So yes, I, I'm Fee Farmer, having slight technical issues, but I am very much here and hosting today's live, live webinar on rethinking infusion. So infusion therapy is a routine part of veterinary practise, but pump alarms, line problems, patient interference can all cause repeated interruptions and additional work for the team, and we're all far too well aware of that dreaded beeping coming from the kennel room. So today we're gonna look at the clinical decisions behind fluid therapy.
We're gonna look at how we make sure that we deliver we actually deliver the intended flu fluid therapy and whether some of the familiar equipment problems deserve a fresh look. We're going to use 3 cases to do this, and there's going to be some time for questions at the end. Please do add your questions as we go along, and we'll get to them at the end of the discussion.
So with me today, I have two fantastic panellists. I've got Sarah Dennis, own brand product manager at NVS, whose portfolio includes infusion concepts, veterinary specific products. So hello, Sarah, thanks for joining us.
Yeah, thank you. Nice to meet you all. And along with Sarah, I have Alison Devonshire, a registered vet nurse with 25 years' experience, including the last decade in anaesthesia and at an ophthalmology and orthopaedic referral centre.
Alison has also recently completed the master's in Veterinary anaesthesia and analgesia, so she is very well suited to talk to us today about all things intravenous fluid therapy. So thank you both for joining us. Thanks for being here, Alison.
Oh yeah, thank you. So we're here today to discuss intravenous fluid therapy and take a look at how the equipment we use shapes that process in practise. Infusion Concepts recently commissioned some market research, and they carried out a survey with 179 veterinary professionals who shared their experiences with using fluid therapy equipment, primarily giving sets and pumps.
And it revealed quite a few interesting findings, notably that problems with giving sets are really, really common. So with those surveyed, we saw that 97.8% of those surveyed experienced at least one giving set problem in practise, which is significant.
I mean that's pretty much everybody having at least one problem a day, potentially more. And the four main problems that people saw were things like pump alarms going off. Half people reported having pump alarms going off.
Kining of lines, just under half the people reported a line kinking or occlusion. Patients interfering with the lines, 40% of those surveyed reported animals biting or compressing the line. And just over a third of people reported that the lines themselves were too short for the kennel or for the cage set up.
So this is a really big problem that we've got because a lot of people are reporting a lot of really common problems. Alison, is this something that you would recognise and be familiar with in clinical practise? Yeah, yeah, absolutely.
It can be a real problem. Especially if you've got, different types of giving sets available to you and you have to have specific ones that are only for use in certain pumps. And if you're, in a setting where you haven't actually got pumps, it can be even more of a hassle.
As the lines themselves can be very sensitive to pressure changes. So obviously that can be as simple as something like the patient lying with its four legs tucked under and then including the vessel or actually laying over the line itself, and including it that way. If you've got infusion lines that are too short, sometimes you can add in extension lines and things like the spiral ones or reinforced lines to help try and Protect the plastic to a degree.
But at the end of the day, obviously if a patient can get hold of and chew through the line, then things have somewhat gone south. If your patient's likely to chew through the line, then using buster colours or IV guards can be useful. .
So I think a lot of this depends on the type of practise set up that you've got. And if you've got enough equipment to go around, sometimes if you've got multiple patients that are needing IV fluids, but only so many pumps, then you might find yourself having to make a rational decision based on individual patient need and divert your resources, there. Obviously, if you've got patients, receiving IV fluids without a pump, then you need to make sure that we're designing their care plan to include close monitoring to.
Check that they're not being over or under infused. So yeah, certainly lots of lots of familiar things there. Yeah, and it sounds like each problem then comes with its own set of problem solving, which I imagine practise across the country are all having to do the same thing.
So yeah, absolutely an everyday problem. But do you think that these reoccurring problems have almost become accepted, like the way you could so easily say, yeah, this happens and we have to do this or this. Yeah, I it just accepted?
Is this just part of everyday practise that we put a line in and just expect a problem 10, 5, 15 minutes later. It does feel like there's some in some cases, yeah. And you know, I've been in scenarios where people will just avoid using certain types of infusion lines if they get a choice.
Throwing certain ones over others, that they know in their experience are less likely to occlude in some environments. Obviously the procurement of consumables, like giving sets is centralised by a corporate buyer. So the clinical team themselves might not have much say in the type of, sets that they've got available to them.
And, I suppose just worth noting in, in, the human setting, you hear about alarm fatigue or alert fatigue, the phenomenon that where workers in the environment where alarms are going off become actually desensitised to safety or clinical warnings, because of the overwhelming amount of signals that are going off and that can actually cause them to ignore delay responding to it. . So if you have pumps that are more likely to alarm because of how they're set up or because of the types of lines that you're having to use, the constant alarms can be off-putting.
And obviously it's disturbing the patients and the clinical team. So, yeah, it certainly can be just an everyday occurrence in different practises. I didn't realise there was a study done like that.
