LOCUM VET NURSE ROLES:

If you would like any more information on any of the roles below, please feel free to call the Nurse team on 01392 314756.

SW London – Locum VN urgently required to start immediately and stay until 8^th Feb.

Lincolnshire (South) – Locum VN required from 13^th February on an on-going basis. 1:5 on-call and 1:4 weekends. ACCOMMODATION AVAILABLE.

Devon – QVN required from January for 6-12 months to cover maternity from 20^th February. 1:6 on-call.

London (North) – Locum VN required from 6^th – 24^th February.

Essex – VN required from January for 6-12 months to cover maternity. Full or Part-time hours considered. You must be confident at sole charge nursing. The client will discuss either full time or part-time hours if you would prefer.

London – Locum RVN required from 26^th March – 29^th June. ACCOMMODATION AVAILABLE.

Berkshire – RVN required on a locum or permanent basis to work Monday-Friday 9.30am-2.30pm.

London – Locum VN required for approximately 2 months from 6^th February.

Gloucestershire – Locum VN required to work for up to 9 months on a part-time basis (25 hours per week).

Cambridgeshire – Locum RVN required to start immediately and work on an on-going basis. 1:3 Saturday’s.

Liverpool – Locum RVN required from 6^th Feb for 2 weeks initially but this is likely to extend to 6 weeks in total. No weekends. No OOH.

Bedfordshire – Locum RVN required to work 1 week from 13^th February.

Maidstone – Locum RVN required to work 2 days per week (Thurs and Fri) from 23^rd February – August.

London (North) – Locum RVN required for 3-6 months from 6^th Feb. Shifts will fall between the hours of 8am-8pm.

Nottinghamshire - Locum VN required (qualified or unqualified with good experience) with immediate effect on an on-going basis. Accommodation available.

London (North) – Locum Veterinary Care Assistant required to work on 15^th, 16^th, 22^nd and 23^rd February.

Woking -Practice in Woking is seeking a full time RVN from 6th March on an Ongoing basis. No OOH or sole charge. Accommodation allowance available.

Hove – Practice in Hove is seeking a full time RVN from 28^th January on an Ongoing basis. No OOH or sole charge but 1 in 2 weekends.

Ashton- Practice in Ashton require a QVN to work on Thurs 26^th and Fri 27^th April.

Taunton- One days cover needed on 19^th March at a small animal practice in Taunton.

Slough- My client in Slough is looking for a qualified nurse from 30^th April- 11^th May. No Sole Charge or OOH. 8 hours per day Mon-Fri.

Manchester- Maternity contract available from end March until Jan 2013 at small animal practice in Manchester.

Bradford- My client in Bradford is looking for a qualified VN from 19^th March- 27^th April. No on call but occasional checks to the hospital late at night maybe required but only very occasionally. Accommodation available.

Gwent- My client in South Wales is looking for a qualified VN to join their team of 4 vets and 4 nurses from the 2^nd of April for 6 months. 4 days per week with 1 in 3 Saturdays.

Harrogate- Maternity contract available at a small animal practice in Harrogate. 4 days a week with occasional weekends. Salary negotiable.

Aberdeen- Nurse needed 2^nd-13^th April including bank holidays. Hours, 8am – 4pm Accommodation available.

Dunfermline – 3 Maternity Contracts available at a small animal practice in Dunfermline. 1 in 5 on call weekends with the following week off. Great rates of pay available.

Charlton – My client in Charlton is looking for a nurse for 6 months from 3^rd Jan 2012. Great rates of pay, No OOH or sole charge.

Glasgow, Edinburgh, Aberdeen- Nurse required for a number of Locum roles in Scotland. Great rates of pay and accommodation offered in most cases.

Derbyshire- My Client in Derbyshire needs a VN to start in February to cover a period of maternity for 9 months. Hours are flexible No OOH or sole charge with 1 in 4 Saturdays.

Glasgow – My Client in Glasgow is seeking a VN to start ASAP for at least 1 month, ideally 2-3 months. Accommodation available on-site. No OOH or sole charge. Hours are full time to include Saturday mornings.

Falkirk – RVN needed from 2^nd April – 13^th April in Falkirk. Weekdays only not including bank holiday Monday. Hours are 9am- 6pm No OOH or sole charge.

Reading- RVN needed for 1 week in Reading from 27^th Feb – 2^nd March. Accommodation allowance available.

Wakefield- My client in Wakefield will require an RVN 6^th – 23^rd July. Hours TBC.

