keep catheter perpendicular to chest wall > advance catheter through chest wall until flash of fluid in hub or a pop is felt
7. Advance catheter a few mm over end of needle > direct catheter + needle ventrally along thoracic wall
8. When in position > advance ONLY catheter > remove needle > attach extension tubing
9. Apply gentle aspiration to the syringe
- If no fluid or air is withdrawn > withdraw catheter a few mm > redirect catheter or needle without removing it from the cavity
- If fluid or air is withdrawn > aspirate until slight negative pressure OR until patient's condition improves
10. Submit lab samples for analysis
11. Postprocedural nursing care
116
What are 4 important parts of thoracocentesis postprocedural nursing care?
1. Close observation
2. RR measurement
3. Auscultation of lung sounds
4. Measure oxygen saturation (use pulse ox)
117
Give 3 possible complications of a thoracocentesis
1. Pneumothorax
2. Lung laceration
3. Intercostal vessel or internal thoracic artery laceration > hemothorax > hypovolemia
118
condition in which blood collects in the pleural space
Hemothorax
119
condition in which volume of blood plasma is too low
Hypovolemia
120
Why is the needle inserted into the caudal aspect of the intercostal space and cranial to the rib?
To avoid intercostal vessels and nerves on the caudal aspect of the ribs
121
a procedure that involves aspiration of fluid from the abdominal cavity for diagnostic and therapeutic purposes
Abdominocentesis
122
Abdominocentesis aids in diagnosis of:
1.
2.
3.
4.
1. Hemoabdomen
2. Uroabdomen
3. Peritonitis
4. Ascites with cardiac or hepatic causes
123
condition in which blood collects in the abdomen
Hemoabdomen
124
condition in which urine leaks and collects in abdominal cavity
Uroabdomen
125
What are 2 contraindications for abdominocentesis?
1. Penetrating abdominal injury
2. Suspected pyometra
126
What materials are needed for an abdominocentesis?
1. Sterile gloves
2. 2 to 4 20- or 22-gauge needles OR 18- to 20-gauge OTN catheter
3. Syringe
4. Clippers
5. Antiseptic scrub and solution
6. Vacutainer blood tubes
- Lavender-top EDTA
- Red-top clot tubes
7. Culture transport media
127
PROCEDURE - Abdominocentesis
1. Place animal in standing, sternal, or lateral recumbency
2. Shave + aseptically prepare several inch diameter around target insertion site at right + midabdominal region
3. Gently insert a sterile 22-gauge needle into peritoneal cavity
4. Apply gentle aspiration
- If no fluid is aspirated > insert a 2nd needle 2 cm away from 1st insertion site OR rotate needle
- If still no fluid > repeat in 1 or 2 other locations
- If fluid is aspirated + open technique used > attach test tubes
5. Submit lab samples for analysis
6. Postprocedural nursing care
128
What are 5 important parts of abdominocentesis postprocedural nursing care?
1. Close observation
2. Vital signs
3. Abdominal distention
4. Continued bleeding or bruising at centesis site
5. Pain
129
Why do you perform abdominocentesis at the right and midabdominal region?
To avoid the liver, spleen, and urinary bladder
130
a procedure that involves fluid infusion into the abdomen and then retrieval of the fluid for laboratory analysis
Diagnostic Peritoneal Lavage (DPL)
131
Diagnostic peritoneal lavage is indicated in cases of:
Peritonitis
132
Diagnostic peritoneal lavage is contraindicated in cases of:
1.
2.
3.
1. Penetrating abdominal injury
2. Suspected pyometra
3. Historical, physical, or radiographic evidence suggests the need for an exploratory laparotomy
133
a surgical procedure that involves opening up the abdomen to expose the organs
Exploratory Laparotomy
134
What materials are needed for a diagnostic peritoneal lavage?