I don't suppose there would be an equivalent study in veterinary practise, but anecdotally, would you say you've recognised that and perhaps you, you turn, turn the beep off without all fully investigating why it's beeping in the first place? Yeah, sometimes and I've been in a practise where there's . The pumps are, you know, there's a variety of pumps, but there's one pump that everybody just avoids using because it's a bit of a problem.
And, so yeah, that's the one that gets kept for the very last for the last minute if you really need to use a pump. Which like as well as it being frustrating for those working, essentially is potentially compromising patient welfare as well. And I think the perhaps that perhaps the fact that it has become so accepted and and based on the back of this research as well, is why are we're going to be asking these questions today about why are we just accepting this as normal, inevitable part of infusion therapy and is there a way we can do it better?
More findings that came out of the research was that not only are problems with giving sex very common, we've already established that, but also nearly 2/3 of those surveyed had experienced a failure that had a direct impact on staff time or costs. So we just mentioned there generally about the potentials of animal welfare, but from a commercial point of view as well, it's taking up so much time which then has an impact on the economic side of the practise as well. Examples of this include having to replace a line mid procedure, troubleshooting a pump alarm, or having to reorder equipment at a really short notice.
So it's having a really big impact on how the working day is flowing. And one of the questions that was in the survey that was sent out was asking people what it is that they look for with their giving set equipment, and reliability was a top feature and already we're seeing a picture of equipment causing frustrations, so it's not really a surprise that that is top of the list. But also really interestingly, 27% of respondents hadn't chosen their current supplier.
They'd disinherited whatever it was that the practise was using when they started in that practise. So that leads us to think perhaps we need to take a step back and look. At what we can do about the, the equipment we bring in.
So Sarah, what do you think is that main takeaway from, from this research and how does that impact veterinary teams? Yeah, I mean, from, from our point of view, I think one of the biggest takeaways from the report that was commissioned was, is we're really encouraging practises to question what they've always done. So obviously, a lot of teams will already establish ways of working and if something goes wrong they'll find a way to work around and carry on.
Perhaps though, in a way we need to ask whether those issues are unavoidable or whether there's actually a better solution out there. And I also think the research highlights an opportunity for practises to take a fresh look at the whole infusion setup rather than just accepting that occasional problems are part of, you know, every day. And it's making sure the equipment they're using is right for the patients as well, the environment and the people using it, I guess.
And like you say, I think it's particularly interesting that when you consider 27% of respondents said that they inherited their current supplier. When they joined the practise, and I think that does raise a question of how many practises are using current products because they've actively chosen them, or maybe just because of what's always been there and you know, just the same products get reordered. So it could be seen, I guess that we have normalised problems that shouldn't necessarily be normal.
I think they are the sort of main takeaways. Yeah, absolutely, I, I agree with you. So I, I'm interested now to pose a question to our audience.
So if we move on, we have got a poll, and I would like to see what these problems look like in day to day work for those that are joining us today. So. What I would like to know is what are the interruptions that you encounter the most?
Is it pump alarms, kinking or occlusion, patient interference, or any other problems, or are you one of the 0.2% that doesn't rarely encounter problems? So, answers are coming in.
Looks like we've got a bit of a clear leader with pump alarms. But we are also seeing 20% of kinking and occlusion and 17% of patient interference. We'll just give that a few more seconds.
Anymore for any more. So it's 63% there with pump alarms, so yeah, I think that probably echoes what Alison was explaining earlier on. And that leads us nicely into what we're going to discuss with our first slide.
So our first case. A dog is admitted following vomiting and diarrhoea with dehydration and ongoing fluid losses. The team needs to decide a fluid therapy plan and put it into practise.
Alison, what are the initial aims of fluid therapy here and what would influence the choice of fluids and the plan that we we provide? So, the initial aim is going to be to replace those fluid deficits. Obviously the choice of fluid is going to be dictated by the veterinary surgeon in charge of this patient.
Their decision will likely be based on lab testing like, PCV and total solids, as we all know that a high PCV and high total solids is a classic indicator of a dehydrated patient. They might also want to get a urine sample and check for specific gravity. And yeah, I think we probably all know that in a dehydrated patient like this, the fluid choice is very likely gonna be lactated ringers or Hartman's.
So, . That will be the initial, the initial thing that we want to look at. The other nursing considerations, I guess, are making sure that we've got the correct size, cannula placed in this patient for the type of fluid that we're gonna use and the rate we want to put it in at.
Make sure we've chosen a giving set that's gonna allow the patient to be comfortable. And in a case like this, if the patient needs to move around, if it's got ongoing vomiting or diarrhoea, then. Perhaps a long line or a spiral extension set might be quite useful if you're going to need to take the patient outside regularly, to allow them, to go to the toilet, you, You'll want to select an infusion set that you can easily undo, if necessary, and then hygienically unattach it and reattach it to the patient and the pump.
