Veterinary Nursing Journal

ISSN: 1741-5349 (Print) 2045-0648 (Online) Journal homepage: http://www.tandfonline.com/loi/tvnj20

Equine Veterinary Nurse

To cite this article: (2004) Equine Veterinary Nurse, Veterinary Nursing Journal, 19:2, 50-51,
DOI: 10.1080/17415349.2004.11013248

To link to this article: http://dx.doi.org/10.1080/17415349.2004.11013248

Published online: 21 Nov 2014.

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Download by: [Library Services City University London] Date: 06 April 2016, At: 15:11
 OFF THE BEATEN TRACK
EQUINE
VETERINARY
NURSE
Veterinary Nursing continues its 'Offthe beaten
track' series, focusing on veterinary nurses whose
career paths have tended away from general
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practice. In this instalment, Kelly Russell
describes her life as an equine veterinary nurse
I began my career in 1993, as
a student veterinary nurse in a
small animal clinic in Maid-
stone, Kent. Mter passing the
then preliminary examinations,
I moved to a larger clinic to gain
the experience to complete my
training. This was a large mixed
practice, where I nursed not
only small animals but also farm
animals and horses. On com-
pleting my training, I decided to
specialise in equine practice.
In late 1999, I moved to the
Bell Equine Veterinary Clinic in
Mereworth, near Maidstone, to
work in a solely equine environ-
ment. There, I undertook the
fast-track pilot training scheme
for the equine veterinary nursing
(EVN) certificate, and qualified
with credit in 2001.
At the Bell Equine, I work
in a team of five nurses. I am
the only qualified EVN at the
moment, but I hope to train the
rest of the team once direct entry
into the EVN training scheme is
established. My main role is to
manage and train the nursing
staff, and to assist the veterinary
surgeons with clinical work.
The practice has been estab-
lished for over 10 years and has a
large client base. We see a range
of equine patients, from retired
ponies and donkeys to top-class
eventers and show jumpers.
We are primarily a first opinion
practice, but our excellent facili-
so
ties and equipment bring a large
number of referrals and second
opinion cases from neighbour-
ing clinics. No two days are the
same, but the following is an
example of the sort of day an
EVN might have at my practice.
A typical day
My shift starts at 08.00. The vet-
erinary staff, yard staff and I tour
the barns and stables to assess
in-patients and discuss the day's
treatment plans. I complete a
hospital sheet which lists all the
in-patients' names, reasons for
hospitalisation, and progress
updates, so that office staff have
something to refer to if the own-
ers telephone.
Once the ward rounds are
done, I check the appointments
book to see what equipment
needs to be ready for the ambu-
latory vets. Generally, two or
three vets work in the clinic at
any one time, so we expect quite
a few appointments in one day-
not including emergencies! To
ensure the clinic runs smoothly,
I organise the nursing team so
that each vet has a veterinary
nurse to assist with consultations
and surgical procedures.
Next, in-patients are individ-
ually examined. I monitor and
record each one's temperature,
pulse and respiration (TPR).
Any medication is administered
and recorded. The vets on duty
advise me on which patients
need bandage changes or treat-
ments such as intravenous
catheter changes. I carry out
these tasks with assistance from
the other nurses.
The first appointment of the
day arrives: a lame seven-year-
old pony. A thorough lameness
investigation commences. I lead
the pony up and down the yard
'in walk' and then 'in trot' so
that the vet can ascertain which
leg is lame. Flexion tests are per-
formed and the pony is lunged
on the hard ground to help the
vet identify the site of lameness.
I then ride the pony in the field:
she feels very awkward when
she moves and is reluctant to go
forward, and she seems to have
numerous sites of pain. She is
booked in for nuclear scinti-
graphy later on. This procedure
involves injecting a radioactive
pharmaceutical (a combination
of a bone-seeking agent, methyl-
ene diphosphate, and a radioac-
tive compound, technetium 99)
into a vein. The drug circulates
throughout the bloodstream and
VETERINARY NURSING Volume 19 No 2Aprii/May 2004
localises in the bone; this process
takes approximately three hours.
The patient is then scanned with
a gamma camera. While she is
'radioactive', the pony is kept in
isolation.
The next patient is a pony
with laminitis. The underlying
cause is Cushing's disease. The
pedal bones in both front feet
have rotated and the tip of the
left fore pedal bone has begun to
come through the sole of the
foot. The vet has previously per-
formed a deep flexor tenotomy
and a dorsal hoof wall resection.
I remove the soiled dressings,
redress the feet and rebandage
the forelimbs.
One of the most common
conditions we see is colic. A
medical colic referral presents
next, with reduced faecal out-
put. I take the horse to the treat-
ment room and stand him in the
stocks - these allow veterinary
staff to examine horses safely.
While the vet listens to the
horse's gut sounds, I assist by
monitoring the patient's TPR.
Following a rectal examination,

