When you are the seller of a veterinary practice seeking to lease your real estate to a new buyer, veterinarian and lawyer Charlotte Lacroix, DVM, JD, recommends negotiating a few terms including the lease term and rent price. In a recent dvm360

 interview, Lacroix offered up a few nuggets to help practice owners successfully streamline the selling process. 

"Typically, you might have [the lease term] for 10 years with two 5 year renewals," Lacroix informed dvm360

staff. "The rent of course is clearly, very important and you want it to be fair market value so that if you end up wanting to sell your real estate later, whoever is buying your real estate has a good source of rent on that."

She then advised owners to be mindful of the escalation clause, and if the commercial lease is triple net, to determine who is responsible for expenses involving maintenance, repair, and replacement. 

“And then finally, I think 1 of the last points that can be quite important is that you should have a guarantee or guarantor sign the lease in the sense as a guarantor," suggested Lacroix. "So, that if the primary tenant defaults, you [have] somebody to go to collect your rent."

Watch the full video below for more of Lacroix's insight on legal considerations surrounding selling a veterinary clinic. 

Videos

Charlotte Lacroix, DVM, JD, shared insight on ensuring success when leasing your veterinary practice real estate to a new buyer.

Legal considerations when selling a veterinary practice

Treatment options for veterinary dermatology patients have advanced significantly in the past several years. Paul Bloom, DVM, DACVD, DABVP, summarized the latest treatments available for treating pyoderma, pruritus, and otitis. If you were not already aware, these are important additions to your treatment arsenal.

Bloom separated these new medications into the broad categories of antibiotics and antipruritics. The mainstay of antibiotics for pyoderma has previously been cephalexin, a first-generation cephalosporin. While this arguably remains the first-line treatment for bacterial folliculitis, the newer antibiotics used to treat pyoderma include cefpodoxime (an oral antibiotic) and cefovecin (trade name Convenia, a long duration injectable antibiotic), which are both broad-spectrum third-generation cephalosporins. Bloom discussed the potential concerns with using third-generation cephalosporins as a first-line treatment.

The oral medication cefpodoxime is promoted by the company as a first-line antibiotic for pyoderma; however, the broad-spectrum nature enhances the development of extended spectrum beta lactamase producing gram negative bacteria. These very resistant bacteria are important causes of serious infections in humans. Whether targeted by the treatment or not, and whether pathogenic or not, resistant bacterial organisms can transfer their resistant genes to other organisms in the environment or other species (animal to humans). The advantage of administering cefpodoxime over cephalexin appears to be primarily logistical, as cefpodoxime is administered once daily, versus cephalexin which is administered twice daily. However, Bloom stated, the risks to developing resistant organisms outweigh the logistical benefits 

Similar concerns exist for cefovecin. This parenteral antibiotic has been approved in other countries for treatment of numerous organisms (including 

. Due to similar risks of selecting for resistant bacteria, Bloom cautions that cefovecin should be reserved for patients who cannot be medicated orally. Therapeutic concentrations are maintained for approximately 7-14 days post-injection, with specific therapeutic timing dependent on the specific bacteria and MIC. Although subtherapeutic, tissue levels persist for up to 65 days. There is question as to whether or not this persistent subtherapeutic tissue concentration will select for the resistant bacterial. Specific concerns exist about selecting for extended spectrum beta-lactamases (

) that are multidrug-resistant. Bloom also reminded us that, with any new therapeutic, long-term adverse effects are not yet fully known.

Available antipruritic medications include oclacitinib (Apoquel), modified cyclosporine (Atopica and Cyclavance), and lokivetmab (Cytopoint). These 3 medications have different mechanisms of action.

Oclacitinib is a janus kinase (JAK 1) pathway inhibitor. Janus kinase 1 is an intracellular pathway that is activated when cytokines bind to specific cell membrane receptors. Activation results in production of various cytokines that trigger and perpetuate pruritus. Oclacitinib inhibits activation of the JAK 1 pathway, limiting the amount of pro-inflammatory and pruritogenic cytokines produced. It may also be helpful off-label for other immune-mediated diseases, including vasculitis, ischemic dermatopathy, pemphigus foliaceus, and discoid lupus erythematous. Adverse effects appear to be rare, but may include neutropenia or leukopenia, and may reduce seizure threshold.