1. Sterile gloves
2. Basic surgical set
3. Peritoneal lavage catheter OR a long OTN catheter
4. IV administration set
5. Isotonic crystalloid
6. Lidocaine 2%
7. Clippers
8. Antiseptic scrub and solution
9. Vacutainer blood tubes
- Lavender-top EDTA
- Red-top clot tubes
10. Culture transport media
135
PROCEDURE - Diagnostic Peritoneal Lavage (DPL)
1. Bladder emptied + animal placed in lateral recumbency
2. Shave ventral abdomen + aseptically prepare the area caudal to the umbilicus
3. Inject 2% lidocaine into target insertion site
4. If…
- peritoneal lavage catheter is used > vet makes a 2-cm midline incision through skin, SC tissue, superficial abdominal fascia (a) Caudal to the umbilicus OR (b) Just to right of umbilicus > to minimize risk of trauma to spleen + descending colon
- OTN catheter is used > vet makes stab incision
5. Ligate any bleeders > to avoid false-positive results
6. Direct catheter caudally + dorsally into the pelvis
7. Gently aspirate the fluid
- If fluid is aspirated > no need to perform lavage
- If no fluid aspirated > remove syringe > connect catheter to warmed crystalloid solution > instill 20 mL/kg into abdominal cavity
8. Rock patient gently from side to side > allow fluid to drain via gravity
- If fluid is clear > remove catheter
- If fluid is not clear > suture catheter in place > serial evaluations
9. Submit lab samples for analysis
10. Postprocedural nursing care
136
What are 5 important parts of abdominocentesis postprocedural nursing care?
1. Close observation
2. Vital signs
3. Abdominal distention
4. Continued bleeding or bruising at centesis site
5. Pain
137
Why is it important to be cautious with patients in respiratory distress when performing a diagnostic peritoneal lavage?
Instilled fluid places pressure on diaphragm
138
a procedure the involves fluid infusion into the trachea and then retrieval of the fluid in order to obtain laboratory samples from the tracheobronchial tree
Transtracheal Wash
139
When is a transtracheal wash indicated?
Chronic productive coughs
140
What are 2 contraindications for transtracheal washes?
1. Patients with severe respiratory distress
2. Patients that are compromised when manipulated
141
Give a few possible complications of a transtracheal wash
1. Postprocedural hemorrhage
2. SC emphysema
3. Acute dyspnea
4. Pneumomediastinum
5. Pneumothorax
6. Iatrogenic infection
142
Transtracheal washes can be performed at the _____ or ______.
Cricoid ligament or Intertracheal membrane
143
The needle is inserted through _____ and between _____ during a transtracheal wash.
Through the trachea and between the cartilage rings
144
Transtracheal Wash:
Measure the 3.5-Fr catheter from the _______ to ________ to _______, then mark with a sharpie
Measure from the [larynx] to the [caudal border of the scapula] to the [approximate distance of the tracheal bifurcation]
145
the process of striking the chest gently but firmly with cupped hands to help loosen secretions trapped in the lower airways and allow them to be more effectively cleared by coughing
Coupage
146
You can expect to retrieve _____ of the injected saline during a transtracheal wash.
20-25%
147
PROCEDURE- Transtracheal Wash (Two-Catheter System)
1. Place animal in sitting or sternal recumbency > extend head + nares pointed toward ceiling
2. Shave + surgically prep insertion site > Inject 2% lidocaine up to level of the ligament > measure 3.5-Fr catheter
3. Tent skin + introduce cath through skin BEFORE advancing through cricothyroid ligament or intertracheal membrane OR make 2-3mm stab incision
4. Insert rigid 16-gauge indwelling catheter with stylet through SC tissues to the level of the ligament > Steady trachea with one hand + hold catheter in other hand > firmly pass catheter through ligament + into trachea lumen
5. Once inside lumen > point catheter down 45º toward tracheal bifurcation > Advance catheter over stylet > keeping hand on catheter hub + remove stylet
6. Attach syringe to catheter + aspirate small amounts of air to verify placement > Pass urinary cath through indwelling cath to the predetermined level
7. Attach syringe with nonbacteriostatic saline to urinary catheter > Rapidly infuse saline > slightly move catheter back and forth in trachea + aspirate fluid > coupage animal's chest > repeat until fluid comes out cloudy or with visible clumps of mucus
8. Monitor patient
9. Remove urinary catheter FIRST > then remove indwelling catheter
10. Bandage site
148
Approximately ____ to ____ mL/kg of body weight, but no more than _____ mL, of nonbacteriostatic saline is used during a transtracheal wash.
