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AVST APPLICANT INSTRUCTIONS
The Academy of Veterinary Surgical Technicians (AVST) appreciates your interest in becoming a
Veterinary Technician Specialist in Surgery, VTS (Surgery). The AVST’s goal is to assure the veterinary profession and the public that an AVST certified technician possesses the knowledge, skills and experience needed to practice surgical nursing at an advanced level of competency.
The requirements of eligibility for the examination are defined in the AVST constitution and bylaws.
Although the academy requirements are rigorous, they are not designed to be obstacles to prevent candidates from becoming certified; they are intended to assure the public and the profession technicians certified by the AVST have demonstrated a high degree of competence.
All forms demonstrated in this packet MUST be used for the application submission. They are available individually online at www.avst-vts.org.
All forms must be typed or word-processed. Download the blank forms from the website for use in your application. With the exception of signatures, hand written forms will not be accepted. Include only the information requested. Extraneous documents will not be accepted and may result in your application being rejected.
This is a professional application and all efforts should be made by the applicant to ensure it is an example of their highest quality of work.
Form 1- Professional Experience and History Form
You may submit your application after you have completed at minimum 6000 hours (3 years) of work as a credentialed veterinary technician. During that time you must have provided at least
4500 hours (75% of 6000) of your time in surgery as described in the AVST definition of surgery.
For the purpose of this eligibility requirement, the definition of surgery as established by the
Academy of Veterinary Surgical Technicians will be used.
Outline your experience working as a credentialed veterinary technician in the five years prior to the application submission date. Read the AVST definition of surgery and determine the number of hours you have spent providing surgical care. Designate which group of patients (large animal, small animal, or both) constitutes the majority of your experience.
If you have recently earned a veterinary technician specialty (VTS) designation in another discipline it means that for the last three years you have spent at least 75% of your time working in that particular discipline. Since the same criteria are required for pursuing a specialty in surgery (dedicating 75% or more of your time to surgical-related duties) you must first complete a minimum of 6000 exclusively surgicalrelated hours (~ 3 years) before you could apply for this specialty.
License and Diploma
Form 2-
Applicant must be a graduate of an AVMA approved Veterinary Technology Program and/or legally credentialed to practice as a veterinary technician in a state of the United States or province of another country. Applicant must provide proof of a legal credential to practice in a state or province. Include a photocopy of your current credentials (i.e., license, certification, registration.)
If you are a graduate from an AVMA approved Veterinary Technology Program submit a photocopy of your diploma as proof of graduation as well. Canceled checks and other documents will not be accepted as proof. Your original date of credentialing, date of passing the VTNE (or its equivalent) and graduation date (if applicable) must be documented on the history form.
Case Log
Candidates must submit a case log of at least 50 (but not more than 75) cases completed from
January 1, 2014 – December 31, 2014.
The case log will be used to demonstrate your experience as a surgical technician and your mastery of advanced surgical nursing skills. The 50 cases contained in the case log must meet the AVST definition of surgery. Additional case log entries may be submitted to demonstrate mastery of a skill where applicable. Please remember case log entries
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submitted to reference a skill that does not meet the definition of surgery should not be included as part of the 50 required cases. In addition, if only 50 cases are submitted, a single unacceptable case could result in an application being rejected.
If you chose to check the ‘large animal’ box for the following inquiry on
Form 1, the Professional
History and Experience Form
, “
You provide surgical care primarily to: _____small animals,
__X__large animals, _____both small and large animals ”, then your case log and case reports must contain only large animal patients. If you provide surgical care for both large animal and small animal patients then both groups should be reflected in your case log. For the purpose of this exam the AVST will include canine, feline, lagomorphs, avian, reptiles, primates, small exotic pets and small laboratory animals as ‘small animal’ patients . ‘Large animal’ patients will include equine, camelids, and food and fiber animals.
Each case log should include the following: name or ID number, date, species/breed, age, sex, weight, duration of surgical care, attending clinician’s name and credentials, diagnosis, and type of surgery performed. It should also concisely describe the preoperative diagnostics and preparation of patient, instrument, equipment and operating room preparations performed prior to surgery, a brief list of instruments and equipment used intraoperatively, as well as any postoperative diagnostics, external coaptation used, postoperative care performed, etc. Information supplied in the case log is intended to provide a summary of the surgical procedure performed on a variety of species while succinctly demonstrating as many advanced surgical nursing skills as possible (as outlined on the AVST Advanced Surgical Skills Form.) If you use a case to demonstrate mastery of a particular skill you MUST provide detailed verbiage pertaining to the use of that specific skill in the case summary (e.g., list the context in which you used the skill). Each case log should also clearly outline your role in the surgical procedure and demonstrate how your actions helped contribute to a successful outcome. The AVST Executive Board also understands that some surgical technicians may not ever have the opportunity to scrub in; it is acceptable for all of your case log entries to be written from the perspective of a circulating nurse.
Remember that the case log MUST demonstrate a variety of surgical procedures to represent the applicant’s diversity in the operating room (i.e., thoracic and abdominal surgery, neurologic surgery, orthopedic surgery, minimally invasive surgery, oncologic surgery, etc.) as well as the applicant’s use of advanced surgical skills and care throughout all phases of the case. Ensure that elective, common or routine surgical procedures do not comprise > 15% of your case log. Elective, common or routine case examples include onychectomy, ovariohysterectomy or orchidectomy, dental extractions, patellar luxation or cranial cruciate ligament surgery, minor mass removal, ear cropping, cosmetic dehorning, displaced abomasum or teaser bull preparation. Furthermore, submitting > 5 similar surgical cases (i.e., routine, elective cruciate surgery example: submitting more than 5 combined tibial plateau leveling osteotomy, extracapsular cruciate ligament repair, and tibial tuberosity advancement, or submitting more than 5 splenectomies) may result in disqualification of the supplementary case log entries.
The applicant must utilize the list of abbreviations provided by the AVST in all of the case logs and case reports. Download this document and include it as the first page of your case log. If you use an abbreviation that is not listed then you must concisely define the abbreviation the first time you use it in your case log (i.e., laryngeal paralysis [LarPar]). Alternatively, you can include an
‘abbreviations addendum’ page with your application packet. On the abbreviations addendum page you can include all of the new abbreviations with definitions that are contained in your case log entries and case reports. Please put your abbreviations addendum page behind the AVST
Abbreviations page in your application packet.
The case log form should not contain more than 2 case log entries per page. Do not exceed this limit. Be sure the case log is detailed, neat, spell checked and clearly written.
Please be careful to
BLACK OUT/DELETE any personal client data such as owner name, address, phone numbers, etc.
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All cases included in the applicant’s log must be completed at the facility where the applicant is employed or while under the supervision of the employer at a different location . (i.e., your practice takes patients to a separate MRI facility.)
Please review the AVST Case Log SAMPLE on page 10.
Four Case Reports
Select four cases from your case log that best demonstrate your diversity and expertise in surgery to submit as case reports. These four case reports should be carefully chosen and will allow you the opportunity to elaborate on your mastery of as many of the AVST Advanced Surgical Skills as possible. All information from the case log should be included in the report. You must also document the case log number as a reference to confirm the case is entered as part of your case log.
In addition to the information from the case log, you MUST demonstrate your knowledge, skills and abilities in advanced surgical nursing techniques on a variety of surgical patient species undergoing assorted (e.g., soft tissue, orthopedic, oncologic, minimally invasive, thoracotomy, ophthalmic, neurologic) and challenging (e.g., non-routine or non-elective) surgical procedures.
The case report should describe, in detail, how the patient was evaluated and managed during all phases of the surgical care. It is imperative that the information contained in your case report is clearly understood. Present each case in a logical manner. Be sure to check your spelling and define any abbreviations (i.e., portosystemic shunt – PSS.) It is important to show how you participated in the evaluation and management of the patient and were not just an observer.
Consider some of the following ways of demonstrating your knowledge and experience:
1. Show how your veterinary team assessed the patient and developed a surgical plan.
2. Discuss the relevant pathophysiology of the patient and include the reason for the
surgical procedure.
3.
Detail the patient’s history, including laboratory data, current medication(s), any prior
4. procedure(s), and describe diagnostic imaging techniques used.
Discuss proposed outcome of surgery being performed. Why was this procedure
chosen over another? (i.e., limb salvage over a limb amputation) Identify potential complications.
5.
Explain preoperative patient preparation details for each procedure such as anatomic landmarks for the surgical clip margins, agents and aseptic technique used, rationalization for antimicrobial agent choice, and intraoperative patient position or positioning devices.
6.
Detail the preoperative preparations and intraoperative setup for the procedure.
7.
Explain the surgical approach, pertinent anatomy and physiology, and a complete synopsis of the full intraoperative procedure. Discuss any particular intraoperative challenges, unique supplies, instrumentation, equipment and suture material requirements as well as
8. their purpose during the procedure.
Discuss the immediate and extended postoperative nursing plan, including rehabilitation, bandaging techniques, and wound care.
Discuss detailed client education and provide a follow-up report summarizing the 9.
final laboratory test results and prognosis or final outcome.
10.
Provide a list of the surgical instruments, equipment and supplies used as well as
information on their proper care; also detail the sterilization techniques and methods
employed to ensure sterility. List wrapping materials used and other pertinent data.
11.
Include a list of references.
Each case report will contain a maximum of 7 pages and may contain a maximum of five 8.5 x 11 inch pages of case report content, a 1 page listing of all surgical instruments and equipment used,
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and 1 page stating references used, following the format provided. Each case report must be printed in a 10-point Times New Roman font, double-spaced, left and right justified, and with 0.5-inch page margins. Case reports that do not meet these requirements will be rejected.
The case reports must be the original work of the applicant. Please be careful to BLACK OUT/DELETE any personal client data such as owner name, address, phone numbers, etc.
Please review detailed AVST Case Report content instructions beginning on page 12. An AVST
Case Report SAMPLE begins on page 14.
Form 3 - AVST Advanced Surgical Skills Form
The AVST requires a licensed veterinarian or a VTS who has mastered the skill attest to your ability to perform the task. Your testifier must sign at the bottom of the form to validate their initials throughout the form. Mastery is defined as being able to perform the task safely, with a high degree of success, and without being coached or prompted. Mastery requires having performed the task in a wide variety of patients and situations.
The applicant must demonstrate mastery of 90% of the skills on this form (equivalent to mastering 104 of the 116 listed skills). The skills you have mastered must be demonstrated in your case logs and case reports.
The AVST understands that some of the skills on the Advanced Surgical Skills Form may be difficult to demonstrate in a typical surgical case log summary. Once you have documented at least
50 valid surgical cases in your case log you may utilize any remaining case log entries for the sole purpose of documenting these skills (i.e., “Dr. Roberts verified my ability to use an ultrasonic cleaner to process surgical instruments”, “Dr. Smith verified that I correctly identified orthopedic plating instrumentation and properly operated nitrogen powered equipment.” “Dr. Jones witnessed me safely and properly handling gluteraldahyde during cold sterilization of the arthroscope.” “Drs.
Daniels and Murphy verified my OR conduct and ability to properly maintain asepsis.”) Please do not exceed 75 case log entries.
If a skill was mastered at a prior place of employment listed in your employment history, it must be validated by the veterinarian associated with the prior employment in the form of a signature on the advanced surgical skills list form or by a letter stating such.
Form 4 - Waiver, Release and Indemnity Agreement
This form must be signed and included in your application submission.
Form 5 - Continuing Education Record
Applicant must submit a minimum of forty qualifying hours of advanced continuing education (CE) pertaining to surgical procedures or associated topics that can be directly correlated to any of the AVST
Advanced Surgical Skills.
However, no more than five (5) hours of anesthesia-related or analgesiarelated CE will be accepted.
More than 40 hours of CE may be submitted in order to compensate for any hours deemed unqualified and subsequently rejected. Continuing education programs MUST be presented by a VTS member (in any of the specialty academies) or a veterinary diplomate of an American or
European college from any of the following approved disciplines: American College of Veterinary
Surgeons** (DACVS), American College of Veterinary Internal Medicine (ACVIM to include small and large animal internal medicine, cardiology, oncology and neurology), American College of Veterinary
Ophthalmologists (DACVO), American College of Veterinary Anesthesia and Analgesia (DACVAA),
American College of Veterinary Emergency and Critical Care (DACVECC), American College of
Veterinary Pathologists (ACVP), American College of Veterinary Radiology (ACVR), American College of Veterinary Clinical Pharmacology (ACVCP), American College of Veterinary Sports Medicine and
Rehabilitation (ACVSMR), American Veterinary Dental College (AVDC), American College of
Veterinary Dermatology (ACVD), Certified Canine Rehabilitation Therapist (CCRT), and the European
College of Veterinary Surgeons (ECVS). You MUST list the CE provider’s diplomate/credential status
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(DACVS, DACVAA, DACVIM, DECVS, VTS, etc.) on the CE form.
Failure to include the speaker’s credentials will result in those hours being rejected.
**Up to and including the calendar year 2014, the AVST will also accept continuing education hours submitted from the American College of Veterinary Surgeon’s Annual
Symposium, regardless of the speaker’s credentials, AS LONG AS THE CE TOPIC IS NOT
ANESTHESIA- or ANALGESIA – RELATED AND CAN BE DIRECTLY CORRELATED
TO ONE OF THE AVST ADVANCED SURGICAL SKILLS, as outlined on the AVST
Advanced Surgical Skills List.
Only the continuing education activities outlined below will be applicable for this academy.
Furthermore, submitting continuing education activities analogous to self-study (e.g., reading journal articles and passing an associated quiz) will not be accepted.
You must use the Continuing Education Record to submit only the continuing education attended by the applicant from January 1, 2010 to the date you submit your application (previous 5 years.)
A photocopy of a CE Certificate provided by the organization or speaker must be provided as proof of attendance and should follow each CE sheet. Cancelled checks or other documents will not be accepted as proof of attendance.
Use the AVST’s definition of continuing education to determine whether or not your CE meets the requirements regarding content. If the title of the CE does not provide enough information to show the CE was related to surgery, you may submit photocopies of the course description provided by the organization providing the CE. Each meeting attended should be listed on a separate copy of this form. For a particular meeting, each lecture attended should be listed on the form. In evaluating the CE resources, the AVST Credential’s Committee is looking for diversity in the percentage of CE obtained from in-house, online, and meeting/conference attendance, therefore no more than 50% (20 hours) of in-house and online combined CE will be accepted. If more than 20 hours total of in-house and online CE are submitted, they will not contribute towards the total hours needed. This means that it is MANDATORY that at least 20 hours of CE must come from national, state or local meetings. Furthermore, ensure that the people providing the CE are
AVST approved speakers.
Continuing Education Definitions
Nationally recognized meeting :
A gathering of people for the purpose of providing continuing education in the field of veterinary medicine. National meetings are announced in journals typically read by professionals in the field of veterinary medicine. There is an expectation that continuing education at a nationally recognized meeting will be provided by lecturers or instructors who are considered experts in the subject they are discussing. You will need an official CE certificate. Please be aware : the people providing instruction may not meet the AVST requirements for acceptable CE.
Local meeting:
A gathering of people for the purpose of providing continuing education in the field of veterinary medicine. Local meetings are announced by state/city organizations. There is an expectation that continuing education at a local meeting will be provided by lecturers or instructors who are considered experts in the subject they are discussing. You will need an official CE certificate. Please be aware : the people providing instruction may not meet the
AVST requirements for acceptable CE.
In-house training:
Continuing education provided for people who work at a particular practice or institution. This type of continuing education is not open to the veterinary profession at large and lecturers or
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instructors often work at the practice or institution. You must be currently employed at the facility providing the in-house training. You may hire an outside speaker to come talk to your practice as part of in-house training. Please be aware : the people providing instruction may not meet the AVST requirements for acceptable CE. If part of your CE is in-house (meetings accessible only to technicians inside your facility) you will need an official CE certificate or a signed letter from the person supervising your attendance. The CE certificate or letter should detail where and when the training took place, the name and diplomate status of the CE provider, the objectives and goals, a statement of your satisfactory performance and the total hours provided. (1 hour of lecture = 1 hour of CE)
Online training:
Requires an official CE certificate or a signed letter from the person supervising your attendance in the program. The CE certificate or letter should detail when the training took place, the name and diplomate status of the CE provider, the objectives and goals of the training program, a statement of your satisfactory performance and the total hours provided.
Please be aware : the people providing instruction may not meet the AVST requirements for acceptable CE.
Letter of Intent
Please provide a brief letter that describes who you are and why you are interested in becoming an AVST member. Please tell us what you feel you can contribute to the AVST and what you plan to do with the certification once you have achieved it. Letters should be a maximum of ONE page in length, singlespaced, using 12-point font Times New Roman, and 1-inch margins.
Letters of Recommendation
You must include two signed letters of recommendation with each copy of the application submitted. One of the letters must be from an ACVS/ECVS diplomate or a VTS member (any academy). The second letter must be from your supervising veterinarian. The letters should include details on training, ethical behavior and quality of skills. The letters may be sealed at the wish of the writer.
Final Instructions
The AVST designed the application forms so you can complete most of the forms using your computer. You will need to complete the forms and print them out. With exception to signatures, all forms must be word-processed. Hand written forms will not be accepted. Remember, this is a professional application; spelling/grammar and overall presentation will be considered when the application is reviewed. The AVST reserves the right to contact the applicant and ask for additional documentation to verify information contained in the application.
You must submit FIVE (5) copies of your application packet; each copy must be professionally bound or secured in a binder. Loose forms will not be accepted or reviewed.
You may submit the $35.00
application fee using the PayPal page or you may enclose a check for
$35.00 made out to: AVST Treasurer. Mail the completed applications to:
ACADEMY OF VETERINARY SURGICAL TECHNICIANS
6516 MONONA DR. # 246
MADISON, WISCONSIN 53716
Applications must be postmarked on or before February 1, 2015 .
Applications postmarked after this date will not be accepted. All submissions are final. Nothing may be added to an application after it has been received.
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Included at the end of this application packet is a checklist to help assure you complete all the necessary steps to submit your application. If your application is incomplete or late, it will be rejected.
You will receive notification of your eligibility to participate in the certification exam in
April 2015. You may take the examination a total of 3 times in 3 years with the acceptance of the application.
Appeals
If your application is rejected, you may appeal the decision within 30 days of the notification of rejection. Your appeal must be made in writing to the AVST Secretary and submitted to AVST,
6516 Monona Dr. #246, Madison, Wisconsin 53716. All appeal decisions will be based on the original submitted application . You may not submit additional data to augment the original application, therefore ensure the original application is complete and accurately reflects your qualifications.
Academy of Veterinary Surgical Technicians (AVST)
Definition of Surgery
A.
Veterinary Surgery includes the advanced knowledge of surgical procedures and instrumentation (including instrument identification and care), proper sterilization techniques, principles of infection control, aseptic techniques, perioperative patient care, physical rehabilitation and a thorough knowledge of the anatomy and pathophysiology of animals.
B.
Surgery is defined as the branch of medicine that deals with the diagnosis and treatment of injury, deformity and disease by manual and instrumental means. A procedure is considered surgical when it involves cutting of tissues or closure of a previously sustained wound. A surgical procedure may include elective, emergency, reconstructive, transplantation, replantation, cosmetic or minimally invasive procedures such as endoscopy, laparoscopy, thoracoscopy and laser surgery.
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Full Name: _____________________________________________________________________
Address: ______________________________________________________________________
Phone: _______________________________ Email: _____________________________
Present Occupation/Title: _________________________________________________________
Are you a graduate of an AVMA accredited veterinary technology program? Y-N Graduation Date: _______
Are you currently licensed/registered/possess a credential to legally practice in your state or province? Y-N
Pass date of VTNE (or equivalent): ______________________
Are you a NAVTA member? Y-N If Yes, please provide NAVTA member ID number:_________
Have you previously earned a VTS designation in any other discipline? Y-N
If Yes, please list discipline and date VTS designation achieved: ______________________________________
You provide surgical care primarily to: _____small animals, _____large animals, _____both small and large animals
Name of Practice/Institution: Start Date: End Date:
Type of Practice: Average number of hours worked per week:
Percent of time devoted to surgery:
Total surgery hours:
Name of Practice/Institution:
Type of Practice:
Name of Practice/Institution:
Type of Practice:
Name of Practice/Institution:
Type of Practice:
Start Date: End Date:
Average number of hours worked per week:
Percent of time devoted to surgery:
Total surgery hours:
Start Date: End Date:
Average number of hours worked per week:
Percent of time devoted to surgery:
Total surgery hours:
Start Date: End Date:
Average number of hours worked per week:
Percent of time devoted to surgery:
Total surgery hours:
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Total surgery hours: ________