And obviously kink resistant veterinary specific lines will tend to be, the ones that will help you keep the will help the patient actually receive the fluids that you've chosen, and hopefully avoid occluding the line. So then once you've got them set up and you've got the fluids running, how do you consider the deficit, the maintenance, and the ongoing losses? So we would obviously already have a, hopefully a nice accurate history from the owner.
And then a full clinical exam we'll have worked out what the current deficits are, and then from there we can look at ongoing losses. But, to evaluate their hydration status, we will look at skin turgia, mucous membrane colour, capillary refill time. We'll want an accurate body weight, so those sorts of things along with baseline blood samples like PCV and total total solids will help us to work out the deficit.
And with that rehydrating, that patient, we can use, the estimate estimated percentage of dehydration and then multiply that by the body weight. Or we can use diagnostic tests like PCV and total solids, as I said. So the, the rule of thumb here as a general guide is that a 1% increase in PCV above baseline.
Can roughly correlate with water loss of 10 mL per kilo. Obviously that's in the absence of any primary red blood cell disorders or any splenic issues that we might want to just rule out. And then maintenance is our daily baseline fluid requirements in a normal patient, which is approximately about 40 to 60 mL per kilo per day, depending on the size of the dog.
And then ongoing losses, . You need to just quantify those and replace them, so any active vomiting or diarrhoea episodes in real time, with those we want to estimate and take a note of any ongoing losses of those while the patient is in hospital and, and obviously you just need to make sure those are recorded in the plan, so that that. Nursing care plan can evolve while we observe the patient picking up or deteriorating.
And again, if we want ongoing checking the fusion, then we'd recheck the heart rate, checking pulse quality, mucous membrane colour again, capillary refill again. We can do core body temperature and compare that with the temperature in between the toe webs, . And Reassessing the moisture content on the mucous membranes, skin turgia and globe contraction is quite a good test to check, and just keep weighing the patient, so obviously any increase in body weight would obviously be seen as a favourable favourable in relation to correcting dehydration.
Urine output's very, helpful to monitor the hydration status as well. So would expect the patient, if they are hypoperfused to produce about 0.5 to 2 mL per kilo per hour, whereas 1 to 2 mL per kilo per hour is getting back to normal status.
And yeah, just. To repeat myself, but we'll make sure we're recording all of these findings on the patient's notes. We might want to retest bloods as well at various intervals, and urine specific gravity every time we, the patient is urinating, we can, .
Catch some and check it, normally we would check that at least every 6 hours or so. And checking our ins and outs. So it's quite easy to check what fluids are going into the patient via the drip pumps, volume infused record that you'll have on the screen.
You can easily calculate the amount of water that the patient's drinking. But calculating fluids coming out can be a little bit more problematic. So if you haven't got an indwelling urinary catheter, you need to estimate what what's going on there.
And obviously any vomiting or diarrhoea. If you've got incontinence pads or anything there, you can soak things up, then we're assuming about 1 gramme is equal to a fluid. And then yeah, we can try and catch urine as it's voided, each time and then obviously make a note of the volume, .
So yeah, comparing the ins and the outs when the patient is hospitalised is really important. And we want to assume that the fluid going into a patient should be about 10% more than the fluid coming out because of fluid losses via sweat and evaporating from the respiratory tract. So a lot to be monitoring and I guess that also helps you check that what is going in actually is what is prescribed and that the delivery is issuing what is prescribed and if any of those things that you've just listed aren't responding and moving in the way you would expect, you can then sort of be quite agile with tweaking flow rates and adjusting the treatment plan.
Yeah, exactly, it needs to be er an evolving process depending on. On your actual goal for for that individual patient. Sarah, are there any practical ways that the giving set design and the setup can play a role here?
Yeah, definitely, just kind of backing up some of that information Alison's given, but . I think the design of the giving set can make a real difference. You've got a patient that's obviously moving around, twisting, turning, interfering, biting, with a standard human giving set, you know, that you, you might be using, that movement can increase the risk of lion kinking, becoming restricted, and then obviously that's gonna trigger the alarm.
That's where if you're using a, a veterinary specific giving set can really help. You know, like an infusion concepts giving set, they're designed. With tougher, more kink resistant tubing, we've taken into consideration the realities of treating animals rather than to assuming they're gonna lie still.
It's also about having the right length of tubing as we've said, so positioning it correctly and making sure that's compatible with the pump being used. It's also, you know, if you've got a giving set, it's got the option of being disconnected, you know, you can, animal can have that sort of comfort break. And, and a long one piece giving set won't offer that flexibility.
Of course no giving set can eliminate every potential interruption, but choosing equipment designed specifically for the veterinary environment can help reduce some of those issues and make life easier for the team. And obviously we're not treating patients like humans are always gonna lie still, so you know, we want giving sets that are gonna reflect that sort of. Difficult patient that might be chewing and, you know, twisting round and round and twisting that line and breaking that line.
