Post Spay Bleed

It is not often we get in a patient that is such an emergency the vet doesn’t have time to do anything but operate straight away, with barely time to do a proper hand scrub. In fact l only remember this happening once not long ago. Going straight in as the vet was about to do was virtually unknown and was an indication of just how bad the dog was.

I was ambling up from dog ward to do the stats in cat ward when the vet, arms full of dog pouring blood came fast down the passage. Propflo, kit, spay bleed was all he said as he turned the corner and headed to theatre suite.

Sometimes a bitch spay will bleed. It may be a suture has slipped because the owner has allowed the bitch to jump on or off furniture or allowed a slightly nutty bitch to run around despite instructions. Maybe a suture slipped as it was not tight enough. The bitch may have been in season when spayed and everything is engorged this can cause problems post op. Usually a vet won’t spay in season bitched but they may have to for some reason or she could just be coming in and was not checked properly on admit or not showing much and was missed. Bleeding may be generalised ooze as she has an undiscovered clotting defect or for some unknown reason.
Usually the first line of defence is a tight belly wrap to put pressure on and keep a close eye for strike through and pray there is none.

Operating on a post op bleeding bitch is never easy. They have to find the short stump remaining from what was removed, buried somewhere in the abdomen amongst all the abdominal contents. And while yes, the vet knows roughly where it is, real life is never that simple. They also need to check all surrounding areas for any bleeding.

I pulled up 15ml propflo, a bitch spay kit and sterile gloves then headed to theatre. The vet had an et tube ready. He barely had to wave the anaesthetic under her nose (so to speak) oh well if l had not pulled 15ml he would have wanted more. I connected the gas, unrolled a kit and while the vet scrubbed up l gave her a clean and undid the skin sutures on her abdomen. We had to use surgical prep moving her to theatre would have taken to long.

Gloves on and back the vet took a deep breath then snipped out the remaining internal sutures. Blood bubbled up in a red flood that ran over the sides of the bitch in small rivers, the vet went hunting.
I put popped 6 (large) abdominal swabs onto his kit. The small normal ones were as useful as emptying a dam with a teaspoon.

“What’s her name” l asked to put it onto my op sheet.
“Don’t know, verbal consent”
“Tsk your helpful” l mumbled he flicked a grin at me.
“You want fluids in her” l asked?
I got a grunt l translated as yes and was about to yell for a hand (so l did not have to leave the patient, theatre is a bit away from the main area) when the auxiliary appeared. She had tracked the vet following the blood trail and wanted to know what to do about the owner in the waiting room.
Well l said after you have helped me with a leg you better print a consent form and we could go from verbal to written consent.

I don’t like placing catheters when the animal is on the op table. The leg is sticking into the air and so it is high, instead of bending and looking down you are looking up. You have to consider the vet operating and can not move the dog and have to worry about sterility. Once it was in l attached a bag of No11 some bolus of voluven and placed more into the bag.
Blood transfusion would wait for now. We have a limited supply unlike human hospitals. Once the bleeding was controlled then the vet would look to give blood transfused. No point putting it in if it runs out and we have no more blood. It also depended on the owner due to cost.

People have complained about vets and costing. The NHS causes a problem in that people have no idea of cost, and then start to call vets greedy for charging a market price without realising the cost of the treatment. However go to a country that has no NHS and try and get human treatment. I am not sure that they would operate let alone do fluids, drugs and assessments until they had credit card or insurance details.

The bitch was weak stats but stable and pure white under anaesthetic. I prefer stronger stats, stable and pink but at least she was alive even if she fitted the term ‘just alive’.
Mutterings were coming from the vet and he was shifting instruments about obviously struggling.
“Want another kit you look to be getting low on ‘bits’ and should l scrub up” l asked
Another grunt, this vet was usually a happy soul who would normally make a comment with a big grin and was always good natured, all l was getting was grunts. Things were not good in the innards l perceived.
I placed another kit for the vet and called for the other nurse to take over the anaesthetic while l scrubbed up and pulled on gloves.

Scrubbing in can be confusing. As a vetnurse you get so used to NOT touching anything and suddenly you have to touch instruments and op sites.
It works in reverse for vets. If they are observing they are forever being “OYED” by the vetnurse as they are about to reach in and touch something. In fact some vets will only observe if scrubbed, it saves them being told off.

