Good evening everybody and welcome to the webinar vet. My name is Bruce Stevenson and I have the honour and privilege of chairing tonight's webinar. We are doing something very unique tonight from a couple of aspects.

First of all, our sponsor tonight is Becton Dickinson, and they are absolutely unique in that they have come to us as veterinarians and asked us what is it we want? What do we want to hear? And the response that we gave them is we want to know about chemo, we wanna know about catheters, and we want to know about environmentally friendly plastic syringes.

So they've gone away and they've found some great presenters for us. They've presenting for us tonight, but the next unique thing is the method in which we are going to be presenting. So bear with us if we have a couple of little technical hitches along the way because it is something that we haven't done before.

But, I'm sure it's all gonna be absolutely fantastic. And just before I move on, once again, Becton Dickinson, our sponsors, thank you so much for this unique approach and for giving us the opportunity to test and trial this method, which I think I agree with you is, is the right way of doing things. Little bit of housekeeping for those attending.

If you do want to ask a question, simply move your mouse over the screen. A little Q&A bar or a little control bar will pop up. There's a Q&A box.

Just click on that, type your question into that, it'll come through to us. We will be holding those questions over to the end and then we will have a discussion with our presenters at the end. Speaking of our presenters, we do have recordings of our presenters, but we have them on live afterwards as well.

I did promise you this was going to be unique. Becton Dickinson doesn't do anything ordinary. Everything's done special.

So recording with our live presenters present for the questions afterwards, but we may not get through all the questions at the end. So if we don't don't panic. Those questions will all be passed on to BD so that they can get in touch and answer all your questions.

Speaking of getting in touch, I will remind you at the end as well. When we finish the webinar, you will have a survey pop up on your screen. Please, please, please take the time and the effort to fill that in and give feedback to our great sponsors tonight so that they have a way of measuring how successful this approach and method has been.

So without further ado, our main speaker tonight is Stuart Ford Fenner, and he has a very varied career which encompasses clinical, academic, publishing, and editorial work. Stuart graduated from the University of Bristol with an honours degree in veterinary nursing and practised administration, and he's currently studying towards achieving his master's in Business Administration. For the last 16 years, Stuart has been administering chemotherapeutic agents to veterinary patients and educating in safe practise for this procedure.

Stuart, welcome to the webinar vet and over to you. Thank you very much. OK, so we're gonna talk about using cyst toxic safety, namely, giving them and and a few little extras.

What we'll do, we'll, we'll, we'll go through, a nice, kind of talk this evening. We'll talk a little bit about the legislation, in the UK and a little bit of the EU as well. And then we'll talk about the, the risks, and then we'll talk about some preparation.

Move on to administration and then dealing with all the other things that happen after administrating these drugs. So first of all, we need to think about The kind of legal framework that we all have to work within, and you know, for the UK we've we have the Health and Safety Executive. And most of our laws are based on EU regulations, certainly until recently.

We have the Health and Safety at Work Act, managing Health and Safety Work regulations, which are all, components of our law, which, . Businesses and individuals can be fined upon if they're not meeting the criteria. And, more importantly, the one which is very much targeted towards cytotoxics is the control of substances has control of substances hazardous to health.

Now, it's it's a big document and thankfully the HSE for has produced an approved code of practise which helps set out what we need to do to achieve the standards to to keep our staff and ourselves safe. So what's this, approved code of practise involve? It's, you know, shorten it to an ACOP, you know, my health and safety head coming on there.

And what we need to do, we need to identify the hazards, decide who might be harmed, evaluate the risk, record those findings, and, review this risk assessment. And that might sound very, very familiar to everyone because that, those are all the steps of doing a risk assessment. So, what we'll do this evening is we'll follow through, all those things that are going to help produce a risk assessment.

In terms of the documentation, but more importantly, develop those procedures and why we would Integrate those procedures into our practise to make sure that we're doing the right thing for our staff, of the animals that we look after, and also the owners of those animals and their families. So first of all, you almost have to take a bit of a step back. And think, you know, what are the risks of using these drugs.

And we know that there's good evidence here for Patients who have had cancer and received chemotherapy agents have In turn, had Conditions and problems associated with those medications. All these chemotherapy drugs. And that includes actually getting in another type of cancer, so whether that be a solid, tumour or leukaemia, testicular and ovarian dysfunction.

We know that there's cumulative DNA damage, which is really important in terms of looking at future instances of problems with these individuals, and there's other organ damage as well, because these drugs are not, not necessarily the nicest drugs in the world and can affect other body functions as well. Now, There's not a huge amount of evidence on the, on the veterinary side, but on the human side, there is a lot of work that's been done. And if we look at human healthcare workers and are they involved or or exposed to these drugs, they certainly are, and, in the environments where they're working, there's detectable amounts of cystooxics in their environment, and this is In the air, and also on the surfaces, door handles, and places like that which are, high touch areas.