Academy of Veterinary Surgical Technicians Case Log
Form 2
Case log #: 1 Name/ID#: Benny 21-18-66
SAMPLE
Species/Breed: Canine/Yorkshire terrier Sex: MI Age: 7 months Weight: 1.2kg
Date: 5/5/2014 Technician role: Scrub nurse X Circulating nurse
Duration of care: 4 days Attending Clinician :_Dan McGood, DVM, DACVS__________________________
Surgery performed and reason: PSS, cystotomy, OE. Presented for hypoglycemia, seizure activity, and elevated serum bile acids.
Preoperative work up: PE WNL. Serum bile acid results were pre-prandial: 213.9umol/L (0.0-12.0umol/L), post-prandial: 183.94umol/L (0.0-
25.0umol/L) performed by the referring veterinarian on March 24, 2014. Samples for a CBC, serum chemistries, electrolytes, and protein C were collected. Urine for UA was obtained via cystocentesis. The hematological and biochemical abnormalities were consistent with a PSS. Nuclear scintigraphy was performed and confirmed the presence of a liver shunt.
Surgical care summary: A ventral mid-line incision was made and a gastro-caval extrahepatic shunt was identified. The packaging of a 5.0 ameroid constrictor (sterilized 3/14 while double-wrapped in 2 Tyvek pouches using 58% hydrogen peroxide gas plasma along with a STERRAD chemical indicator located in the inner-most pouch) was inspected for sterility assurance before being aseptically issued to the surgeon. The ameroid constrictor was then placed around the shunt and a stainless steel key was placed in the ameroid constrictor. A liver biopsy was obtained using the guillotine technique and a cystotomy was also performed to remove any remaining uroliths found upon preparation for surgery. Routine closed castration performed.
Post operative care provided: ICU monitoring for portal hypertension, seizures, hypothermia, and hypoglycemia. Meloxicam was prescribed for
4 days and owners were instructed to continue lactulose and Hill’s l/d diet until recheck bloodwork is performed in 3 months.
Specialized instrumentation and/or equipment used: Baby Balfour, bi-polar electrocautery, Mixter right angle forceps, 5.0 ameroid constrictor.
Miscellaneous surgical supplies: General surgery pack, suction.
Aseptic techniques used: Prior to entering the OR the entire ventral abdomen was clipped from mid-thorax to pubis, including the scrotum and all hair from the preputial skin, extending 4 cm laterally from midline. The prepuce was flushed 3 times with 0.05% chlorhexidine solution and a preliminary scrub using 2% chlorhexidine scrub was performed ensuring a 2-minute contact time. Once in the OR a sterile target pattern of
0.05% chlorhexidine solution, repeated 3 times, completed the patient scrub. Dr. McGood verified the correct application of the aseptic scrub for this celiotomy. The surgeon performed an aseptic scrub using Avagard®, a waterless antiseptic, prior to gowning and closed gloving. The resident and student used a timed 5-minute scrub with a 4% chlorhexidine scrub and disposable scrub brush.
Sterilization techniques used: EO gas X steam X plasma cold
Case log #: 2 Name/ID#: Cosmo Smith Species/Breed: Feline/Cornish Rex Sex: MN Age: 5 months Weight: 2.6 kg
Date: 5/13/2014 Technician role: X Scrub nurse Circulating nurse
Duration of care: 36 hours Attending Clinician :_Samuel Swellguy , DVM, ___________________________
Surgery performed and reason: FHO. Presented with a NWB lameness, pain and crepitus on palpation of the left pelvic limb, and a history of falling off a small balcony. Radiographs revealed a capital physeal fracture.
Preoperative work up: A complete PE was performed and revealed an elevated heart rate at 224bpm and an increase in respirations at 60bpm. A
CBC and serum chemistry evaluation was completed and WNL. Two orthogonal pelvic radiographs were taken and revealed a capital physeal fracture on the left side. Parental analgesia was provided and surgery was scheduled for the following morning.
Surgical care summary: Patient was induced and placed in right lateral recumbency. Surgical site was prepared by clipping fur circumferentially from the level of the tarsus and extended proximally to include the cranial extent of the ilium, caudally to tail head, ventrally to midline, and dorsally to 2 in. past midline (to incorporate site shaved from epidural.) The patient was then moved into the OR, placed in right lateral recumbency, and a craniolateral approach was made to completely incise the broad ligament and fully luxate the hip. A pneumatic oscillating saw was used to perform the ostectomy at the junction of the femoral neck and femoral metaphysis. The femoral head was removed and the cut surface was palpated for irregularities. Irregularities were removed using a Hakansson rongeur.
Post operative care provided: Overnight ICU monitoring. Analgesia included a CRI of hydromorphone and meloxicam. Post op rehab consisted of 36 hours cryotherapy followed by 2-3 weeks of PROM. Full recovery and satisfactory ROM was documented 8/15/14.
Specialized instrumentation and/or equipment used: Pneumatic oscillating saw, 4mm osteotome and mallet, Gelpi retractor, Hakansson rongeurs and a point-to-point reduction forceps.
Miscellaneous surgical supplies: General surgery pack, Senn retractors, electrocautery and suction (latter 2 items were sterilized with EO).
Aseptic techniques used: The patient area was thoroughly vacuumed prior to an antiseptic scrub. The foot was covered with an exam glove and vet wrap. White tape was used to suspend the limb and care taken not to allow previously clipped hair to adhere to the bandage material. The suspended limb was wiped with alcohol prior to entering the OR. A final prep was applied starting at the incision site, using a Duraprep
®
, 3M (0.7
% iodine and 74% isopropyl alcohol) sponge and allowed to dry for 3 minutes. Sterile team members performed an aseptic scrub using Betadine prior to gowning and closed gloving. The limb was covered by the surgeon with sterile wrap and then with an iodine-impregnated adhesive drape.
Sterilization techniques used: X EO gas X steam plasma cold
**Include a copy of the abbreviation list in this packet
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AD - right ear
ADCA - adenocarcinoma
ALD - angular limb deformity
AS - left ear
MLP/MPL - medial patellar luxation
MN - male neutered
MRIT - modified retinacular imbrication technique
NaCl – 0.9% sodium chloride
AU - both ears
B/C - bandage change
BAR - bright, alert, responsive
BAS – brachycephalic airway syndrome
BCS - body condition score
BG - blood glucose
BID - two times a day (q 12 hours)
BPM - breaths per minute or beats per minute
BUN - blood urea nitrogen
Bx - biopsy
CBC - complete blood count
CCL/CrCl - cranial cruciate ligament
CDET - common digital extensor tendon cm/mm - centimeter / millimeter
CRI - constant rate infusion
CRT - capillary refill time
CSF - cerebrospinal fluid
CVP - central venous pressure
DDFT - deep digital flexor tendon
DJD - degenerative joint disease
DLH - Domestic longhair
DSH - Domestic shorthair
ECG - electrocardiogram (graph)
EMG - electromyelogram (graph)
EO/EtO - ethylene oxide
ESF - external skeletal fixator
FCP/FMCP – fragmented (medial) coronoid process
FHNE - femoral head and neck excision
FHO - femoral head ostectomy
FI - female intact
FLUTD – feline lower urinary tract disease
FNA - fine needle aspirate
FS - female spayed
FSA - fibrosarcoma
Fx – fracture
GSP - general surgery pack
HCT - hematocrit
HSA - hemangiosarcoma
IC - intracardiac
ICU - Intensive care unit
IM - intramuscular (or intramedullary)
IP - intraperitoneal
IPPV - intermittent positive pressure ventilation
IV - intravenous
LarPar – laryngeal paralysis
LBO - lateral bulla osteotomy
LDA - left displaced abomasum
LFS - lateral fabellar suture
LLP/LPL - lateral patellar luxation
LRS - lactated ringers solution
MCT - mast cell tumor
MI - male intact ml/cc - milliliter/cubic centimeter
PUT ABBREVIATIONS ADDENDUM PAGE NEXT→
NormR - Normosol
NPO - nothing by mouth/nil per os
NSAID - non-steroidal anti-inflammatory
NWB - non-weight bearing
OA - osteoarthritis
OCD - osteochondritis dissecans
OD - right eye
OE - orchidectomy
OHE - ovariohysterectomy
ORIF – open reduction and internal fixation for fracture repair
OS - left eye
OSA - osteosarcoma
OU - both eyes
P - pulse
PCV/TS – packed cell volume / total solids
PDA - patent ductus arteriosus
PLA - PlasmaLyte
PO - by mouth
PPDH – pericardial peritoneal diaphragmatic hernia
PPV - positive pressure ventilation
PRN - as needed
PROM - passive range of motion
PSS - portosystemic shunt
PU - perineal urethrostomy
QAR - quiet, alert, responsive
QID - four times a day (q 6 hours)
R - respirations
RADS - radiographs
RDA - right displaced abomasum
R-IV - remove IV
ROM - range of motion
S/R - suture removal
SC - subcuticular
SID - once daily
SQ - subcutaneous
STS - soft tissue sarcoma
Sx - surgery
T - temperature
TECA - total ear canal ablation
TER – total elbow replacement
TGH - to go home
THA/THR - total hip arthroplasty/ total hip replacement
TID - three times a day (q 8 hours)
TPLO - tibial plateau leveling osteotomy
TPO - triple pelvic osteotomy
TTA - tibial tuberosity advancement
UA - urinalysis
UAL – unilateral arytenoid lateralization
UTI – urinary tract infection
VBO - ventral bulla osteotomy
WB - weight bearing
WNL - within normal limits
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Academy of Veterinary Surgical Technicians (AVST) Case Report Layout
1.
Case Log Number
2.
Name/ID number
3.
Signalment
Species/Breed (Ensure a variety of species are represented amongst all case report submissions.)
Sex
Age
Weight
4.
Presenting Problem
5.
Differential Diagnosis
6.
Attending Clinician
7.
Pertinent Patient History and Physical Exam
Physical examination findings
Pertinent laboratory test results
Current patient history and pertinent previous history; outline pre-existing/related health problems or procedural complicating factors
Current medications
8.
Tentative Diagnosis
9.
Diagnostic Imaging Options
Explain any additional procedures or diagnostics used before, during, or after the procedure.
10.
Surgical Treatment Options
Include the type of surgical procedure performed and explain why it was chosen over an
alternative procedure (i.e., ameroid constrictor versus cellophane banding for a portosystemic
shunt.) Include an explanation about the pertinent anatomy and physiology as it relates to the
overall surgical plan.
Detail any anticipated complications as well as problems you anticipate from the operative procedure itself.
11.
Patient and Equipment Preparation
Pre-surgical care summary
Thoroughly explain preoperative preparation details for each patient’s surgical procedure such as anatomic landmarks for the surgical clip margins and other special preoperative considerations (i.e., prepucial flush prior to laparotomy, aseptic prep application precautions around open or draining wounds.)
Provide rationalization for antibiotic or antimicrobial agent choices.
Outline your plan for pain management during the procedure and provide a brief synopsis of any analgesic techniques used.
Explain your role in the preoperative preparations for the surgical procedure. Detail how you anticipated the surgeon’s needs regarding unique or specialized instrumentation or equipment requirements and advanced preparation of the surgical suite.
Intraoperative preparations
Discuss aseptic prep agents used and reason for agent selected. Include the application technique or patterns used for both the initial and final aseptic prep applications, recommended contact times, and list any complicating factors encountered.
Explain intraoperative patient position or positioning devices and aseptic technique used for the patient.
Describe the aseptic technique or gowning and gloving methods utilized by all operating room personnel.
Discuss techniques used to ensure that the proper sterilization of instruments and specialized equipment was accomplished before being issued to the surgeon.
12.
Operative Report
Provide detailed information regarding the intraoperative setup of the operating suite.
Explain the surgical approach, pertinent anatomy and physiology, and a complete synopsis of the full intraoperative procedure. Discuss any particular intraoperative challenges.
Include all pertinent supplies, instrumentation and equipment used and explain their intended function or purpose.
Include an explanation of implants, sutures or other materials used and why they were chosen.
12

