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Ebffiledocnew - 538download Full Chapter Small Animal Clinical Techniques 2Nd Edition Susan M Taylor PDF
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Procedures
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Small Animal
Clinical Techniques
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Small Animal
Clinical Techniques
Second Edition
SUSAN M. TAYLOR
DVM, Diplomate ACVIM (Small Animal Internal Medicine)
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(other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment
may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such infor-
mation or methods they should be mindful of their own safety and the safety of others, including parties
for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to
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Printed in China
Preface
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ix
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Contents
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Venous Blood 1
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Collection
PROCEDURE 1-1 Jugular Venipuncture
PURPOSE
To obtain a sample of venous blood for analysis
INDICATIONS
Collection of a blood sample for clinical pathology tests
COMPLICATIONS
1. Hemorrhage.
2. Subcutaneous hematoma formation.
SPECIAL ANATOMY
Jugular vein: The right and left external jugular veins are
large superficial veins that lie within the jugular furrow, a Equipment required for venipuncture in dogs and cats.
groove on each side of the neck dorsolateral to the trachea.
RESTRAINT
Small dogs and cats should be restrained on a table in
sternal recumbency for jugular venipuncture. Grasp the
front legs just above the carpal joints and pull the front
External
legs off the edge of the table. Extend the animal’s neck
jugular so that its nose is pointing toward the ceiling.
vein
1
Cephalic Lateral
vein Medial saphenous
saphenous vein
Cephalic vein
vein
The veins accessible for collection of venous blood in dogs and cats.
EQUIPMENT
• 22- to 20-gauge, 1-inch needle
• Syringe
• 70% alcohol
Jugular venipuncture can be performed in large dogs
Medium-sized dogs can be restrained in a sternal posi-
while they sit on the floor, straddled by the restrainer,
tion or sitting position on a table, cradled against the
with the nose pointing toward the ceiling.
holder’s body with one arm while the head is restrained
and the nose pointed toward the ceiling.
3
2A
TECHNIQUE
Restraining a medium-sized dog for jugular venipuncture. Anatomy
2B 1
Distend the vein with blood (raise the vein) by applying 3. Palpate the distended vein. If the vein cannot be seen
firm pressure at the thoracic inlet at the most ventral or palpated, clip hair from a small area over the jugular
portion of the jugular furrow, lateral to the trachea. furrow.
4. Apply alcohol and palpate the distended vein, tracing
2A its path from the angle of the mandible to the thoracic
inlet.
Insert the needle, bevel upward, at a 20- to 30-degree
angle to the vein. Once the tip of the needle is in the
vein, apply suction to collect the sample. If flow stops, at-
tempt to withdraw the needle slightly to reestablish flow.
2B
PURPOSE
To obtain a sample of venous blood for analysis
INDICATIONS
Collection of a blood sample for clinical pathology tests
COMPLICATIONS
1. Hemorrhage.
2. Subcutaneous hematoma formation.
SPECIAL ANATOMY
Jugular vein: The right and left external jugular veins are
large superficial veins that lie within the jugular furrow, a
groove on each side of the neck dorsolateral to the trachea.
RESTRAINT
External
jugular 1. Some cats violently object to restraint for routine jugu-
vein lar venipuncture. In these cats and in struggling young
kittens and puppies, an inverted technique often is
Cephalic Lateral superior.
vein Medial saphenous Place the animal in a cat bag or wrap it in a towel with
saphenous vein
Cephalic vein
only the head and neck accessible (Box 1-1).
vein
2
The veins accessible for collection of venous blood in dogs and cats.
EQUIPMENT
• 22- to 20-gauge, 1-inch needle
• Syringe
• 70% alcohol
BOX 1-1
Putting a Cat into a Cat Bag
A. Scruff the cat and place the cat on top of the open cat bag on D. Zip up the back of the cat bag.
the table.
C. Grasp the cat’s rear legs in one hand and curl them forward
toward the cat’s chest.
6 CHAPTER 1 Venous Blood Collection
2A Holder compresses
jugular vein in the
thoracic inlet Venipuncturist
holds head
3B
2B
PURPOSE
To obtain a sample of venous blood for analysis
INDICATIONS
Collection of a blood sample for clinical pathology tests
COMPLICATIONS
1. Hemorrhage.
2. Subcutaneous hematoma formation.
SPECIAL ANATOMY
Cephalic vein: The right and left cephalic veins are super-
ficial veins that lie on the anterior surface of the forearm,
making them very accessible for venipuncture.
