Post Procedural Care Training

This handout is also available by contacting the IACUC Coordinator

Post procedural care is NOT limited to post operative care. Although post op care is essential, it is important to realize that enhanced animal care is necessary after any procedure in which an animal is anesthetized, an animal experiences pain or distress or an animal undergoes any procedure which causes more than minimal physiologic disturbance. Consideration of possible complications before the procedure and regular monitoring after the procedure help to minimize unnecessary complications. To help research staff provide appropriate post procedural care and to assist principle investigators complete the related sections of the ASRF, this module will cover the following areas:

Who provides post procedural care?

The specific personnel who will be responsible for post procedural care should be identified in advance of a procedure and listed as performing this function in the ASRF. These individuals should be appropriately trained to identify the "normal" and have an idea of the clinical signs and tests which will be used to identify the abnormal. Back up personnel should be identified to assure animal post procedural care in case the primary individual is away. If necessary, these individuals will need to be available evenings, weekends and/or holidays. Timing of a procedure should take into account availability of post procedural care personnel.

Animal care personnel should be aware of animals that have had procedures requiring special observation and they should know what lab personnel to notify in case of emergency.

How often should care be provided?

Post procedural care can generally be broken down into three basic phases: anesthetic recovery; acute recovery; chronic recovery.

Anesthetic recovery - This period is often the time of greatest physiologic disturbance. Careful attention to cardiovascular function is important. This can be accomplished by monitoring: heart and respiratory rate; observation of mucous membrane color; and capillary refill time. Sophisticated monitoring devices may be appropriate in some cases but are often not necessary. In some cases, anesthetic recovery problems can be minimized by providing supportive care during a procedure. Assuring a patent airway; providing supplemental oxygen, subcutaneous, intraperitoneal or intravenous warm fluids; and paying attention that the animal's position does not compromise cardiopulmonary function are just some ways to provide intra-procedural and post procedural support. Animals should be closely monitored until they are able to hold themselves in a sternal position. If used, endotracheal tubes should not be removed until the animal can swallow. Supplemental heat is critical to avoid hypothermia, however heating pads and lamps must be watched closely to avoid thermal burns. Take care to assure that the animal is not in a position to be injured by cage mates.

Acute recovery - This period encompasses the time from anesthetic recovery to physiologic stability. During this time the animal may be unable or unwilling to eat or drink normally and thus require supplementation. Wound care should also be done. During this period, it is generally necessary to observe an animal at least daily.

Chronic recovery - During this period the animal's condition usually does not change rapidly and thus observation by research staff may only need to occur every other day or every few days. During this time, issues of analgesia, nutritional support and wound care may still be seen. In surgical cases, this period would last at least until suture/wound clip removal at 10-14 days. It is important to note, with some procedures such as tumor implantation or creation of another disease state, the animal's condition may actually worsen with time. In such cases, the frequency of observation may increase with time.

What clinical signs will be observed?

Clinical assessment of animals includes observation of behavioral changes, attitude changes and physiologic changes.

Behavioral/Attitudinal changes may include: immobility; reluctance to move; lack of appetite; abnormal posturing; abnormal vocalization unresponsive; depressed; anxious; apprehensive; hypersensitive; or aggressive

Physiologic changes may include: pupillary dilation; increased heart rate; increased respiratory rate or difficulty breathing; hyperthermia; dehydration; or weight loss.

Observation of hair coat; skin turgidity, body weight, abnormal discharges, and urine and fecal output and quality all can help assess an animal's clinical condition. Abnormalities in any of these areas may signify post procedural complications such as infection or pain. Recommendations for analgesia are available from an ARC veterinarian or in the ACUP Compliance section of this site.

If surgery has been performed, the incision site should be closely observed for signs of infection including: redness; swelling and pain. Post surgical infections cause unnecessary discomfort, delays healing and may lead to the loss of the animal from the project.