[0.5 to 1.0] mL/kg of body weight but no more than [10 mL]
149
PROCEDURE- Transtracheal Wash (TTN Catheter)
1. Place animal in sitting or sternal recumbency > extend head + nares pointed toward ceiling
2. Shave + surgically prep insertion site > Inject 2% lidocaine up to level of the ligament > measure 3.5-Fr catheter
3. Tent skin + introduce cath through skin BEFORE advancing through cricothyroid ligament or intertracheal membrane OR make 2-3mm stab incision
4. Stabilize trachea with one hand + hold catheter with other hand > Insert cath needle perpendicular to trachea + bevel down through SC tissues > until it contacts ligament
5. Firmly introduce needle through ligament > then point needle down 45º toward tracheal bifurcation > With cath sliding down enclosed plastic housing > advance cath through needle
6. Once cath is advanced to full length > withdraw needle from trachea + skin > leaving cath in place > Place needle guard over needle > to prevent animal injury or cutting catheter
7. Attach syringe with nonbacteriostatic saline to urinary catheter > Rapidly infuse saline > slightly move catheter back and forth in trachea + aspirate fluid > coupage animal's chest > repeat until fluid comes out cloudy or with visible clumps of mucus
8. Monitor patient
9. Remove catheter
10. Bandage insertion site
150
What kind of saline is used for transtracheal and endotracheal lavages?
nonbacteriostatic saline
151
What 3 anesthetic agents are needed to intubate for an endotracheal lavage?
1. Ketamine hydrochloride + diazepam
2. Propofol
3. Thiopental
152
PROCEDURE - Endotracheal Lavage
1. Induce anesthesia deep enough only to cleanly place the ED tube > reduce to lighter plane of anesthesia once Ed tube placed + secured
2. Patient in ventral recumbency + hold patient head > Measure polypropylene urinary catheter from larynx to caudal border of the scapula > mark with a sharpie
3. Wearing sterile gloves > advance catheter to the predetermined distance to the tracheal bifurcation
4. Attach syringe with nonbacteriostatic saline to urinary catheter > Rapidly infuse saline > slightly move catheter back and forth in trachea + aspirate fluid > coupage animal's chest > repeat until fluid comes out cloudy or with visible clumps of mucus
5. Remove catheter
6. Provide supplemental oxygenation via ED tube (as needed) > monitor for respiratory effort + distress signs > Patient regains swallowing reflex + no longer tolerates the tube in place > remove ED tube
153
a procedure performed involving the aspiration of fluid from a joint
Arthrocentesis
154
Give 3 scenarios an arthrocentesis is used
1. Cases of joint fluid and pain
2. Attain samples for synovial fluid analysis
3. To diagnose arthritis
155
Give 7 indications for synovial fluid analysis
1. Persistent or cyclic fever
2. Generalized stiffness or limb lameness
3. Leukocytosis
4. Neutrophilia
5. Hyperfibrinogenemia
6. Malaise
7. Anorexia
156
condition in which there is excess fibrinogen in the blood
Hyperfibrinogenemia
157
Give 2 contraindications for synovial fluid collection
1. Moderate to severe pyoderma
2. Lick granuloma
158
pus in the skin
Pyoderma
159
illness caused by medical examination or treatment
Iatrogenic
160
introduction of infective material
Inoculation
161
What is the most common space used for carpal arthrocentesis? What do you need to avoid?
Medial radiocarpal joint
Avoid the cephalic vein
162
PROCEDURE - Arthrocentesis (Carpus)
1. Place patient in lateral recumbency
2. Shave + aseptically prepare site
3. Wearing sterile gloves > hold carpus in flexion > palpate any intercarpal space with index finger
- Most common = medial radiocarpal joint
4. Hold syringe so you can aspirate without needing to reposition hands on syringe > insert needle perpendicular to skin
- To avoid articulating surfaces
5. Aspirate until fluid fills needle hub > usually 0.05-0.3 mL range
- If no fluid is aspirated > retract needle > try aspiration again
6. Release suction > withdraw needle
- Prevents blood contamination of sample
163
PROCEDURE - Arthrocentesis (Tarsus)
1. Place patient in lateral recumbency
2. Shave + aseptically prepare site
3. Wearing sterile gloves > hold hock in partial flexion at 90º with metatarsals + tibia > palpate medial OR lateral intertarsal space with index finger
4. Hold syringe so you can aspirate without needing to reposition hands on syringe > insert needle parallel with metatarsals toward toes
- If lateral approach > insert needle just caudal to lateral malleolus + dorsal to tibial tarsal bone > direct under lateral malleolus
5. Aspirate until fluid fills needle hub > usually 0.05-0.3 mL range
- If no fluid is aspirated > retract needle > try aspiration again
6. Release suction > withdraw needle
- Prevents blood contamination of sample
164
What forms the "triangle" landmarks for a stifle arthrocentesis?
