Veterinary dental nursing procedures

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Veterinary dental nursing procedures

• SAFETY, ANESTHESIA, POSITIONING

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Usual GA precautions

• Appropriate monitoring equipment
• IV catheter and fluids as required

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Contaminated Surgery

• Veterinarians should in general avoid performing
  dirty dentals on an individual animal at the
  same time as major sterile surgery
• Bacteria entering the blood stream during dental
  work can lodge in the blood clots of the major
  surgery site.

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Safety Considerations

• Patient safety
• Operator safety

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Patient Safety

• Head movement gt endotracheal tube induced
  tracheal trauma if tracheal trauma
• subcutaneous emphysema if tracheal air escapes
  
• tracheal stricture can appear days or weeks
  later.
• Head movement gt tube twisting and kinking
• Head tilted up gt fluids, blood, blood clots,
  calculus easily enter trachea.
• Cuffed tube gt distal cuff still permits fluid to
  enter proximal trachea.
• Wet face, cold table/grill gt greater heat loss
  and hypothermia
• Wet ET tube tie gt loosens and falls out easily

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Use Cuffed ET tube

• Just enough to occlude air leakage

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Good grip on ET tube

• Ensure good grip on tube tie might use
• Rubber elastic band (not too tight on face)
• Drip tubing (not too tight on face or tube)

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Good grip on ET tube
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Disconnect Tube

• When turning or moving animal

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Dont turn over the back

• Turn under belly
• with legs kept underneath
• reduces chance of fluid entering trachea

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Slight incline for trachea

• Tilt table, or
• Use padding (eg bubble wrap)
• More under shoulders, less under neck
• Just think of airway position!

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Patient Positioning

• Options
• Dorsal
• Lateral

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Dorsal Recumbency
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Lateral Recumbency
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Place absorbent wad in pharynx

• eg swabs, throat pads
• Past hump of tongue
• REMEMBER TO REMOVE when finished
• have a reminder check system eg a marker on the
  ET tube when swab placed

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Pharyngeal Packing

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Ocular lubricant

• To protect eyes from aerosol
• Artificial tears
• Lacrilube

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Care with Mouth Prop

• Is used to protect operator and improve
  visibility
• But not too wide!

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Warmth

• Consider
• Heating mat
• Bubble wrap
• Warm water bottles
• Some methods need care as may have risks of
  either scalding and/or electrocution

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Head on a grill

• To keep body and face drier

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Monitor Temperature

• Usually rectal temp measured

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Recovery

• Place in lateral or sternal recumbency with the
  head and neck extended, preferably head below
  thorax
• Monitor temp, pulse, respiration, consciousness
  until able to maintain sternal recumbency
• Keep orifices clear, clean and dry
• Remove pharyngeal swabs
• Remove endotracheal tube at appropriate time
• Analgesics as indicated
• Report recovery problems
• Final grooming before discharge

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Operator Safety
What operator safety precautions shown here?
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Risk of being bitten

• Especially under light GA
• Use a mouth prop

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Eye protection .

• Risks
• Calculus flicked into eyes
• Aerosol in eyes (possible conjunctivitis)
• Protection
• Full head visor
• Goggles or glasses

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Pneumonia

• Large numbers of bacteria in aerosolised water
  droplets
• These small droplets float deep into lungs
• Possible bacterial pneumonia
• Use face mask
• Quality type, well fitted
• But discard after use

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General contamination

• Build up of debris on the skin or under the
  fingernails
• Moisture contaminates clothing (hospital hygiene)

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Posture

• Often a lengthy procedure in fixed posture
• Use adjustable stool

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Sharps

• Discard of scalpel blades, needles, old burs into
  sharps container
• Care with handling sharp instruments

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Anaesthetic gases

• Usual scavenging systems
• Good fittings required if patient movement

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Electrocution

• Electric heating mats
• Faulty electric dental equipment

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Other protection

• Gloves
• Cap
• Apron - waterproof

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The End