Clinical Standards

Surgery/Dentistry Procedure Shifts

Because anesthetic procedures carry an increased risk and require more detailed protocols, Partner Hospitals must complete an additional profile before an Associate IndeVet can perform surgery or dentistry procedures. 

General information 

1. An Associate IndeVet must perform at least two exam-only shifts prior to accepting a surgery/dentistry shift. This ensures our doctors know your staff, protocols, medications, equipment, and space. 
2. Once this protocol is completed, an Associate IndeVet can select procedure shifts at your hospital.

Process

1. First review the standards below to determine if your hospital can support an Associate IndeVet performing anesthetic procedures (surgery or dentistry procedures). 
2. Then, please complete this form that outlines your hospital’s processes and procedures in more detail surrounding anesthetic procedures.
3. Once our clinical leadership team reviews your completed form, our scheduling manager or a member of our clinical leadership team will alert you to the ability to post surgery/dentistry shifts through our online scheduling system.
4. Completing this process doesn’t guarantee an Associate IndeVet will sign up for procedure shifts at your hospital, but we do make every attempt to match hospitals with Associate IndeVets who want to perform surgery and/or dentistry.  

Standards 

Pre-anesthetic Procedures

All anesthetic patients will have: 

1. A valid VCPR with the Partner Hospital prior to being scheduled for a procedure with an Associate IndeVet. The Associate IndeVet will perform a pre-anesthetic exam the day of surgery and has the right to refuse an anesthetic patient based on the results of that exam (new heart murmur, etc.) 
2. A consent form signed by the owner that explains anesthetic risks, covers a treatment plan for services, has an emergency contact number and ideally a DNR.  
3. Pre-anesthetic bloodwork completed within 12 weeks of the procedure. Bloodwork includes a minimum of a small chemistry screen and a complete blood count. Older animals undergoing procedures will have additional diagnostics based on the individual case. 

Peri-anesthetic Procedures

All animals must have: 

1.  An intravenous catheter placed prior to induction of general anesthesia with the exception of cat neuters.
2. An anesthetic chart completed for each patient’s procedure, including drugs, doses, and monitoring parameters. 
3. Multi-modal anesthesia providing adequate analgesia and sedation.  
4. Pre-medications, induction, and surgical clipping take place outside of the surgical room with the final surgical scrub being completed in the surgery room. 
5. The option for intravenous induction. 

Surgical Anesthetic Procedure Requirements

1. Surgical equipment and machines adhere to safety/regulatory guidelines. 
2. Associate IndeVets will cap, mask, sterilely glove and gown for procedures.  
3. Exceptions include cat neuters (cap, mask, and sterile gloves) and dental procedures (cap, mask/face shield, non-sterile gloves, non-sterile covering to protect clothing). 
4. All animals under general anesthesia will be intubated. 
5. The use of intravenous fluids unless an underlying medical condition prohibits this. 
6. The minimal level of monitoring includes SpO2, EKG, non-invasive blood pressure and temperature recorded every 5 minutes. Heat support is also required if needed and is defined as forced air warmers, warm water blankets, or another veterinary-approved heating device.   
7. Anesthetic monitoring by a dedicated technician trained in emergency procedures. 
8. An Associate IndeVet may refer any procedures they have not been adequately trained to perform and/or do not feel comfortable performing. This referral could be to a specialist or to another veterinarian in the same practice with additional training/expertise. 
9. Surgery will take place in a dedicated surgery room. 

Dental Procedures

1. Dental procedures will not take place in the surgery room.
2. Only licensed veterinarians may extract teeth  (unless a specific state practice act allows licensed technicians to extract specific types of teeth).
3. Associate IndeVets require access to a high-speed drill, dental radiography, and appropriate analgesics to administer local nerve blocks. 

Post-anesthetic Procedures 

1. Patients will have immediate supervision until they are extubated and are then monitored routinely until their temperature is above 99F and they are responsive. 
2. A surgical report will be completed for each procedure performed and the entire anesthetic record added to the patient’s chart. 
3. Patients will be discharged with appropriate bandaging and/or an Elizabethan collar (if appropriate), written discharge instructions, and properly labeled medication vials.