1. Patella + Straight Patellar Ligament
2. Tibial Tuberosity
3. Lateral Condyle of Femur
165
PROCEDURE - Arthrocentesis (Stifle)
1. Place patient in lateral recumbency
2. Shave + aseptically prepare site
3. Wearing sterile gloves > hold stifle in partial flexion > palpate stifle "triangle" landmarks with index finger
4. Hold syringe so you can aspirate without needing to reposition hands on syringe > insert needle just lateral to straight patellar ligament > direct medially at 35º-45º angle + slightly upward into origin of cruciate ligaments between femoral condyles
5. Aspirate until fluid fills needle hub > usually 0.05-0.3 mL range
- If no fluid is aspirated > retract needle > try aspiration again
6. Release suction > withdraw needle
- Prevents blood contamination of sample
166
Synovial Fluid Analysis commonly includes:
1.
2.
3.
1. Gross Appearance
2. Histologic Analysis
3. Bacterial Culture
167
Gross appearance of SF is used to _________.
to indicate any issues with the joint
168
How much SF is necessary to evaluate:
1. Gross Appearance
2. Histologic Analysis
3. Bacterial Culture
1. Gross Appearance - 1 drop
2. Histologic Analysis - 1 drop
3. Bacterial Culture - 2 drops
169
Histologic analysis of SF is used to ________.
to determine presence, types, and levels of blood cells
170
The gross appearance of SF is evaluated for:
1.
2.
3.
1. Color
2. Turbidity
3. Viscosity
171
Increased number of ______ in SF may indicate inflammation of synovial joint lining.
Polymorphonuclear Neutrophils (PMNs)
172
Bacterial culture of SF is used to _________.
to determine presence of infectious microorganisms
173
Normal SF is:
1.
2.
3.
1. Colorless
2. Clear
3. Viscous
- Forms a long string between the needle + slide
- Drop remains global on slide
174
Abnormal SF:
Uniformly red indicates >
hemarthrosis
175
bleeding into the space around the joint
Hemarthrosis
176
Abnormal SF:
Nonhomegenously red indicates >
SF contaminated with blood
177
Abnormal SF:
Yellow-orange indicates >
previous hemorrhage into the synovial membrane followed by release of hemoglobin pigment
178
Abnormal SF:
White-yellow indicates >
increased cellularity due to sepsis, inflammation, or neoplasia
179
Abnormal SF:
Increased turbidity indicates >
increased WBCs, microorganisms, crystals, or presence of fibrin
180
Abnormal SF:
Low viscosity indicates >
inflammatory disorders
181
hpf
high-power field, aka the microscopic field
182
a procedure performed to provide information regarding the underlying cause of low RBC counts/many other diseases and to determine the presence/type of neoplasia
Bone Marrow Aspiration
183
Give 2 contraindications for bone marrow aspiration
1. Clotting factor abnormalities
2. Severe thrombocytopenia
184
condition in which there are low levels of platelets in the blood
Thrombocytopenia
185
Where bone marrow is obtained is determined by the patient's:
1.
2.
3.
1. Size
2. Age
3. Conformation
186
Bone marrow can be obtained from:
1.
2.
3.
1. Iliac crest
2. Humerus
3. Femur (cats + small dog breeds)
187
What materials are needed for bone marrow aspiration?