Bloom does remind us of one important factor to be aware of when using oclacitinib; it will mask pruritus regardless of etiology. For example, a patient with sarcoptic mange, flea allergy dermatitis, or bacterial or yeast pyoderma, possibly masking the untreated underlying disease. For this reason, identifying the underlying cause of pruritus is an important component of diagnostic and treatment planning.

Although not new, modified cyclosporines remain highly utilized in dermatology. Bloom does caution that it is essential to use the modified cyclosporines, such as Atopica or Cyclavance, to achieve consistent absorption. Bloom recommended using modified cyclosporine in uncomplicated atopic dermatitis, where oclacitinib and lokivetmab have failed. Full therapeutic effect is typically reached within 4-6 weeks of administration. Adverse effects appear to be minimal and consist of gastrointestinal signs, cutaneous papillomatosis, and gingival hyperplasia. Maropitant or ondansetron may help offset vomiting.

Another new medication used in veterinary dermatology is lokivetmab, a canine monoclonal antibody that binds to and neutralizes IL-31. Blooms noted that, although low amounts of IL-31 are beneficial, higher amounts are detrimental and contribute to the pathogenesis of atopic dermatitis. Lokivetmab is administered via subcutaneous injection, once every 30 to 60 days. As it is a specific canine monoclonal antibody, it can only be used in dogs. Bloom recommended using it in cases of pruritus from allergic skin disease, with or without concurrent demodex or bacterial pyoderma or cystitis, or patients with a history of (or current) cancer. Bloom does find that cases that failed to respond to either oclacitinib or lokivetmab, may respond to the other treatment, due to the different mechanisms of action. As such, if a therapeutic trial with one of these medications is not effective, it is worth trying the other.

Bloom’s final update in “new drugs in veterinary dermatology” relates to treatment of otitis. Administering topical ear medications can be tricky for owners, and often treatment is prescribed for 7 to 14 days. Easotic is a new product containing hydrocortisone aceponate, miconazole, and gentamicin. What is particularly unique about this treatment is the delivery system. Easotic is in a pump bottle, with a flexible tip that allows easy application of the medication deep (but safely) into the ear canal. The pump is metered to allow 1cc dispensed with each pump, and treatment duration is only 5 days. Bloom’s experience with this has been positive, due to both compliance and efficacy.

Dermatological conditions are one of the more common diagnoses requiring veterinary care, and several new treatments have become available over the past few years. Bloom’s overview of novel treatments should help all practitioners better understand the options available to care for their patients.

Dr Rebecca A Packer is board certified in neurology by the American College of Veterinary Internal Medicine and is an associate veterinarian at BluePearl Specialty and Emergency Pet Hospital in Lafayette, Colorado.

She is also the founder and owner of the Pre-Veterinary Mentoring Group, LLC, through which she provides mentorship for pre-veterinary students during their path to veterinary school, and is the founder and owner of The Pocket Neurologist, LLC, a vet-to-vet teleconsulting service.

Articles

During his lecture at the Atlantic Coast Veterinary Conference (ACVC), Paul Bloom DVM, DACVD, DABVP, highlighted a few new medications to consider implementing into your treatment plan for patients with pyoderma, pruritus, and otitis. 

Dermatology advancements: An overview of the latest treatment options

It's National Veterinary Technician Week! To celebrate all the hardworking technicians out there who provide the highest quality care to their beloved patients, we are bringing a robust mix of industry news and engaging content.

Here is a quick look at this week's headlines:

A Q&A highlighting what veterinary technicians enjoy most about the profession, their inspiration for pursuing this field, and beyond. 

According to the AVMA, there has been a record number of veterinary school applications this year.

Charlotte Lacroix, DVM, JD, provides tips for success when leasing your veterinary practice real estate to a new buyer.

A veterinarian outlines the latest treatments available for pyoderma, pruritus, and otitis.

