As veterinarians, we often find ourselves facing one of the most challenging aspects of our profession: euthanasia. It's a heart-wrenching decision for pet owners and an emotionally taxing task for us. While we strive for a peaceful and painless process, there are times when things don't go as smoothly as we'd hoped, particularly when it comes to accessing a vein for euthanasia.
In this blog, we'll discuss what to do when you can't hit a vein during the euthanasia process, offering guidance and solutions to ensure a compassionate and dignified farewell for your patients.
Stay Calm and Communicate
First and foremost, it's crucial to remain calm and composed when faced with difficulties in accessing a vein. Your demeanour can greatly influence the pet owner's emotional state and the overall experience. Explain the situation to the pet owner, emphasising that you are committed to ensuring a peaceful end for their beloved companion. Encourage them to spend quality time with their pet during this process.
At Roundwood Pet Hospice we sedate every patient before euthanasia. Sedation can provide analgesia and calms the pet within 5-10 minutes which makes venous access smoother. It also bridges the transition from life to death, which can make the process a little easier for the owner to witness. Consult with the pet owner to ensure they understand the necessity and benefits of this additional step in the process. They can hold their pet and be close to them throughout the process.
Use Local Anesthesia
If sedation is not an option, then don't hesitate to use local anaesthesia in the conscious patient. Administering a small amount of local anaesthesia at the intended injection site can help minimise any discomfort the pet may experience.
Consider Using Alternative Veins
For most patients, we would usually attempt cephalic veins first. However, in many patients, these veins will have been used multiple times for cannula placement or blood draws, scarring from which can make further attempts difficult.
Alternative veins that can be used:
Accessory cephalic: this runs over the carpus medially, and is closer to the surface of the skin, making it easier to find.
Dorsal pedal: also in the foreleg, this also has the advantage of being closer to the skin surface and easier to find.
Saphenous: in the hind leg, this can be useful in larger dogs, but does have the disadvantage of being quite 'wobbly' under the skin.
Medial femoral vein: this vein can be useful, especially in cats.
Tongue: Veins under the tongue are easy to access in a heavily sedated patient, however using this vein has the disadvantage of looking unusual to owners.
Lateral ear vein: This is a very useful vein to use in rabbits.
Opt for Alternate Routes
When conventional methods fail, it's time to consider alternative routes for administering euthanasia drugs in the heavily sedated patient. Intraperitoneal (into the abdominal cavity) injections are a viable option when venous access proves difficult. The intrarenal route is particularly useful in cats. Using this route will result in death after approximately 2-5 minutes.
The intrahepatic route can also be used, this route takes 5-10 minutes. If a patient has an intra-abdominal tumour, this can be used but again death may take 5-10 minutes. The intraperitoneal route can be used in all species, however, the time taken for death to occur can be lengthy- 40 minutes to an hour.
The intracardiac route can be used but should be reserved as a last resort and only when the patient is very heavily sedated.
The needle and syringe should be shielded from view to avoid alarm being caused to the owner due to flash back into the syringe.
When using any of these alternative routes you should ensure that the patient is heavily sedated.
Seek Help or Consult a Specialist
If you've exhausted all your options and still can't access a vein, it's essential to reach out for assistance. Consult with a more experienced colleague or consider involving a veterinary specialist who specialises in euthanasia or emergency care. Their expertise and experience may provide alternative solutions or techniques to ensure a dignified and compassionate passing.
Remember that dealing with complications during euthanasia can be emotionally draining for you and your team. Don't hesitate to seek emotional support or debrief with colleagues who have faced similar challenges. Emotional well-being is essential for providing the best care for your patients and maintaining your own mental health.
Euthanasia is undoubtedly one of the most emotionally challenging aspects of veterinary practice. When faced with difficulties in accessing a vein, it's essential to stay calm, communicate effectively with the pet owner, and explore alternative methods to ensure a peaceful and dignified end for the patient. Remember that you are not alone; seek help and support from colleagues and specialists when necessary. By approaching these situations with empathy and professionalism, you can continue to provide compassionate care, even when things don't go as planned. Ultimately, our shared goal is to make the difficult journey of saying goodbye as gentle as possible for both pets and their loving owners.