The search goes on...we are looking too find a vet that is chasing his /her dream of owning their own Vet Clinic, or a that Vet Nurse that has been driven by passion to own thier own clinic!!

Triage Pets is UK's First VN clinic - beating the recession and the public scrutiny in the veterinary field, this charming practice has the perfect credentials to be the perfect FULL Veterinary Clinic. This clinic is in beautiful charming village of Mill Hill, and already has built up a reputation of trust, loyality and first class service within its community. The potential of this clinic is the real key to this clinic.

so you might say why have i given this opportunity up, well let me introduce to Kyle - My 17 month old son, he is gorgeous fun, happy and cheeky little baby..he is my world...Its very hard wanting to be in two places at once.

so this opportunity is not to be missed, please do get in touch if you are interested in finding out more!! we have already had a great response!

Hina

Assessing whether a patient requires nutritional supplementation and determining how to provide it are two of the most important tasks of veterinarians in critical care situations. Although veterinary technicians generally do not assess nutritional needs, determine the type of supplementation, or place feeding tubes, knowing how these tasks are accomplished and understanding the role of the technician are very important for monitoring and caring for affected patients.

If enteral feeding is chosen for a patient, the next step is to choose the method of administration. Consider the best choice for the patient, the available materials and equipment, and the anticipated duration of nutritional support. Various feeding tube options are available for veterinary patients.

Nasoesophageal Tube

A nasoesophageal tube may be a good short-term option. Tube sizes range from 5 to 12 French and from 38 to 140 cm in length. The lumens of tubes do not correspond to the French gauge and vary depending on the manufacturer and the material of the tube. Such tubes are relatively easy to place and usually do not require sedation of the patient. These tubes are a good option for patients that are too compromised to undergo an anesthetic procedure or that have head trauma.

Patients with intractable vomiting, regurgitation, or physical or functional abnormalities of the upper GI tract should not be considered for nasoesophageal tube placement. A feeding tube can easily become displaced during vomiting, putting the patient at high risk for aspiration pneumonia.

The tube size and length must be appropriate for the patient. A 5-French tube works well for most cats and small dogs, and an 8- to 10-French tube works well for most medium-size to large dogs. The appropriate length can be determined by measuring the patient from the nasal planum to the caudal margin of the last rib. With an indelible marker, mark the rostral end of the tube at the point of insertion so that you know when the tube has been fully inserted. To help with placement, instill a few drops of topical anesthetic (e.g., 2% lidocaine), into the nostril. Care must be taken with cats because they are especially sensitive to the effects of lidocaine. To administer the anesthetic, tilt the patient’s head back, insert a few drops into the nostril through which the tube will be placed, and let the patient sit for a few minutes to allow the anesthetic to take effect. Lubricate the end of the tube with water-soluble ointment or lidocaine ointment or jelly to facilitate insertion of the tube.

While holding the patient’s head in a forward-facing position, pass the tube in a caudoventral, medial direction into the ventrolateral aspect of the nares. Caution should be used in patients with coagulopathies because an occult bleed could easily occur during placement of the tube. In dogs, when the tube reaches the medial septum at the floor of the nasal cavity, the external nares can be pushed dorsally (“pig nose”) to open the ventral meatus, facilitating passage of the tube into the oropharynx. In cats, the tube can be inserted in a ventromedial direction and passed directly into the oropharynx. Secure the tube with sutures to a tape or butterfly tab where the tube enters the nares, and then suture the tube to the patient. Alternatively, a Chinese finger trap friction suture may be used to secure the tube.³ A lateral radiograph or endoscopy is the only way to ensure that the tube has been properly placed in the caudal esophagus.

Most patients must wear an Elizabethan collar to prevent them from removing the tube. Before each feeding, placement of the tube should be checked by placing a syringe on the end of the tube, aspirating for negative pressure, infusing water through the tube (3 to 5 mL is usually sufficient, depending on the length of the tube), and watching for coughing or gagging, which would indicate displacement of the tube.

A disadvantage of nasoesophageal tubes is that they can only accommodate liquids. Anything other than liquid (e.g., pills) can easily obstruct these tubes. Even administering crushed medications through nasoesophageal tubes is not advised.

Esophagostomy Tube

Esophagostomy tubes are surgically placed and offer more versatility than small-French nasoesophageal tubes because the former allows feeding of gruels in addition to liquids. Additionally, esophagostomy tubes seem to be more comfortable and are, therefore, better tolerated by patients, usually making Elizabethan collars unnecessary.