Outline your responsibility and detail any special handling considerations for tissue or fluid specimens or cultures obtained during the procedure.
Detail how your role was integral to the success of the procedure as you performed duties of either the scrub nurse or circulating nurse.
13. Postoperative Care
Discuss the immediate postoperative patient care provided.
Summarize the complete postoperative nursing care plan and outline anticipated complications as well as treatment options should they occur.
Describe pertinent postoperative care required to complete surgical treatment for the patient’s condition (i.e., use of external coaptation, rehabilitation, or wound care.)
14. Client Education and Prognosis
Define any care the patient requires post operatively including; activity restriction, bandage care, nutrition, medication, rehabilitation, and any follow-up care necessary.
Provide a final summary of the case and/or diagnosis; describe the results of all laboratory tests and how the surgical findings or diagnosis may impact the patient’s future prognosis.
15. Include a copy of the instrument and equipment used (as < 6 th
page). Provide a list of the surgical instruments, equipment and supplies that were anticipated or used during this procedure.
Detail the sterilization techniques utilized for the procedure as well as the methods used to document sterility assurance. List wrapping materials used for each item and include other pertinent data on how each item was wrapped.
16.
A list of references should be on the last (< 7 th
) page.
Each case report will contain a maximum of 7 pages and may contain a maximum of five 8.5 x 11 inch pages of case report content, a 1 page listing of all surgical instruments and equipment used, and 1 page stating references used, following the format provided. Each case report must be printed in a 10-point Times New Roman font, double-spaced, left and right justified, and with 0.5-inch page margins. Case reports that do not meet these requirements will be rejected.
The case reports must be the original work of the applicant. Please be careful to BLACK OUT/DELETE any personal client data such as owner name, address, phone numbers, etc.
An example of an AVST case report follows these instructions.
13