the vet diagnoses a large doughy
pelvic flexure impaction. He
asks me to place an intravenous
catheter in the jugular vein and
begin fluid therapy. I take the
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horse to the barn and the yard
staff prepare a stable.
A dressage horse with behavi-
oural problems - rearing when
ridden- arrives for consultation.
He has already had scintigraphy.
Today we are performing endo-
scopy. I prepare the equipment
and stand the horse in the
stocks. He is very nervous but
we do not want to sedate him, so
I place a twitch on his nose to
restrain him. The vet passes the
endoscope up into the nostril
and examines the larynx and
guttural pouches for signs of dis-
ease or trauma.
A lame polo pony comes in
for a magnetic resonance imag-
ing (MRI) scan. We are lucky
enough to have a purpose-built
MRI room: the machine has
been designed so that we can
image limbs and feet without
having to anaesthetise patients.
On this occasion, we take a
series of scans, each one lasting
for about five minutes. The
pony must be perfectly still so as
not to distort the final image, so
he is sedated on entry to the
MRI room. I remove his front
shoes because the magnet in the
MRI scanner is so powerful it
would attract the shoes and
cause injury. With the assistance
of another nurse, I position the
pony in the stocks and prepare
the foot. Once it is in position, I
hold rhe leg to try to minimise
movement during scanning.
The vet identifies a problem
area from rhe final MRI scans.
I move rhe pony to the radiogra-
phy room, help the radiographer
VETERINARY NURSING Volume 19 No 2 April/May 2004
x-ray both forefeet, and develop
the images.
Three hours have passed
since the lame pony was injected
with technetium - she is ready
to scan. Wearing protective
clothing (boiler suit, extremity
dose meters, lead gown and
gloves), and with the help of
another nurse, I lead the pony
into the nuclear scintigraphy
room. The technetium IS
excreted in the urine, so my
assistant has the lovely job of
catching any expelled urine in a
bucket on a long handle! The vet
sedates the pony so that we can
move the large gamma camera
around without startling her.
We carry out a 'full body'
scan, scanning her neck, back
and legs. The image is displayed
on a computer screen. Any areas
that may be causing problems
show up as 'hot spots'. The scan
identifies some hot spots on the
dorsal spinous processes of her
thoracic spine. We will x-ray this
area when the pony is no longer
radioactive, 24 hours later.
Meanwhile, the office staff
receive a telephone call from a
neighbouring practice, which
has referred a severe colic case to
us. We are to expect the patient
within the hour, so I immedi-
ately begin to prepare the equip-
ment we may need. I set up the
theatre and turn on the oxygen
supply. Horses may need to
be anaesthetised immediately if
they have severe abdominal pain
which, for example, may make
them roll violently, sweat, move
continuously, drop to the ground
or paw at it.
When the horse arrives, I
direct it into the treatment room
for an initial examination. This
horse is quiet and in shock.
clockwise from left: Flushing a facial
wound with dilute povidone-iodine
solution; an exteriorised small
intestine distended by obstruction
(colic); providing postoperative
treatment via an intravenous
catheter; changing a leg dressing
While the vet examines it, I take
a blood sample to check its
packed cell volume, and protein
and albumin levels. I place a
catheter in the jugular vein and
begin fluid therapy with 3 litres
of hypertonic saline while the
horse is prepared for surgery.
This patient is quickly taken
to the theatre and sedated prior
to induction of anaesthesia.
Once anaesthetised, the horse is
positioned in dorsal recumbency
on the operating table. I clip and
aseptically prepare the abdomen.
When the surgeon is ready, I
assist by opening sterile gowns,
drapes and surgery kits. Colic
surgery usually takes about two
hours, depending on the type of
problem. During surgery, I am
responsible for keeping the guts
moist and well lubricated in
order to minimise postoperative
formations of adhesions. This
patient had incarceration and
strangulation of small intestine
in the epiploic foramen; basi-
cally, a loop of small intestine
had formed an internal hernia.
As soon as the surgery is
completed, the horse is taken
to a recovery box. I clean the
operating theatre and put the
equipment away. All the instru-
ments used must be cleaned and
sterilised in readiness for the
next operation. Once the theatre
is clean and tidy, I check the
stocks, including oxygen, and
restock and reorder as necessary.
The horse recovers unevent-
fully. Once standing, it is left in
the recovery box until it can
walk to the barn. Meanwhile,
my last job of the day is to check
that a stable is prepared for the
colic patient. The stable floor is
lined with thick rubber matting
to protect the horse from injury
if pain makes it roll. A thick bed
of white dust-free shavings is
placed on top of the matting.
I normally finish my shift at
16.00, but this varies from day
to day. Emergencies can arrive at
any time, day or night, so nurs-
ing assistance is required at all
times.
Living the dream
For as long as I can remember, I
have always liked animals and
wanted to work with them. As
a child, I loved all animals, but
when I grew older and started
horseriding lessons, I knew that
horses were my favourite species.
Equine veterinary nursing is
a varied and satisfying career. I
thoroughly recommend it. The
time that I have spent studying
over the last 10 years has defi-
nitely paid off. I am now in my
dream job - surrounded by
horses all day, being paid for it!
51