Placement of a midcervical esophagostomy tube is a surgical procedure requiring general anesthesia. First, the tube is measured and marked with an indelible marker in the same manner as for a nasoesophageal tube. The cervical region from ventral to dorsal midline is clipped and aseptically scrubbed.

Several different techniques are used for placing esophagostomy tubes. In one method, an appropriately sized curved forceps is inserted into the proximal cervical esophagus. The tip of the forceps is turned laterally and pressed outwardly so that it is visible and palpable through the tented skin in the neck region. A small incision is then made through the skin. The feeding tube is grabbed by the forceps, drawn into the pharynx through the incision, and redirected down the esophagus. The tube is capped and sutured in place, and a light bandage is placed around the patient’s neck. Placement can be confirmed with an endoscope or a lateral radiograph. Complications include displacement of the tube due to vomiting or infection at the tube site. Every other day, the tube should be cleaned and rewrapped and the patient checked for signs of infection.

Gastrostomy Tube

A gastrostomy tube may be placed surgically or endoscopically (i.e., percutaneous endoscopic gastrostomy [PEG]). Placement of a gastrostomy tube is a good choice for patients in which placing a tube proximal to the stomach is contraindicated because of megaesophagus, penetrating bite wounds to the neck region, esophageal dysmotility, esophagitis, or vascular ring anomalies. If a patient requires nutritional intervention and abdominal surgery, this surgery is a perfect time to place a feeding tube. If a gastrostomy tube is placed surgically, the patient should not be fed through the tube for the first 24 hours to allow a stoma to form between the stomach and the body wall. This is a good opportunity to check gastric residuals to ensure that the patient has gut motility before feedings begin. In the meantime, the tube may be flushed with water every 6 hours to maintain patency.

A PEG tube can also be placed with the aid of an endoscope while the patient is under general anesthesia. A complete description of the procedure is beyond the scope of this article. PEG kits with tubes ranging from 16 to 28 French are available for small animal patients.

Enterostomy (Jejunostomy) Tube

For some patients, bypassing the stomach may be necessary, such as in cases of pancreatitis. Enterostomy tubes are most often placed surgically but may also be placed through a gastric tube and then directed through the pylorus using endoscopy or fluoroscopy. Feedings must be carefully controlled. Bolus feeding is risky because it can cause pain and cramping if a large volume of food is delivered into the jejunum.

The type of food to feed can be determined by the following:

• The patient’s disease process (e.g., protein or fat tolerance)

• The type of assisted feeding chosen for the patient

• The types of diets available

If a nasoesophageal tube has been placed, a liquid diet is required. Complete and balanced liquid formulations are available for dogs and cats. If you cannot obtain these products, a human product can be used if it is supplemented to be complete and balanced for the appropriate species. An example of the need for appropriate supplementation is that a cat can quickly develop hyperammonemia if fed a human formulation that has not been adequately supplemented with arginine. In addition, human products are very low in protein compared with similar veterinary products.

An esophageal tube allows more options when choosing diets. The larger the gauge of the tube is, the better. Blended diets work well, especially if the patient will be transitioned to the nonblended form of the diet when the feeding tube is removed. Some manufacturers make foods especially for tube feeding, and some of these foods do not require blending or the addition of water.

The energy requirements of critically ill dogs and cats can be determined; however, many clinicians continue to use illness (“stress”) factors to determine energy requirements, and much of the literature regarding this method has been found to be inaccurate. The patient’s RER is usually sufficient to maintain current body weight, except under certain conditions. The best way to ensure that a patient is receiving adequate nutrition is to weigh the patient daily and adjust the feeding plan as needed.

Problems associated with tube feedings can be categorized as mechanical, GI, or metabolic.

Mechanical Complications

Mechanical complications are related to the placement and maintenance of the feeding tube. The position of the tube should be checked immediately after placement using radiography or endoscopy. A good safety measure is to check the placement of nasoesophageal and esophagostomy tubes by aspirating for negative pressure and flushing water through the tubes before each feeding. The amount of flush used should be sufficient to clear the tube (e.g., 3 mL is sufficient to clear a 5-French, 15-inch nasoesophageal tube). When these tubes are used, residuals cannot be checked because there is no reservoir in which food can collect. Regurgitation may result from improper placement of a tube.

Improper administration of medications may also cause mechanical complications. Care must be taken when administering crushed medications through small-gauge tubes, which can easily become clogged. In addition, viscous medications may build up and clog the lumen of tubes; diluting medications with water and flushing tubes well after administration can minimize this risk. The lumen of a tube may be several sizes smaller than the French gauge of the tube. If a liquid form of a medication is available, it is the safest choice.

