Patient Health Education Seminar

Patient Health Education Seminar

Humongous Insurance Pentobarbital Euthanasia Presented by Wendy Blount, D.V.M. Pentobarbital Barbiturate Suppresses the nervous system (brain) Ideal euthanasia solution must reach the brain quickly Euthanasia solution is carried to the brain by the blood Blood is pumped forward by the heart Ideal euthanasia solution must stop the brain prior to stopping the heart

The brain is the destination of the ideal euthanasia solution SDS Pentobarbital 2 CONFIDENTIAL Venous Access Dogs cephalic vein often used (top of front leg) or lateral saphenous vein (outside of rear leg) Lateral ear vein in the basset hound or rabbit (outside edge of outer surface of ear) Cats

Some like cephalic vein Some like medial saphenous vein (inside of rear leg) Jugular vein (neck) 3 CONFIDENTIAL Cephalic Vein 4 CONFIDENTIAL

Cephalic Vein Assistant grasps the front leg on the opposite side just below the elbow Rolls vein to the side (laterally -- away) Holds animals the head toward the assistant, away from the euth tech 5 CONFIDENTIAL

Lateral Saphenous Vein Dogs Only -Too small in the cat Dog in its side lateral recumbency 6 CONFIDENTIAL Lateral Saphenous Vein Assistant holds vein off just below the knee (stifle), from behind 7

CONFIDENTIAL Lateral Saphenous Vein Assistant holds vein off just below the knee (stifle), from behind The vein rolls stabilize with the thumb Entering the vein higher up on the leg than in the picture results in less rolling

8 CONFIDENTIAL Medial Saphenous Vein Cats Only -Too small in the dog Cat in its side lateral recumbency 9 CONFIDENTIAL Medial Saphenous Vein Assistant Stretches the cat Scruff with one hand

Hold off vein and restrain upper back leg with other hand Euth Tech restrains the lower rear leg 10 CONFIDENTIAL Medial Saphenous Vein Good for fractious cats Work away from the head and front claws Assistant holds vein

off by putting pressure on the inner surface, high up on the thigh 11 CONFIDENTIAL Jugular Vein The largest accessible vein in the body Can use larger needle in inject fast

Difficult to locate in obese animals May be the only visible vein when blood pressure low 12 CONFIDENTIAL Jugular Vein Assistant holds head up with one hand And restrains front legs with the other

hand if necessary Euth Tech holds vein off at the thoracic inlet 13 CONFIDENTIAL Jugular Vein 14 CONFIDENTIAL Jugular Vein

The practical lab video says you must point the needle toward and inject the solution toward the heart You must have the animal on its side to do this That technique is fine, but not necessary Direction of blood flow will carry drug to the heart, no matter which way the needle is pointed when you inject 15 CONFIDENTIAL Other Techniques

IP intraperitonial For very young or very small animals Euth solution takes too long to reach the brain in animals >15-20 pounds Injection technique On the ventral (underside) midline 1-2 inches behind the umbilicus (belly button) Longer time before death (up to 30 minutes) Larger volume of pentobarbital needed (3 cc per 10 pounds body weight) Smoother if sedated first 16 CONFIDENTIAL

Other Techniques IP intraperitonial Inject far enough beck to avoid the liver and spleen Inject far enough forward to avoid the bladder 17 CONFIDENTIAL Other Techniques IC intracardiac

Fastest of all methods Painful only for unconscious animals Technically difficult Confirming unconsciousness Press on cornea of the eye to make sure there is no blink reflex Pinch web between toes with fingernails or hemostat firmly to make sure no withdrawal reflex 18 CONFIDENTIAL

Other Techniques PO per os by mouth Takes at least one hour, not always fatal Can be given in food to a dangerous animal IV injection can be added if needed, after anesthetized Fatal Plus powder in #1 gelatin caps (bitter taste) - 1/8 tsp per 10 lbs body weight Devastating results if ingested by accident NOT LEGAL IN THE STATE OF TEXAS HSUS and AHA consider acceptable AVMA generally unacceptable as sole means of euthanasia, but OK for sedation (Brenna) 19

CONFIDENTIAL Other Techniques I Cant Believe I ate the Whole Thing 20 CONFIDENTIAL Other Techniques IT intrathecal Injection directly into the spinal cord, at the base of the skull

Is often done in small birds and pocket pets, for which IV or IC is nearly impossible NOT LEGAL IN THE STATE OF TEXAS Considered unacceptable by HSUS 21 CONFIDENTIAL Unacceptable Techniques

IH intrahepatic in the liver IR intrarenal in the kidney IS intraspleen in the spleen extremely painful slower than IC similar to IV injection Much faster than IP 22 CONFIDENTIAL Calculations Sodium pentobarbital

98% powder (Fatal Plus II) 39% 1cc per 10 pounds 26% (Sleepaway) 1 cc per 6 pounds 2cc per first 10 pounds, then 1cc per additional 10 lbs Round up to the nearest 10 pounds Add a 0.5cc if near the increment Example 15 lb animal needs 2 cc Example 20 lb animal 2.5cc to be safe

Draw up 2nd syringe and have ready in case 2nd dose needed (butterfly catheters help) 39% solution = 390 mg/ml pentobarbital 98% powder = 1040 mg (1.04g)/teaspoon 23 CONFIDENTIAL Choosing Your Solution Many prefer a colored solution so it can not be confused with other injectable drugs Soccumb and Fatal Plus premixed are blue Beuthanasia, Euthasol, Somnasol are bright

pink Dangerous uncolored solutions Sleepaway is clear Fatal Plus powder is straw colored You will need to work with a veterinarian to use schedule III drugs containing phenytoin (pink) Beuthanasia, Euthasol, Somnasol 24 CONFIDENTIAL Euthanasia Time Table Time to unconsciousness

1-3 minutes when injected IV 5 minutes when injected IP Time to respiratory arrest 1-3 minutes when injected IV 5-7 minutes when injected IP Time to cardiac arrest 3-5 minutes when injected IV Usually 12-15 minutes, but up to 30 minutes when injected IP 25 CONFIDENTIAL

Sharing Pentobarbital It is permissible to borrow or lend pentobarbital when supplies are low Must fill out the proper paperwork Schedule II drugs Receiving shelter completes DEA Form 222 and sends copies 1 and 2 to the providing shelter. The providing shelter completes left side of the form quantity being "sold date of "sale." The green copy (2) is sent to the local DEA office

The same process must be followed when the receiving shelter replaces donated 26 CONFIDENTIAL drug(s). Sharing Pentobarbital Schedule III Drugs (Beuthanasia-D and Euthasol) handled by standard invoice number of bottles "sold"; buyer's and seller's names, addresses, and DEA numbers date of the sale

strength of the drug Trade name of the product size of the bottle (in milliliters). Both parties involved need to keep this record for 5 years (DVM must be involved). 27 CONFIDENTIAL Safeguarding Pentobarbital Euthanasia solution has been used to commit suicide and murder

Be extremely careful to keep this drug locked up, as you would a gun Euth techs and veterinarians know how to kill with this drug All they need is motive and access There is also potential for abuse, or monetary gain by selling on black market Secondary poisoning of pet and wildlife can occur 28 CONFIDENTIAL Safeguarding

Pentobarbital Wendi Davidson DVM Eligible for parole 2019 Rick & Jake 29 CONFIDENTIAL

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