Absolutely. So, this, this case is gonna develop slightly and the alarm starts to pump, the, the pump starts to alarm, sorry, as we all have experienced in practise. So it's intermittently alarming.
Alison, what does this alarm tell us and what do we need to check before restarting it? So the alarms are obviously there primarily to protect the patients, so they shouldn't become background noise. So, they can obviously mean a number of different things depending on the type of pump and infusion set that you've got in use, but often there'll be occlusion alarms, so those mean that something's blocking the flow, which will be kink tubing, catheter positioned in a flexion area.
Or against the vessel wall, it might be partially dislodged. You might have left, or somebody might have left a clamp on, engaged somewhere. So if with those you need to check everything, so you're checking that the tubing is straight, that the catheter flushes properly, no clamps are left on.
In, it can, it can even be that the sensor system on the pump is malfunctioning or it's a set overly sensitive for the set that you're using. The other one that we get a lot of is air in line alarms. So that obviously means it will get your infusion pump has detected some air bubbles somewhere in the line.
So that can occur. For a number of reasons, but often when air is accidentally introduced, when you're changing drip bags, or if the chamber hasn't properly been filled when you're first setting up, you might have a loose connection somewhere which is allowing air to just creep into the line. So to address those sort of problems, you need to have a, a really thorough look of the whole line, locate the air bubble, undo it from the patient and re-prime the tubing and check that your chamber is at least half full.
And if that alarm is still going off despite. You, you knowing that you've primed the line fully, then you might have a malfunctioning air sensor. On your pump.
We get the end of infusions or KVO keep vein open alarms. They are obviously expected alarms, and if your programmed amount is nearing its end, that alarm helps us to get ready and replace the fluids if needed. Or you might just have something nice and simple like a low battery alarm.
Again, they're an expected alarm. They just let us know that it's time to plug in or recharge our pump. .
When you've got an alarm going off, you need to systematically go through, how you're gonna check or how you're gonna deal with the alarm. So, the first thing is obviously to look at the, pump and actually read what the error message is saying, because if it's just the the battery's dying, then all you've got to do is plug it in and everyone's happy. But if not, you need to look at the tubing, examine the whole length of the tubing, and check for any damage or kinks or air.
And then you'll obviously examine the patient and so look at the dressing, check the actual catheter and examine the limb and above and below the IV site, and then you might need to make a decision about whether you need to undo anything and flush, flush the catheter and actually check that everything's patent. And what could some of those implications of interrupted delivery be? I mean, I guess there's, you know, obviously there are clinical consequences.
So if the patients can't can't receive their fluids, then they're not going to get not gonna get rehydrated and their, condition might continue to deteriorate through, you know, us failing to replace, what they need. I suppose, the other thing is to consider though is if, . If a catheter is sort of at standstill, you'll lose patency and you might get a clot forming.
And the other thing is the, the time that it costs. So staff and resources drain, I suppose, from reestablishing the lines and troubleshooting alarms. So again, that takes attention away from the team.
And yeah, it costs us all time and hassle. Absolutely. So we are gonna move on to a poll now and ask our audience, when a pump repeat the alarms in your practise, what would you check first?
Is it the patient and catheter, the line and connections, pump set up and settings, or does it depend on the alarm and the clinical context? So we've got some answers coming in. Looks like the majority say it depends on the alarm in the clinical context, although the patient in the catheter also is getting a look in, as is the line and connection.
So let's give that a few more seconds. OK, so 50%. Choose, it depends on the alarm and the clinical context.
29% would choose the patient and catheter and 20% look at the line and connections first and just 2% check the pump setup and settings. So, yeah, I guess that links right back to what we said at the very beginning that the practises across the country all experience these unique but similar scenarios where every time it's going in and troubleshooting as we're going. OK, so let's move on to our next case.
Case 2. So we've looked at setting up and delivering an initial plan, but fluid requirements can change when a patient is hospitalised. Our second patient is a cat whose hydration and perfusion have improved after IV fluids, but it does still need inpatient support.
Alison, what would you reassess before deciding on the next day's fluid plan? So I guess this is essentially what we've already discussed, when checking the patient's clinical status and adapting your plan depending on what you find each time. So this is where keeping your communication with the rest of the team nice and open, making very clear records of what you have observed, that can make a real difference.
There is certainly an argument for making sure that cats when they're hospitalised are weighed. On the same set of scales twice daily instead of once daily in order to just accurately track, any weight change trends, and evaluate if any fluid shifts are happening. Obviously if you've got sudden rapid weight gain, that can be a really early sign of, fluid overload.
So cats would probably would recommend weighing more often than dogs once they're having IV fluids in the hospital. What else should we be looking at when sort of reassessing that hydration and and perfusion? Is there anything else, any other additional information that we need to take into account?
