BSAVA Guide to B S Procedures in A Small Animal Practice V A Edited by Nick Bexfield and Karla Lee G u The BSAVA Guide to Procedures in Small Animal Practice provides practical, i step-by-step guidance on how to perform the diagnostic and therapeutic d procedures commonly performed in small animal veterinary practice. In e addition, routine clinical examination of the major body systems, and protocols for the management of selected emergencies, are described. t o In addition to the actual technique, each procedure has information on P indications and contraindications, equipment required, and potential complications, together with the editors’ own hints and tips. Details of BSAVA r o Manuals where wider information can be found, such as interpretation of results, are given throughout. c e Special features: d ■■ A to Z format to aid information retrieval u ■■ Extensive cross-referencing in highlighted text ■■ Specially commissioned drawings r e ■■ Lay-flat binding s This is a truly useful guide, which will provide a valuable and lasting reference i for veterinary surgeons, veterinary nurses and students alike. n S Contents m Abdominocentesis; ACTH response test; Anaphylaxis – emergency treatment; Arthrocentesis; Aseptic preparation; Barium contrast media; Barium studies of a the gastrointestinal tract; Blood pressure measurement; Blood sampling; Blood smear preparation; Blood transfusion; Bone biopsy – needle; Bone marrow l l aspiration; Bronchoalveloar lavage; Bronchoscopy; Buccal mucosal bleeding A time; Cardiopulmonary–cerebral resuscitation; Cardiorespiratory examination; Cast application; Cerebrospinal fluid sampling; Cranial draw test; Cystocentesis; n BSAVA Guide to Dexamethasone suppression tests; Diagnostic peritoneal lavage; Ehmer sling; i Elbow luxation – closed reduction; Electrocardiography; Endoscopy of the m gastrointestinal tract; Endotracheal wash; Fine needle aspiration; Fluorescein test; Gastric decompression; Gastrostomy tube placement; Haemagglutination test; a Procedures in Hip luxation – closed reduction; Intraosseous cannula placement; Intravenous l catheter placement; Intravenous urography; Iodinated contrast media; Myringotomy; P Nasal oxygen administration; Naso-oesophageal tube placement; Neurological examination; Oesophagostomy tube placement; Ophthalmic examination; r Orthopaedic examination; Ortolani test; Otoscopy; Pericardiocentesis; Platelet a Small Animal count; Prostatic wash; Resting energy requirement; Retrograde urethrography/ c vaginourethrography; Rhinoscopy; Schirmer tear test; Seizures – emergency t protocol; Semen collection; Skin biopsy – punch biopsy; Skin/hair examination; i Soft padded bandage; Spica splint; Thoracocentesis – needle; Thoracostomy tube c Practice placement; Tibial compression test; Tissue biopsy – needle core; Tracheostomy; e Transtracheal wash; Urethral catheterization; Urethral retrograde urohydropulsion; Urinalysis; Velpeau sling; Water deprivation test; Whole blood clotting time Nick Bexfield ISBN 978 1 905319 17 6 and Karla Lee Covers spreads.indd 1 8/1/10 12:09:58 BSAVA Guide to Procedures in Small Animal Practice Editors: Nick Bexfield BVetMed DSAM DipECVIM-CA MRCVS European Specialist in Veterinary Internal Medicine Wellcome Trust Research Training Fellow Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 OES and Karla Lee MA VetMB PhD CertSAS DipECVS MRCVS European Specialist in Small Animal Surgery Lecturer in Small Animal Surgery The Royal Veterinary College, University of London, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA Published by: British Small Animal Veterinary Association Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB A Company Limited by Guarantee in England. Registered Company No. 2837793. Registered as a Charity. Copyright © 2010 BSAVA All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in form or by any means, electronic, mechanical, photocopying, recording or otherwise without prior written permission of the copyright holder. The illustrations in this Guide were drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission. A catalogue record for this book is available from the British Library. ISBN 978 1 905319 17 6 The publishers and contributors cannot take responsibility for information provided on dosages and methods of application of drugs mentioned in this publication. Details of this kind must be verified by individual users from the appropriate literature. Veterinary surgeons are reminded that they should follow appropriate national legislation and regulations, for example in the UK the prescribing cascade. Printed by: Replika Press Pvt. Ltd, India Printed on ECF paper made from sustainable forests. ii Procedures in Small Animal Practice Other titles from BSAVA Manual of Canine & Feline Abdominal Imaging Manual of Canine & Feline Abdominal Surgery Manual of Canine & Feline Advanced Veterinary Nursing Manual of Canine & Feline Anaesthesia and Analgesia