There's also, detectable amounts, cytotoxics in their, biological monitoring. So, for these members of staff, they can also have their urine tested, and the scary thing is that, they can find these drugs, or the metabolites of these drugs in the workers, you know, healthcare workers' urine. And this is even when they're using biological safety cabinets as well.

What is the evidence for occupational risk here? Certainly, with these individuals, there is an increased risk of frequency of DNA damage, when they're being exposed to cystooxics. We're definitely seeing contact irritants, in these, individuals, especially where appropriate PPE is not always being utilised, and there's a higher association.

With reproductive dysfunction, this, and, and, and that is always slightly controversial, because there's so many factors involved there, and it might not just be, as like toxics, but certainly it seems to be when you look at the evidence. More likely to have a problem if you're working in these environments. So with these occupational exposures, we've got repeated long-term exposure.

however, at the moment, These small, repeated long-term exposures haven't been identified as a cause of cancer. I guess I, I sit here and, and ask people, are you going to take that choice, that risk? And, you know, I'm certainly not, with my own health, so I'm gonna do everything I can to reduce the risk to, to myself, and the people that I work with, because I do actually like my colleagues and, and care about them as well.

This is quite a quick diagram really, I'm just gonna bring my mouse up on the screen, . I guess It's important to remember that cancer is a multi-step process, and it usually takes time to collect enough DNA mutations to, to, to develop a tumour. And I guess what you've got down here at the left hand side is, is a normal cell.

And then we've got multiple mutation events happening along here, and this could be, I don't know. 10s, hundreds, thousands maybe of different mutation events, which will then eventually increase the risk of, of getting a tumour. And I think when you have DNA damage.

The chances of you having these mutations is more likely as the DNA becomes more and more unstable, and that's what these drugs do to the DNA. So what is the risk to us? We have some confirmed risks, with the contact irritants, and mutagenic, so we know that for sure.

We've got some potential risks, which are the risks that I'm not willing to take a chance with. So whether they are carcinogenic, they cause cancer, teratogenic, cause the developmental abnormalities with the foetus, and reproductive failure. I guess I'm not too worried about reproductive failure because I've already had our children, but certainly everything else that goes with that is not gonna be, a positive outcome for anyone.

The International Agency of Research in Cancer have classified loads of substances in the world. And, ultimately you end up with group 12, and 3. I think at this point, it's always worth highlighting to people the drugs that fall into different categories.

So, group one, includes a lot of the, alkalizing agents. So, this includes lamusin or CCNU. Cyrophosphamide and melphin, and, group two, are these drugs which are probably carcinogenic, so it's your anthrocyclins and your platinums, so this, these are drugs like doxorubicin, epirubin.

Moxantrain, so these are the drugs, I mean carboplatins, of course, and these are the drugs which I don't know, as a clinic, we use a lot of, and, they're saying that they're probably or possibly carcinogenic. So the, the differentiation between Group 1 and group 2 to me is, you know, must will treat everything as the same. And then group 3 and 4 have been unclassified or probably not carcinogenic, so that includes drugs like diazepam or something like that.

So in the veterinary world, who is at risk? We've got the veterinary surgeon, we've got the veterinary nurse, we've got all our support staff, because remember we have a huge team around us, helping us care for these patients and the clients. So we've got our patient care assistants, reception staff, and, and we need to remember our stock control staff as well.

And even though they're not part of the team, so they're not part of that occupational exposure. We do need to remember our pet owners as well. So we need to bear them in mind because we do have a responsibility to maintaining their safety as well and making sure that we're doing, Our, our part and doing our processes properly in a way that reduces the risk to them.

Especially as they're not always as familiar with the risks as we are. How are we at risk? We can breathe these drugs in, and this can be through a, a, a drug dust or aerosol lysium of, the drug, you know, for breaking open ampules and things like that, and hopefully no one's.

Doing that. It could be through ingestion, so if we don't wash our hands, if, or if we're eating, food in the areas where we would normally give chemotherapy, and we can absorb these drugs to your skin as well. They're very good at getting through your skin.

When are we at risk through the entire journey of looking after a patient really from preparation of that drug, administration of that drug, there's always a chance of an accident along the way, and we've got animal wastes at the end as well, near the byproduct of what's coming out of that patient. I think in terms of animal waste, I kind of refer to taking blood samples and things there as part of that, even though it's not really waste, you know, we're sampling them for a reason, we still need to bear in mind that when we're taking blood from patients that we need to treat that very carefully, as well. Needs to be considered.

And this can be through direct contact with us, so these drugs can get directly onto us, directly breathe the mist into us if it's an aerosolation. But also we can contaminate the environment as well when we're doing this. So when the aerosol goes up into the air, if we're, you're not using a closed system or biological safety cabinet, then that mist will.

Gently, fall to the table tops to the floor, and, and, and contaminate our environment, if you touch the door handle with contaminated gloves, then that's gonna contaminate the door handle. How am I at risk, you know, if we're not gonna be wearing PPE, personal protective equipment, if we're not going to be protecting ourselves against, drug aerosols, and if we're gonna have a poor preparation or administration technique. So, we'll start talking about some of these things a little bit more in the moment.