So, yeah, just, . Looking at, mucous membranes, capillary refill, having a very close listen to their chest and, noting any changes in their respiratory rate or pattern, you might want to repeat any lab testing that's already been done and urine testing. So there's quite all all of those things that you could repeat, and you would schedule those on your nursing care plan to make sure that they happen at the correct time.
And Sarah, when we're dealing with a mobile patient like a cat can be, and this cat in our cases, what difference can the length and the robustness of the giving set and the way it's positioned make to reducing these interruptions? Yeah, I think this is a really good example of why the design of the giving set really matters, cos obviously cats in particular cos they're very active aren't they? Even when receiving treatment, they're changing positions, stretching, turning, getting themselves into all sorts of positions.
So, firstly the tubing needs to be flexible but also tough, so resistant to kinking. It needs to be coped with movement without becoming twisted. If you take an infusion concept set for example, these are all veterinary specific lines that won't kink or occlude and won't restrict that flow.
The material of the tubing means you won't get a kink like you would in a giving set designed for human use, cos obviously they're designed for the patient that's gonna lie still and that tubing's really soft and it will kink very easily. Like the length, that's also really important. You need to, you need enough tubing obviously to allow the patient to move comfortably.
But equally not excessive tubing that could become tangled, caught, or create additional risks. So that's where you know you get the spiral giving sets and stuff like that, but you've got the length, but it's then gonna sort of come back together, . I think it's about finding the right balance between allowing the patient some freedom of movement while maintaining a reliable infusion.
So small considerations in the setup can make a real difference, I think in reducing interruptions and making life easier for the team. Thanks for that. So before we move on to the next case, is there anything that you would.
I'd like to add I think you know it's just sort of backing that up isn't it, you know, it's backing up the veterinary specific lines and the and the benefits in those and using something that's actually designed for veterinary use and it has all those sort of plus points. That goes with it. Yeah, I think, particularly when you're caring for cats, that have got, IVs, running, you can, you really find that organising the kennel quite carefully can make a big difference.
So if you've got the luxury of having the space, so making sure that the kennel is organised. So ideally you want a clear path in between the patient to allow them to navigate into a bed and a feeding station, a litter tray. Which is then less likely for them to get the line tangled in objects, if it, if you use boxes for the cats to actually hide in or under, make sure that the doorway is a bit wider than normal to allow some space for the line, and using the low profile ceramic drinking bowls and food bowls rather than light stainless steel bowls that can get easily lifted by moving lines is a good idea.
So just sometimes there's little practical things like that can make a big difference, with cats. They obviously don't like having. A whopping great bandage on their forelimbs.
So we always try and go less is more with cats and not have too much tape, not to have too much bandage. So yeah, it's, it's about being quite holistic and looking at what the patient's like and and making sure that if you can that the environment's, suitable for them. Yeah.
Yeah, that's some really good practical tips, thank you. Sarah, do you think that the design sort of helps the movement and reduces these problems? Can, is it particularly noticeable in cats compared to dogs?
Yeah, I mean, I think, you know, the giving sets, they, they're good for both, and the, the advantages having, you know, a wide selection. So you don't, you've got, you can either have a longer giving set that, you know, work for that or a spiral giving set that, you know, lots and then like I said before, the ones that will disconnect. I think it's just having the, the options, isn't it, that for your different cases, which is ideal.
Absolutely So we're gonna move on to our 3rd case now, and we're moving away from a clinical situation and looking at what happens across a busy vet veterinary practise. And so infusion pumps obviously are used every day and staff regularly encounter alarms and interruptions. The team is experienced at dealing with these problems and no single incident seems particularly significant, and this is just what we've echoed throughout this whole, conversation today.
But Alison, at what point should a reoccurring problem prompt a wider practise review rather than it just chalking it down to just another individual fix, another thing to add on to a really busy day? I think, . If, if you find that a very, a particular pump or a type of giving set is causing more problems, then it's actually being useful, then it's a good scient just to reevaluate what's being used.
You know, you, if you know that a lot of time and resources are being used in troubleshooting infusion problems, then it's probably a good time to audit it, in house and see how much time goes onto those things and how many times per shift that happens. So you can, . But, I think when, when it becomes the norm, they're seen as more of an operational burden, they don't really have to be, so that's probably time to, to trigger something if you, if you want to actually find out what's going on.
So over time the alarms and the workarounds have simply become accepted as part of normal inpatient care. But when the team starts discussing how much time they're spending dealing with these rare occurring problems, they decide it is worth taking a closer look. They agree to carry out an audit of their infusion equipment and how it's being used.
So Alison, what would an audit process look like in practise? I mean, it can be quite a simple process of just simply recording how many times an alarm goes off. So some, Actual pumps will have an alarm log, so you can access that on the control panel and literally just, find out how many times it's gone off and what type of alarm it is.