The new online toolkit from the Purina Institute offers veterinary professionals with nutritional resources to share with clients. 

Stay tuned on dvm360.com for our most recent coverage of the veterinary industry.

A sneak peek look at this week's headlines.

This week on dvm360: A Q&A spotlighting veterinary technicians, plus more veterinary news

I have highlighted 3 individuals who are leading the charge to make veterinary medicine more diverse, equitable, and inclusive. Recently, I had the honor to sit down with all 3 to ask what drives them and how others can follow in their footsteps.

Their answers were not surprising, but inspiring. All of them believe in the need to make veterinary medicine reflect the society in which we live and in their passion for a better veterinary space. Additionally, and not unexpectedly, all 3 believe in giving back to their communities. Below is a transcript of our conversation:

Juan Sebastian Orjuela, affectionally called Juancho, is a fourth-year veterinary student at 

, University of Guelph in Canada. During his time in vet school, Juancho looked around and did not see many students who looked like him. Many of us would have been discouraged but Juancho decided to do something about it. With the goal of representation in mind, Juancho cofounded the 

 (LVMA) to form a community of Latinx excellence in veterinary medicine. LVMA is open to veterinarians, veterinary professionals, students, pet parents, and allies. Additionally, Juancho is a proud member of the LGBTQ+ community.

Prior to vet school, Juancho attended the University of Wisconsin-Milwaukee. He credits his hard work ethic to having been an immigrant child. When he was just 10 years old, he and his family emigrated to Minneapolis, Minnesota, from Bogotá, Colombia, to follow other family members.

In Bogotá, Juancho’s mother was a textile designer. His father was a lawyer and ran for governor of Bogotá. Following his unsuccessful run for government, the family decided to emigrate to the United States. In Minneapolis, Juancho’s father took a job as a line cook to build a base for his family and his mother was a school cleaner. Juancho’s life is the typical immigrant story of the desire to build a better life for the next generation.

 My parents are my biggest superheroes. If it was not for them, I would not be here. Also, in third grade, I was offered a job to walk puppies. I found my mentorship through squeezing out information from other people and always questioning things and being very curious. That gave me the confidence to pursue this career. I double majored in biology and in conservation and environmental sciences in college. I also started the first preveterinary club in college.

: Coming out was really tough. I had a lot of pressure. My dad was a politician and lots of our life [consisted of putting] out a vision of our family. That caused me lots of difficulties. I thought I would be disowned. I have always been someone who was unapologetically myself; I don’t care what others have to say. I grew up really fast. I came out to my sister first. I came out last to my dad. My mom was super embracing. My mom is my number 1 fan. Following family conflict, today my dad is my second number 1 fan.

I have always had an entrepreneurial mindset. I have always been interested in law…and…I always wanted to be a servant to the people. My struggles, being told that I was not good enough to get into vet school, fueled me when I got into vet school to do something. I got into vet school and did not feel fulfilled. I felt very underrepresented. I saw zero veterinarians on social media who were Latino. I started networking with folks in the community [and] that’s when I met the other cofounder of LVMA. We joined forces. That’s when we created the mission, vision, and logo of LVMA. It was during my second year of vet school.

: How can we get other Latino/Latinx veterinarians and veterinary professionals to support the LVMA mission?

: We want to put [out] a call to action and need support from others to be part of our organization. We want the purpose to be Latinx support. We want to represent more and better. Veterinarians who are Latinx need the support. We need to serve this community which is currently underserved. We want to represent veterinary professionals and veterinary students. Most of what we are doing is to help veterinarians and veterinary students.

: I am interested in emergency medicine. I’ve always been passionate about creating change in the profession. I am a believer in being the change you want to see in the world. I see a gap and I go to fill it. That’s why I costarted the LVMA, that’s what defines me. There is so much in this profession that needs to change. I want to do more things [and]…make things better. I want to create something to make life better…to elevate veterinary medicine and have an impact. I want to help more people.

Prior to finishing our interview, I attempted to recruit Juancho into a veterinary role with my organization. I have no doubt that wherever he lands, he will continue to positively affect veterinary medicine and help patients in need. Any hospital would be lucky to have him.

