Infusion confusion? Here are some pointers on CRIs in cats
Robin Downing, DVM, DAAPM, DACVSMR, CVPP, CCRP, CVA, MS in Clinical Bioethics, is a founder and past-president of the International Veterinary Academy of Pain Management. She owns Windsor Veterinary Clinic and The Downing Center for Animal Pain Management in Windsor, Colorado.
Help kitties in your clinic todayand minimize your risk for errorwith these tips from Dr. Robin Downing.
Pain management expert and CVC speaker Robin Downing, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP, calls continuous-rate infusion (CRI) “a very effective strategy for providing intra- and postoperative pain control.” Here are her tips on using the technique for cats in your clinic, shared with dvm360 during a recent CVC:
Don't reinvent the wheel. Once Downing's team figures out the appropriate dose of CRI medications from the formulary, they create Excel spreadsheets containing dosing information using standard dilutions, print out those spreadsheets and keep them in a notebook in the treatment area. This way veterinarians and team members don't have to calculate a new set of medications, dosings and flow rates for each patient, and the information is readily accessible.
“By having a standard dilution available for our CRI medications, and having that standard dilution precalculated based on body weight, we minimize our risk for medical error,” Downing says. “Human nature being what it is, if we don't make something easy it won't get done. Precalculating those doses and having them in the treatment area makes using CRI very easy-it's almost an everyday occurrence in our practice.”
Downing's team also keeps a printout in the treatment area with instructions for making standard dilutions quickly. “This isn't really too much different from what we do in dogs, but cats have their own needs,” Downing says.
Choose the right meds. While medication choices will vary depending on the patient, Downing says her team typically reaches for both fentanyl and ketamine CRI at specific doses calculated for the individual cat, in addition to the intravenous fluids used during anesthesia.
Another drug Downing uses for CRI in cats-one that's not a pain medication-is metaclopramide. “I use this in kitties that are having issues in their GI tract, or postoperatively when I see ileus,” she says.
“By doing a CRI versus pulse dosing, I'm able to provide a lower dose at each delivery because it's delivered continuously," Downing says. "And I'm able to produce a much more sustained response and result. Frankly, we love using CRI in cats.”
Watch Dr. Downing describe her use of CRI in the video below.