Or if not, you can just have a piece of paper up on the wall or use a whiteboard and just ask members of the team to record the problems that they've had. if you've got a, digital inpatient, thing like the smart flow, you can. Actually set up, set it up as a product so people can just digitally, again digitally record what they've done, and then you can go back and audit those at a later date.
I would say whenever you do an in practise audit, you just need to have a very clear question that you want an answer to. So, keep that process of gathering data nice and simple. So an example of the question might be, you know, how many times in one day do the infusion pumps alarm.
And then you can just break that down by having a simple tally chart on the wall where people can mark on it, which pump is alarmed, what infusions that they're using, and what, what was the code that's been going off. And Sarah, what should a team consider when reviewing its infusion equipment? And if an audit identifies reoccurring problems with giving sets, what options are available to practises who want to improve their setups?
I think the first thing to look at is the equipment as a whole, rather than just assuming maybe it's just the pump that's a problem. As our research showed, the the reliability was the number one consideration when choosing a giving set. And that a lot of practises have simply inherited that existing supplier, so I'd encourage teams to look at problems they're experiencing most frequently to begin with.
Are they getting reoccurring alarms, kinking, occlusion or disconnections? Is the tubing, is the tubing suitable for the patients they're treating and the environment? So you know, it's just making sure things like, you know, is the giving set suitable for the pump?
Is it a pump specific giving set, cos obviously we do hear quite a lot that people are using, well, they don't realise they're using sort of gravity giving sets within the pump, so then obviously it's not, working properly. And then to look at the alternatives that are available to them. Just because the practise uses a particular pump brand, you know, it doesn't mean that they have to use the lines, that go with them necessarily.
There's lots of different, our lines will go in lots of different pumps. So it's just being aware of that as well. So compatibility is a real important consideration, cos you may be able to improve, with the giving set without having to replace the whole pump system.
So it's ultimately I think it's about understanding what's working, what's not, and whether the equipment is still meeting the needs really. Yeah, sure. Thank you for that.
There's lots of. Good points there and some nice ideas that we can take back into practise. So, we're gonna move on to our final poll before going into our questions.
So, Final poll of the day, would reoccurring infusion interruptions prompt you to review your practises, equipment and protocols? Yes, it would, possibly. We already review these regularly or you're not sure?
OK, so I think the yes is just creeping ahead there, 55% of people at the moment, 57%. Which Be prompted to review their practises, equipment and protocols. I wonder if that would have been the same answer at the beginning of this webinar or not.
A couple of people not sure. 33% of people possibly would, and only 4% of those would are already doing this regularly, so there certainly is. Showing that there is space for equipment to be reviewed internally within practises.
So Thank you, we will move on to the next slide, please, where we have some questions and answers for our panel. So we've got our experts with us today, so let's have your questions in and we'll fit as many as possible in. So there is one already that's come in.
Can you tell us any more about the old trick of putting spirit on the giving set to stop false alarms? Alison, have you got anything to add to that one? No, I don't know about that one.
I mean, I'm very old, so I feel like I should probably know about it if it's not, if it's an old trick. But no, that's not one I'm familiar with. But I am certainly intrigued.
Maybe it's to do with the type of giving set and the type of plastic. I don't know. I would suggest that if there were repeated false alarms, probably a better.
Thing to do would be the audit as you suggested and looking into why it's repeatingly and perhaps looking into it changing equipment so that we don't keep getting the repeated alarms. I was actually gonna add on to my what I was saying about doing in practise audits actually, if it's something that people were interested in doing, but they're a bit daunted by, if you actually go onto the, our CVS Knowledge website, they've got some really good advice on those pages about how to set up and run, in-house, audits, so you can do clinical audits or just equipment audits, anything like that. They've got like a toolkit online so.
And we've used them in the past and there's really good examples of one other ones that practises have done. So you can actually see how other people have set up their audits. And then if you do an audit and it's useful, you can share it and actually publish it online and then they, they're quite keen for people to do it.
Urge people if they're going to do something like this, have a, have a quick look on there before they start and it's quite helpful. That's really useful. Can you just repeat again where you can find that?
So it's the Royal College of Veterinary Surgeons. So the RCVS knowledge, is the website. So if you, if you look on there, it will take you straight to their, their their knowledge database basically for doing, in-house audits.
Brilliant. Thank you. Another question has come in.
We have issues with our T connector breaking at the point where it joins. It seems to kink at the junction. Sarah, perhaps have you got any input for that one?
I mean, yeah, it, no T connector should be breaking at any point really, so, it's, it's not something that should be happening. I wouldn't have thought it's hopefully not an infusion concept T connector though. But yeah, it doesn't sound like a, a great quality.
It sounds like a quality problem to be honest. Well, it looks like that one might need replacing. Yeah, yeah, definitely a replacement on that one.