External
jugular
RESTRAINT
vein 1. Place the animal in a sitting position or in sternal re-
cumbency on a table or (for large dogs) on the floor.
Cephalic Lateral The holder should stand on the side opposite the leg to
vein Medial saphenous be used and should use one arm to restrain the animal’s
saphenous vein
Cephalic vein
head by encircling the neck and turning the muzzle
vein away from the leg to be used. The holder should use the
other arm to extend the animal’s front leg by holding
the elbow and pushing the leg forward.
2
The veins accessible for collection of venous blood in dogs and cats.
EQUIPMENT
• 22- to 20-gauge, 1-inch needle
• Syringe
• 70% alcohol
TECHNIQUE 2. If the vein cannot be seen or palpated, clip hair from a
Laterally roll and compress the cephalic vein. small area over the dorsal forearm, and apply alcohol.
The venipuncturist should grasp the paw to keep the
leg extended. He or she should identify the distended
1A
cephalic vein and place the thumb alongside the vein to
stabilize it during venipuncture.
1B
Using the thumb of the hand holding the leg, the cephalic vein is
rolled laterally and compressed so that it becomes distended with
blood.
PROCEDURE 1-4 Lateral Saphenous Venipuncture 9
PURPOSE
To obtain a sample of venous blood for analysis
INDICATIONS
Collection of a blood sample for clinical pathology tests
COMPLICATIONS
1. Hemorrhage.
2. Subcutaneous hematoma formation.
SPECIAL ANATOMY
Lateral saphenous vein: The right and left lateral saphenous
veins are small superficial veins that run diagonally across
the lateral surface of the distal tibia.
External
jugular
RESTRAINT
vein 1. Restrain the animal in lateral recumbency with the legs
toward the venipuncturist and the back toward the h
older.
Cephalic Lateral Have the holder restrain the animal by grasping the
vein Medial saphenous forelimbs with one hand and elevating them slightly off
saphenous vein
Cephalic vein
the table while applying pressure down on the neck of
vein the patient with the same forearm. Grasp the uppermost
hind leg with the other hand.
The veins accessible for collection of venous blood in dogs and cats.
EQUIPMENT
• 22- to 20-gauge, 1-inch needle
• Syringe
• 70% alcohol
TECHNIQUE
The holder should encircle the caudal aspect of the up- 2. The venipuncturist should grasp the hind foot and pal-
permost hind leg, applying firm pressure at the level of pate the distended vein. If the vein cannot be seen or
the stifle to compress the lateral saphenous vein and palpated, clip hair from a small area over the vein and
cause it to distend with blood. apply alcohol, while ensuring that the holder is com-
pressing the vein adequately.
1A Once the vein is identified, the venipuncturist should
place the thumb adjacent to the vein to stabilize it and
prevent movement during venipuncture. Insert the nee-
dle, bevel upward, at a 20- to 30-degree angle to the
vein. Once the tip of the needle is in the vein, apply suc-
tion to collect the sample.
1B
External
jugular
vein
Cephalic Lateral
vein Medial saphenous
saphenous vein
Cephalic vein
vein
1A
1B
RESTRAINT
1. The medial saphenous vein is most useful in cats. Re-
strain the cat in lateral recumbency with the legs toward
the venipuncturist and the back toward the holder.
Have the holder scruff and stretch the cat with one hand
while retracting the uppermost hind leg with the other
hand.
Occluding the medial saphenous vein, causing it to distend with
blood.
12 CHAPTER 1 Venous Blood Collection
INDICATIONS
1. Most commonly used to collect a drop of blood for blood Marginal ear
glucose measurement in dogs and cats vein
2. Used for evaluation of multiple sequential blood glucose
measurements where repeated venipuncture would be
stressful and difficult
Cutaneous marginal
3. Collects capillary blood and does not require venipunc- pouch
ture skills, so can be performed by owner at home
bruising.
3. Sometimes an inadequate drop is obtained if techniques 2. Puncture is usually performed on the back (haired) side of
to improve blood flow (massage, heating) are not utilized. the ear between the visible vein and the outer edge of the
ear between the apex (tip) of the ear and the cutaneous
SPECIAL ANATOMY marginal pouch to initiate capillary bleeding. If the vein
1. The marginal ear vein, or lateral auricular vein, runs itself is nicked, bruising is more likely to occur.
along the lateral margin of the pinna of the ear.