Having a designated area is really important. It's not always easy to do in practise to have a dedicated chemotherapy suite. And I certainly don't sit in my ivory tower in a referral centre and say that everyone must have a chemotherapy suite, but having an area which everyone knows is designated to be the place where chemotherapy occurs is really, really important.

And you can just make sure that that's restricted away from a corridor, you know, or any surface, not in the middle of any preparation rooms, and there's certainly no food or drink there and you've got good facilities to hand for dealing with ski spills and incidents as well. It's always good to try and store these drugs near where you're preparing the chemotherapy as well. But obviously we need to make sure that they're stored, to manufacturers, recommendations, .

Refrigerators, in the past for me, I've noted that a lot of drugs will get stored in the normal pharmacy fridge. I think the use of, if this is your situation, then using Ziplob bags with the cytotoxic symbol on the front is a really good way to help identify those and make sure that everyone knows that that is a different type of drug that's like that. Not, syringe really.

Not bottle. Making sure that we're using good nominated staff, for, for us, they have to be over 18 years of age, certainly in the UK definitely not pregnant, and because we want to reduce our risk as much as possible. When we start talking about personal protective equipment, you know, we need a good protective gown.

It needs to be low permeability, only worn for cytotoxics, and it's always worth, getting ones with breakthrough times for these drugs. So they've been tested to make sure that these drugs can't get through or can't get through for a period of time which is appropriate for what you're using them for. And this is also the same for gloves.

So I, I get asked about gloves a lot, believe it or not, but, pretty much all the materials you get are, are, are permeable to to some degree, and, breakthrough times are really important here because if you get a drug on your hand, you know that you've got. 90 minutes, 180 minutes, 270 minutes whatsoever that product's been tested to before it starts to penetrate the drug and contaminate you. Eye protection, is also really important and often forgotten.

We wear eye protection, we don't wear full face shields, because we have confidence in the products that we use, . And of course, you can use a biological safety cabinet as a bit of personal protective equipment as well. It's currently accepted as a pretty ideal bit of kit to have in a sense where you're doing lots of chemotherapy.

They are very expensive, but what you can't do is you can't, put a Great Dane in one of these, or anything much bigger than the Yorkshire terrier. And as they're so noisy, you'll get no animals near them anyway. So they only protect you while you're preparing the drug, not while you're administering it.

What other things can you do instead of using a biological safety cabinet, you can send patients to one to vets that have one, or you can use a HEPA filtered respirator and there's reusable versions and disposable versions of those. If you don't have a biological safety cabinet as well, there's other things you can use, and, you can use, You're getting liquids that are pre-made rather than powders are good because it's on that stage in the preparation, . You could use some of these products like chemo pens or something like chemolave, these filtered devices, which are not closed devices, but they provide some protection against the positive pressurisation of the vial.

They're not ideal. And certainly for all of these drugs you should be using the lock syringes, because whatever you screw onto the end of your syringe, whatever needle or giving set there is there or device, you don't want it to come off. I'm just gonna pop this slide up here very quickly because there are other products on the market which are closed drug transfer systems.

The, the product that I've used for the last 16 years is Farseal, and, you note on Farseal here, that, it has a really good level of safety margin in here compared to all the other ones. I mean, pretty much EShield and seal are the market leaders. Personally, I feel that Farseal comes out a little bit better in this, measure here.

And certainly the next best systems are far, far, below where what I would consider to be acceptable if you can get, a, a good system like Forseal. Yeah, so, you know, far seal is my choice and it is an alternative to biological safety cabinet, and it provides a good, physical barrier to these drugs and prevents a lot of the problems that we've already talked about. We'll skip over the tablets and capsules quite quickly, but because all the tablets now come with an inert barrier coatings, so that we never really come into contact with it.

But it's really important that we never crush, divide or open the capsules or tablets. If you need to . Give a different dose, then my recommendation would always be send these away to a specialist lab and have them reformulated in specialist controlled environments.

And of course, if you're going to dispense these, make sure that you're going to dispense them in individual packs, make sure they are very clearly labelled as cytotoxic in childproof containers, and ask the client, the owner to bring these back to the practise if the patient doesn't finish the the course. So going on to preparation. Of drugs.

First, we need to prepare the patient. We do everything over a plastic lined absorbent pad, in constant sheets, to make sure that any spillage is contained, should there be one. And what we're gonna do is we're gonna avoid high pressures within the vial when we're doing injectable solutions.

We're gonna use Li lock syringes. We need to be careful of bubbles. We're not going to be recapping any, I should say needles, not syringes.

We're gonna make sure that we dispose of our waste correctly and always wash our hands. Of course, accidents can happen. So make sure you've got, spill kits to, to, to hand, and more importantly, make sure that you have the equipment, to look after the personnel that you've got as well.