OK, we also have a question here, why do some pumps alarm more frequently than others? That's a good question. I think it's always worth checking that they're calibrated to be used with the giving sets that you've got for them.
So, every now and again you might find a road giving set from a different brand is in the box. So if it's something as simple as that, just always check that you're using the right giving set. Or if you've changed supply, you need to check if your pumps will accept those.
So sometimes you'll have to actually arrange to have them recalibrated. And Annoyingly, most, infusion pumps are meant to be serviced every, every year. So if you've got a problem child pump, then maybe it's time for that one to be packaged off and sent in for a service just to check that it is functioning properly and the sensors are all correct.
OK, thank you. A few more questions come in. In my previous practise, we didn't have many infusion pumps, so larger patients often get fluids without one.
Would you recommend using an infusion pump for all patients regardless of size to help prevent fluid administration problems? Do you consider infusion pumps essential for ensuring reliable fluid delivery? I, I would, but I mean, 20 years ago I was in a practise that just had one pump and it, you know, you'd blow the dust off it and use it occasionally.
But I think it, I think they are far more, affordable now and you can get really basic ones. You can get, rebadged, human ones that you can get calibrated to work with veterinary specific lines. So you can pick them up in, Medical auctions for really cheap, so they're not hard to get hold of, .
And yeah, I would say for for all patients it's better to have them on a pump, just so that you've got that you've got that little bit of a safety net to have an alarm. Available to you if there is a problem or an interruption in fluid delivery, but they, they're not necessarily essential, and yeah, I've given plenty, of, of fluid therapies, without a pump, without any huge problems, but I do think it's for peace of mind, it's quite nice to have a, a pump running. Yeah, thank you.
Next question. There was an interesting comment, something along the lines of outs should be 10% more than the ins. Could that be repeated?
I think Alison, that's when you're talking about our dog, our dehydrated dog where you are monitoring the fluid outgoings. Be that urine or . Or whatever and saying that the input you're putting in should be 10% more than what you're expecting to come out.
I think that's what you mentioned earlier. Yeah, it's just so that you can allow for the the losses that you would normally expect through just panting or sweating and respiration tract basically. So you just want to assume that you're going to have more going in in those cases.
So we're gonna be closing the gap on that deficit. Yeah, yeah, exactly. OK, next question, thank you guys for all your questions by the way, we regularly have trouble with the drip chambers due to condensation.
Any tips to prevent this apart from using cold infusions? I don't, I'm not 100% sure that, I suppose you. You wanna make sure that the, the infusion going in is, is not gonna be affecting the patient in that it's not gonna make them feel, start to lose temperature.
So I think providing you're happy that the, The fluid going in is at body temperature or in some cases warmer depending on what their core temperature is. I don't know whether condensation would be a problem in and of itself if it's just in the chamber, because providing the fluid that's moving through the line hasn't got air in it, then it should be OK. OK, thank you.
Another comment here, we regularly have trouble with the oh sorry, I've just answered that 11 of our infusion pumps keeps alarming when it's unplugged or switched off at the socket. It also turns off and resets when unplugged. Does this sound like a battery issue?
Yeah, it does sound like a battery issue. Or, or just a pump that perhaps needs to be serviced. It might need a, a new battery or it might have, a dodgy connection, from the battery.
So yeah, I would get that sent off to the supplier if you can and see if you can get it serviced. OK, thank you. And a few more in the chat.
I was wondering about the general practise where some injection medication in the yellow, where some inject medication in the yellow rubber, can that affect the long-term pressure sensors, so this is adding medications to the fluid bag. Can that affect the, the long-term pressure sensors? I would change the viscosity perhaps of the fluid running through, whether that would have a yeah, I guess it, I guess in theory, depending on sort of the molecular weight of what's going in, it could.
It could change what the sensor's able to feel, so it might upset the, the pressure sensor. I guess it depends how you've got your pressure sensors set in your actual pump. So if you've got them set really low, so they'll they'll alarm when it's, a very small change, then you might notice that.
Whereas if you have a a bit more of a wide scope on how you've set the pressure up. You probably won't notice it, but I don't know whether it actually cause any deterioration in that. You'd probably have to check against the sort of manufacture guidelines of both the giving sets and the and the pump to be completely sure on that.
That might be a nice one to sort of do for your internal audits. So just keep records of when you are adding medications, just make a note of was that, were there any alarms? Were there any differences, and then you can sort of do a.
Internal review back, can't you, and have a look at some changes on that one. Yeah. Oh, we didn't talk about bunny rabbits, but there's a question here.
Does anyone have tips to stop rabbits chewing through the lines? I have seen, and I don't know what they're called, I don't know, but they're a swivel attachment that you can put. You can actually attach it to the top of the patient's kennels.
