ClinLife-21

Introduction This book was a labor of love for all of the authors and we are so honored & humbled that you have taken it on to read! You’ll find that every chapter continues to weave the story from the previous ones and while there are medical facts and inspirational stories throughout, they aren’t contradictory – they’re complimentary, and necessary for everyone turning the pages. Enjoy. Engage. Take notes! Learn. Take this with you & share it. This is how we’re going to not only get through 2021, but this is also how we’ll thrive – together. ~ EVT & GM 2

Ch. 1 - Go for the Jug This title is not meant to encourage aggression, nor is it directed at humans. C’mon people, this is a veterinary playbook, we’re talking about our favorite vessel for blood draws, that lovely garden hose for sampling, the jugular vein! OK, it’s not everyone’s favorite. This vein certainly felt like my nemesis when I was learning how to access it. It would either roll away, be so deep within a skin fold that it disappeared, or pretty much attached to the trachea of every cat I tried to palpate. Anyone else relate? Most of us at one point or another likely struggled with the jug, and let’s be real for a second – it IS intimidating to be going at a live patient’s neck that has so many other vital pieces that we do NOT want to poke. So, how do we get over ourselves and do what this chapter says and just go for it? Back to A & P We gotta revisit anatomy and physiology just for a hot second. If we know what we’re looking for, where it ‘should’ be, and why it might not be in its proper place, then we can gain an 3

edge. Somedays we need all the help we can get. I swear, the veterinary gods that oversee venipuncture and those that supervise IVC placement are never on the same team. I would have days where I would never miss a jug stick, but couldn’t place an IVC to save my life, and then other days the opposite would happen. Was stress & mind clutter a factor? Perhaps, but I digress…back to anatomy lab! If we had the opportunity to work together, every time we had to do a blood draw, I’d grab you and we’d go for it together. First, close your eyes. Trust me. If you can feel it & locate it by tactile senses, you’ll be better at this. Plus, it limits distractions. Now I’d be there to guide you & to ensure that you don’t puncture the trachea. Truthfully, I wouldn’t make you close your eyes the 1st time, but the 3rd? Definitely. What are we feeling for? The thoracic inlet and the insertion of the mandible. Make an “L” with your thumb and index finger of your non-dominant hand – index at mandible, thumb at thoracic inlet – that’s your window. The jugular tends to be laterally adjacent to the trachea, usually 1-2 finger-widths away, except in cats. Because, cats. Deep or shallow? Depends on the patient! Applying pressure with your non- dominant middle & ring fingers to occlude the jugular – either right or left depending on your handedness – and release & re-occlude to confirm you’ve found it. It should ‘plump’ up from being occluded, and midway between thoracic inlet and the mandible, at a 45° angle is where you insert your needle. Bevel up! This is also where alcohol application comes in but keep the mantra ‘less is more’ in mind here – especially for cats. Isopropyl alcohol (70% in most practices) isn’t going to clean the fur, so let’s not soak our patients – it'll make them cold & cranky, which in turn will make this process way less fun. What the alcohol really does is constrict the smaller blood vessels closer to the skin (capillaries) and allows for clearer visualization of the jugular, and it does smooth the surface of the fur to poke through. Again, a dab will do ya, and your patients will thank you! As a rule, don’t shave your patients either, please. There are only 3 exceptions to this rule. 1) you have the pet’s parents' permission, 2) visualization of the jugular requires it, or 3) the patient’s fur is too matted or dirty to allow for minimal prep. If you do have to shave, keep the window small & your edges neat. You can be the best phlebotomist in the state, work at the premiere hospital of the region, and if your margins are sloppy – game over. 4