And if, these drugs were to get into the eye, a lot of them are very, Basicant, and irritant, so giving them a really, really good washout is really important to make sure that they get some medical, some medical assistance, very, very quickly. If we do have a spill, you know, make sure we're prepared. You can get some really good spill kits.

I'm a big fan of the burner spill kits. Everything's in there that you really need. It's probably the, industry standard, really.

And everything's in there to confine a spill, sort out any broken glass that might have happened, so absorb any liquids, bring it together any solid, and, . After you've got rid of your gross contamination, it's really important that you wash the area with a detergent and the detergent you'd you'd go for would be a a a a a bleach to help degrade any of the The products. I'm just going to go and talk about Fars here a little bit, because this is the system I've used for the last 16 years.

It's just coming up to its third kind of version at the moment. The, it, it gets better every time, it's, it's created. I, I like the system that we currently use, which is the 2nd version.

with the, twist, push, push, twist, push it. And, I'm going to talk a little bit about that now. I mean, basically, when you look at file seal, you've got the file seal on the bottom here, and, you've got the standard technique on top.

With the standard technique, we've got fluoresce in this bottle and this bag here, and you can see that when you draw out. Some fluorine, into the bottle or inject it into the syringe. You can see that the needle is highly contaminated.

You can see it's in the syringe here. You can see it's in the bottle. But more importantly, you can see it's in the environment here as well.

And this is the same when we've injected fluorozine into the bag of, fluids here. What you don't get with fast seal is that you don't get that, environmental contamination because the system is sealed. It's a closed system, that means nothing can get out, and, there's adapters to, connect onto the tops of vials, and onto bags as well.

Interestingly, this a little bit on the side here of the fire seal connector, this is to equalise the pressure of the the vial inside. So if you want to draw out 10 mLs and you put in 10 mLs of air and draw out your 10 mLs, so it kind of equalises the pressure and what you don't end up with is a positive pressure vial, which is really, really important. So taking, you know, think back to our early days when we were learning about how to give drugs to patients, most people would have learned about the five rules of clinical pharmacology where you make sure you've got the right patient, you've got the right drug, you've got the correct dose, the correct dose interval, and the correct route of administration.

And with, I guess with some drugs, you might be able to get away a little bit with . With this, with chemotherapy, there's absolutely no margin of error. The drugs are dangerous.

If a patient who doesn't need them gets them, there's gonna be some adverse effects for them. And certainly dosages, if you're giving a 10 times overdose of one of these drugs, it's going to be catastrophic for those patients. So, we talk about slow intravenous injections or bolus injections now and we're gonna place for these always an intravenous catheter.

. Make sure we've got a nice patent catheter, cleanly placed at the first attempt, so make sure it goes in straight in and threads off beautifully. We need to make sure that we don't obscure the catheter in vein, and what we use is we use a clear tape so that we can see what everything that's going on underneath. Check patency, so we will flush a good volume of, say, lying down these catheters to make sure that we're 100% happy and that they are intravascular, and, and that's going extravascular.

And we routinely don't use any heparin in any of our flushes, to prevent any precipitation with any of the drugs. So when we're given the drug, we're usually giving it down for an infusion, we're gonna be giving it with a fast infusion rate of 0.9% saline, so it's normal saline.

We administer the drug quite slowly, and we observe the vein constantly for any extrasation. And this would be for drugs like doxorubicin, epirubin, myxantrone, soarabine, and, some of these drugs will give you a little bit quicker than others. What I've got next is I've just got a little video, just to play through.

And So that you can see the false in use and . A drug administration. It does skip forwards in a few places to make sure that we're not sat here for 20 minutes watching the video, but, I'll talk through it as we go.

I might just pause it a few times as well. So what we've got here, they're just checking for the patency, we get a nice flashback of blood there, and checking that we've got good patency of that catheter. What we're using here is we're using the file seal Y sight connector, which is the CAT.

We've got our own consonant sheets everywhere now, and we've got the The drug syringe connected here with an N95 far seal connector into the specialist fast seal connector on the side of the N on the CAT connector again to the patient. We're just checking patency again. We, check patency a lot to make sure that we're, definitely getting extravascular.

And what you can see here is that we have a 20 mL syringe of saline here, being a misture alongside this mitoxantro. Mitoxantrone's a lovely drug to give because it's blue, so you can see it really nicely. We can see this, this is a cat, which is why we're using a 20 mL syringe here to make sure that we are diluting this, mitoxantrone nicely, but still able to, administer this, .

Really nicely as you see the cat looks pretty relaxed, we can see all of the cat's leg here, the assistant is, viewing, . The the the catheter site, making, they're watching the administration, they'll alert the person administering the drug if there's any problems. Every now and then, we may stop and draw back to make sure we get a flashback of drug.

As you see, we've now got to the end of the syringe of myoxantrain, and just shortly they'll start to inject saline and flush that back up into the drug syringe, . Just sending a little bit of saline down first. So they're just flushing this, so it's going down the saline syringe up into the drug syringe.