AVST Case Log # 1 Name/ID#: Benny #21-18-66 Signalment: Canine, Yorkshire terrier, MI, 7 mos, wt. 1.2 kg.
Presenting Problem: May 4, 2014 with hypoglycemia and increased serum bile acids
Differential Diagnosis: Suspected extrahepatic portosystemic shunt (PSS)
Attending Clinician: Dan McGood, DVM, DACVS
Pertinent Patient History and Physical Exam
Benny was purchased from a breeder in January 2014. He was admitted to his referring veterinarian on January 4 th
for depression and was treated for hypoglycemia. He was discharged with instructions to feed every 4 hours to prevent any further hypoglycemic episodes. Benny was seen again through the emergency service on March 19, 2014 for trembling. His owner reported possible seizure activity after they found him at home in lateral recumbency with rigid limbs. Benny was hypoglycemic (BG 74g/dL; normal, 86-
108g/dL), so he was treated with an IV bolus of dextrose (1 ml 50% Dextrose diluted into 3 mls of saline), and sent home with canned
Hill’s a/d food. On March 24, 2014 serum bile acids were measured. Results included a pre-prandial concentration of 213.9umol/L
(normal, 0.0 – 12.0umol/L) and post-prandial concentration of 183.94umol/L (normal, 0.0 – 25.0umol/L), indicating decreased hepatic function.
1
Based on the breed, age, clinical signs, and results of the bile acids, a congenital portosystemic shunt was suspected .
1
Benny’s diet was changed to Hills l/d, because it is protein restricted and readily digestible. Liver diets such as l/d decrease the amount of substrate presented to colonic bacteria that produce ammonia and other toxins, thereby reducing clinical signs associated with liver disease .
2
Benny was also prescribed lactulose (1-2 mls q 8h so that stools are soft but formed.) Lactulose is a sugar-based syrup that changes the pH in the colon and acts as a cathartic. This should also help reduce the amount of bacteria and substrate in the colon and the amount of ammonia absorbed into the bloodstream.
1
Referral to a specialty practice for further diagnostics and treatment was recommended.
At presentation Benny’s T: 101.3
o
F, P: 120bpm, R: 20bpm, mm: light pink, CRT: < 1 second, and the body condition score was 3/5. The physical exam was within normal limits. Two milliliters of blood was collected for a complete blood count, serum chemistries, electrolytes, and protein C. Protein C is a vitamin K dependant protein in the liver that is decreased in patients with PSS and some other liver diseases.
7
Small patients possess a limited blood volume (60-90 ml/kg): therefore minimal blood quantities were obtained for the additional laboratory tests. Urine for a complete UA was obtained via cystocentesis to rule out a concurrent urinary tract infection and assess for the presence of ammonium biurate crystals, both of which may occur in dogs with PSS.
1,2
A 20-gauge IV catheter was placed into the right cephalic vein. Benny was started on Normosol-R with 2.5 % dextrose fluids and admitted to the
ICU for a seizure watch because of historical concerns. Orders were written to administer IV diazepam (0.05mg/kg) and contact the clinician if he developed seizures, to periodically monitor his BG (which had historically been low and could be a cause of seizures) and to continue the lactulose, q8h. The hematological and biochemical abnormalities consistent with a PSS included; decreases in
MCV, total protein, BUN, albumin, glucose, and cholesterol and increases in liver enzymes.
1
[WBC 20.4x10^3 (5.1-14x10^3/uL), absolute segmented neutrophils 10.72x10^3 (2.65-9.8x10^3uL), absolute lymphocytes 7x10^3 (0-0.3x10^3/uL), absolute monocytes
14

2.13x10^3 (0.165-0.85x10^3/uL), MCV 61.6fL (62-74fL), MCH 18.5fL (22-26.2fL), MCHC 30.1g/dL (34.5-36.3g/dL), TPP 5.1 g/dL
(5.7-7.9g/dL), BUN 7mg/dL (8-32mg/dL), creatinine 0.3mg/dL (0.7-1.7mg/dL), total protein 4.5g/dL (5.3-7.2g/dL), albumin 2.3g/dL
(2.9-4.1g/dL), glucose 54mg/dL (86-4-108mg/dL), calcium 9.3mg/dL (9.5-11.2mg/dL),alkaline phosphatase 203u/L (42-126u/L), aspartate aminotransferase 68u/L (4-42u/L), anion gap 13u/L (19-27u/dL ), creatine kinase 266u/L (35-166u/L), cholesterol 65mg/dL
(129-309mg/dL).] Urine specific gravity was low at 1.013g/mL and amorphous sediment on UA was noted by the lab.
Tentative Diagnosis
Based on signalment, history and laboratory results, Benny was suspected to have a single congenital extrahepatic PSS. A
PSS is a vascular anomaly that diverts blood from the abdominal viscera directly to the heart before it can be filtered by the liver.
Liver shunts can be classified as congenital or acquired, intrahepatic or extrahepatic, and single or multiple. A single, congenital extrahepatic shunt is most common in young small breed dogs. Certain breeds, such as Yorkshire terriers, have an increased risk for the condition, which is thought to be hereditary in those breeds.
1
Patients with congenital diseases, such as PSS, should not be used for breeding.
Diagnostic Imaging Options
A PSS cannot be diagnosed solely on clinical pathology findings. Therefore, further diagnostic imaging is recommended for a definitive diagnosis in patients with laboratory abnormalities and clinical signs consistent with a PSS. Diagnostic imaging test options include portal scintigraphy, portal angiography, doppler imaging ultrasound (U/S), magnetic resonance angiography (MRA), or dual-phase contrast CT scan. Scintigraphy is a nuclear medicine scan in which a radioactive pharmaceutical- technecium99- is injected into the spleen or administered into the colon. Scintigraphy detects liver shunting but cannot definitively differentiate between intrahepatic and extrahepatic PSS or congenital versus multiple acquired PSS.
6
Typically, >60% fractions are detected in dogs with congenital PSS. Animals must be isolated until their level of radioactivity is no longer considered a hazard to humans.
Doppler U/S is noninvasive and, like scintigraphy, requires sedation. Accuracy is operator dependent and can be as high as 100%.
1
Intravenous mesenteric or splenic portogram can be used to more accurately locate the shunting vessel but usually requires surgery to perform. MRA and CT have been used to diagnose single extrahepatic congenital shunts; both require anesthesia. In this case, nuclear scintigraphy was performed.
Prior to nuclear scintigraphy Benny was administered IV acepromazine and butorphanol and masked down with isoflurane gas inhalant. Technetium99 at 1-3mCi was injected into the spleen under ultrasound guidance. A gamma camera was used to detect the blood flow through the portal system. Benny’s shunt fraction of 94% (normal, <15%) and the presence of a liver shunt was confirmed. At the end of the study Benny was emitting less than 0.2rM per hour at a 1-meter distance; therefore, isolation was not required. He was returned to ICU and placed on Normosol
®
-R with 2.5% dextrose at a rate of 2.4 ml/hr. Overnight Benny had one episode of hypoglycemia that resolved after eating. The owners were notified of the results and a plan was made to perform surgery the following morning for PSS repair, liver biopsy and castration.
15