Mariliz Hernandez, DVM, is the proud owner of 

 in Queens, New York, a successful multidoctor 

-accredited hospital that is focused on high medical standards. Hernandez was born in Puerto Rico and attended the University of Puerto Rico in Arecibo. In 2002, she received her doctor of veterinary medicine degree from the 

College of Veterinary Medicine at Tuskegee University

 in Alabama. Her interests include primary medicine, surgery, and dermatology, as well as communicating with her Spanish-speaking clients.

: What do most people not know about you?

: I have a fraternal twin, a brother, and I have a younger sister. I lived in Puerto Rico for 23 years before I decided to join the veterinary program [in Tuskegee]…This was always a dream of mine. A lot of people thought I wasn’t going to make it, that it was just me desiring a beautiful career. I guess I proved them wrong at the end. It was always something I was very consistent [about]. You know that kids can change; I never did. I was very focused on that goal and it was very difficult at the time because usually in Puerto Rico, as you know, there’s no veterinary program.

: I went there because it was a minority school and the most important thing for me was finances but also the surgical [opportunities]. It had the surgical experience I was looking for because I’m very crafty and I love doing things with my hands. I ended up finding my husband there. [Hernandez is married to another veterinarian]. It was one of my best experiences in the middle of Alabama, in the middle of nowhere, and it was a great school.

: As a native Spanish speaker practicing in Queens, what can you tell me about your Hispanic, Latino, and Latinx clients?

: They’re my heart. They’re communicating in Spanish. When you practice and they know you know Spanish, their eyes open up, their shoulders go back, they relax, they understand.

: What is your management style toward hospital culture and staff retention?

: If they don’t fit in, they have to go. If you’re comfortable here, you stay. …I don’t even give them [doctors] a contract. If it’s meant to be for them to be here, they can be here. If they don't want to be here, I don’t want any disgruntled employees; [they] can go. [This] has been the foundation since I bought the place with my husband.

I would tell my younger self to work hard, be fair. And I would say be very frank and clear. Just don’t leave anything inside, express yourself in a very respectable way and try to…communicate to the client the truth straight in the eyes.

: We work as a team. I will never take full credit for my success. It is the people behind me that are watching my back and are my right hand. They’re the ones who are keeping me in business, and, of course, the trust of the clients. And the reason they trust me is because they’ve seen the good outcome. They know we’ve come from a good side. [They] know we want the same goals that they have to get their pets better. And if I am wrong, I have no problem saying I’m wrong because it is the way that we grow. We’re growing every day, and medicine, as you know, doesn’t stop improving. So imagine, at an emotional level, we’re constantly evolving and in order for you to continue evolving, you have to be open and receptive. I was really tough before, I wouldn’t even care. Not anymore. I let go. It’s much easier that way.

What are you doing with Tuskegee to help that next generation of veterinarians?

: I made a studio just for my [Tuskegee] interns to stay in. They don’t have money to stay anywhere. That’s free. You stay there and make it your own little bedroom and that’s it. And you stay there until you go. Because I was there and I had an amazing veterinarian student from Tuskegee that lent me her house with my cat at that time. You have to remember where you came from and how hard it was.

After such a tough, nearly 2 years, what keeps you going?

: I think the resilience is part of it. It’s a survival skill that comes in our DNA also. No one is going to hand it to you when you get out of your country. You want to be the best of the best to represent your country. And I think that’s in your DNA. So yes, resilience comes in our DNA and there’s no time for failure. You try and if you fail, you pick yourself back up.

: Stop doing things to impress others. Do it for yourself. You’re grown up now. You have to be happy. If that idea of being a veterinarian made you happy, go there. Find the right place, a place that can nurture your passion. I don’t want to impress anybody. I want to impress myself now. I did everything I had to do to make my parents proud. Hopefully my husband [and] my kids see what I’m doing, and I think I’m so comfortable with myself now that I hope I can inspire them too. But I’m doing this for me now.