And I'll do this a number of times to make sure. Here we go. So we got a good flash flashback there, just making sure it's still in patent at the end.

Flushing it nicely, we've still got plenty of saline here. And then we're a little bit way through the flushing process here so they just Flushing the same, it's going in a lot quicker because it's more dilute because they're using the saline. Again, you know, they're drawing back on that saline, closing off the gate, so, you don't get back flow of the drug.

The cat's starting to get a little bit agitated now. So they've just checked that we do are definitely in, that the catheter is still patent, so we get that flashback of blood that we saw just a moment ago. And then we can see the my sunshine getting slightly slight lighter shade of blue.

We flush it a few times and what we'll end up with is a little bit of flush just at the end, just to flush that little bit extra. Blue 3 into the into the cat, and, that will remove the, the, remove as much uhm on train from the catheter tip as we can because up until this point, our system has been completely closed, and, the highest risk point now is when we take this IV catheter out. And this is a real, really good thing, and I will try and play this twice, to talk through it because it happens quite quickly because our team's pretty slick, but we, at this point, we've cut the tapes, and it's taking the tapes off.

We've got a A, a bit of gauze over the top. We're gonna cover the the catheter in there. You never see the catheter, it's contained within that swab.

You just see how slick and well trained our team are in doing this. And then everything then gets taken away and put into the cytotoxic bin, and, disposed of properly. So that, that cat, it's outpatient, the, person that you saw giving that chemotherapy, was on their final sign-off, for giving chemotherapy.

So they've usedarseal a few times, but it certainly wasn't me who's been using it for 16 times, 16 years, and you know, you can see that she's very confident in, in giving that, so it's not a difficult system to use, if you're, if you've, if you've been taught how to use it properly. Finally, we'll just look at animal waste and I think the focus is always around urine and faeces, and this is where a lot of these drugs are excreted out of. And we're concerned about the drug coming out as an unchanged product.

We've got active metabolites, so these are drugs which can actually cause problems with people. We've got inert metabolites, which are the ones which the drugs have been changed and we're not too worried about. Now for at least the 1st 48 hours afterwards, these patients are gonna be excreting and depending on.

The Drug used. The half-life can go on for up to 7, 10 days. So owners need to be very much aware of, of this if you're doing this as an outpatient procedure.

When we're dealing with these wastes, we need to make sure that we're wearing appropriate PPE. We're not going to be using sprayers to, hose out kennels or disinfect areas because the sprayer can then aerosol, the, the waste. We use separate bedding.

Purple always seems a very good colour to use with cytotoxic, and chemotherapy patients. So we use purple, bedding. We wash that bedding separately.

We wash it, in machines which have, the ability to finish with a bleach disinfection cycle. When we're advising owners at home, make sure that they always wear gloves, we offer them bags to collect the waste, and we return the, the, that waste back to us. So The ultimate question at the end here is, so does it work?

And I guess when you look at human hospitals, up to 70% of swabs from human pharmacies and administration rooms are, are positive, and a large portion of drugs and prep mats in the human side are also positive. Now, does this work in practise? We don't really know, because, there's not enough data out there.

There's been no study. I think we, we do swap our environment that we work in, and, our, values came back well within the notifiable value of 718 nanograms of carboplatin, which is the one that we, we. We look for .

It's really important, I think that we're able to quantify what we're doing. We've always Use our seal in our facility. I think the value of using the closed drug administration system is really, really important.

We're doing, I guess, you know, between, 20 and 40 chemotherapy procedures a week, on site, and, you know, to have such good response like that is really important to us. OK, that, that brings me to the end. It is a little bit of a whistle stop tour, of cytotoxic safety, but certainly if you've got any additional questions, then please do pop those in the question.

Box and we will get around to providing answers for you for them. Stuart, that was fantastic. Thank you so much and you are absolutely right.

We will hold those questions over right to the end. Folks, this is the next stage in this innovative webinar tonight. We do have the presenter on with us, but we're going to play a recording because Juliet will be around for questions in the end.

So Juliette Roy works as the European product manager for injection systems and anaesthesia systems at BD. She has over 10 years of marketing experience in medical devices and consumer health industry, working with leading manufacturers in national and international environment. She graduated with a master's degree in Marketing Management from the University of Pantheon Sorbonne.

And completed her education with an additional one-year university diploma in medical biology. She's notably passionate about understanding the clinical applications and usages of the product she's in charge of, and also of the enabling new product developments in line with customers' unmet needs. So over to the presentation from Juliet, please, Dawn.

Welcome to the 2nd section of this webinar. I'm Juliet Hua. I work for BD as a European product manager for injection system as an anaesthesia, and in this presentation, I'm going to introduce you to BD Emerald syringe and how this syringe can help you improve your environmental impact.

When using plastic syringes. So what is BDM? This is a BD products offered to clinicians who require a little sleep connections in Europe.