Surgical Treatment Options
Options for this patient included placement of an ameroid constrictor or cellophane band around the shunt or partial suture ligation. The best surgical options for single, extrahepatic shunts are those that result in gradual attenuation of the shunt over a few weeks, such as with cellophane band or ameroid constrictor attenuation.
1
When acute ligation is performed, the portal pressures must be measured intraoperatively to monitor for portal hypertension.
Cystotomy may also be necessary in some patients. Dogs with PSS are predisposed to producing ammonium biurate urinary stones because they excrete excess ammonia through the urine. When present, bladder stones can be removed during PSS surgery.
Patient and Equipment Preparation
Anesthetic concerns for PSS patients include avoiding hypoglycemia, hypotension, prolonged sedation, and hypothermia.
Normosol-R with 2.5 % dextrose was continued intraoperatively at a rate of 10mls/kg/hr. Cefazolin was given IV at 22mg/kg, 30 minutes prior to the first incision. Cefazolin sodium is a first generation cephalosporin, a good broad-spectrum antibiotic used to reduce the incidence of post surgical infection from bacteria translocation resulting from the change in portal blood flow.
3
The surgical site was prepared using an electrical clipper with a clean #40 blade. The hair was shaved from mid-thorax to pubis, including the scrotum and all the hair from the preputial skin. The clip margins extended 4 cm laterally from ventral midline to allow for adequate draping of the surgical site. While expressing the urinary bladder small uroliths were noted in the urine. The surgeon was informed and a cystotomy was added to the surgical plan. Ammonium urate stones are radiopaque but could have been detected with ultrasound before surgery.
The prepuce was flushed with a 0.05% chlorhexidine solution. Chlorhexidine is a broad spectrum antiseptic that has a rapid onset of action and binds to keratin. It requires a two-minute contact time and has residual activity for up to 2 days.
3
A preliminary scrub of the surgical field was performed with 2% chlorhexidine scrub on cotton moistened with water and applied wearing clean exam gloves. The surgical site was then sprayed with a light mist of 0.05% chlorhexidine solution before moving to the surgical suite.
All operating room personnel wore surgical caps, masks, and shoe covers, and lab coats were removed prior to entering the surgical hallway. A radiolucent operating table was prepared in the event the surgeon decided to perform an intraoperative portogram.
Because Benny was small and a cautery plate would interfere with fluoroscopy for a portogram, bipolar electrocautery was used instead. The operating table was covered with a HotDog
®
warming device and Benny was transferred onto the table. He was connected to anesthesia monitoring equipment and placed on a ventilator. A final prep was performed with sterile gloves using an open gloving technique, using 0.05% chlorhexidine solution and sterile gauze applied in a concentric circle target pattern, working from the center of the surgical field to the hairline. The surgeon used Avagard
®
, a waterless surgical hand prep containing alcohol and chlorhexidine. Avagard requires two minutes contact time and hands must air dry for this agent to become fully effective. The resident and student used a timed 5-minute scrub with a 4% chlorhexidine scrub and disposable scrub brush. Surgical gowns, hand towels, and gloves were aseptically opened by the circulating nurse and properly donned by the surgical team. Gowns were secured by
16

the circulating nurse. Surgical packs and instruments were aseptically opened on the instrument table by the circulating nurse after the patient was in position so as not to be contaminated by non-sterile personnel.
Operative Report
A sponge count was performed and a ventral midline incision was made through the skin with a #15 blade on a Bard-Parker
#3 handle. Curved Mayo dissecting scissors were used to cut the linea and enter the abdominal cavity. A baby Balfour abdominal retractor was placed to allow visualization of the abdominal organs. A gastro-caval extrahepatic shunt was identified and bluntly dissected with Mixter right angle thoracic forceps. A 5.0mm Ameroid constrictor was grasped with an Allis tissue forceps and placed around the shunt and the stainless steel key was placed into the constrictor with a Halstead mosquito hemostatic forceps. A liver biopsy was obtained using a guillotine technique with 3-0 Monocryl suture. Subsequently, the bladder was isolated with moistened laparotomy pads and a cystotomy was performed. A 5 French red rubber catheter was passed through the penile urethra and advanced into the urinary bladder to flush out any remaining uroliths. The stones were collected into a sterile container and submitted for analysis. A 3-0 Monocryl suture was used to close the urinary bladder wall using a two-layer closure of the inverting Cushing pattern followed by the inverting Lambert pattern. Monocryl (poligecaperone 25) is a monofilament absorbable suture that has a high initial tensile strength and loses 75% tensile strength at 14 days. Since the urinary bladder heals rapidly and retains 80% of its strength after
7 days, Monocryl suture is an ideal choice for closing the urinary bladder wall. A final sponge count was performed by the surgical scrub nurse and minimal blood loss was noted. Polydioxanone (PDS) 2-0 suture was used to appose the linea in a simple continuous pattern. Polydioxanone is an absorbable monofilament suture with a slow rate of degradation, losing only 26% of the tensile strength after 14 days. Intradermal sutures in a continuous pattern with 3-0 Monocryl closed the subcutaneous layer and skin. A routine closed castration was performed by exposing the left testicle with a #15 blade. A single encircling 3-0 PDS suture was placed around the vessels and vas deferens and transected distal to the ligature. Procedure repeated on the right testicle. Intradermal 3-0 PDS used for skin closure. The liver biopsy sample was preserved using a 1:10 ratio of tissue to 10% formalin and submitted for histopathology.
Postoperative Care
Benny was extubated in the operating room and moved to ICU. Postoperatively, Benny was monitored closely for portal hypertension, seizures, hypothermia, pain and hypoglycemia. Signs of portal hypertension may include increased CRT, pale mm, weak or absent peripheral pulses, abdominal pain or distension, and diarrhea or vomitus that may contain digested blood. He was administered IV buprenorphine q 4-6hrs for pain and a single dose of IV acepromazine was given to reduce anxiety. Vocalization associated with pain or anxiety can increase intra-abdominal pressures and thus could result in portal hypertension. Benny was maintained on Normosol-R with 2.5% dextrose fluids at 2.4 ml/hr (maintenance fluids) and covered with a Bair Hugger
® warming device. Benny’s blood glucose decreased to 64 g/dL 2 hours after surgery. The cause of postoperative hypoglycemia in PSS patients that are on crystalloid fluids containing dextrose is unknown but may be a result of an inadequate response to stress and may respond to administration of glucocorticoids.
4
A physiologic dose of dexamethasone sodium phosphate (dex SP) 0.03 mg/kg was given slowly
17

intravenously. An hour later the BG was still decreased (63 g/dL) so a higher dose of dex SP 0.1mg/kg IV was repeated and 50% dextrose (25mls 50% dextrose to 500mls Normosol R with 2.5% dextrose) was added to the fluids to increase them to a 5% solution.
Benny was offered a small amount of Hill’s l/d food, which he ate. One hour later Benny’s BG was normal at 81g/dL. Frank blood was noted in his urine, which is expected after a cystotomy. Intravenous fluids are important after a cystotomy because the subsequent urine production flushed blood from the bladder, preventing clot formation. Benny was given a pain score of 3 out of 10, 12 hours after surgery. He had a very good appetite when aroused but slept most of the evening. Benny was bright, alert and responsive 18 hours after surgery and was returned to the ward wearing an Elizabethan collar. His BG was stable at 116 g/dL and he seemed very comfortable. Benny was prescribed the NSAID meloxicam once daily for the next 4 days for postoperative analgesia.
Client Education and Prognosis
Upon discharge from the hospital the owners were given instructions to curtail his activity for 2 weeks, monitor him closely for seizure activity or development of ascites, and to contact the surgeon if the hematuria worsened or did not resolve within 5 days.
Benny’s skin sutures were buried and did not require removal, but the owners were instructed to use the Elizabethan collar for 10 days to prevent him from traumatizing the incision. Because Benny was receiving an NSAID, the owners were instructed to watch for gastrointestinal signs such as vomiting, diarrhea, loss of appetite, lethargy or black, tarry stools. They were advised to discontinue the medication and contact their veterinarian if any of those occurred.
Lactulose and Hill’s l/d diet were continued for a minimum of 3 months, or until liver function improved. The owners were instructed not to feed additional protein. For dogs with PSS the protein content of the diet, on a dry matter basis, should be 18 to 22%.
5
In dogs with PSS, the liver no longer transforms ammonia to urea via the urea cycle, and that cycle must be performed in other places such as muscle. Diets too low in protein may result in muscle loss, which may exacerbate clinical signs.
A pre- and post-prandial serum bile acid test, biochemistry profile, and UA were recommended at 3 months postoperatively to reassess liver function. Long-term increase of bile acids could be caused by continued shunting, multiple acquired shunts, or microvascular dysplasia (MVD) secondary to congenital portal hypoplasia (CPH).
1
CPH/MVD is a hereditary disease of the liver that is primarily diagnosed in the same small dog breeds prone to congenital PSS. Clinical signs and laboratory abnormalities can be similar but are usually milder than those of dogs with congenital PSS. Diagnosis is based on normal scintigraphy and an abnormal liver biopsy. Dogs with CPH/MVD usually have normal protein C activity. Dogs can have PSS and CPH/MVD simultaneously. The diagnosis of CPH/MVD cannot be made until 6 months after PSS repair. In dogs that continue to have abnormal liver function, milk
(silymarin) thistle and SAM-e (denosyl) could be added to aid in liver regeneration.
The uroliths were composed of ammonium biurate, which was consistent with a single congenital PSS; recurrence was not expected as long as liver function improved. The liver biopsy revealed portal hypoperfusion consistent with PSS or MVD/CPH.
Benny was clinically normal 3 months after surgery, and the biochemistry profile was within normal limits. The post-prandial bile acids remained slightly elevated 38.4umol/L (normal, 0.0 – 25.0.)
18