As we continued our interview, I found myself talking with Hernandez as if she was an old friend. From the outside, it looks like she has it all. She has found a way to have a family and a successful practice and has kept her passion in place. Her humility is understated. Lastly, she reminded me again that she would not be here without the help of her doctors, staff, and hospital manager, Kyle.

 of the American Veterinary Medical Association (

) and the first Latino to hold that position. Born and raised in Puerto Rico, Arce attended Louisiana State University in Baton Rouge for his undergraduate degree and 

Louisiana State University School of Veterinary Medicine

, where he earned his doctorate in veterinary medicine. He further completed a clinical internship at Rowley Memorial Animal Hospital in small animal medicine, surgery, and emergency medicine. His medical interests include dermatology, ophthalmology, soft tissue surgery, and ultrasonography. He is also co-owner, with his wife, of 

 in San Juan, Puerto Rico, and is active in the 

Colegio Médico de Veterinarios de Puerto Rico

From a young age, Arce had a passion for animals and science and knew he wanted to be a veterinarian. He was exposed to animals on his grandfather’s farm and kept fish in aquariums while growing up. Eventually, he combined his passion and love for both and pursued the “perfect career.”

: What led you to get involved in organized veterinary medicine?

: Giving back to the profession. It’s part of why I got involved in organized veterinary medicine. My dad was involved with the American Medical Association and so it was a natural thing to me to get involved in the AVMA. I started at the Student AVMA (SAVMA).

: What is your secret to keeping employees engaged?

: I think it’s about developing that relationship with them, trusting you know them and not micromanaging everything.

: I think you have to take one day at a time and remember why you became a veterinarian. We’re all in this together to make a difference, to make the life of our clients and our patients better. And I would just encourage everyone to fight through these stressors because, at the end, I think this is the best profession on earth. I really think that most of us are here because we really think that this is a great profession. Personally, sports helped me a lot. One of my stress relievers is playing soccer. It could be walking, running, whatever. Also, separating yourself from the practice after you come home. Good nutrition is important too. If you’re going to have an unhealthy life, it’s just going to make things worse.

: How does it feel to be breaking down barriers in veterinary medicine?

 know it feels good. I feel very proud of it. At the same time, some responsibility comes with it. I’m trying to do the best job and lead by example throughout my presidency. I hope my being present in AVMA attracts other minorities. Whether [they are] Hispanic or Black or Asian American, it doesn’t matter. If I did it, anybody else can do it. When I started getting involved with SAVMA and later at the AVMA, I felt welcomed. Sometimes you hear about discrimination and I never felt that within veterinary medicine being Hispanic.

: How do we make veterinary medicine more accessible to underserved minority communities?

We have to get to these areas. We’re not there yet. The underserved communities are something we have to reach out to by getting kids from these communities interested in becoming veterinarians. That’s going to change and we’re going to have veterinarians in the middle of some of these underserved communities for the rest of our lives. We just need to get that interest, tell them that you can be a veterinarian if you’re from South LA [Los Angeles] or from the Bronx.

: I invite everybody from any background, …any type of practice, sexual orientation, or whatever it is, to get involved. Given the opportunity, get involved: whether it’s in your county VMA [veterinary medical association], your state VMA, the AVMA, AAHA [American Animal Hospital Association], or whatever association…, [you] can make a difference.

Arce knows he has a large task ahead of him and he is facing it head-on. His commitment to veterinary medicine and his need to serve is admirable and infectious. When we sat down, he was 45 days into his AVMA presidency. His 

Promoting AVMA diversity and inclusion in membership and leadership

Improving the student debt-to-income disparities in veterinary medicine

Promoting the health and well-being of veterinarians and veterinary students

This operations support manager engages in a Q&A with 3 figures in the veterinary field striving to make the industry more diverse, equitable, and inclusive. 

Shattering the glass ceiling in veterinary medicine

Laura Champagne, CVT, BS (Veterinary Technology), Surgery & Anesthesia Nurse at BluePearl in Waltham, Massachusetts, began her career at 

 in 2016. However, like many others who pursue a career as a veterinary technician, veterinary medicine was a second career. Prior to a career in pet health, Champagne obtained a bachelor’s degree in English, and took steps to attain master’s degree in teaching. She worked for several years, but nothing seemed to fulfill her.