The product is offered in multiple configurations and with different volume capacities. So we have a syringe ranging from 2 millilitres to 10 mL in the portfolio. The product is offered as a stand-alone syringe, but also in a variety of combination products in the, this presentation, for example, you can see or a BDMO syringe combined with a conventional needle, but we also have combination products.

With safety needles. PDro is used across a variety of clinical settings, hospital use, of course, and also emergency use and is also suitable for veterinary use. So let's have a closer look and how the syringe is is, is made.

And the features and the benefits it can offer. So the first, the first feature that the syringe offers is a contrasting and precious scale marking, and this helps the clinician to deliver accurately the dosage of the medication. It also has a robust retaining ring.

And this ring helps minimise the risk for plunger withdrawal and potential leakage. The texture retaining ring is also designed to help the clinicians manipulate and grab the syringe appropriately while administering the medication. Similarly, the, ergonomic designs also helps on the smooth plunger movement, to help to deliver the medication smoothly across the procedure.

And the syringe has also a distinctive emerald green coloured stopper, which is particularly visible through the clear barrel and enable the visualisation of of the medication delivered. So, when Bi created the BD emerald syringes, there were a number of sustainable practises that were taken into account, for the product design and also for the manufacturing process. And as a result, one of our key facilities located in in Spain.

Has been certified with an ISO standards for environmental management systems which recognise the the company efforts to reduce the environmental impact. So the first, one of the first aspects of the syringe is that the BDMro uses 30% less plastic material than other syringes, which helps us reduce the use of plastic. BD has also a worldwide manufacturing network.

So for example, in Europe, we source them the majority of our syringes from our Spanish facility. Which helps us to reduce the long distance transportation and fuel that that would be used if we were not sourcing so locally. And also, Using a syringe coming from a BD Fraga facility also guarantees that using a syringe made with 100% renewable electricity.

So between 2008 and 2010, Bi looked at a number of data points to measure the outcomes and the improvement that would be generated from this new manufacturing process. So the first measure we looked at was the energy source. So as I just explained, our BD fra and plant now runs with 100% renewable, .

Electricity, sorry, coming from, renewable sources, which basically helps us saving a little bit more than 20,000 metric tonnes of carbon dioxide. And as a comparison, this is the equivalent of taking off 4000 cars off the road for a year, so quite significant. The second data point we looked at was the energy consumption and between 2008 and 2010, we've been able to reduce our energy consumption for about 5 million kilowatts.

And again, as a comparison that the energy, 9000 light bulbs would use to function for one year. Water conservation is the third parameter we also looked at. We wanted to estimate how much water we would save, and we managed to calculate that we saved a little bit more than 33 million litres over the two years.

Which would be in comparison what a little bit less than 700 people would use for water consumption for their household per year. And last but not least, we also looked at the amount of landfill waste we had been able to save, and we measured that the landfill was decreased by 73,000 kilogrammes. And again, making the comparison with the household consumption, that would be the waste 130 people would would waste per year.

Thank you. Right. Juliet, thank you for that pre-recorded presentation and it really worked fantastically well.

Stuart, these, these syringes and that, are you guys using them in your hospital? Yeah, we've been, we've been using emerald syringes now for Quite, quite a while. In fact, it feels like we've had them for forever now.

I guess, you know, for us initially, we went for them because of the . The, the environmental kind of impact really, because, you know, we're always trying to find, do our bit, to try and improve . Our our green footprint or or reduce our carbon footprint.

And, I guess what you forget is that sometimes there's a little bit of innovation that goes in there to, to make it. A little bit better than you thought it was gonna be. And I think the one thing that I, I quite like about the emerald syringes is the, is the green plunger.

So you can see the dark graduations quite easily, and that makes a real difference, when you're trying to dose really accurately. I guess when when we're using them clinically, happily use them to give drugs, medications, take blood samples, . Our, our anaesthetists are not as keen on them for, for doing epidurals, but, you know, we, we use them across the board, for everything else apart from that, in the hospital.

And, you know, we're very much looking forward to having the, the, the, the larger range of sizes coming out as well, so we can use them even more. As a hospital, we're, we're working towards the, the investors in the environment, bronze, at the moment are actually going to try and aim for silver, but, you know, products like the emerald syringe helpers really aim, and, and incorporate that just. Little change without actually having any real impact on this clinically.

It's great really. Yeah. Yeah, and as you said, you know, one doesn't think about everything that actually goes into it and, and, I mean VD has has put an immense amount of research into this and and The, the changes or the impact that they can be making on the environment is, is quite phenomenal, you know, with those figures that Juliet was just giving us in her presentation.

I know it's incredible, isn't it? I mean, just that, I, I guess it's not just 30% less plastic, it's all the other things that encompass that, all the energy, landfill, and everything like that. It's it's amazing what that What difference is actually made environmentally just by those changes.

