Archive for March, 2012:

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General

Veterinary Nursing in focus

By admin On March 26, 2012 - Comments

A common comment when I explain to people that I am a Qualified Registered Veterinary Nurse (RVN), is, “that’s amazing”, and then I listen to the perception that I play with puppies and kittens for the majority of my working day!  I would love to say an element of that is true however there is much more involvement in my daily role as a RVN.  It is very common for clients to know how long the Veterinary Surgeons’ training is.  It is however uncommon for clients to understand the content and length of the Veterinary Nursing qualification including our options for further qualifications.

The Veterinary Nursing qualification currently involves two years of difficult studying with practical examinations, oral examinations and written examinations to qualify as a RVN.  It is then common for newly qualified nurses to work alongside the Veterinary Surgeon normally in first opinion veterinary practices to gain experience and become more confident as a newly qualified nurse.

Another option that Veterinary Nurses can undertake is specialising in certain subject areas such as Medical Nursing, Radiography or Anaesthesia.  The nurse would have to ideally work alongside specialist Veterinary Surgeons and partake in research and submit case reports to the Royal College of Veterinary Surgeons (RCVS) to obtain the Higher Education Clinical Veterinary Nursing and Advanced Veterinary Nursing Diploma.

This involves two and a half years of intensive study, submitting case studies, oral examinations, practical examinations, written examinations and a final written dissertation with an additional examination.  This qualification is recommended and recognised by the RCVS and results in the Veterinary Nurse achieving a specialist qualification.  It is considered by the RCVS the highest clinical nursing qualification available to Veterinary Nurses at this current time and is a great achievement to gain.

In the past Veterinary Nurses were never accountable for their actions or negligence if such occurred – this always fell with the Veterinary Surgeon. However recent improvements to the Veterinary Nursing profession has included Veterinary Nurses having their very own governing body and as a result RVN’s are now accountable for their actions, similar to that of Veterinary Surgeons.  An addition to the title Veterinary Nurse has been established and newly qualified nurses are now titled Registered Veterinary Nurse (RVN) and must perform continuing professional development (CPD) regularly to remain on the RVN register which is monitored by the RCVS.

There are a wide range of CPD courses for RVNs to keep up to date and learn new techniques from anaesthesia to surgical nursing and oncology to dermatology so you can rest assured we never stop learning!

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General

Airway obstruction, can surgery help?

By admin On March 8, 2012 - Comments

Bulldogs and Pugs are two brachycephalic (short nosed) breeds that unfortunately suffer with breathing problems due to excessive soft tissue in their mouths and a narrowing of various components of their airways. Bulldogs and Pugs are usually very friendly in nature and are lovely to have as pets but they are often unable to engage in  normal family activities due to the compromise of their upper airways. Exertion, particularly in hot weather can result in extreme difficulty in breathing ( dyspnoea) and collapse.

The usual problem areas are :

The nasal apertures (openings)  are often stenotic ( narrowed). So the patient’s initial ability to draw air into the nostrils is reduced. Currently in the soft tissue surgery department at Northwest Surgeons, we would advise that a lateral wedge resection is performed to widen the nasal apertures. A triangular wedge is removed from the side of the each nostril. The wound bed created is sutured to create a wider opening. The sutures placed are small, soft and dissolvable.

The soft palate is often over long and dangles over the top of the epiglottis and into the airway, obstructing airflow. The soft palate is a muscular structure that should contract and shorten, allowing the epiglottis to flip upwards and protect the opening of the airway (glottis). Surgery is advised to shorten an overlong soft palate so that the ‘new’ edge is level with the back end of the tonsils. At Northwest Surgeons we perform a staged cutting of the excess soft palate tissue and meticulously over sow the cut edge using a dissolvable suture material.

The laryngeal saccules are two fleshy balloons of airway lining near the vocal chords that evert and obstruct the opening of the airway (glottis) if there is excessive friction in air movement. In the brachycephalic breeds there is often a lot of constant airway friction, a high pressure gradient as the patient tries to draw the air past the larynx into the windpipe. The saccules can spend most of their time everted and swell with oedema (fluid), which for some individuals means that the aperture of their airway is reduced in size by 50%. We would recommend that the everted saccules are removed surgically.

Hypoplasia of the trachea is yet another additional condition that can hamper the breathing efforts, particularly in bulldogs. This is a congenital condition and is characterized by a significant narrowing along the entire length of the trachea. This causes yet more resistance to airflow when the dogs breathe in and out. This condition cannot be corrected surgically.

Recovery from airway surgery is a time for vigilance and careful preparation by our specialist in anaesthesia, Matthew Gurney. Our patients have a smooth transition from the endotracheal tube delivering oxygen to a laryngeal mask. This enables oxygen delivery for a longer period during recovery and can be safely removed as the patient becomes more conscious. Surgery to the upper airway, not matter how meticulous can cause localised swelling which could lead to temporary airway obstruction . It is therefore vital that provision is always made for an emergency tracheostomy, though it is very rarely required. Airway patients at Northwest Surgeons, always stay hospitalised the night of the surgery so that they can be regularly monitored and the surgeon is on hand should a problem arise.

What happens if patients do not have surgical correction of the above problem areas?

The constant increased respiratory effort and low airway pressures may cause the laryngeal ( voice box) cartilages to tire and lose their rigidity. The cartilages become floppy and scroll inwards, the patient can develop a progressive collapse of their larynx.

At Northwest Surgeons we feel that the vast majority of our brachycephalic patients do benefit from  corrective surgical procedures. They will always have excessive upper airway noise despite surgery but we hope  that the removal of some of the obstructive  tissues enables these lovely pets to enjoy  a more full and active life style.

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