AVST Instrument and Equipment List
Steam: pre-vacuum autoclave with cycle settings: 132 C, 17-20 psi, 20 minute cycle.
Gas/Plasma: Sterrad
®
using 58% hydrogen peroxide, 46°C, 55 minute cycle.
General Surgical set-up:
Linen Pack: Sterilized by manufacturer
(1) 10” Fenestrated drape
(1) 14” Fenestrated drape
(6) Huck towels
(1) Mayo stand cover
Disposables: Sterilized by manufacturer
#10, #11 and #15 surgical blade
Monopolar cautery pencil including scratch pad and tips
Suction tubing
(5) Laparotomy pads
(20) 4x4 gauze sponges
Instrument Pack: Sterilized with steam, double wrapped in blue polypropylene sheets
(6) Backhaus towel clamps
Curved and straight Mayo scissors
Curved and straight Metzenbaum scissors
(2) Mayo-Hegar needle holders
(2) Allis tissue forceps
(2) Brown Adson thumb forceps
(1) Bard-Parker #3 handle
(3) Curved Crile hemostats
(3) Halstead mosquito straight hemostats
(3) Halstead mosquito curved hemostats
Additional Steam Sterilized Instruments:
Mixter right angle thoracic forceps; wrapped in a single paper heat sealed pouch
Baby Balfour retractor, small; double wrapped in blue polypropylene sheets
(2) Light handles; double wrapped in blue polypropylene sheets
Irrigation bowl: double wrapped in blue polypropylene sheets
Large Poole suction tip; wrapped in a single paper heat sealed pouch
Additional Gas/Plasma Sterilized Instruments:
Bipolar cautery handpiece, single Tyvek® pouch
Ameroid constrictor, double Tyvek® pouch
Red rubber catheters (sizes 3.5, 5, and 8 French): manufactured with radiation sterilization
Additional instruments/supplies available but not used:
Cellophane strips; sterilized in a single Tyvek® pouch with Gas/Plasma
Sterile cover for fluoroscopy c-arm unit
Portogram supplies and radiographic contrast
Quality Control Methods
Biological indicator run in every cycle and incubated; Steam: 56°C for 48hrs and Gas/Plasma 58°C for 48hrs
Class 1 external chemical indicator tape; Steam: Comply™ indicator tape, Gas/Plasma:Sterrad® SealSure
Class 5 / other internal chemical indicator strips**; Steam: Comply™ SteriGage, Gas/Plasma: Sterrad® indicator strip
** Internal chemical indicator strips were placed in the least accessible/most dense part of the pack or inside the innermost wrap or pouch.
19

Reference page
1.
Berent A, Tobias K: Portosystemic vascular anomalies. Vet Clin N Am Small Anim. 39(3):513-541, 2009.
2.
Berent AC, Rondeau M: Hepatic Failure. p.552 In: Silverstein DC, Hopper K (ed): Small Animal Critical Care Medicine: 1 st
Ed.
Saunders Elsevier, St. Louis, 2009
3.
Fossum TW, Small Animal Surgery.
3 rd
ed. St. Louis, MO: Mosby, Inc 2007
4.
Holford AL, Tobias KM, Bartges JW, et al. Adrenal response to adrenocorticotropic hormone in dogs before and after surgical attenuation of a single congenital portosystemic shunt. J Vet Intern Med 2008;22:832-8.
5.
Proot S, Biourge V, Teske E, et al. Soy Protein Isolate versus meat-based low-protein diet for dogs with congenital portosystemic shunts. J Vet Intern Med 23: 794, 2009
6.
Sura PA, Tobias KM, Morandi F, et al: Comparison of
99m
TcO
4
−
Trans-Splenic Portal Scintigraphy with Per-Rectal Portal
Scintigraphy for Diagnosis of Portosystemic Shunts in Dogs
Vet Surg 36:654, 2007
7.
Toulsa O, Center SA, Brooks MB, et al: Evaluation of plasma protein activity for detection of hepatobiliary disease and portosystemic shunting in dogs, J Amer Vet Med Assoc 229(11): 1761, 2006
20

- Form 3
The applicant is required to state whether or not he/she has mastered the skills on this form. The AVST is aware that some states or provinces may not allow a task to be performed by a credentialed veterinary technician. The AVST requires that a Veterinary Technician Specialist (of any specialty) or a veterinarian who has mastered the skill attest to your mastery of each skill on this form.
Mastery is defined as possessing an outstanding skill or having expertise. The applicant must be able to perform the task safely, with a high degree of success, and without being coached or prompted.
Mastery requires having performed the task in a wide variety of patients, situations, and a multitude of times.
Aseptic Technique
A VTS (Surgery) plays an integral role in maintaining asepsis under a variety of conditions. Aseptic technique is described as a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination by pathogens.
Skill Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)
2
1 Demonstrate maintenance of asepsis in the OR with appropriate use of surface disinfectants and contact times
Demonstrate maintenance of asepsis in the OR with appropriate use of various types of antiseptics and contact times
3 Demonstrate asepsis in the OR with appropriate OR conduct while acting as a circulating nurse
(e.g., pouring sterile lavage, issuing sterile items, passing between sterile field and adjacent sterile personnel)
4 Demonstrate asepsis outside of the OR for a variety of procedures
(e.g., sterile gloving for wound care, open abdomen bandage changes)
5 Perform a surgical hand scrub using a water-based scrub (e.g.,
2% chlorhexadine scrub
6 Perform a surgical hand scrub using an alcohol-based scrub
(e.g., Avagard)

Skill
7 Perform open gloving technique
8 Perform closed gloving technique
Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)
9 Perform assisted gloving technique
10 Demonstrate proper OR technique in the event of contamination (use of sleeves, re-gloving or regowning techniques, etc.)
Operating Room Techniques
A VTS (Surgery) must be able to perform successfully in a surgical suite to reduce the overall time of the procedure, reduce contamination, and maintain the patient’s well being as the highest priority.
Skill Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)
CIRCULATING NURSE DUTIES:
11 Properly set-up an OR and possess anticipatory skills regarding needed equipment and instrumentation for an abdominal surgical procedure
12 Properly set-up an OR and possess anticipatory skills regarding needed equipment and instrumentation for perineal or urogenital surgical procedure
13 Properly set-up an OR and possess anticipatory skills regarding needed equipment and instrumentation for a thoracic surgical procedure
14 Properly set-up an OR and possess anticipatory skills regarding needed equipment and instrumentation for an upper respiratory or surgery of head
(e.g., aural, oral) and neck procedure
15 Properly set-up an OR and possess anticipatory skills regarding needed equipment and instrumentation for an endocrine soft tissue surgical procedure

Skill Mastered
(Date observed)
Signature of
DVM/VTS
CIRCULATING NURSE DUTIES (continued):
16 Properly set-up an OR and possess anticipatory skills regarding needed equipment and instrumentation for an orthopedic surgical procedure
17 Properly set-up an OR and possess anticipatory skills regarding needed equipment and instrumentation for a minimally invasive surgical procedure
18 Properly set-up an OR and possess anticipatory skills regarding needed equipment and instrumentation for an ophthalmic or neurologic surgical procedure
SCRUB NURSE DUTIES:
19 Possess anticipatory skills and demonstrate appropriate handling and passing of instrumentation while assisting the surgeon during an abdominal procedure
20 Possess anticipatory skills and demonstrate appropriate handling and passing of instrumentation while assisting the surgeon during a thoracic procedure
21 Possess anticipatory skills and demonstrate appropriate handling and passing of instrumentation while assisting the surgeon during an orthopedic procedure
22 Possess anticipatory skills and demonstrate appropriate handling and passing of instrumentation while assisting the surgeon during a minimally invasive procedure
Reference
Case #(s)

Anatomy and Physiology
To assist in surgery, a VTS (Surgery) must have a thorough understanding of the structures of the body and how they function.
Skill Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)
23 Demonstrate advanced knowledge of anatomy and physiology as it relates to a variety of abdominal surgical procedures and identify potential complications and postoperative considerations for each (e.g., PSS and normal liver function. Portal hypertension, seizures, limited protein diets.)
24 Demonstrate advanced knowledge of anatomy and physiology as it relates to a variety of perineal/urogenital surgical procedures and identify potential complications and postoperative considerations for each
(e.g., perineal urethrostomy for
FLUTD: urethral stricture, recurrent
UTIs re-obstruction, etc.)
25 Demonstrate advanced knowledge of anatomy and physiology as it relates to various thoracic surgical procedures and identify potential complications and postoperative considerations for each (e.g., PDA: cardiac function. Lung lobectomy: normal lung function, lung lobe removal limitations, potential development of pneumothorax, chest tube placement and management)
26 Demonstrate advanced knowledge of anatomy and physiology as it relates to various upper respiratory or surgery of head (e.g., aural, oral) and neck procedures and identify potential complications and postoperative considerations for each (e.g., BAS and treatment options such as alaplasty, partial staphylectomy, laryngeal ventriculectomy. Stages of laryngeal collapse. Gutteral pouch surgery considerations.)