Although Champagne had little exposure to the veterinary field while growing up (other than family veterinary visits), she recognized her love for animals at a young age. She decided to follow her passion and return to school for a career in veterinary medicine in 2012. During school, she interned at various pet hospitals, including BluePearl. After graduating with a Bachelor of Science in Veterinary Technology, she landed her first job at BluePearl as an Advanced Patient Care Associate. She immediately fell in love with the medicine and science aspect of the role, the challenge of pet health, and the diversity and variation of each day’s work, specifically surgery.

“When an adorable dog or sweet cat comes into the clinic and I get to love on them, there is nothing better,” said Champagne. “I have an innate love for animals and a passion for science, so a career in veterinary medicine felt just right. I love fixing pets, specifically through surgery to remove bleeding or cancerous masses, repairing fractured bones/cruciate tears, or opening airways.

Although new to the field, Champagne says the 

 was very encouraging, and this helped her to advance within her role. After passing the Veterinary Technician National Exam, she quickly rose to a veterinary technician level 1, then level 2, then level 3. As a recognized leader within her hospital, Champagne was asked to run the technician internship program, which she did, from 2017 until 2020.

“My management recognized that I enjoyed teaching others and was really enthusiastic about learning, so I was able to take that and apply it to new interns who were in a similar boat that I was when I first started working at BluePearl. The feedback I always received while running the internship program was that we throw them ‘into the deep end’ and allow them to get hands-on with trying skills and working with patients, instead of hugging the walls and watching from the sidelines like many of the other hospitals do,” explained Champagne. 

“I think a lot of the techs and doctors are super encouraging and have patience to allow someone new to try practicing skills enough times to get really good and improve," she continued.

Shortly after Champagne got her footing at BluePearl, she began to look for ways to expose local high school students to veterinary medicine and animal sciences. In 2018, she started to research and visit local technical schools that did not have any animal science programs. The greatest luck she had was with Minuteman High School.

“I feel it’s important for people to be introduced to this career at a younger age, and it is lacking representation in primary education when I approached Minuteman, they were already thinking about starting a similar program, so the partnership was a perfect match," said Champagne. 

"It took 3 years of work with an amazing committee of people that wanted to see this program succeed to launch the program. Half of being a great nurse in veterinary medicine is the hands-on experience, and with a program like this, students can start gaining these kinds of experiences prior to stepping into a hospital,” she continued.

Minuteman High School added Animal Science to its list of career technical education majors for the 2021-22 school year. The Massachusetts Department of Elementary and Secondary Education approved Minuteman’s Animal Science program for Chapter 74 career/vocational-technical education status in June, with the help of BluePearl committee members.

Outside of work, Champagne has been a program coordinator of the Veterinary Medicine program presented by the Boston Leadership Institute each summer since 2018. It is a three-week program that offers students across the U.S. (and internationally prior to the COVID-19 pandemic) immersive courses that cover multifaceted aspects of veterinary medicine, including how to detect pain through physical examinations and how to analyze imaging from x-rays, MRIs, and CT scans.

“I worked with a surgeon in our hospital who coordinated the program for the first 2 years, and this past year, I took over as coordinator,” said Champagne. “I also coordinated a new one-week middle school program the Boston Leadership Institute started, only with a little less depth. I found it really rewarding to be able to engage and work with students that were from across the country, educating them and perhaps inspiring them to carry some enthusiasm and interest back to a specific area of animal medicine.”

Champagne is currently applying to advance to veterinary technician level 4 through BluePearl’s career pathing platform, 

. CareerTrax is the industry’s largest electronic career pathing platform, which supports a first-of-its-kind leveling and compensation structure. Champagne is also applying for her VTS (Veterinary Technician Specialty) certification in Anesthesia & Analgesia, with hopes to attain this by 2022.