Gastrointestinal Complications

GI problems can result from feeding too quickly, a cold formula, or  an excessive amount. Maximum gastric capacities of dogs and cats can be as high as 45 to 90 mL/kg; however, assuming a maximum capacity of 20 mL/kg for dogs and cats can ensure that the gut does not become overdistended. When a feeding tube is used, the patient cannot regulate food intake. The 20-mL/kg guideline not only minimizes the chance of GI upset but also encourages the patient to begin eating on its own.  I have often found that the longer a patient remains anorectic, the more difficult it is to encourage the patient to eat on its own. These cases are often complicated by the presence of a learned food aversion brought on by force-feeding.  After assisted feeding begins, the presence of food in the stomach often makes the patient feel better. Sometimes, this is all the patient needs to “jump start” its appetite and encourage it to eat on its own. Most patients will eat on their own with a feeding tube in place.

Alkaline or hyperosmolar medications that are not diluted with water before administration may cause GI upset and vomiting, followed by inappetence. 

Metabolic Complications

Metabolic complications from diets containing highly digestible carbohydrates include rapid absorption of glucose, resulting in hyperglycemia. Other metabolic complications include azotemia, hyperammonemia, lipemia, and hypophosphatemia, as in refeeding syndrome.

Refeeding syndrome is a metabolic disturbance that occurs when patients that have been starved or severely malnourished are reintroduced to food. This syndrome occurs more rapidly in patients receiving parenteral nutrition than in patients receiving enteral nutrition. At presentation of a patient, serum electrolyte levels may be normal. However, when nutrition is reintroduced, there are significant electrolyte shifts from the extracellular compartment to the intracellular compartment. The rapid repletion of nutrients most commonly results in hypokalemia, hypophosphatemia, and hypomagnesemia. Clinical signs include generalized muscle weakness, tetany, myocardial dysfunction, dysrhythmias, seizures, and hemolytic anemia. Death may result from cardiac and respiratory failure. Electrolyte levels should be monitored at least once a day. Patients should not receive feedings in excess of their RER, and food should be introduced very slowly by dividing the RER into multiple meals throughout the day. Start by feeding 25% of the patient’s RER and slowly work up to 100% by day 4. Patients that have been starved or critically ill for ­>4 days are at high risk for refeeding syndrome.

Nutritional support can be an important part of a patient’s treatment plan. However, because nutritional support can have disadvantages (e.g., higher risk of infection, increased cost, prolonged hospitalization), it should be reserved for cases in which patient outcome would otherwise be negatively affected.

Saker KE, Remillard RL. Critical care nutrition and enteral-assisted feeding. In: Thatcher CD, Hand MS, Remillard RL, et al, eds. Small Animal Clinical Nutrition. Topeka, KS: Mark Morris Institute; 2010:439-476.

DEFRA confirms areas selected for badger cull pilots
 

 If you would like any more information on any of the roles below, please feel free to call the Nurse team on 01392 314756.

Lowestoft – Head Nurse required to join this busy Practice.

Hertfordshire – Permanent Qualified VN required for sole charge work. No OOH.

Gloucestershire – Locum VN required working for up to 9 months on a part-time basis (25 hours per week).

Surrey – RVN required on a permanent basis for this 7 Vet, 8 Nurse Practice. 1:8 full weekends and 1:8 Saturday’s.

Hertfordshire – RVN required for this 5 Vet Practice. Minimal on-call.

Hertfordshire – Qualified VN required for this 1 Vet, 1 Nurse Practice.

London – RVN required on a permanent basis. No on-call. 1:2 Saturday’s.

Kent – Permanent VN required in this 3 Vet Practice. 1:5 on-call.

South Devon – RVN required to join this team of 7 Vets and 6 Nurse. 1:7 on-call.

Devon – RVN required joining this team of 3 Vets and 4 Nurses. 1:8 on-call.

Surrey – RVN required. No OOH. 1:3 Saturday’s (8.30am-1pm).

Somerset – Receptionist required to work 28 weeks of the year to cover holidays.

Gloucestershire – VN required on a permanent basis. Experience of handling equine is a must.

Portsmouth -Full Time RVN or 2^nd year trainee needed to start ASAP, salary dependant on experience. Small animal practice no OOH or sole charge.

Berkshire – RVN required on a locum or permanent basis to work Monday-Friday 9.30am-2.30pm.

Durham- RVN needed on a permanent basis. 40 hours per week, 1 in 4 weekends.

