Thursday, September 13, 2018

Diary of a Fourth-Year Vet Student: Let's Get It On


During my anesthesia rotation, I got the opportunity to put catheters into veins and arteries of dogs, cats, horses, and a sheep who did something stupid (oxymoron) and needed surgery to fix it.

As in any profession, anesthesia has its own set of entertaining "old wive's tales" that often have a tiny grain of truth in them. For example, here's one: little white dogs bleed more than other dogs. That's not actually true--little white dogs bleed no more or less than any other animal. You can be super careful but collecting blood for analysis and inserting catheters is a messy activity, and blood is going to get somewhere awkward or inconvenient. Even a tiny, stray drop or smear of blood on the fur of a little white dog shows up like it was painted in neon.


Another interesting one is "pitbull skin." This is in fact a real thing. Pit bulls (and bulldogs and related breeds) often have skin issues, with dry scales, bumps, and thickened skin that is not elastic like normal skin. When you push a catheter into them, their skin drags on the plastic catheter and bunches up around it. The drag makes it really hard to tell where you are, and whether you have hit the vein or not (if you have a good touch, you can feel a small change in resistance when the needle tip enters a vein but that is almost impossible to detect when you are pushing through pit bull skin). When you get a bunched up roll of skin in front of the needle, it makes it all that much harder to even advance the catheter. The thickened skin also makes it hard to see the veins which do not pop up like they do in normal skin. I poked the front leg of a pit bull completely blind--conceptually, I knew where the vein should be, but I could not see it at all. Even pit bull puppies, who shouldn't have had time to develop such bad skin, have pit bull skin.

In addition to placing venous catheters to use for fluids and drugs, vet students also place arterial catheters for use in a specific type of blood pressure monitoring setup. You've probably seen blood pressure cuffs. They are not very sensitive but are easy to use, and are not invasive. But if you place a catheter in an artery and run a line filled with fluid from the artery to an electronic sensor, you can measure blood pressure directly. Large animals (horses, ruminants) always get arterial lines because cuffs don't work well on them. But sometimes small animals got arterial lines too when it was critical that we monitored their blood pressure very accurately during a procedure.

During my three weeks of anesthesia rotation, I placed lots of catheters, and I didn't miss a single one. Only two or three required more than a single poke. I had some particular successes amongst all the successes. I placed an arterial line in the lingual facial artery of a horse in a dark surgical suite when the surgeons needed the lights off to see their monitors for the laparoscopic procedure. I could only feel the artery, not see it at all. It's a miracle that I didn't poke myself in the dark. While placing a catheter in the front leg of a cat, the cat twitched as I was preparing to tape, and the plastic catheter bent and blood began spurting out. Sure that I had just buggered that up, I pushed it back in, and looked up at the tech helping me. She said, was the blood coming from the catheter or from around the catheter? I said, um, from around it. Okay, she said, tape that sucker in there. That catheter remained patent for over 24 hours--it got the cat through surgery and a day of aftercare in ICU.

I am also proud of the catheter pictured below. Sometimes, for various reasons, we have to use rear legs or the jugular vein to place catheters. This particular dog had already had many procedures done and the veins in his front legs were total shit--collapsed, full of clots and hematomas. He was a mess. On top of that, he was a pit bull and had the aforementioned shitty skin! I had to push that long, long catheter into his lateral saphenous vein with that crummy thick skin dragging all the way. He was having surgery done on both of his elbows, but the surgeon wanted to take a look at his knees for grins and giggles. When the radiographs were made and I saw my handiwork, I immediately snapped a picture of it. Beautiful!







I got much better with my taping too. Taping catheters is its own arcane art, and everyone has their preferred way. The best way is the way that keeps the catheter in the vein as long as you need it to be in there. At the teaching hospital, the first piece of tape is not supposed to be pretty or perfect--it is supposed to hold the darned thing in place while you put the pretty and perfect tape pieces on. The anesthesia techs encourage us to be less tentative with that first piece and to just get it taped on there by singing Marvin Gaye's "Let's Get It On" to us while we work. It is effective because we all end up humming it by the end of the first couple of days.