So if you've got your rabbit in like a, a cat sized kennel, presumably you've got the IV in their ear and they might have a little buster collar on. So you can then have the, the line running from, you can have it taped to the inside or the outside of the buster collar and it can actually go up to an anchor point at the top of the kennel. And then the, you can take the IV line all the way across the ceiling of the kennel and then have your pump running in a kennel above it or hooked up somewhere.
I've never used them, but the one I saw, at another practise looked really good and the rabbit seemed to be tolerating it really well. And it means obviously the bunny can hop around multiple times and providing the line is out of reach so that he can't actually nibble on it, then, it works quite well. I've seen people also use those for cats.
I think they are. But I, I think they are probably quite useful, but I can't remember where they're available from, but they're, they're meant to be quite good. Yeah, I think that you know, obviously we, you can't stop a little bunny from chewing through a line completely, but toughened tubing definitely, definitely helps that.
Apparently retractable pen holders work. OK. Another question here, er, do you apply soft ban and vet wrap to cats catheter site or just tape as in, I think we had a photo up previously that just had tape on the catheter.
I think that cat was having surgery, wasn't it? What, what's your usual bandaging and securing protocol for cats? I do use tape, but I try and use less tape than I would for a dog IV.
I'm a big fan of the Durafoam rather than Durapore. So the slightly stretchy, foamy tape, which has got a bit of stretch and a bit of padding in it. I think cats tolerate that quite well.
Do use a little bit of soft ban and a bit of vet wrap, but I just try and keep that, catheter site as light as possible so that. There's not like this huge heavy thing hanging on the end of their foot and they're less likely to hopefully flick it off, or just be massively offended by it, so just less. Sorry, I interrupted.
I was gonna say questions just come in foot in or foot out for bandage for cats. It is a treat. I, I've worked with people that, argue about this one actually.
So I think it really depends, but you know, gold standard would be that you always have a couple of toes available to check, that everything's OK because we need to be able to check above and below the cannula site, and that's for dogs and cats. So normally you need to be able to see a couple of toes. But I also know people that think cats are better off having their toes bandaged in.
But I tend to leave a couple of toes available and obviously you just need to be really cautious that you're not, taping or bandaging anything in too tightly. Yeah. We've got another comment, not a question, but thought it'd be nice to add to anyone who doesn't know, as I didn't for quite some time, that the pressure alarm sensitivity can be adjusted on your infusion pumps to stop the high pressure alarms.
I.e., if you have a high infusion rate and a small IV, you should adjust the pressure alarm to account for that increased pressure.
Is that something you do routinely, Alison? Yeah, ours are often set quite high, because we do have quite a lot of, CRIs and things running at any one time. So we do tend to adjust them.
And it's worth, yeah, absolutely worth having a look on the menu on your pumps or if you've got a manual sitting in a drawer somewhere, it will show you where to find that. But it's usually quite straightforward to increase or decrease the pressure sensors. Fab.
We have a few attendees with some raised hands. I don't know if those that have raised their hands, did so intentionally or if they have questioned, if you want to type them into the Q&A box or the chat box, we can get those questions answered for you. And I have one more question here.
I think this is for Sarah. What difference can veterinary specific sets make? I think it's just kind of reiterating, what I've gone through, but I think it can make a massive difference, can't it, to, to, everyday work because if you're using a veterinary specific line, you're not gonna get that kinking that you would on a human line.
You're gonna have that toughened tubing, like say you're probably not gonna stop a very, excuse me, determined little bunny from chewing right through, but it is toughened, so it is, you know, you, it's more resistant to a. To a chew, you know, you've got a long, longer lengths, you've got detach, you know, got in, inline low locks where you can sort of disconnect, and the patient can go for a comfort break, you know, you've got all these added benefits that you would have, that you wouldn't get on a human line, so. I think there's quite a lot there.
Thank you. I think that might be all the questions answered for now. So if we.
Pop on over to the last slide please, before we finish. I just want to say a really huge thank you to both Sarah and Alison for joining us today, sharing their insights, and thank you to all of you who have joined and and watched this webinar. I hope that you have either learned something.
Or I've had the chance to think about this topic in a slightly different way or come away with an idea to take back into practise or discuss with your team. I understand it's been a mix of clinical and practicalities, so hopefully it's something that's useful, at all aspects of the practise. The central question today has been whether some infusion interruptions have become so familiar that we no longer question them.
Reviewing the patient's changing needs, checking delivery systematically, and looking at reoccurring problems across the practise can all be part of rethinking infusion. And you can find the rethinking infusion report and resources on the infusion concepts website, the QR code here on the slide, and a web address that will give you more information about how the research was found and more ideas for how you and your team can review your infusion equipment and explore what's possible. If you're attending London vet show later this month, the infusion concepts team will be with NVS on stand L50.
So do please come along and say hi, and you can have a discussion about how the infusion setups and the veterinary specific equipment can help you, your patients, and your practise. So thank you very much for joining us today. Enjoy the rest of your day and the rest of your week and goodbye.
Thank you.