Skill
27 Demonstrate advanced knowledge of anatomy and physiology as it relates to various endocrine (e.g., pancreatic, thyroid, adrenal) surgical procedures and identify potential complications and postoperative considerations for each (e.g., parathyroid gland function, laboratory abnormalities and clinical signs associated with parathyroid mass, potential developmental hypocalcemia, treatment, etc.)
28 Demonstrate advanced knowledge of anatomy and physiology as it relates to various orthopedic surgical procedures and identify potential complications and postoperative considerations for each (e.g., long bone fracture and repair options such as ORIF, external fixation or combination repair techniques and coaptation options such as casting.
Delayed healing, implant failure & infection, post-op external coaptation management concerns & cryotherapy)
29 Demonstrate advanced knowledge of anatomy and physiology as it relates to various minimally invasive procedures and identify potential complications and postoperative considerations for each (e.g., arthroscopy for fragmented coronoid process, pathophysiology, prognosis)
30 Demonstrate advanced knowledge of anatomy and physiology as it relates to various ophthalmic or neurologic surgical procedures and identify potential complications and postoperative considerations for each
31 Demonstrate advanced knowledge of anatomy and physiology as it relates to joint replacement surgical procedures and identify potential complications and postoperative considerations for each (THR, TER)
Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)

Equipment
A VTS (Surgery) must have knowledge of various equipment specific to surgery, including proper applications, identification, care, maintenance, and troubleshooting.
Skill Mastered
(Date observed)
Signature of Reference
DVM/VTS Case #(s)
32 The ability/ knowledge to set-up, maintain, and troubleshoot various equipment used for orthopedic or neurologic surgery (e.g., nitrogen powered equipment care and maintenance)
33 The ability/ knowledge to set-up, maintain, and troubleshoot various equipment used for arthroscopic surgery
34 The ability/ knowledge to set-up, maintain, and troubleshoot various equipment used for laparoscopic or thorascopic surgery
35 The ability/ knowledge to set-up, maintain, and troubleshoot various equipment used for class IV laser surgery
36 Set-up, maintain, troubleshoot and understand indications for different stapling or vessel sealing equipment (e.g., LDS, GIA, EEA or TA; Ligasure; Surgiclip)
37 Maintain, set-up, troubleshoot, and sterilize battery-powered instruments
38 Maintain, set-up, troubleshoot, and understand indications for electrocautery units
39 Maintain, set-up, troubleshoot, and understand indications for portable or central suction units

Instrumentation
A VTS (Surgery) must demonstrate advanced knowledge in the application or use of all surgical instrumentation, including care and maintenance.
Skill Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)
PROCEDURE SPECIFIC INSTRUMENTATION:
40 Identify, maintain, and explain indications for specific abdominal
(such as gastrointestinal, hepatic, renal, reproductive organs) surgery instrumentation
41 Identify, maintain, and explain indications for specific perineal or urogenital surgery instrumentation
42 Identify, maintain, and explain indications for a variety of thoracic or cardiovascular surgery instrumentation
43 Identify, maintain, and explain indications for a variety of upper respiratory or head (aural, oral) and neck surgery instrumentation
44 Identify, maintain, and explain indications for a variety of endocrine soft tissue surgical instrumentation
45 Identify, maintain, and explain indications for orthopedic surgical instrument sets such as specific use knowledge of drill sleeves, drill guides, taps and countersinks; understand various screw sizes and types or IM pin thread type and their indications
46 Identify, maintain, and explain indications for specific ophthalmic or neurologic instrumentation
47 Identify, maintain, and explain indications for joint replacement instrumentation

Surgical Instrument Care and Sterilization Methods
A VTS (Surgery) must have knowledge of various sterilization methods. Sterilization is the process of destroying all microorganisms in or on a given environment to prevent infection.
Skill Mastered
(Date observed)
Signature of
DVM/VTS
48 Know products and application recommendations for enzymatic cleaning of surgical instruments
49 Know application, maintenance, and troubleshooting of ultrasonic cleaners
50 Know appropriate application of products used for the lubrication of surgical instruments
51 Know appropriate use and disposal of products used for high-level disinfection of surgical instruments
52 Set-up, load, maintain, troubleshoot, and know how to assess sterility when using ethylene oxide sterilization
53 Set-up, load, maintain, troubleshoot, and know how to correctly wrap items and assess sterility when using hydrogen peroxide gas plasma sterilization
54 Set-up, load, maintain, troubleshoot, and know how to assess sterility when using steam sterilization
55 Demonstrate proficiency in preparing surgical packs using class II wraps (drape materials made of paper, linen or SMS polypropylene)
56 Demonstrate proficiency in the proper use of peel pouches (e.g., plastic/paper combinations) for individually processed items
57 Demonstrate proficiency in the proper use and sterilization of tiny or multiple items doublepouched in peel pouches
Reference
Case #(s)

Skill
58 Demonstrate knowledge of shelf life of sterile goods when using low temperature sterilization methods (e.g., ethylene oxide, hydrogen peroxide gas plasma)
59 Demonstrate knowledge of shelf life of sterile goods when using steam sterilization methods
60 Perform a biological test for any type of sterilizer and evaluate the results
Surgical Procedures
Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)
A VTS (Surgery) must have a diverse surgical procedure knowledge base. A surgical procedure is a medical procedure involving an incision with instruments performed to repair damage or arrest disease in a living body.
Skill Mastered
(Date observed)
PATIENT PREPARATION AND POSITIONING:
Signature of
DVM/VTS
Reference
Case #(s)
61 Perform an appropriate surgical clip and aseptic prep application on intact epithelium
62 Perform an appropriate surgical clip and aseptic prep application on torn or denuded epithelium
63 Identify the appropriate anatomic landmarks for various abdominal procedures (such as gastrointestinal, hepatic, splenic, herniorrhaphy), perform an appropriate surgical clip and aseptic prep application and properly position patient for surgery

Skill Mastered
(Date observed)
Signature of
DVM/VTS
PATIENT PREPARATION AND POSITIONING (continued):
64 Identify appropriate anatomic landmarks for various perineal or urogenital surgical procedures
(e.g., perineal hernia or laceration repair, urethrostomy, Caslick’s operation), perform an appro- priate surgical clip and aseptic prep application and properly position patient for surgery
65 Identify appropriate anatomic landmarks for various thoracic procedures (such as rib resection, lung lobectomy, pericardiotomy), perform an appropriate surgical clip and aseptic prep application and properly position patient for surgery
66 Identify appropriate anatomic landmarks for various upper respiratory or surgery of head and neck (such as tracheostomy, soft palate resection, jaw resection, ear surgery), perform an appropriate surgical clip and aseptic prep application and properly position patient for surgery
67 Identify appropriate anatomic landmarks for various endocrine soft tissue procedures (such as adrenalectomy, thyroidectomy) insulinoma), perform an appropriate surgical clip and aseptic prep application and properly position patient for surgery
68 Identify appropriate anatomic landmarks for various orthopedic procedures (such as tenotomy, ligament repair, amputation, joint replacement), perform an appropriate surgical clip and aseptic prep application and properly position the patient for surgery
Reference
Case #(s)

Skill
69 Identify appropriate anatomic landmarks for various minimally invasive procedures (such as laparoscopic cryptorchidectomy or liver biopsy, arthroscopy), perform an appropriate surgical clip and aseptic prep application and properly position the patient for surgery
70 Identify appropriate anatomic landmarks for various ophthalmologic (e.g., enucleation) or neurologic procedures (e.g., hemilaminectomy, ventral slot), perform an appropriate surgical clip and aseptic prep application and properly position the patient for surgery
SURGICAL CARE EXPERTISE:
71 Demonstrate an advanced knowledge of various types of abdominal surgical procedures in
2 or more species
72 Demonstrate an advanced knowledge of various types of perineal or urogenital surgical procedures in 2 or more species
73 Demonstrate an advanced knowledge of various types of thoracic surgical procedures
74 Demonstrate an advanced knowledge of various types of upper respiratory or head and neck (e.g., aural, oral) surgical procedures
75 Demonstrate an advanced knowledge of various types of endocrine soft tissue surgical procedures
Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)

Skill Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)
SURGICAL CARE EXPERTISE (continued):
76 Demonstrate an advanced knowledge of various methods used for orthopedic surgery of the bone, tendon or ligament such as using minimally invasive or external fixation techniques (e.g., external ring fixators), ORIF (e.g., plating or IM pin fixation), tenotomy or neurectomy procedures, and/or joint replacement techniques
77 Demonstrate knowledge of orthopedic surgical procedures utilizing allograft products or autograft techniques
78 Demonstrate an advanced knowledge of various types of minimally invasive surgical procedures (laparoscopic, arthroscopic, etc.)
79 Demonstrate an advanced knowledge of ophthalmic and/or neurologic surgical procedures
80 Identify different suture patterns and indications
81 Demonstrate appropriate use of various suture materials
82 Demonstrate knowledge of various intraoperative coagulation aids (e.g., Surgicel, Gelfoam)
Bandaging and Wound Management
Bandages are materials used to protect, immobilize, compress, or support a wound or injured area of the body. A VTS (Surgery) must possess knowledge in external coaptation methods and wound care techniques.

