Euthanasia in Small Animals.pptx

Euthanasia in Small Animals Dr Emilie Law BVMS MRCVS Lecture ILOs Year ILOs: • CP3002 – Demonstrate effective written and verbal communication, in relation to year 3 topics, expected of a veterinary surgeon. • CP3034 – Demonstrate an appreciation of the impact of domesticated species on society a...

Euthanasia in Small Animals Dr Emilie Law BVMS MRCVS Lecture ILOs Year ILOs: • CP3002 – Demonstrate effective written and verbal communication, in relation to year 3 topics, expected of a veterinary surgeon. • CP3034 – Demonstrate an appreciation of the impact of domesticated species on society and environment in relation to Year 3 topics. • CP3035 – Discuss the ethical considerations and legal responsibilities which underpin veterinary professional judgement. Lecture ILOs: • Demonstrate an understanding of when it is the right decision to consider euthanasia and what aids a ‘good’ euthanasia. • Demonstrate when consent for euthanasia is required and what is required on the consent form. • Demonstrate an understanding of the different options of aftercare for an animal. • Demonstrate an understanding of the appropriate routes of administration of phenobarbital in the different small animal species. Why do we euthanise our patients • ‘Painless killing to relieve suffering’ RCVS • ‘Ending the life of an individual animal in a way that minimises or eliminates pain and distress’ AVMA • Sad part of our job, but an important one. When is euthanasia the right decision? • Uncontrollable pain and/or suffering – are the owners aware of this • Terminal/progressive illness • Age related cognitive dysfunction/senility - loss of learned behaviour (urinating/defecating in house). Be sympathetic to owners feelings. • Unable to treat condition • Does the animal have a good quality of life - importance of quality over quantity of life • Behavioural problems/aggression • Infectious diseases – public health risks • Overpopulation? Making the decision to euthanise Clinical indication: • Acute trauma, sudden • ‘end of road’ palliative care • Devastating diagnosis Owner request: • Why? • Do you agree? • Is there another option? AVMA Guidelines for the Euthanasia of Animals 2013 How to have the discussion with owners • Designated quiet room/as private a setting as possible • Be open and honest • Prepare client for the discussion – ‘warning shot’ • BE CLEAR – never use euphemisms (‘put to sleep’) • Allow some time for the owner to consider – very variable and don’t want to rush them into making a decision! • Actively listen • Display empathy – this is a difficult decision for the owner When do we need consent? • In person – consent form • Consent over the phone – update records • Brought in by member of public and no way to trace owner – is the animal suffering? Or can you stabilise to give time to find the owner. • Wildlife – Is the animal suffering? Will it be able to go back into the wild with it’s injury? What has must be included in the consent form • Requires owner’s details and signature • Requires discussion about the body of their pet, before the euthanasia • Most practices will have their own template with owner name, patient name, etc. I request the euthanasia /*and disposal (*delete as appropriate) of the animal described above. I have discussed the appropriate methods of disposal available. If you must discuss over the phone • Make the call somewhere quiet, where you will not be disturbed • Ask the owner if they are able to talk • NEVER leave a message delivering bad news • If consent is given over the phone, record the conversation details and if possible ask a colleague to witness • Ask if they would like to come in to see you to discuss/be with their pet Options for Aftercare Cremation • ROUTINE – no ashes back • PRIVATE – ashes back, increased cost Burial at home – check local legislation • Must be deep • Not close to any water supply Private arrangement with pet crematorium/cemetery Options for Aftercare Payment • Euthanasia costs money • Remember, costs will be on top of treatment costs e.g., sedative, visits, diagnostics, surgery, etc • Usually discuss when discussing options for aftercare • Check with your boss about asking for payment What makes a ‘good’ euthanasia • Rapid process • To be pain free • Minimal distress and fear for the animal (and owner) • Reliable • Irreversible • Safe (for veterinary staff and owner) • What is important to us and the owners for their pet. Prepare the room • Quiet room • Book double appointment if possible • Tissues • Comfortable space for client and animal • Get assistance if required • Equipment required • Let colleagues know euthanasia in progress – something on consulting door to denote Prepare the client for what to expect • What will you do first? – sedate their pet and give them time with them while sedation take affect • Take pet away for couple of minutes to place IV catheter and then bring them back to be with the owner • If unwell patient, may need to have on oxygen, etc so take this into consideration in your planning • Some animals may benefit from sedation/pain relief if distressed or in pain before euthanise. • Describe step by step what is going to happen • What the owner can expect • Warn