Beyond these goals, Champagne wants to continue to foster a relationship between BluePearl and other local clinics, hospitals, farms for the students to participate in co-op possibilities during their senior year. A specific long-term goal is to help develop an on-site clinic, staffed primarily by students, on the Minuteman High School campus which provides general practice care for community pet owners at lower costs.

“Minuteman program is mainly capable of working with small animals, but I hope it can grow into utilizing large animals and potentially exotic, marine, or wildlife animals,” said Champagne. “As for me, personally, I really enjoy being a source of support for new coworkers who are learning the ropes of our hospital and may need help with odds and ends; things that aren’t necessarily ‘tech’ questions."

Champagne summed it up by demonstrating her core values and passion for for the profession. "I believe supporting one another helps us do our best on a daily basis and this uplifts the level of medicine we practice. I am simply passing along the insights and encouragement that was given to me when I first started in the field, because I know I am only as skilled as I am today because of those who taught me.”

Laura Champagne, CVT, BS (Veterinary Technology), BA, is a level III Surgery & Anesthesia Veterinary Technician at BluePearl Specialty and Emergency Pet Hospital in Waltham, MA. She is also the interim secretary for NAVAS (North American Veterinary Anesthesia Society) and sits on the New Programs Development Board for Minuteman Regional Vocational Technical School. She also is an instructor for the Boston Leadership Institute–Veterinary Medicine Track, and member of MVTA, NAVTA.

BluePearl veterinary technician shares her unique journey into the veterinary sector and how it's inspired her mission of implementing animal science education into high schools and technical schools.

More than a career: A level 3 veterinary technician shares her incredible career path journey

Phlebotomy is a skill practiced daily by veterinary technicians. Blood samples are used for numerous diagnostic tests that guide patient care. While it seems some technicians can “hit” every vein they look at, it is a skill that can be developed and mastered by any technician with time and practice. During a session at the recent Atlantic Coast Veterinary Conference, Karen Roach, RVT, VTS (ECC), of Mount Laurel Animal Hospital in New Jersey, discussed phlebotomy tips for technicians.

The ability to obtain blood samples rapidly without altering cells in the sample is essential to maximize diagnostic quality. Syringe, vacutainer, and needle size should be appropriate for the size of the patient. Syringes that are too large can damage cells and vessel walls with excessive vacuum. Roach reminds technicians to fill tubes appropriately, especially lavender top tubes, which contain EDTA, as an inappropriate ratio of EDTA to sample can alter cell morphology.

The timing of sample collection is also important to maximize accurate results. Cell degradation can begin as soon as the sample is collected. Additionally, administration of fluids and medications can alter results, so samples should be drawn from patients prior to administration of fluids and medications when possible. Patients who have eaten recently may have lipemic samples, which can interfere with some test results. Consider recommending a fast prior to scheduled blood draws when scheduling appointments.

When preparing a site for venipuncture, ensure that the skin is free from obvious infection and inflammation. Roach notes that wiping the site with alcohol prior to venipuncture not only removes superficial contamination but also improves visualization by wetting down the fur and causing vasodilation of the vein beneath the surface of the skin. Full sterile preps should be performed if sampling is being done for blood cultures.

Finally, patient fear, stress, excitement, and struggle can alter some values, such as white blood cells (ie, presence of a stress leukogram), cortisol, and blood glucose (especially in cats). Repeated sampling from the same site can also increase leukocytes and platelets in the area, which could confound results. If a technician notes that any of these events are occurring, they should note it on the patient chart and inform the veterinarian in charge of the case to help aid in the most accurate interpretation of results.

There are numerous sites available for venipuncture in canine and feline patients. The most common sites are the cephalic and jugular veins, the lateral saphenous vein in dogs, and medial saphenous vein in cats. For patients who may be hospitalized, the cephalic vein should be avoided for venipuncture as it is the preferred side for placement of an intravenous catheter.

Roach reminds technicians that proper restraint is critical for successful phlebotomy. The handler is responsible for positioning the patient in a way that maximizes visualization of the vein while maintaining patient and staff safety and minimizing patient stress. If a vein cannot be palpated or visualized, Roach does not recommend poking blindly as it is “doomed to failure and causes unnecessary discomfort to the patient.” Following sample collection, pressure should be applied to the site for a minimum of 30 seconds. For patients with known coagulopathies, additional pressure will be needed.