Manual of Canine & Feline Behavioural Medicine Manual of Canine & Feline Cardiorespiratory Medicine Manual of Canine & Feline Clinical Pathology Manual of Canine & Feline Dentistry Manual of Canine & Feline Emergency and Critical Care Manual of Canine & Feline Endocrinology Manual of Canine & Feline Endoscopy and Endosurgery Manual of Canine & Feline Gastroenterology Manual of Canine & Feline Haematology and Transfusion Medicine Manual of Canine & Feline Head, Neck and Thoracic Surgery Manual of Canine & Feline Infectious Diseases Manual of Canine & Feline Musculoskeletal Disorders Manual of Canine & Feline Musculoskeletal Imaging Manual of Canine & Feline Nephrology and Urology Manual of Canine & Feline Neurology Manual of Canine & Feline Oncology Manual of Canine & Feline Rehabilitation, Supportive and Palliative Care: Case Studies in Patient Management Manual of Canine & Feline Reproduction and Neonatology Manual of Canine & Feline Thoracic Imaging Manual of Canine & Feline Wound Management and Reconstruction Manual of Exotic Pets Manual of Farm Pets Manual of Ornamental Fish Manual of Practical Animal Care Manual of Practical Veterinary Nursing Manual of Psittacine Birds Manual of Rabbit Medicine and Surgery Manual of Raptors, Pigeons and Passerine Birds Manual of Reptiles Manual of Rodents and Ferrets Manual of Small Animal Dermatology Manual of Small Animal Fracture Repair and Management Manual of Small Animal Ophthalmology Manual of Wildlife Casualties Small Animal Formulary Every member of BSAVA receives a complimentary copy of the Formulary as part of their membership benefits or has access to the online edition For further information on these and all BSAVA publications please visit our website: www.bsava.com Procedures in Small Animal Practice iii Contents Foreword Preface List of abbreviations Procedures A to Z A Abdominocentesis; ACTH response test; Anaphylaxis – emergency treatment; Arthrocentesis; Aseptic preparation B Barium contrast media; Barium studies of the gastrointestinal tract; Blood pressure measurement; Blood sampling; Blood smear preparation; Blood transfusion; Bone biopsy – needle; Bone marrow aspiration; Bronchoalveloar lavage; Bronchoscopy; Buccal mucosal bleeding time C Cardiopulmonary–cerebral resuscitation; Cardiorespiratory examination; Cast application; Cerebrospinal fluid sampling; Cranial draw test; Cystocentesis D Dexamethasone suppression tests; Diagnostic peritoneal lavage E Ehmer sling; Elbow luxation – closed reduction; Electrocardiography; Endoscopy of the gastrointestinal tract; Endotracheal wash F Fine needle aspiration; Fluorescein test G Gastric decompression; Gastrostomy tube placement H Haemagglutination test; Hip luxation – closed reduction iv Procedures in Small Animal Practice I Intraosseous cannula placement; Intravenous catheter placement; Intravenous urography; Iodinated contrast media M Myringotomy N Nasal oxygen administration; Naso-oesophageal tube placement; Neurological examination O Oesophagostomy tube placement; Ophthalmic examination; Orthopaedic examination; Ortolani test; Otoscopy P Pericardiocentesis; Platelet count; Prostatic wash R Resting energy requirement; Retrograde urethrography/ vaginourethrography; Rhinoscopy S Schirmer tear test; Seizures – emergency protocol; Semen collection; Skin biopsy – punch biopsy; Skin/hair examination; Soft padded bandage; Spica splint T Thoracocentesis – needle; Thoracostomy tube placement; Tibial compression test; Tissue biopsy – needle core; Tracheostomy; Transtracheal wash U Urethral catheterization; Urethral retrograde urohydropulsion; Urinalysis V Velpeau sling W Water deprivation test; Whole blood clotting time Procedures in Small Animal Practice v Foreword It is with tremendous pleasure that I am able to introduce to you the first edition of the BSAVA Guide to Procedures in Small Animal Practice. Having read through the new title, I have absolutely no doubt this is going to be a book of huge and practical value to veterinary surgeons and their teams, up and down the country. The concept is simple. A ‘real world’ guide that provides rapid access to useable information on common practical techniques. And crucially, it is designed in a manner that ensures the information can be accessed easily and quickly in the busy and demanding environment of small animal practice. Whether you want a quick refresher on how to perform that abdominal tap, or a reminder of the protocols for endocrine diagnostic testing, the BSAVA Guide to Procedures in Small Animal Practice is simply designed to enable you to find exactly what you want, when you want it. Fast. Accurate. Dependable. The team behind this new and exciting guide have worked tremendously hard to ensure that it meets the needs of veterinary surgeons with busy schedules but who need to be able to absolutely rely on the information in front of them. They have done a truly superb job and I am sure you will be as impressed with