Technicians and cystocentesis: A closer look at veterinary supervision

Highly trained and experienced team members with the proper credentials can handle delicate procedures as well as-or better than-their bosses. So why do veterinarians have to be involved at all?

Photo: Shutterstock/StokketeCystocentesis, or collecting a sample for urinalysis by inserting a needle through the abdominal wall into the bladder, is the gold-standard procedure for obtaining a diagnostic urine sample. Technicians perform cystocentesis on a routine basis, either under direct or indirect veterinary supervision, depending on the state where they practice. 

To perform something as delicate as cystocentesis takes time, skill and lots of training. And credentialed technicians have training in spades-they've graduated from a veterinary technology program, passed the Veterinary Technician National Exam and are required to obtain continuing education to maintain their licenses. Many of them are better at these kinds of procedures than the veterinarians they work with.

So why do state veterinary boards require a veterinarian to be involved? Wouldn't it be more efficient (and even empowering) to let technicians handle cystocentesis-and catheterization, and endotracheal intubation, and anesthesia induction, and all the other seriously tricky procedures that go on every day in a veterinary hospital-outright so that doctors can focus on the things only doctors can do?

Maybe so, but the greater issue at stake is liability, experts say. “There are a couple of serious complications for a cystocentesis going wrong,” says Kenichiro Yagi, BS, RVT, VTS (ECC, SAIM), ICU and blood bank manager at Adobe Animal Hospital in Los Altos, California. “One would be bladder laceration and subsequent uroabdomen, and the other would be accidental laceration to the descending aorta and hemorrhaging.”

Technicians aren't necessarily more likely to experience these complications than a doctor (remember all that training and experience?), but they are less well-positioned to deal with liability if something does go wrong. And most state boards would prefer that risk to remain in the hands of doctors, who have an even more stringent level of licensing and scrutiny than technicians-along with malpractice insurance.

On a practical level, client perception is also a factor. “If something were to go wrong, how would a client react?” asks Jim Kramer, DVM, CVPM, partner at Columbus Animal Hospital in Columbus, Nebraska. “If a doctor were to encounter a bad result, the client may be more forgiving than if the client believed the doctor to be ‘too busy' or ‘too self-absorbed' to perform the task him- or herself instead of delegating it.”

Defining supervision

Knowing the differences between immediate, direct and indirect supervision can be tricky. Here's how the Georgia Veterinary Medical Association defines these terms, although details vary from state to state. Get familiar with your own state's practice act if you're unsure.

Immediate supervision: The licensed veterinarian is in audible and visual range of the animal patient and the person treating the animal.

Direct supervision: The licensed veterinarian is on the premises and is quickly and easily available. This also means the patient has been examined by a veterinarian in accordance with a specific delegated task.

Indirect supervision: This means the licensed veterinarian is not on the premises but has given either written or oral instructions for the treatment of the patient and the animal has been examined by a licensed veterinarian.

The state of Nebraska, where Kramer practices, specifies that technicians may perform cystocentesis with indirect veterinary supervision, according to the AVMA's list of veterinary technician and assistant duties. Kramer's malpractice insurance specifies that a technician would be covered in the event of a lawsuit or complaint as long as he or she was a licensed graduate of an AVMA-accredited veterinary technician program. In California, where Yagi is based, cystocentesis is not specifically mentioned in the practice act, so it falls under the skills that can be performed with indirect supervision if a veterinarian orders it.

Rebecca Rose, CVT, founder of Catalyst Veterinary Practice Consultants in Littleton, Colorado, is a frequent speaker on issues affecting veterinary technicians. “Within a veterinary hospital, the veterinarian will ultimately be responsible for how a case is managed and how a veterinary technician is leveraged,” she says. “If the vet is confident that the technician can correctly perform cystocentesis, they should be able to.” Which speaks to why most state practice acts leave tasks such as cystocentesis as “unspecified.”

“The question for veterinarians is, do you trust your technician?” Rose says. “Deciding who on the team does what is a management decision, but in the end it all comes back to who is trusted and who is trained.”

Speaking of training, all the experts interviewed here echoed the same line of thought: Training needs to be ongoing, it needs to involve the whole veterinary team, and it needs to involve all aspects of the state practice act.

“State practice acts have less to do with things like cystocentesis and more to do with keeping veterinary work under the aegis and purview of veterinarians,” says Bash Halow, BA, CVPM, LVT, partner and veterinary practice consultant at Halow Tassava Consulting in New York City. “Practice acts ensure that animal medicine is undertaken correctly, ethically, effectively and humanely.”

As a prior administrator for the Technician Association of Colorado, Rose makes it a point to get the word out about the importance of state practice acts. “We encourage veterinary technicians to attend state board meetings as observers,” she says. “This helps them understand what it means to be governed by a practice act. They get the information in school but don't realize how pertinent it is to their jobs.”

The veterinarian's job is not only to also know the state practice act inside and out but also to trust her team and recognize that each member has an important role to play. “Training, overseeing veterinary technician programs and helping to create these skills contributes to the growth of the whole team,” Rose says. “This goes for any sort of training in the hospital.”