I had to hold instruments in various positions to keep them out of the way. Instrument rings on various fingers, hand tilted and fingers splayed to try and follow instructions and one hand free to pass instruments or hold others.
The vet was struggling, he had found the stump but there weren’t any slipped sutures, instead it was a sort of general ooze from different areas.
Finally everything was as ooze free as he could get it. Part of the problem was there was no set vessel bleeding. When he tried to suture the tissue that was bleeding it was very friable and tore easily.

When he decided he did not need me any more holding instruments l took back the anaesthetic, the other nurse went to check the inpatients and eventually he closed the patient up.

I gave her a clean as best l could to remove as much blood as possible but did not want to wet her down to much. After that and while she was still recovering he helped me to put a tight belly wrap on her.
Not the best of dressings as she was floppy but made easier though when you have a rugby playing vet holding the patient in the air as if she was lightweight. Was he a football player he wouldn’t have been able to hold her, ok l am biased but it is true.

Normally we do not want owners to wait but in this case we made an exception because of the circumstances and the owner was still in the waiting room, the auxiliary had made her tea. The vet went out to have a word with her and get himself a cuppa, and everyone else bar me, I only like my Dr Pepper.

Post operatively the patient was placed onto another iv catheter and a bag of blood was attached to that. She was closely monitored for any more bleeding, thankfully there was none and after a couple of days she went home, making a full recovery.

All operations even routine carry a risk, the vast majority are free of post operative problems. For my mind and most others in the veterinary profession the benefits of the standard elective operations like spay and castration outweighs post operative risk.
Un-neutered males or females are at high risk from tumours, babies and pyometras, hormonal problems, species specific virus passed during sex or fighting not to mention injuries caused with others of same sex after the mate they want or accidents with cars while looking for the dog/cat in heat.

If you do suspect anything post operatively after any operation on your pet, or if you are worried about anything, contact the vet straight away. In this case it was very obvious but it is not always and it is better to be safe than sorry.

Providing Fluids

I decided to explain some of the basic ways that we provide fluids and medications to animals that are hospitalised. And figured l would pop up some photos of animals l have got catheters in. I remembered to take photos of 2 of the puppies l do not usually bother to take photos iv catheters are so routine. The kitten was so pathetic looking l had to take a photo.
The iv catheter is hidden in the blanket on the second pup l wanted to show his size and forgot the leg.
I am lucky that because of the emergency work l see so varied an array of patients in size and type.

On admit most animals have an IV catheter placed so we can give them fluids and certain medications directly into the vein. The smaller animals can be a nightmare to get an iv catheter in. The problem with the smallies is that there is no decent handles on them to grab. They generally wriggle a lot and your fingers trying to raise the vein are somehow always in the way.

Puppies are usually the worst, as they get better they often end up with a buster collar on or they chew out their iv. If the nibbling has not been noticed this brings the “It is your turn to go play with the little git” comments.

You can give fluids various ways. Into the scruff off the neck but not much at a time, it takes a long time to absorb and it often hurts.
Birds are crop fed via syringe and a special long curved sort of blunt feed ended needle.

Interperitoneal (into the abdomen) but in the youngsters it is always nerve racking that they may move at the wrong point and are so small everything so tight.

In rabbits iv catheters are generally placed in the ear. I have never liked ear veins they are so fiddly and easy to damage. We tend to pop on some local anaesthetic cream but the rabbit still jumps at just the wrong moment. And no matter how much you clip the hair is so fine it is almost impossible to totally remove so you have it covering the area you need to see.
As an added bonus we often need to syringe feed a lot of rabbits. Some take it well others cause more stress damage to their mental health than the good of getting food into them can do.

For the very young animals there is the syringe feed. You can be sure you get these in when you are rushed off your feet. And it is never a quick job. First they hate the syringe, they hate the replacement milk. To fast the milk goes into their lungs and they risk inhalation pneumonia, then there is peeing and pooping them. And often after you have done this they want more food as there is now more room so the repeat takes place, usually after the second lot they will sleep. If they are gluttons and love the syringe and replacement milk then they try and gulp it and scream when you decide they have had enough for that feed. So you end up taking even longer as they want more and won't settle.

