School makes protocol changes after patients die

[pp9]

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http://www.veterinarypracticenews.com/Illinois-Alters-Protocol-After-Cow-Deaths/

Thought this article might be good for discussion. What are things like at other schools, the ethics of teaching surgery on live animals, etc.

Thoughts??

 

[battie]

Very first thing I thought: PETA/HSUS is going to love this.

Second thought: If this isn't something that happens on a yearly basis, it might not be a school problem, but a problem with those students. The article was kind of bare, so it's really hard to gauge.

 

[pp9]

Very first thing I thought: PETA/HSUS is going to love this.

Second thought: If this isn't something that happens on a yearly basis, it might not be a school problem, but a problem with those students. The article was kind of bare, so it's really hard to gauge.

Yeah and I haven't heard any whispers about this, either, so this article is all I have haha. Maybe it is something that has been happening for a while, but was only caught this one time. I also wish I knew exactly how aseptic technique was broken. Was an instrument dropped and used, or what? I also had no idea that while teaching surgeries, there wouldn't always be a DVM or tech scrubbed in in case you needed help.

 

[dyachei]

Yeah and I haven't heard any whispers about this, either, so this article is all I have haha. Maybe it is something that has been happening for a while, but was only caught this one time. I also wish I knew exactly how aseptic technique was broken. Was an instrument dropped and used, or what? I also had no idea that while teaching surgeries, there wouldn't always be a DVM or tech scrubbed in in case you needed help.

I think it's easy to be a first or second year and not really understand surgeries that are performed on livestock. Even the best places don't do all procedures in a sterile surgical suite. Many procedures are performed using standing sedation and local anesthesia (particularly cows and GI surgeries). As for aseptic technique, scrubbing in on a cow literally means pulling on sterile gloves sometimes. The oversight that is most heinous is that they weren't corrected for becoming non-sterile when it happened. They probably touched part of the chute while trying to angle into the surgical site. I'd definitely need more detail on this one.

 

[pp9]

I think it's easy to be a first or second year and not really understand surgeries that are performed on livestock. Even the best places don't do all procedures in a sterile surgical suite. Many procedures are performed using standing sedation and local anesthesia (particularly cows and GI surgeries). As for aseptic technique, scrubbing in on a cow literally means pulling on sterile gloves sometimes. The oversight that is most heinous is that they weren't corrected for becoming non-sterile when it happened. They probably touched part of the chute while trying to angle into the surgical site. I'd definitely need more detail on this one.

I agree, it sounds like there wasn't enough supervision.

I didn't want to sound stupid, but I did think field procedures were very common for LA med. I'm not sure how invasive procedures get outside of a hospital though. In that case, what's the big deal of doing it in a prep area as opposed to a surgical suite? I've seen a few procedures that I've been told are called "clean." No mask/hairnet, no gown, etc. Where would one draw the line for what's acceptable and what's not (assuming planned procedures, I guess emergencies might not always apply here?)?

 

[dyachei]

I agree, it sounds like there wasn't enough supervision.

I didn't want to sound stupid, but I did think field procedures were very common for LA med. I'm not sure how invasive procedures get outside of a hospital though. In that case, what's the big deal of doing it in a prep area as opposed to a surgical suite? I've seen a few procedures that I've been told are called "clean." No mask/hairnet, no gown, etc. Where would one draw the line for what's acceptable and what's not (assuming planned procedures, I guess emergencies might not always apply here?)?

Well, things might have changed but in vet school we wore face masks and caps with sterile gloves in a "prep area" because that's where the chutes were.

 

[Coquette22]

I also had no idea that while teaching surgeries, there wouldn't always be a DVM or tech scrubbed in in case you needed help.

For our third year surgery labs, there was one DVM per two student groups. But they weren't scrubbed in unless you needed them to be. And just speaking for myself, this worked best for me. I like knowing help is available if I need it, but there's no one hovering over me.

 

[pp9]

For our third year surgery labs, there was one DVM per two student groups. But they weren't scrubbed in unless you needed them to be. And just speaking for myself, this worked best for me. I like knowing help is available if I need it, but there's no one hovering over me.

That makes sense, I just had no idea! So if something goes wrong, do they just verbally direct you and scrub in if things get really hairy?

 

[jmo1012]

Correct me if I'm wrong, but I assume most if not all procedures performed in the field by veterinarians are not very sterile, even if the best sterile technique is applied. Heck, Dr. Pol seems to get away with questionable techniques all the time, and his patients seem to do just fine...It just seems to me that something else must have happened during the procedures for the cows to end up that way, because what was the standard of care at the teaching facility is probably way cleaner than a dairy or beef farm.

