Monday, 29 December 2008

Drips and Drops

I really need to learn to say no to work. I was rung up Sunday at 16:30 in the afternoon and said ok to working the 17:30-03:30 shift and as we were so busy l didn’t leave till 04:30.
Just as well l went in as from 22:00 there were 2 of us nurses and a vet with no auxiliaries, so we had to do their jobs the laundry, bins, cleaning and reception, phones as well as our own jobs.

I ended up doing the anaesthetics and assisting the vet on ops, l took x-rays (nurses job generally), did dressings (nurses are better at dressings than vets), placed drips, took and ran blood tests and the odd bit of inpatient ob’s to help when l got a chance.
The other nurse did the inpatients, a bit like painting the forth bridge never ending.
The rest of the jobs we shared between us. The 02 alarm has a fault on and at one point l ended up laughing hysterically, leaning against a wall as the other nurse marched like the honey monster snarling in frustration towards the alarm to slam it with her hand for the 10th time or was it the 15th l lost track.

We had a couple of major operations like removing a collar buckle from a stomach. The dog got bored and ate his friend’s collar FFS talk about a pimple brain!
“Duh l am bored wonder what l can do, l know l is gonna eat your collar”
His friend joined in and ate the studs and other bits of the collar that fell on the floor. After all it was his collar so fair is fair, x-ray showed they were moving through his intestines.
That was the op that ended late then l had theatre and prep to clean and mop post op, l refused to pack the kit though just slung it into the cleaning fluid to soak.

A pyo, the uterus fills up with pus and it is life threatening. Why oh why do people not get their bitches neutered when they are puppies. They would avoid the £700+ bill, the misery and illness of the animals.

Add that to the usual night time crop of x-rays of dog and cat RTA’s or accidents and temporary support dressing (if possible) till the patient is operated on.
Stitch up wounds, gastro enteritis - joys of Christmas dinners, blocked bladder cats and renal failures.
Wound breakdowns – Listen people use the sodding buster collars they are there for a reason, don’t sit and watch your pet chew the bloody wounds.
A rabbit, a couple of birds some medical cases and oh 2 Parvo dogs in isolation.

It added up to a fun round of work yourself silly night. Think it was 36 inpatients with 32 on drips. Not the busiest of nights but more than enough to keep us going without a break as we had so few staff. If one more dog pulled, ate or disconnected its drip line then there was going to be a group of hysterical staff on duty. Drip lines can be the bane of our lives. If you have a “Bad Drip Night” you know things are just going to go downhill.

At one point l had 5 redrips waiting for me. I tend to prefer dripping to holding and the other nurse on was happy with that as she prefers holding to dripping.
I had the locum vet holding earlier in the evening. He is a Jelco person. And is to bloody slow when we need to motor. Being male he can hold and talk but not drip and talk and l felt that taping his Irish mouth shut was a bit extreme as being the only other option.

There is 2 main makes of iv catheters (canulas) we all tend to use Surflo or Jelco. I have had to get used to Jelco with locuming about but generally if you can use one sort you will screw up the other. I am in the hate Jelco camp.
The other type is winged catheters. These have little wings next to the cap to suture them in. Not something you do with animals we chop them off.
We tend to use these for rabbit ears. Yes rabbits do need iv fluids and we give it via their ears. I also hate doing rabbit ears. We put a local on their ears but it never properly works. They jump at just the wrong second. The skin is so thin and veins so tender it is all done by hope.. “hope l am in this ***ing time”.
For those who understand sizes, 27 or 26 (purple, yellow) rabbits, puppies and kittens, 23 (blue) cats and small dogs, 21 and 18 (pink, green) bigger to huge dogs.

One Jack Russell broke 2 buster collars and chewed out 2 lines. The little git got a shock when his teeth descended on the 3rd line though. I left his buster collar off and he thought Christmas had come again, stupid vet nurse. I won that round though, l sprayed the line and dressing with bitter spray.
I also placed the drip into his back leg vein. This can be a difficult one to get, but often patients will tolerate it better here. The vein is very wobbly and the stylet on the catheter bounces off it, you have to give a hard jab but not to hard so you go straight through the vein and blow it. The hind legs are a difficult shape (The vein goes diagonally towards the back of the leg just above the animals hock from front to back, run your finger round your pets leg there and you will see what l mean about shape, lumpy, bumpy and a rounded leg.)

There was a lot of short legged dogs last night, again a nightmare to drip. We call the short front legs, Queen Ann legs. The veins are very loose and wobbly, run in weird shapes around the legs and are a nightmare to find let alone drip. These dogs tend to wriggle a lot often try and bite as well and there is no decent handles on them to grab.

The drip lines used where l was disconnect part way up. This is useful when you have dogs to walk and swop lines for some reason or trying them off drips for a bit. The down side is that they can come apart and when this happens blood flows out till it clots. The clot happens fairly fast but not fast enough that the bed is not a blood bath (blood mixed with the fluid leaking out of the bag spreads well).
To sort it you disconnect the whole line and flush the blood this comes out like a hard long worm, then reattach everything. Change the bed, which was probably cleaned about 10minutes before when they peed or pooed on it.

Then there is the restless walkers, round and round till your drip is one long snarling twisted mess and pulls out the leg. Mind you not that it was dripping anyhow. Even if you manage to untangle the drip line before it pulls out they damage it with the tight twists. We were to busy though to give hourly boluses. At least there was only one “walker” and she was a non critical dog, being a recovery and going home the next day, we ended up taking her drip out.

I was so glad to get home last night and climb into bed forgot to drink my coffee. I fell asleep while trying to decide if l should reach a finally warming up arm and hand out to the cold air to grab the mug.


Fi from Four Paws and Whiskers said...

Thank you for this - and hope you feel better today!
I have posted this onto my facebook site for past Christchurch, New Zealand vet nursing students... I suspect they will identify with all these issues, although perhaps not so many at one time!

joker the lurcher said...

oh boy! i hope you got some sleep! i will never moan about life as a lawyer again...