There will always be patients who don’t read the anatomy book, and I am not suggesting that you root around in there until you hit that wiggly vein – do not do that. Go where you know it should be and avoid the trachea & carotid artery. Be aware that smaller dog & cat jugs tend to be closer to the surface, whereas a larger dog’s jugular tends to be more hidden. Also be prepared that ANYTHING with white fur will bleed, a lot. Even if you apply excellent digital pressure, it’s just what’s gonna happen. Use saline to clean them up. Peroxide is no good for healthy skin, plus it turns the white fur a rusty brown color, which is less than aesthetically pleasing! It’s All in the Wrist To be more accurate, it’s in the wrist and the ring & pinky fingers. True story. You’ll be using your weakest fingers to pull back on the plunger once you’ve struck liquid gold, so now’s the time to get that muscle memory working! All joking aside, you do need to build up this musculature to minimize the amount of movement that can impact the whole process. Let’s start from the beginning… We’ve already covered where the jug is, now you have to obtain your sample safely, strategically & smoothly. Regardless of patient size, your approach to the vessel is the same. Not to the patient – this goes back to patient care/restraint that you’ve already mastered – to the vessel. This applies to either the left or right jugular, the only change would be to your hand and/or body positions. Remember, move to your patient, not the other way around. Now’s the time to get ambidextrous and use these EVTips so that along with progressive practice, you’ll nail it. 5

EVTips Smooth & steady • 1 fluid motion • Avoid jerking/stabbing • Insert needle @ 45° only • 1-2 mm @ a time – bevel UP • Redirect ONLY when necessary; 1-2 mm Flex your muscles • Literally, be flexible • Practice the plunger w/draw – 1-handed Read the room • 2 attempts, then tap out • Find a friend • Go to a quiet(er) location • Use Fear Free℠ techniques The Last Drop Jugular venipuncture is not for the faint of heart and takes time, practice & patience to master this skill. Utilizing a training model before moving on to live patients is always a good idea and knowing the anatomical workings of your patients is helpful as well. Take the time to practice, and then practice some more – we all have to. Remember too that there will be days when the jugular gods are just not showing up for you, and that’s ok. Just don’t be afraid to ask for help. There will always be another chance, and when there is, you’ll be ready to go for the jug. Ch. 2 - Don’t Bleed Out 6

Take a second and think of your dream mode of transportation. Is it a luxury car? A sports car? A private jet? Or maybe you’re a parent, and a spacious minivan with all of the bells and whistles would be your preferred choice. Now, I want you to close your eyes and actually see yourself sitting in your private jet or minivan. Got it? Great! Now imagine that you are in your vehicle and ready to go to your destination. If you’re in your private jet, maybe you want to go to Bora Bora (that’s where I’d want to go). If you’re in your minivan, maybe you’re wanting to take the family on a trip to the beach. Imagine you just settled into your seat and the Captain announces “Ladies and Gentlemen, unfortunately we’re have engine issues. If you’re in your car you turn the key and all you hear is “ka-thunk. Disappointment hits as you realize you have NO FUEL! In essence, your vehicle is pretty much worthless because it can’t do its job - transport you to where you want to go. Your performance and productivity as a human are very similar to this! You Can’t Give What You Don’t Have We are hearing a lot of talk about self-care these days, and it is almost exhausting. It’s becoming a cliche thing to say or suggest. However, I must admit, that ‘self-care’ is a damn good buzzword, and I firmly stand by it. As veterinary professionals and caregivers, we are notorious for putting the wellbeing of others ahead of our own wellbeing, which is the very opposite of what we should be doing! Remember, your private jet or luxury vehicle is useless without a source of fuel, and believe it or not, you and everyone else on this planet are - I’m not going to say useless - but you are underperforming and under-living if you aren’t practicing RADICAL self-care. \"You can't pour from an empty cup. Take care of yourself first.\" - Unknown Now that we know why it’s important, the next hurdle is actually doing it. So many people talk about how important it is, but then they don’t give you clear cut directions. Or even worse, they tell you to go to a spa or on vacation or to the gym or to take a bath… how is that even remotely helpful? Instead, I’m going to recommend a 3-step process on how to cultivate radical self-care. 3 SIMPLE Steps to Radical Self-Care Step 1 - Think: Ask yourself these deep, introspective questions: 7