Roach shared several positioning tips with her audience:

For jugular venipuncture, patients can be in sternal or lateral recumbency with the head and neck extended. This vein tends to roll less than other veins.

For neonates, holding the patient with the head down and inserting the needle in a caudal direction for jugular venipuncture will allow blood to pool in the direction of the needle and improve sample yield.

For the lateral saphenous, placing the patient in lateral recumbency is ideal, though some patients will tolerate this from a standing position. The vein will roll easily and will need to be stabilized, usually by the phlebotomist.

The medial saphenous vein can be used in both dogs and cats and requires patients to be placed in lateral recumbency. A butterfly catheter and vacutainer are helpful to use when drawing blood from this site.

Finally, Roach discussed handling considerations for fractious and fearful patients. “We really need to get away from the culture of calling in 5 staff members to lay on a dog to get blood from it,” she said, “By causing undue stress to our patients, we are just making things worse for the next time.” Instead, she recommends using Feliway spray for cats, spending time with canine patients to improve trust, and using minimal restraint and distraction when possible. In cases where a blood draw is planned, premedicating patients with trazodone and/or gabapentin, depending on the species, can be very helpful. In some cases, chemical restraint in the form of injectable sedation will be necessary.

Some patient characteristics or disease conditions can make venipuncture especially challenging, even for the most skilled technicians. Roach shared several tricks to improve outcomes:

Severe dehydration: administration of fluids by intravenous or subcutaneous routes may be necessary prior to sample collection

Hypotension: warm pack the site for 10 to 15 minutes prior to sampling, use 2 tourniquets, and pump the limb.

Peripheral edema: massage of the limb can redistribute fluid temporarily to improve visualization.

Obesity: use a longer needle for jugular venipuncture and don’t be afraid to press hard on the neck over the vein.

In some cases, other sampling sites must be considered when traditional venipuncture sites are not easily visible, scarred, swollen, or bruised. When a small sample size is needed, such as for a blood glucose or lactate reading or creation of a blood smear, the marginal ear vein can be used. Roach also notes the dorsal pedal vein can be helpful in obese patients or patient with peripheral edema, as the foot is usually less swollen and has less fat present.

Considerations for arterial blood sampling

In some cases, arterial blood samples are needed. These samples provide the best assessment of pulmonary function. There are several considerations when sampling arterial blood. First, a syringe containing a heparin anticoagulant should be used. These are available commercially or can be created by coating a syringe with lithium heparin prior to blood draw. Second, pressure should be applied for at least 1 minute following sampling and the site should be monitored for 5 minutes for hematoma formation or continued hemorrhage.

The dorsal metatarsal artery is used most commonly to collect these samples. Patients should be positioned in lateral recumbency. The needle should be inserted at the site where the pulse is best palpated. Alternative sites include the femoral artery and, for anesthetized patients, the sublingual artery.

Phlebotomy is an important skill for veterinary nurses to master. Taking a few moments to plan an approach through site selection, patient positioning, and collecting the appropriate-sized equipment can maximize outcomes. Reducing patient stress should be a priority when obtaining samples from dogs and cats to minimize alteration to the sample and prevent the patient from becoming more reactive for future blood draws. When blood draws become difficult, technicians should not get discouraged, but instead consider alternative approaches and sites to obtain the needed samples.

Dr Kaitlyn Boatright, a 2013 graduate of the University of Pennsylvania, is a practicing veterinarian and freelance speaker and author in western Pennsylvania. She is passionate about mentorship, education, and addressing common sources of stress for veterinary teams and recent graduates. Outside of clinical practice, Dr Boatright is actively involved in organized veterinary medicine at the local, state, and national levels.

Editors note: All veterinary technician content for this month is supported by Banfield Pet Hospital.

Learn how you can improve your skills as a phlebotomist to maximize successful blood draws by understanding what affects sample quality, proper patient positioning, and how to work with difficult veins.