EQUIPMENT
• Glucometer and test strips
• 25-gauge needle or lancing device with lancet
• Gauze sponges or cotton balls
PROCEDURE 1-6 Marginal Ear Vein Blood Collection 13
Replace the plastic guard cap, which has a hole on the end
to allow the needle to puncture the site when triggered.
Insert a new lancet into the lancing device, pushing it Adjust the depth setting using the dial on the side of the
firmly into the cup. lancing device.
1 4
Insert a new lancet into the lancing device (arrow). Adjust the depth setting by turning the dial (arrow).
Twist off the rounded guard, exposing the needle. Pull the dark cocking handle out until it clicks.
2 5
Twist off the rounded guard, exposing the needle. Pull back on the dark handle to cock the device (arrow).
14 CHAPTER 1 Venous Blood Collection
TECHNIQUE: PREPARE THE CAT 3. Position the lancet between the vein and the outer mar-
1. Hold the cat in a position in which it is comfortable. gin of the ear.
2. Identify the marginal ear vein.
3. If desired, apply a very small bit of Vaseline to the area Press the trigger button to release the spring-loaded
you will puncture to make the vessel more visible and to lancet and prick the ear.
make the blood drop bead up instead of spreading into
the fur. 4
4. If desired, apply a dry warm compress to the lateral ear
margin for 20 to 60 seconds before puncturing to increase
blood flow.
Position the lancet between the vein and the outer ear margin and
press the trigger button (arrow), lancing the ear.
Massage the ear toward the puncture site until there is a visible
drop of blood.
Hold the ear margin against a gauze sponge wrapped around your
finger.
PROCEDURE 1-6 Marginal Ear Vein Blood Collection 15
Once a drop of blood has formed, hold the tip end of the 7. Once the strip has enough blood, apply gentle pressure to
test strip to the base of the blood drop and “sip” it up. the ear for 15 seconds to prevent bruising.
Language: French
PARIS
ERNEST FLAMMARION, ÉDITEUR
26, RUE RACINE, 26
LIBRAIRIE E. FLAMMARION
EN PRÉPARATION :
PRÉAMBULE
LE BUT ET LE PLAN
CHAPITRE PREMIER
LE BONHEUR
Nous aussi, nous croyons à une vie meilleure, à une vie future.
Mais nous ne la garantissons pas dans cet au-delà de la mort que
nul encore n’a sondé d’un regard certain. Notre vie meilleure, c’est
celle de nos descendants. Notre vie meilleure, c’est l’Avenir. Elle
n’est pas dans le ciel. Elle est sur la terre. C’est la vie que nous
forgeons pour ceux qui nous succéderont. Nous y croyons parce que
nous y travaillons, parce qu’elle est le prolongement de notre vie.
Voilà l’acte de foi qui doit nous soutenir au cours de notre existence.
Cette vie meilleure, nous ne l’attendons pas dans la résignation,
sous le joug des dogmes. Nous la préparons, nous apportons notre
humble pierre à l’édifice, dans le courage et l’allégresse.
J’entends des gens dire que nous avons la même mentalité que
l’homme des cavernes, que la morale n’a pas fait de progrès,
parallèlement à la science et sous son influence.
Est-ce bien sûr ? Et surtout s’est-il écoulé assez de temps pour
que ces progrès nous soient sensibles ? Les phénomènes
d’évolution, ceux qui ont sculpté la surface de la terre, ceux qui ont
peu à peu réalisé l’être humain, sont tellement lents, exigent tant de
milliers d’années !
Les notions acquises depuis quelques siècles seulement
modifient peut-être l’esprit de l’homme. Mais l’empreinte n’est pas
encore assez profonde pour que nous discernions ce relief nouveau.
Prenez en exemple la conception de l’infini, la conception qu’il y
a des astres derrière les astres, qu’il n’y a pas de limites à l’espace.
Elle est récente, puisque les anciens voyaient un univers borné,
voûté. Elle est fille de l’astronomie moderne. Or, cette notion de
l’infini, de notre terre perdue comme un grain de boue, comme une
cellule isolée d’un organisme immense, cette notion n’est-elle pas
pour nous montrer la petitesse, la vanité de nos querelles, de nos
luttes, et par conséquent pour améliorer peu à peu la morale ? Ne