them of possible changes – rapid breathing, agonal gasps, stretching, muscle twitches, loss of bowel or bladder control, eyes remain open • Calmly ensure them that these changes are normal, only happen once the heart has stopped • Their pet is feeling no pain/reaction • Ask if they are ready, then proceed to inject Euthanasia Process • Sedation required • Place catheter in cephalic, saphenous, lateral ear vein • Pentobarbital sodium 200mg/ml • Schedule 3 • 80mg/kg in debilitated animals • 120-160mg/kg in younger, fitter animals • Rapid IV injection • Overdose of anaesthetic which will cause respiratory and cardiac arrest Where can we inject Pentobarbital? • What sites of the body can it be given? • Intravenous • Intracardiac • Kidney • Liver • Intraperitoneal *Sedate if injecting into an organ* Small Mammals • Inhalational agents, using chamber? • Suitable for smaller animals < 7Kg or when venipuncture difficult. • Some have pungent odour - may hold breath. • Animals struggle and become anxious as vapours irritating and can induce excitement. • Consider personnel health and safety. • Slow acting (5-15 mins). • Consider injectable sedation Confirmation • No audible heart beat • Pale mucous membranes • Apnoea • Pupils fixed and dilated – eyes open • No palpebral/corneal reflex – no blink • Stay with your patient until any changes have ceased • Offer the owner time with their pet • Ask if they would like collar, paw print impression, fur, bed, carrier Support for owners • Give owners plenty of time with their pet. • Quieter exit from practice so don’t have to go thru waiting area • Pet bereavement help • Blue Cross offers free and confidential help: https://www.bluecross.org.uk/pet-bereavement-and-pet-loss • Further advice for owners on the process: https://www.animalwelfarefoundation.org.uk/saying-goodbye/ Once owner has left • Remove catheter and any other bandages etc. • Remove collar (if not done already) • Place in the appropriate size bag for routine or private cremation • Ensure all paper work is filled in correctly, double check names and dates, especially if having inscriptions • Seal the bag • Label the bag with the correct paperwork if private, with patient id and weight • Place bagged body in practice chill/freezer • If very heavy or giant breed may have to contact company directly for special uplift Taking body home • Advise on burial – deep hole, away from water supply • Advise rigor mortis will set in in a few hours • Advise may ‘leak’ urine, faeces, fluid • Must be done promptly • If they are still sure they want to take pet then confirm death, wrap body in a blanket and place it in bed/box/vehicle for owner House visits • Minimises stress of transport and visit to vet • Additional cost incurred • Take a colleague! • Take a consent form for signature • Take extra of everything! • Arrive respectfully Problems? If owner will not give consent: • • • • Get support Get a more senior colleague to speak to the client Speak to another member of the family if possible Phone governing body for advice You can euthanize a patient without owner consent if you feel the animals welfare is severely compromised. BUT….always make sure you are protected legally. Consent not required in emergency first aid situations or in cases involving strays or wildlife when welfare is severely compromised Euthanasia without the owner's consent 8.12 The Animal Welfare Act 2006 (which applies in England and Wales), the Animal Health and Welfare (Scotland) Act 2006 and the Welfare of Animals (Northern Ireland) Act 2011 contain provisions to safeguard the welfare of animals. For animals in distress, there are no provisions in these Acts that specifically authorise a veterinary surgeon to destroy an animal. Powers to destroy an animal, or arrange for its destruction, are conferred on an inspector (who may be appointed by the local authority) or a police constable. A veterinary surgeon may be asked to certify the condition of the animal is such that it should in its own interests be destroyed. An inspector or constable may act without a veterinary certificate if there is no reasonable alternative to destruction, and the need for action is such that it is not reasonably practical to wait for a veterinary surgeon. 8.13 A person with responsibility for an animal may commit an offence if an act, or failure to act, causes an animal to suffer unnecessarily. An owner is always responsible for their animal but a veterinary surgeon is likely to be responsible for the animal when it is an inpatient at the practice. If, in the opinion of the veterinary surgeon, the animal’s condition is such that it should, in its own interests, be destroyed without delay, the veterinary surgeon may need to act without the owner’s consent and should make a full record of all the circumstances supporting the decision in case of subsequent challenge. Generally, there should be discussions with the owner of the animal before such a decision, which should be endorsed by a veterinary surgeon not • Further information on euthanasia from the RCVS can be found here: https://www.rcvs.org.uk/setting-standards/advice-and-guidance/code-of-professional-cond uct-for-veterinary-surgeons/supporting-guidance/euthanasia-of-animals/