Absolutely incredible. Right, let's move on now quickly. The next part of this unique webinar tonight, folks, is again, by a presenter who is on with us to help.

With questions later on, but has pre-recorded part of this for us. So Kirsty Sanders works as the National Animal Health account manager for BD. She has over 20 years of commercial experience in the animal health, pharmaceutical and medical devices industry.

She's a skilled communicator with a warm approach and a natural open and honest style. Hello, my name is Kirsty Sanders, and I am the BD account manager for animal health. Now, I am going to run through today some of the options that you have available when choosing a catheter for the veterinary market.

I guess to start, there are several decisions that we need to make in order to decide on our catheter of choice. Firstly, we need to establish which gauge size catheter to choose from. We need to consider the size of the vein that we plan to access, and then we need to try to utilise the smooth smallest gauge and the shortest length catheter where possible, whilst also taking into account infusion flow rate requirements.

The gauge size is measured by how many catheters will fit into a tube with an inner diameter of 1 inch. Therefore, the smaller size catheters are numbered with the larger gauge sizes. As you can see on the diagram, if you count the circles within the 1 inch circle on the left is a 22 gauge, and on the right is a 16 gauge.

The other chart shows the different colours for the different size catheters, and these colours are standard across all catheter manufacturers. So a blue catheter will always be a 22 gauge and a pink will always be a 20 gauge. So from this you can see on the other chart which size catheter you might need depending on the size of the animal that you'll be treating.

Now the first option that you can choose from is either to have A straight catheter, such as this. Or A winged catheter, and you can see clearly the wings on this catheter here. This is a matter of personal choice, there's no right or wrong, whichever you prefer.

The next option is to choose which catheter material that you'd like to go ahead with. Now, there are really two types of catheter material. There is a Teflon material, and most of your older catheters will consist of this material.

It's quite rigid. It's rigid to insert and then it remains rigid. The challenge with this type of material really is because if you get any kind of kinking with the catheter, It remains kinked and this can cause issues if you have if you have any movement of the catheter whilst it's inserted.

It can Because it remains kink cause phlebitis or irritation to the inside of the vein. If you imagine the vein is just one that consists of three layers and that inner layer is just one cell thick. So when if you start to have any kind of kinking within the catheter material that you are going to see irritation and phlebitis occur.

The other option and BD manufacture particular material is called BD violon. This catheter is actually rigid to insert. So whilst it's at room temperature, it's rigid, like so.

However, Once it is warmed up to body temperature and I have. Had this in a glass of warm water, then the material completely softens and you can see here. That instead of kinking, it just completely softens.

And so that whilst that's inside the vein, if you have any movement on the catheter because the material is soft, it will go with the movement. So you'll see less. Irritation, less phlebitis, and you, it will mean that in reality, you'll be able to keep this catheter.

You shouldn't have to take change it so often because you'll see less irritation with it. So that's the two catheters so far. The rigid catheter, which is The BD angiocaf.

And then We also have a softer material made of BD vion, which is called BD Insight. So that's your two choices so far. No.

Oh, you also have the option of having a port, if you're interested in a kind of a port. So you can see from this catheter type decision tree that you have several choices to make in order to choose which catheter you'd like to use. So firstly, you choose whether to have wings or no wings, and BD angioca is a straight catheter, whereas if you wanted a winged version, you'd either have to go for BD inside or insight or BD Venflon.

You then would decide whether you'd like an injection port or not. And if you would require an injection port, that would be the BD Vflon or BD Vlon Pro. And your final decision would be whether you would like a Teflon material, which is your older, more rigid material, or whether you would like a polyurethane BD vilon catheter.

BD just launched a new catheter called Kapina. It comes in a straight catheter like so, and also a winged version, and you can see there that the wings are firstly quite small and they're really nice and it is really easy to manipulate. Nice and pliable.

Now the great thing about the straight catheter is that you can see there is that, well, both catheters actually they both have a platform in which to hold the catheter. So you have these ridges on the side of the platform, which is a nice place to put your finger and thumb. It it provides ED insertion.

You also, and I don't know whether you can see that it has two ridges along the top of the straight catheter. So you instantly know when you're inserting the catheter, which way up to insert. The wings, it's a bit easier because you know that the wings are on the bottom anyway, but again, you have those two ridges, so you know which way up to insert the catheter.

Now, the great thing about this catheter and the new innovation that BD can bring is that between the catheter and the needle, you have a space so that when you insert this catheter into a vein, what happens is instead of having to wait to see the blood to appear in the hub back here, you actually start to see the blood move up the needle. So you get an instant visibility that you are inside the vein. I insert it into the vein.

I'm going to see the blood flash up through the needle there. I then insert it another 1 millimetre, lower my catheter, push the catheter forward. You can already see the blood in the hub here.

I know that I'm in the vein, I keep the catheter secure, pull the needle back. Now this catheter also has a really lovely valve in the back of the catheter. It's called a multi-guard safety so that you won't see any blood spillage coming out the back.