Kidderminster- RVN to work up to 40 hours per week (min 27). Shift patterns work as follows: Week 1: Mon to Fri 10-7.  Week 2: 8.30-5.30 Mon, Tues, 9-6 Wed, 9-5 Thurs, Fri off.  Week 3: Mon, Tues & Fri 8.30-5.30, Wed & Thurs 8.30-4.30.  Weekends on 1 in 3 Sat 9-5, Sun 10.30 -3.30.  No OOH or sole charge.

Sheffield- Full time RVN required to start within 2 months. No OOH, Full sole charge. 40 hours per week, Mon – Fri. No weekends.

Middlesbrough-Full Time RVN needed to start ASAP, salary dependant on experience. Small animal practice no OOH or sole charge.

Hove - Full time or Part time Veterinary Nurse needed for brand new surgery in Hove.  Weekends will be on a rota basis.

Slough - Full Time RVN required joining our friendly team in Slough.  1 in 3 weekends, no OOH, no sole charge.

New Maldon - Full time Veterinary Nurse required to join our friendly team of 4 Vets and 4 Nurses in our busy surgery in New Malden.  Weekends on a rota basis, No OOH, No Sole Charge

Swindon- Full time RVN with minimum year’s experience, to work 8.30-7.30 Mon, Wed & Thurs and weekends on 1 in 3.

Chingford - Full time RVN needed for small animal practice in Chingford.  All experiences considered.  Weekends on a 1 in 3 rota basis.  No OOH.

Hove- Head Veterinary Nurse needed for a new surgery based in Hove.  Full time, no OOH.  Previous team management experience desirable.

Taunton- Full time experienced Veterinary Nurse required to join our team of 2 vets and 3 nurses.  The weekday hours are variable with a 1 in 3 weekend rota.  There is no OOH or sole charge.  Medical Nursing experience is essential.  The successful candidate will be required to perform Nurse Clinics and puppy parties. 

Colchester - RVN required for expanding practice, ideally will have some experience.

Salisbury - Full time RVN needed for small animal practice in Salisbury.  A range of experiences will be considered.  Weekends on a 1 in 3 rota.  OOH involved to be discussed at interview. 

Farnham - Full time or Part time Veterinary Nurse needed for brand new surgery in Farnham.  Weekends will be on a rota basis.

Leicester- Full time RVN to work 40 hrs p/w with 2 vets and 2 nurses, weekends on a 1 in 3 rota, no OOH will be involved in nurse and weight clinics.

Worcester- Full time registered nurse to work  Tues- Fri 8am to 7pm & weekends on 1 in 3 rota (Sat 8-5 & Sun 10.30-4).  No OOH.  Joining a team of 2 Vets and 2 Nurses.  Salary approx 18k pa.

Oldham - Full Time qualified RVN.  Any level of experience  considered.  Shifts are 8-4, 8.30-4.30, 9-5, 11.30-7.30 sat 9-6, Sun 11-5 (on 1 in 4 basis).

Colchester - RVN required for expanding practice, ideally will have some experience.

Norwich- Full or part time nurse to work 20/40 hrs per week inc of 1 in 4 weekends.  No OOH.

Harrogate – My client in Harrogate requires a qualified and registered Nurse for a period of maternity from end April for a minimum of 6 months. 4 days per week and occasional weekends.

Medicine nurse- Derby- My client in Derby is seeking a qualified medicine nurse. The successful candidate will assist the Internal Medicine Clinicians with the management of referred cases, including diagnostic and therapeutic procedures and supervision of hospitalised and intensive patients. Applicants should have experience in a referral environment and ideally hold the DipAVN.

Night Nurse- Derby- Night nurse required to work alongside night vets to provide a high level of care for the referral and first opinion in-patients and emergency cases. You will have a strong support from the day staff and will work alongside them on a 1 in 3 rota. (7 days of night week, 7 days off, 5 days of day work) Experience of emergency and night work is essential, experience of intensive care and DipAVN would be an advantage.

Hospital Nurse- Derby- For this role you would be based in a busy prep room, working with the anesthetists and clinicians from the referral service and the first opinion team. You will also spend time in the imaging suite, using ultrasound, digital radiography, fluoroscopy, CT and MRI. Experience of working in a referral environment is essential and DipAVN would be an advantage.

Theatre Nurse- Derby- My client in Derby is looking for a qualified VN Theatre nurse. The applicant will be working with clinicians from the Ophthalmology, Soft tissue and orthopedics referral services as well as their first opinion vets. Experience of working in a referral environment is essential and DipAVN would be an advantage.