1. What do I think I need to take care of myself appropriately? 2. What things do I want in my self-care picture? 3. What do other people and sources of information say that all people need to take care of themselves appropriately? In other words, what are the common deno minators of self-care? These are questions that we suggest you answer for yourself. There are many resources on the internet that will help you with this process. I do recommend taking a look at the wheel of wellbeing or the wellness wheel. It can serve as a general guideline for what areas you may need to focus on to ensure your self-care. Head to the back of this book for an example. Step 2 - Plan: Spend some time planning how you’re going to achieve this radical self-care so that you can live, perform, and produce better! Begin your planning by asking yourself these questions: 1. What specifics steps do I need to make it happen? 2. Will I need additional funds to carry out my self-care? What type of environment or supplies will I need? 3. What is the frequency by which I will do my self-care? 4. How much time do I need and how will I create the time? 5. How will I make sure that I maintain my responsibilities while I’m taking more time for myself? 6. How will I know if I’m failing or succeeding in my self-care? In the planning phase of your radical self-care, the goal is to map out what you need for yourself and how you are to acquire these things and implement them into your life.This part is extremely fun because you don’t necessarily need to know the ‘how’ for accomplishing the things you need for your self-care. You simply need to know that you need something – the rest kind of takes care of itself! Step 3 - Act: Things tend to not manifest until we start taking action. The first action you need to take is that you must go over your self-care plan with regular (weekly at a minimum) frequency. The more frequently we look at our self-care plan, the more involved the subconscious (unconscious) mind becomes at making sure we get what we need. 8

Ultimately, we want your self-care to be controlled both consciously (by you) and subconsciously by your reticular activating system. The more frequently you think about your self-care items, the more you will discover that awesome solutions to your self-care riddles will appear. Your goal is to hold the thought of your self-care in your mind, continuously. This ensures that you will always have your self-care in mind (either consciously or subconsciously), and it works like magic! The first thing to do is to just get started! Pick out the things on your list from your thinking stage; develop your plan as best as you can; HAVE FAITH that the answers are coming and that you’ll get what you need. Visualize your self-care happening. No procrastinating. Just do it! For the items on your self-care list that you aren’t sure how you are going to fit them in or do them, worry not. The ‘hows’ you can’t figure out on your own just require some intervention from the universe. Keep looking at them and saying them out loud as frequently as you can in the manner described, and you can certainly thank me later! The fact that you are reading these words is positive proof that if you follow the instructions you will eventually manifest your self-care list. This of course assumes that you really have a strong desire to have the things listed, so do you? No matter how ridiculous they may seem, everything you put there can certainly be yours. Remember, if you don’t take care of yourself, you can’t possibly be doing the best you can for your patients and the clients you serve as a veterinary professional. Therefore, take your self-care seriously! Ho w can I tell if I’m actually practicing self-care? If you are bringing the self-care version of yourself to work each day, you will notice the following: • You will be in better spirits because you will be taken care of o This will lead to Improved client experience because you will be a delight to be around, and it will lead to improved co-worker/employee interactions because you will be in better spirits. • Less client/co-worker confrontations - o Your fuse will be longer if you are taken care of o You will have more patience with yourself and others • The well-rested and well-nourished nature of self-care will lead to more energy to perform physical and mental tasks - o This will lead to increased performance and productivity. o This will likely manifest in making less errors and being more focused on tasks at hand. • You will be less likely to burnout - 9

o A part of self-care is having boundaries. Boundaries can help you leave work on time, not take work home with you, and prevent you from being overworked by clients and the day-to-day of the hospital. There you have it. The results that you achieve will be in direct proportion to the tenacity at which you go after your radical self-care! I challenge you to make your own self-care the BIGGEST priority in your life, with the understanding that it will cause you to radiate more positive energy to everything and everyone around you. 10