the guide as I am. Nick Bexfield and Karla Lee, the Editors of this inaugural edition should be enormously proud of the new guide. Likewise the Publishing team at BSAVA have done a great job and I would like to congratulate them all. I am sure the BSAVA Guide to Procedures in Small Animal Practice will become a ‘must have’ in every good small animal practice and indeed in every BSAVA members’ coat pocket! And of course being designed exclusively for our members, it is yet another trusted benefit of membership of the BSAVA. Richard Dixon BVMS PhD CertVR MRCVS BSAVA President 2009–2010 vi Procedures in Small Animal Practice Preface It is our great pleasure to introduce the fi rst edition of the BSAVA Guide to Procedures in Small Animal Practice. Our primary aim was to create a book dedicated to the diagnostic and therapeutic procedures performed routinely in small animal veterinary practice, with the objective of providing practical, step-by-step guidance on how to perform these techniques. In addition, this guide also includes sections on clinical examination of the major body systems, and protocols for the management of selected emergencies, including anaphylaxis and seizures. Most of the procedures contained within this guide have originated from the BSAVA library of publications. However, they have been adapted to focus on the technical aspects of the procedure and to include hints and tips that we ourselves fi nd useful. Each procedure also includes indications and contraindications, an equipment list, and potential complications. Procedures for sample collection additionally contain brief sections on sample handling. Photographs and other illustrations are included to provide clarifi cation as necessary. The BSAVA Guide to Procedures in Small Animal Practice focuses on procedural technique and therefore should be used in conjunction with other sources of information, such as for diagnostic test result interpretation. We have included throughout details of the relevant BSAVA Manuals where further information can be found. We are grateful to the authors of the BSAVA publications from which much of the material from within this guide has been derived and also to our teachers and colleagues, who have been the source of many of the hints and tips. We must also thank the Publishing team at BSAVA for their editorial and administrative assistance. Marion Jowett deserves a special mention for her enthusiasm, patience and attention to detail. We are also grateful to Samantha Elmhurst for her careful illustrations. We hope to have created a truly useful guide which will provide a valuable and lasting reference for veterinary surgeons, veterinary nurses and students. Nick Bexfi eld Karla Lee December 2009 BSAVA MPPrreoocceemdduurreebss iinne SSrmm aaBllll AAnneiimmnaall PPerraaccfttiiicctees vviiii We stick together to get ahead The British Small Animal Veterinary Association exists to promote excellence in small animal practice through education and science. More than 6000 members in the UK and overseas benefi t from the widest range of practical and scientifi c benefi ts, including… BSAVA Congress: Nowhere else in the UK can you access such high-quality CPD over four days delivered by world-renowned experts. Member rates subsidised. Manuals: Members save around one third off our highly regarded series of Manuals designed for the busy practitioner, covering canine and feline medicine and surgery, diagnostic techniques, exotic pets, and veterinary nursing. MP3s & Online Tools: With a 3-year archive, members now have access to over 1200 hours of CPD with BSAVA Congress MP3s available online, as well as a range of other vital resources online at www.bsava.com Journal of Small Animal Practice: Members benefi t from a free subscription so they remain informed and engaged with the latest ideas, techniques and research through high-quality original articles. companion: The latest free subscription for BSAVA members delivers relevant, indispensible and practical features, essential for everyone in veterinary practice. 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[email protected], See www.bsava.com for details. or call 01452 726700. viii Procedures in Small Animal Practice List of abbreviations ACD Acid citrate dextrose ACTH Adrenocorticotrophic hormone BAL Bronchoalveolar lavage BMBT Buccal mucosal bleeding time CCL Cranial cruciate ligament CNS Central nervous system CPD Citrate phosphate dextrose CPDA Citrate phosphate dextrose adenine CPCR Cardiopulmonary–cerebral resuscitation CSF Cerebrospinal fluid CT Computed tomography DPL Diagnostic peritoneal lavage DV Dorsoventral ECG Elecrocardiography EDTA Ethylene diamine tetra-acetic acid ET Endotracheal GI Gastrointestinal HAC Hyperadrenocorticism i.m. Intramuscular i.v. Intravenous LMN Lower motor neuron MRI Magnetic resonance imaging PCV Packed cell volume RER Resting energy requirement UMN Upper motor neuron VD Ventrodorsal