 

[DVMDream]

Correct me if I'm wrong, but I assume most if not all procedures performed in the field by veterinarians are not very sterile, even if the best sterile technique is applied. Heck, Dr. Pol seems to get away with questionable techniques all the time, and his patients seem to do just fine...It just seems to me that something else must have happened during the procedures for the cows to end up that way, because what was the standard of care at the teaching facility is probably way cleaner than a dairy or beef farm.

Yeah, there has to be more to this story. Especially because it is cows. They are generally really hardy.

 

[Minnerbelle]

Yeah, there has to be more to this story. Especially because it is cows. They are generally really hardy.

My thoughts exactly. I remember being all, "holy crap really? This is where and how you're going to do surgery?" With ambulatory LA vets. Given that student labs are done with quite a bit of iacuc involvement, things are usually way above and beyond what is required in practice. Something must've been very off. I also can't tell if the lab animal vet being quoted was taken way out of context to give such a vitriolistic tone or if there really was some sort of disconnect between iacuc and the actual people running the lab.

 

[pp9]

My thoughts exactly. I remember being all, "holy crap really? This is where and how you're going to do surgery?" With ambulatory LA vets. Given that student labs are done with quite a bit of iacuc involvement, things are usually way above and beyond what is required in practice. Something must've been very off. I also can't tell if the lab animal vet being quoted was taken way out of context to give such a vitriolistic tone or if there really was some sort of disconnect between iacuc and the actual people running the lab.

I agree that the article is written poorly...in a way to make the school look like it lets incompetent students do surgeries. What do you guys think is missing? The cows were already sick, or something bigger happened?

 

[DVMDream]

My thoughts exactly. I remember being all, "holy crap really? This is where and how you're going to do surgery?" With ambulatory LA vets. Given that student labs are done with quite a bit of iacuc involvement, things are usually way above and beyond what is required in practice. Something must've been very off. I also can't tell if the lab animal vet being quoted was taken way out of context to give such a vitriolistic tone or if there really was some sort of disconnect between iacuc and the actual people running the lab.

Yeah, I don't get it... they are all making some big deal about the cows being a prep area and not a surgical facility and about the cows being taken back to the farm three days later. Those things happen multiple times a day by licensed vets on many farms all across the US. It isn't like cows are sitting in hospitals for days after surgery. And they definitely aren't being cut in some sterile surgery room every time. Surgeries regularly occur out in farms, fields, barns and cows are left at the farm to be observed by the farmer. So it really makes me wonder what happened here and I highly doubt it was just some students "breaking aspectic technique" that caused this. Odd, but we will probably never know what really occurred.

 

[Minnerbelle]

I agree that the article is written poorly...in a way to make the school look like it lets incompetent students do surgeries. What do you guys think is missing? The cows were already sick, or something bigger happened?

Who knows. I think it would be foolish to speculate

 

[CalliopeDVM]

Correct me if I'm wrong, but I assume most if not all procedures performed in the field by veterinarians are not very sterile, even if the best sterile technique is applied. Heck, Dr. Pol seems to get away with questionable techniques all the time, and his patients seem to do just fine...It just seems to me that something else must have happened during the procedures for the cows to end up that way, because what was the standard of care at the teaching facility is probably way cleaner than a dairy or beef farm.

No kidding! Even the "prep area" at the school is far cleaner than the barn or field where many large animal vets do surgery.....something else is going on.

 

[scb44f]

What do you guys think is missing? The cows were already sick, or something bigger happened?

I'm unsure what is missing and don't feel like speculating but we don't do surgery on healthy animals anyway. I know you know that, but these cows may have had more going for them than the average cow that actually needs a standing procedure done.

Agree with the sentiments of this thread though. Not having a doctor scrubbed in is not uncommon. I'm helping a lab this week where we have 6 groups, 2 food animal vets, one anesthesiologist, and a vet tech. Of course, things are not skewed this far when we do surgery in the clinic, and we always have a doctor there to back students up.

While I agree it would be a waste to speculate what happened, I do want to throw out there that as you learn to operate with a sterile (or "clean") field, don't be afraid to take the extra minute to regown if you brush up against the cow, or reglove if you are at all unsure. There was one surgery in particular I could not get into surgery. I touched a poorly placed cabinet after scrubbing and had to completely do it over. Then I ripped my gown while putting it on. The next surgery I did, I ripped my glove while gloving and then touched the cow. Own it, fix it, and move on.

 

[that redhead]

To me, not knowing the details, the bigger deal is the post-op care. I know a lot of animals just get tossed back out with the herd in a true field situation but it seems to me that when you have a slew of fourth years that you can assign to monitor patients post-op, you'd take advantage of that resource.

 

[shortnsweet]

Cows are pros at walling off infections and continuing to just chew their cud and ignore you. What's a cow surgical suite look like?