1. #11 scalpel
2. 12 or 20 mL syringe
3. Sterile gloves
4. Sterile drape
5. 2% lidocaine in a syringe + needle
6. Clean glass slides
7. EDTA collection tube
8. Bone marrow aspiration needle
188
18-gauge stainless steel Rosenthal bone aspiration needle
189
16-gauge Illinois-style bone aspiration needle (with depth stop)
190
PROCEDURE - Bone Marrow Aspiration (Iliac)
1. Administer sedation/analgesic or general anesthesia to patient
2. Place patient in sternal or lateral recumbency + legs drawn forward
3. Wearing sterile gloves > shave + aseptically prepare the insertion site
4. Inject 2% lidocaine into skin, SC tissue + periosteum of bone
5. Make stab relief incision in skin with #11 scalpel + over iliac crest
6. Check stylet is perfectly occluding distal tip of bone marrow needle
- If using Rosenthal needle > place counter pressure on stylet with index finger or palm > so stylet does not back out
7. Stabilize ilium with one hand > advance needle + stylet through incision > into the bone
8. Advance needle into bone using wrist rotary motion + immobilized elbow > 1 to 1.5 cm or until needle is well seated
9. Remove stylet from needle + place on a sterile field > attach 12 or 20 mL syringe to needle
10. Apply negative pressure to syringe plunger > stop after obtaining 0.1 to 1.0 mL of sample
11. Remove syringe from needle > reinsert sterile stylet into needle
12. Immediately make 6-8 smears + 2 pull slides
13. With needle still in place > add drop of new methylene blue stain to 1 pull slide + coverslip > determine if bone marrow elements are present
- If sample not adequate > obtain another
14. Remove needle using same wrist rotary motion > hold pressure on site until hemostasis occurs
191
PROCEDURE - Bone Marrow Aspiration (Humeral)
1. Administer sedation/analgesic or general anesthesia to patient
2. Place patient in lateral recumbency
3. Wearing sterile gloves > shave + aseptically prepare the insertion site
4. Inject 2% lidocaine into skin, SC tissue + periosteum of bone
5. Make stab relief incision in skin with #11 scalpel + over craniolateral aspect of greater tubercle of proximal humerus
6. Check stylet is perfectly occluding distal tip of bone marrow needle
7. Assistant flex patient elbow + rotate or abduct shoulder externally > advance needle + stylet perpendicular to humeral shaft through incision > into the bone
8. Advance needle into bone using wrist rotary motion + immobilized elbow > 1 to 1.5 cm or until needle is well seated
9. Remove stylet from needle + place on a sterile field > attach 12 or 20 mL syringe to needle
10. Apply negative pressure to syringe plunger > stop after obtaining 0.1 to 1.0 mL of sample
11. Remove syringe from needle > reinsert sterile stylet into needle
12. Immediately make 6-8 smears + 2 pull slides
13. With needle still in place > add drop of new methylene blue stain to 1 pull slide + coverslip > determine if bone marrow elements are present
- If sample not adequate > obtain another
14. Remove needle using same wrist rotary motion > hold pressure on site until hemostasis occurs
192
PROCEDURE - Bone Marrow Aspiration (Femoral)
1. Administer sedation/analgesic or general anesthesia to patient
2. Place patient in lateral recumbency
3. Wearing sterile gloves > shave + aseptically prepare the insertion site
4. Inject 2% lidocaine into skin, SC tissue + periosteum of trochanteric fossa
5. Make stab relief incision in skin with #11 scalpel
6. Check stylet is perfectly occluding distal tip of bone marrow needle
7. Grasp femur + hold hip in flexed position > advance needle + stylet medial to greater trochanter + parallel to femoral shaft through incision > into the bone
8. Advance needle into bone using wrist rotary motion + immobilized elbow > 1 to 1.5 cm or until needle is well seated
9. Remove stylet from needle + place on a sterile field > attach 12 or 20 mL syringe to needle
10. Apply negative pressure to syringe plunger > stop after obtaining 0.1 to 1.0 mL of sample
11. Remove syringe from needle > reinsert sterile stylet into needle
12. Immediately make 6-8 smears + 2 pull slides
13. With needle still in place > add drop of new methylene blue stain to 1 pull slide + coverslip > determine if bone marrow elements are present
- If sample not adequate > obtain another
14. Remove needle using same wrist rotary motion > hold pressure on site until hemostasis occurs
193
a procedure performed to acquire cytologic samples in order to differentiate between inflammation, neoplasia, and hyperplasia in soft tissue
Fine-Needle Aspiration (FNA)
194
thickening or enlargement of an organ or tissue
Hyperplasia
195
abnormal and uncontrolled growth of cells that may lead to a tumor
Neoplasia
196
What are 3 possible complications of FNA?
1. Minor hemorrhage
2. Tissue damage
3. Infection
197
PROCEDURE - Fine Needle Aspiration (FNA)
1. Use appropriate restraint to access the mass
2. Prep the skin over the mass
- Visceral aspirates > surgical scrub
- Superficial aspirates > wipe with alcohol
3. Secure mass with one hand + introduce needle to mass with other hand > redirect needle within tissue once or twice
4. Attach syringe with at least 1 mL of air to needle > aspirate tissue
5. Quickly depress syringe plunger > removes all material onto microscope slide
- If material is liquid > make push slide
- If material is viscous > make pull smear
198
Skin Prep for FNA:
If visceral aspirates >
use surgical scrub
199
Skin Prep for FNA:
If superficial aspirates >
wipe with alcohol
200
_______ can be performed to obtain a sample from non-superficial tissues.
Ultrasound-guided FNA
