Plus-Hex CLINICAL
ABSTRACT Most veterinary nurses will experience a cardiopulmonary resuscitation ( CPR ) attempt at least once in their career .
It is important that all members of the veterinary team feel confident in performing CPR . This requires training in clinical skills and communication skills , with standard protocols and documentation being an essential part of this process .
This article reviews the process of standardising CPR training , protocols and documentation . It also includes a case review , in which the author reflects on her own experience of standardising CPR at her veterinary practice .
Keywords cardiopulmonary resuscitation , CPR , standardisation , protocols , training
Next , consider whether all of the tools needed to perform CPR can be accessed in the environment . This will vary between theatres and other environments such as wards .
Components of a suitable environment
• A designated area in which to carry out CPR
• All team members are aware of its purpose
• Clear of clutter and unnecessary equipment
• Space to perform chest compressions effectively
• Easily accessible resources , including a crash box or trolley with the required equipment
• An oxygen source ( not essential but preferable )
• A height-adjustable table
Introduction
Most veterinary nurses ( VNs ) do not want to encounter a patient needing cardiopulmonary resuscitation ( CPR ), but many of us will experience this scenario at least once in our careers . It is therefore important that VNs receive appropriate training to build confidence in CPR and increase the likelihood of positive patient outcomes .
The emotional impact of being involved with CPR depends on the individual , but practices should establish a unified response to a cardiopulmonary emergency to ensure CPR can be performed as confidently as possible and to try to ease some of the emotional impact .
When introducing or reviewing any training provision , the first step is to understand any prior related training carried out by the practice and the team members ' existing knowledge . This is important because they will vary depending on the practice and the levels of experience of the individual team members .
Considerations for CPR broadly fall into three categories :
• Environment and equipment
• Protocols and documentation
• Training and standardisation .
Environment and equipment
The first thing to consider is where CPR is most likely to be carried out in the practice ( probably in theatre or in the wards or kennels ), and whether the environment is suitable for CPR . If it is not , consider what could be done to make it more suitable . Keep human factors in mind , as well as those relating to animals , to ensure the environment is as suitable as possible for all involved .
Equipment needed for life support
The equipment in a crash box or trolley will vary depending on the practice and the team members . For example , if your practice team includes anaesthetists , you may find they are comfortable working with a wide range of drugs , so your crash trolley may contain a plethora of medications . However , it is crucial that everyone is familiar with the essential equipment and the most commonly used drugs , and that the crash box / trolley contains standardised contents [ 1 ] .
Table 1 ( page 32 ) provides a list of the equipment needed for basic life support ( BLS ) and advanced life support ( ALS ); drugs listed are taken from the RECOVER initiative guidelines [ 2 ] and would be considered as ALS . It is assumed that the patient would have an intravenous catheter ( IVC ) in place , but an IVC kit has been included .
A cautionary note about the optional equipment . The drug section can become unnecessarily overstocked , and most of these drugs would fall under the ALS category , so they would be used only once BLS has been established . While BLS is being established there will be at least 2 minutes ( a full cycle of compressions ) to obtain the drugs from their usual storage place in the practice . However , if you work in a large veterinary hospital you may want to keep some of these drugs close to the designated CPR area . Be mindful of expiration dates and check the supply regularly ; having a nominated person to do this may be useful .
It is important to ensure that all members of the team understand what is in the crash box / trolley . This needs to be included in all training sessions , and team members should be updated whenever there is a change to the contents . Pictures of what is in the crash box can be a useful aid , as well as a stock list and labelled areas .
Volume 38 ( 6 ) • December 2023
31