This will last for about 10 seconds. So it gives you time to go and find your extension set or need a free connector. Also, It's a safety catheter, so it's lovely and smooth to pull out, but you also have a safety device on the needle, so that if you did have anybody accidentally leave it around, you're not going to have any needle stick injuries.

And you can see from this animation that as the needle enters the vein. You will see an instant flash of blood run up through the catheter tubing. This is called BD insta flash.

And once you see that instant flash of blood, you know that you're inside the vein. So then you just insert your catheter for another 1 millimetre or so, and then you'll receive a second tertiary flashback in the hub of the catheter. From here, push your catheter forward so you know that it's fully inside the vein and then you can proceed to remove your needle.

Cahena has a passive needle mechanism so that that means that when you pull back that mechanism to remove the needle, the whole thing. The whole needle is covered by a safety mechanism, so there's no risk of needle stick injuries. So BD cathena comes in a range of sizes from 18 gauge to 24.

It is available in either a straight or a winged catheter. Cathena's catheter material is BD's unique BD vilon. This is a polymer biomaterial specifically developed by BD for vascular access.

It's a strong material on insertion, so that the catheter material remains rigid at room temperature, but once it's inside the body, it warms up, and will soften up to 70% inside. This gives it longer 12 times and reduces mechanical phlebitis by up to 50%. BD in the flash is a tiny little hole in the needle that allows blood to escape and travel between the needle and the catheter space.

So you'll see the initial blood return seen in the catheter and then the blood. Travels up through the needle to the flash chamber as a secondary confirmation source. So Cahena also has BD Multiguard technology.

This is a small valve in the catheter hub, which remains closed when a lure is not connected and opens once you connect a lure onto the device. This means that you have About a 10 to 15 2nd window before you'll see any blood spillage at the back of the catheter, means that it gives you time to attach your extension set or your needle-free connector, whatever it is you need to attach without having blood escape the back of the catheter. And finally, Kahena has a Passive safety device, which means that the needle shield automatically activates upon removal of the catheter, meaning that there's a less chance of needle stick injuries to your vets, nurses and other staff.

To complete the range, we also have Neflon. Now Nelon in September will be updated to Neoflon Pro, which means That it comes in a winged version. It's a 24 and 26 gauge.

So this is a small catheter for your smaller animals. It contains BD violon and BD Insta flash. So to conclude, BD has an extensive range of catheters to suit your needs.

We have new innovative technologies, making vascular access much easier and simpler. If you'd like further information, then please get in touch after the webinar is finished, or if you'd like to ask any questions, please leave them to the end and I'll be happy to answer any questions or queries that you may have. Thank you very much for listening to my part of this webinar.

Thank you. Well, Kirsty, thank you for that. And Stuart, I, let me call on you to comment again.

The fact of having a catheter in a vein and not having blood spill everywhere while you're trying to connect things. That appeals to me. Yeah, definitely.

I think trying to keep everything as clean as possible is always really important, especially on those white patients. Yeah, it's always the white ones that seem to be blooded up to the elbows, even though there hasn't been much coming out, has it? Absolutely, it goes about 10 times as far on the patient.

Right. Let's jump into some questions here. Stuart, the first one is for you.

Laura wants to know, would you still recommend using goggles when you're using a closed system with chemo? Thanks Laura, for asking that one. And the short answer is yes, I would, because even though, with the closed system, especially system like Far seal, which is locked, and I know it's very secure, there is always that risk of, of a human error.

And, you know, at the end of the day, we also have the patient on the other side of that catheter. And, and should the patient jump back, very, very quickly, and, and the catheter came out while we were mid administration, then the, the systems are all closed and there is a risk at that point. Although it's never happened to me, I think that, you, you want to have goggles on in that situation to protect your eyes.

Yeah, it's always better safe than sorry, isn't it? Especially when you're dealing with these sorts of strong agents. Absolutely, absolutely.

Yeah, fantastic. We're getting a lot of comments coming through, commenting about what a fantastic presentation that was. Unfortunately, folks, we seem to have run out of time.

Fascinating presentation tonight. Huge, huge big thank you to Becton Dickinson, for their sponsorship of Tonight, but also for their innovation in going to the vets first, asking what subjects they wanted, and then coming and presenting it and then giving us this opportunity to have quite a unique presentation tonight. So to everybody that's played a role in it, to my controller in the background, Dawn, to Phil who's doubled up as a safety mechanism there, to all our presenters tonight, especially to you, Stuart.

Thank you so much for your time. And folks, just a big reminder, the survey that will pop up when we end tonight. Please do us a favour, do our sponsors a favour, fill that in, give them some feedback.

They are clearly a hugely innovative company and let's give them something to come back to us. With, they have shown a commitment to that. So once again to Becton Dickinson, BD, and the presenters tonight, Stuart, Juliet, and Kirsty, thank you so much for being on with us.

From my side, Bruce Stevenson, it's good night everybody.