The bird and the rabbit ear l admit to borrowing from the web as l have none handy l will place the rabbit ears onto my need to photo list. The other patients in these photos survived and were discharged, enjoy the awww factor.

Puppy with Haemorrhagic Gastro Enteritis (vomiting and shitting blood)

Another HGE Puppy with a pen leaning against him to show size

Abandoned Kitten Being Syringe Fed


Rabbit Ear Clipped for Catheter into Vein

Crop Feeding

Blood

This is a request for help from all dog and cat owners of any breed but specific sizes and certain requirements.

It was just over a week ago l was placing a PBBuk blood bag onto a canine patient post op, relieved we had the blood in as it was midnight and did not have to play hunt the donar. True it was a fluke we had the correct type in for this patient, the one it was ordered in for had died but we had the blood in store. Dogs can take their first transfusion from any of the canine groups but idealy it should be the correct one.

I do not know about humans and blood but with animals we take a pre placement measurement of temperature, pulse, respiration (TPR)and check the gum CRT(capillary refil time). We then put the blood on at a very low flow rate and monitor TPR every 5min while sitting by the patient. If they stay stable for about 20mins then we move to 10min TPR for a few checks then 20(ditto) and finally we will up the flow rate, monitor them again for the first 15 min. If all stays stable we place them on full flow. If they have a bad reaction to the blood we are able to react instantly.

Until not long ago the law would not allow the storing of pet blood. When it was needed then donars were rung and blood sought for immediate use. Thankfully this has all changed and now storage is allowed. This has led to the setting up of the Pet Blood Bank UK

The website is based around dogs and you will not find cats mentioned there. However in 2008, PBBuk was awarded $15,000 from the Waltham Foundation, an organisation which provides funding towards research that directly improves the health and welfare of animals world-wide, which has enabled PBBuk to start the research project into collecting feline blood.

Like canine donors, feline donors will be required to meet certain criteria before they are able to donate. Cats should be indoor cats, fully vaccinated, friendly in nature, aged 1 - 7 years, in good health and a few other requirements. Full info for cat requirements are available via phone

PBBuk break the blood down into whole blood, packed red blood cells, fresh frozen plasma, frozen plasma, cryoprecipitate and cryo-supernatant just the same as the human blood service and this is then available all over the country to vets, sent via courier.
Yes vets do pay for the blood/products it is not free however it is not cheap to run the service and yes the cost is passed onto the owners of animals that have received the end product.

Some times it is not possible for the vets to order blood in and they need to use local donors but the PBBuk has made a huge difference. Before we only had whole blood from local donars. If a practice does not have many blood donors available and they have just given or do not have suitable blood type, or the one that did has owners on holiday etc.

Blood (and their byproducts) are not just a life saver for humans but for dogs and cats so if you think your dog or cat would fit the criteria and are interested in helping, please go to Pet Blood Bank UK and if you fit the criteria apply.

I have helped with a lot of donar dogs and cats and they all come off the table happy to have a bicci and a bowl of food. None have been harmed and many are multiple donors.

There was a situation l was peripherally involved in. A patient had died and the vet decided that the owners that were away may like an autopsy. Bodies for PM must not be frozen so it was left on the side in the back with orders to keep it cool. I asked an auxiliary to sling some wet towels into the freezer these could be placed over the body at various intervals.

One of the nurses decided to place some ice packs around the body to help. A lot of lab slides and tests are sent though chilled with blue ice packs. Practices keep these as they are useful. So the nurse slung a big blue “ice pack” on the dog.

A week later l went back to work and was asked about the dog as l had been there. I explained my part, the nurse asking then broke into shreiks of laughter. It was not a large ice pack but actually several bags of plasma in a blue outer bag.
I stared in astonishment, asking if no one had marked the bags on arrival. I was told well they were marked…inside the blue outer bag.
I am afraid l joined in the general laughter especially when told that it was now about £1000 worth of worthless mush, ok so it was not politcially correct but it was not a small one man practice, then l would have been upset, it was one of the big national groups in the UK and tough tits to them.
Just a pity that the donar dogs blood products ended up useless in that case.