83
84
85
86
87
88
89
90
Skill
Demonstrate knowledge regarding the phases of wound healing and proper wound management
Demonstrate knowledge of moist wound healing and different primary layers
(calcium alginate, polyurethane, honey, hydrogel, etc.) available
Identify various bandage materials and properly place a variety of bandages including, but not limited to, chest bandages, soft padded (or
Robert Jones), and wet-to-dry bandages
Demonstrate an advanced knowledge of, and indications for coaptation including proper placement of a variety of splints and casts
Evaluate a variety of bandages and demonstrate knowledge of potential complications associated with extended wear
Perform a proper wound lavage and select an appropriate solution or product for various wounds
Demonstrate the proper care of skin grafts or flaps
Evaluate surgical wounds and incisions for potential complications (seroma, infection, and dehiscence)
Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)

Skill Mastered
(Date observed)
91
92
93
94
Demonstrate knowledge and appropriate use of novel wound treatment therapies
(biotherapy [e.g., maggots or leeches], hyperbaric oxygen chamber, class IIIa or IIIb low level laser therapy (LLLT), etc.)
Maintain passive drains
Maintain active drains
Maintain vacuum-assisted drain system
Pharmacology and Laboratory
Signature of
DVM/VTS
Reference
Case #(s)
A VTS (Surgery) needs to understand indications and usage guidelines for a variety of antimicrobial agents used in the perioperative period.
Skill Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)
95 Demonstrate indications and appropriate use of peri-operative injectable antibiotics
96 Demonstrate indications and appropriate use of beta-lactam antibiotics
97 Demonstrate indications and appropriate use of fluroquinolone antibiotics
98 Demonstrate indications and appropriate use of antimicrobials used for topical wound management and/or burns
99 Demonstrate indications and appropriate use of time-released antibiotic impregnated gels/liquids (e.g., Clinzgard®, R-
Gel)
100 Demonstrate proper tissue handling of samples submitted for histology (e.g., correct formalin ratio to sample size)
101 Demonstrate proper technique for inking or labeling the tissue margins of histology samples

Skill
102 Demonstrate proper specimen handling of fluid and tissue samples collected for culture
103 Demonstrate proper specimen handling of samples collected for cytology
Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)
Personal Safety
Maintaining an individual’s safety is imperative while working in a surgical environment.
Skill Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)
104 Demonstrate proper radiation safety and the importance of limited exposure
105 Demonstrate proper fluoroscopy safety in a surgical setting
106 Demonstrate proper class IV laser safety in a surgical setting
107 Demonstrate proper handling of chemicals used for cold sterilization (e.g., gluteraldahyde)
108 Obtain operator certification for ethylene oxide sterilizer or demonstrate proper use of EO
Adjunct Surgical Skills
A VTS (Surgery) needs to be well rounded and have advanced knowledge and skills in other areas considered pivotal in the management of surgical patients.
Skill Mastered
(Date observed)
Signature of
DVM/VTS
109 Demonstrate advanced knowledge and ability to obtain high-quality diagnostic orthogonal appendicular skeleton radiographs
Reference
Case #(s)

Skill
110 Demonstrate advanced knowledge and ability to obtain high-quality diagnostic orthogonal axial skeleton radiographs
111 Demonstrate use of interventional radiology techniques (e.g., tracheal stent placement, fluoroscopy-assisted closed fracture reduction)
112 Demonstrate knowledge and ability to care for and maintain chest tubes
113 Demonstrate knowledge and ability to place purse string and/or finger trap suture
114 Demonstrate knowledge and use of stem cell therapy
115 Demonstrate knowledge and capabilities to perform industry accepted modalities of postoperative rehabilitation (e.g., heat therapy, cryotherapy, low level laser therapy [LLLT], extracorporeal shock wave therapy
[ESWT])
116 Demonstrate advanced knowledge of at least 4 different methods of providing analgesia under a variety of circumstances
(e.g., regional/epidural, parental, transdermal, local)
Mastered
(Date observed)
Signature of
DVM/VTS
Reference
Case #(s)

-
The applicant is required to state whether or not he/she has mastered the skills on this form. The AVST is aware that some states or provinces may not allow a task to be performed by a credentialed veterinary technician. The AVST requires that a Veterinary Technician Specialist (of any specialty) or a veterinarian who has mastered the skill attest to your mastery of each skill on this form.
Mastery is defined as possessing an outstanding skill or having expertise. The applicant must be able to perform the task safely, with a high degree of success, and without being coached or prompted.
Mastery requires having performed the task in a wide variety of patients, situations, and a multitude of times.
Applicant Name : ________________________________________________________
I, the undersigned, declare that I have read the AVST Advanced Surgical Skills Form . I further attest that the above-named applicant has achieved the AVST definition of mastery for the above skills that are marked with my signature.
_______________________________/____________________________/____________
Signature Initials Printed Name
_______________________________/____________________________/____________
Printed Name Signature Initials
_________
Degree
_________
Degree
_______________________________/____________________________/____________
Printed Name Signature Initials
_______________________________/____________________________/____________
Printed Name Signature Initials
_________
Degree
_________
Degree

Waiver, Release and Indemnity Form - 4
I hereby submit my credentials to the Academy of Veterinary Surgical Technicians (AVST) for consideration for examination in accordance with its rules and enclose the required application fee. I agree that prior to or subsequent to my examination the AVST Credentials Committee may investigate my standing as a technician, including my reputation for complying with the standards of ethics of the profession. I understand and agree that the application fee shall be nonrefundable.
I agree to abide by the decisions of the AVST Credentials Committee and thereby voluntarily release, discharge, waive and relinquish any and all actions or causes of actions against the Academy of Veterinary Surgical
Technicians and each and all of its members, committees, officers, examiners and assigns from and against any liability whatsoever in respect of any decisions or acts that they may make in connection with this application, the examination, the grades on such examinations and/or the granting or issuance, or failure thereof, of any certificate, except as specifically provided by the Constitution and Bylaws of this organization. I agree to exempt and relieve, defend and indemnify, and hold harmless the Academy of Veterinary Surgical Technicians, and each and all of its members, committees, officers, examiners and assigns against any and all claims, demands and/or proceedings, including court costs and attorney’s fees, brought by or prosecuted for my benefit, extended to all claims of every kind and nature whatsoever whether known or unknown at this time. I further agree that any certificate which may be granted and issued to me shall be and remain the property of the Academy of Veterinary Surgical Technicians.
I certify that all information provided by me on the application is true and correct. I acknowledge that I have read, understand and agree to abide by the above two paragraphs.
____________________________________________ _______________________
(Signature) (Date)
___________________________________________
(Please print your name)

Date(s) of Conference:
CONTINUING EDUCATION RECORD Form 5
Name of conference, meeting, etc:
Organization or Person providing the CE:
Speaker Name
_____________
Credentials
__________
_____________
_____________
_____________
_____________
__________
__________
__________
__________
Title of Presentation
_____________________
_____________________
_____________________
_____________________
Hours
_____
_____
_____
_____
_____________________ _____
_____________
_____________
__________
__________
_____________________
_____________________
_____
_____
_____________ __________ _____________________ _____
Total Time ___________
Type of CE:
Continuing education programs MUST be presented by a VTS member (in any of the specialty academies), a veterinary diplomate of an American or European college, or other qualified speakers as outlined in the AVST Application Packet. You
MUST list the CE provider’s diplomate/credential status (DACVS, DACVAA, DACVIM, DECVS, VTS, etc.) on the CE form. Failure to include the speaker’s credentials will result in those hours being rejected.

To: Supervising Veterinarian or Veterinary Technician Specialist mentor:
This letter has been presented to you by a credentialed veterinary technician currently employed at your facility who has an interest in pursuing membership in the Academy of Veterinary Surgical Technicians (AVST).
In order to achieve this objective your technician will complete a two-step process of submitting an application packet for approval by the credentials committee and sitting for a comprehensive examination. Successful completion of both steps will earn your technician the title of Veterinary Technician Specialist in Surgery. A technician with VTS (Surgery) certification demonstrates superior knowledge in the care and management of veterinary surgical cases while promoting patient safety, consumer protection and professionalism.
The application process is especially time consuming and your technician will need your support and guidance throughout the process. I recommend that you read the entire application packet to become familiar with the areas in which your technician will require your assistance. Listed below are some areas of the application that are particularly important as well as some suggestions and guidelines to assist you in helping your technician prepare an application for submission.

All cases contained in the case log must be performed within the year prior to the application deadline of
December 31.

All cases must be performed at the facility where the technician is employed or while under the supervision of the employer at a different location (i.e., your clinic performs an MRI at a different location but you and your technician are still in charge of the case and perform the surgery).

Allow your technician to assist in developing a surgical plan from start to finish. The technician should be able to anticipate the needs of the surgeon in performing the surgical procedure, including instrumentation, equipment, suture, aseptic technique, post operative care, bandages, diagnostics, etc. that is specific for each surgical case and discuss with you why they selected each instrument, piece of equipment, suture, bandage, radiographic view, etc.
 The AVST requires that a licensed veterinarian or VTS member attest to the technician’s ability to master the required percentage of skills on the AVST Advanced Surgical Skills Form. Mastery is defined as being able to perform the task safely, with a high degree of success and without being coached or prompted. Mastery requires having performed the task in a wide variety of patients and situations. o Look over the skills list completely and only sign off on a skill if you feel confident that your technician meets the definition of mastery. o All signed skills must be demonstrated in the case logs. o Assist your technician in acquiring new skills for the application process.

Send your technician to at least one national meeting a year to give them ample exposure to the most current information related to surgery and allow them to accumulate continuing education credits.
On behalf of the Academy of Veterinary Surgical Technicians, I would like to thank you for supporting your technician through the application process. If you have any questions please do not hesitate to contact me at
Hreusslamky@avst-vts.org.
Sincerely,
Heidi Reuss-Lamky, LVT, VTS (Anesthesia, Surgery)
President of the Academy of Veterinary Surgical Technicians

PLEASE INCLUDE A COPY OF THIS CHECKLIST IN YOUR APPLICATION PACKET
YOU MUST PLACE EACH ITEM BELOW IN YOUR APPLICATION PACKET IN
EXACTLY THE FOLLOWING ORDER :
1.
Professional History and Experience Form. (Form 1)
2.
Photocopy of your current in-date license, registration, or certification and photocopy of your diploma (if applicable) from an AVMA approved program.
3.
Case Log of at least 50 cases, but not more than 75. (Form 2) Include the AVST
Abbreviation Page.
4.
Four Case Reports – include the Case Log number.
5.
AVST Advanced Surgical Skills Form. (Form 3)
6.
Waiver, Release and Indemnity Agreement. (Form 4)
7.
Continuing Education Record for each meeting attended. (Form 5) a.
At least 40 hours, but not more than 20 hours from in-house/online. b.
Proof of attendance should follow each meeting page. c.
Providers credential status must be listed for all speakers.
8.
Include three letters 1.) Your letter of intent and 2.) Two letters of recommendation.
One of the letters must be from an ACVS/ECVS diplomate or a VTS member (any academy). The second letter must be from your supervising veterinarian.
9.
Include the $35.00 application fee made out to the AVST. Provide a copy of your
PayPal receipt if you paid the application fee online, or include a check for $35.00 payable to the AVST Treasurer. If enclosing a check as payment, please put it in a separate envelope labeled “AVST PAYMENT” and place it on top of the 5 copies of your application packet.
10.
FIVE (5) copies of your application packet professionally bound or secured in a binder.
Mail all copies of your application packet to:
All applications must be postmarked on or before February 1, 2015.