If tumors have been implanted or induced, size of tumor, tumor ulceration or tumor impact on normal physiologic function and mobility should be regularly assessed. When working with tumors, it is important to understand the growth rate of the tumor and incidence and type of metastasis. If this is unknown for the strain of animal or type of tumor used, error should be on the side of more frequent observation rather than less. The policy for allowable size of tumors may be found on here.

If ascites are produced, the guidelines for monoclonal antibodies should be followed. These are found on the NIH website (click here).

What records should be kept?

The purpose of procedural and post procedural records is to assure appropriate and timely care of potentially impaired animals. These records should be readily available to the ARC veterinary staff who may be called upon to provide veterinary care in an emergency. These records also must be readily available to any regulatory inspector who wishes to verify appropriate treatment and post procedural care. Records should be maintained if any experimental procedure has been done to animal which is reasonably expected to create significant physiologic disturbance or has the potential to cause pain and/or distress. All the animal rooms in the ARC have a notebook that contains Clinical Incidence Forms (CIF), instructions and colored dots to place on the cage card for efficient identification. For nonrodent species, a Clinical Incidence Form (CIF) should be completed for each animal. Regulations require individual records for nonrodent mammals. The CIF should note the animal cage card number(s), date and procedure as well as any post procedural observations and treatments. The post procedural observations noted on the CIF should be at least as frequent as those indicated on the ASRF. When an animal no longer needs special observation, the CIF should be signed off at the bottom and taken or sent to the applicable ARC office. Rodent users should also maintain post procedural records. Rodent users may find the CIF process a useful tool to assure post procedural care and efficient communication with the ARC staff, or they may chose alternative ways to maintain such records. Since procedures are often done in groups of rodents at the same time, one CIF may be completed for the group.

Determining early euthanasia criteria.

The decision to euthanize an animal is based upon the animal's clinical condition and prognosis along with the experimental endpoint. The criteria which will be used to determine if an animal should be euthanized must be described in the ASRF. In general, early euthanasia is only done at the direction of an ARC vet or a representative of the research lab. If an animal is in an acute emergency situation, the veterinarian or their designee will make every reasonable attempt to contact the lab representative prior to euthanasia. The ultimate welfare of the animal must always be the primary concern.

Completing the Animal Subjects Review Form (ASRF)

Section E of the ASRF is most closely linked with describing the procedures and post procedural care. In this section the following questions should be answered:

E1. What procedures will be done on an animal? If multiple procedures are described, it should be clear how many procedures occur in an individual animal, what the sequence of procedures are and the timeframe of the procedures. It is often helpful to provide a table for complicated studies. It should be clear if procedures are survival (animal regains consciousness) or acute/terminal (animal does not regain consciousness from anesthesia)

Details of procedures should also include number of treatments, volumes, and routes of administration. If drugs (including anesthetics) are used, they should be identified and the dosages given. If animal preparation is necessary (such as shaving and disinfecting the skin prior to immunizations) this should be described.

For surgical procedures, a brief explanation of aseptic techniques and the surgical procedure should be included.

E2. This section should describe all the details of post procedural care including: who will provide this care and observation and how often the care and observations will be done. How animals will be recovered from anesthesia and what supportive care will be provided during this time should be outlined. Potential post procedural complications should be listed along with what will be done if such complications occur. In procedures which can reasonably be expected to have the potential to cause pain (generally procedures which would cause pain in humans), how the animal will be monitored (e.g.: what signs will be observed to determine if the animal is in pain) should be described. Consideration should be given to routine post procedural analgesics for potentially painful procedures as it is reported that preemptive analgesia decreases the dosage and duration of analgesics. The rationale for withholding analgesics in the presence of clinical signs of pain must be scientifically justified in the ASRF. This section should also include what post procedural records will be maintained and who will do this.

Where to go for help

The ARC provides several guidelines and the IACUC has several guidelines on the website. These are listed below and may be accessed by clicking here. The veterinary staff of the ARC are also available to consult on questions of procedural and post procedural care. The email addresses and phone numbers are listed here. The ARC has an extensive library available with references on surgical procedures and animal anesthesia and analgesia. Members of the IACUC are also good resources for assistance in completion of an ASRF.

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