Veterinary Surgical Nursing

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Veterinary Surgical Nursing

• SKIN PREPARATION

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Intro

1. Define Potential Incision Site/s
2. Clipping
3. Cleaning with detergent antispetic
4. Initial non-detergent antiseptic
5. Transport to theatre
6. Final non-detergent antiseptic

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Abdominal Incisions

• Midline
• Beside midline (paramedian)
• rarely used
• Beside rib cage (paracostal
• for kidney liver Sx
• Beside prepuce (paraprepucial)
• males only

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Landmarks

• Sternum
• Manubrium cranially
• Xiphoid caudally
• Umbilicus
• Midpoint of pubic bone (pubic symphysis)
• Rib arch (costal arch)

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Abdominal Incisions

• On Midline
• Beside midline (paramedian)
• Beside rib arch (paracostal)
• Beside prepuce (paraprepucial)

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Abdominal Incisions
paracostal
paraprepucial
paramedian
midline
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Desexing

• Also called neutering
• Male desexing
• Castration
• Orchiectomy
• Gelding (horses)
• Female desexing
• Spay (or spey)
• Ovariohysterectomy (OHE)

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Cat Spay

• Centered1/2 way downfromumbilicus
• Cervix hardest to reach

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Dog Spay

• Centred1/3 way downfrom umbilicus
• Ovaries hardest to reach

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When to clip?

• Before anaesthesia (within 12 hrs)
• Slower
• Requires more people
• Difficult if animal uncooperative
• Reduces time under GA (Caesarians!)
• Hair can fall off coat
• During anaesthesia
• Quicker
• Less people required
• Good for uncooperative animals
• Increases time under GA
• Hair not allowed to fall off coat

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How much to clip?

• Ask the surgeon
• Varies, 2-10 cm around expected incision (on all
  sides)
• Keep it neat (for the owner)

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How to clip

1. Use 40 clipper blade
2. First in same direction as hair growth
3. Then in opposite direction
4. May use lubricants/coolants
5. Done outside surgery
6. Vacuum hair

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Clipping Open Wounds

• Apply Sterile Lubricant (e.g. K-Y) into wound and
  onto surrounding hair
• it will wipe rinse out well
• Clip an outside ring first
• Then clip towards the wound
• Finally clip wound margins last
• Rinse wound with sterile saline

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Open Wounds

• Never allow antiseptic into wound
• Unless specially diluted
• That includes alcohol

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Other clips

• Cat castrations may be plucked of hair rather
  than clipped
• General abdominal surgery clip from several cm
  cranial to xiphoid to several cm caudal to pubis,
  lateral to nipples
• Orthopaedic clip is usually right around the
  whole limb onto body and foot
• Trim long hairs that might later fall onto wound

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Care of clippers

• Use only sharp, clean blades
• Blunt blades and broken teeth cause clipper rash
  and grazes
• Clean only with commercially prepared solutions.
• Clean before storage
• Clean between cases
• Use a new blade when blade hot

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Antiseptics Detergents

• The 2 common antiseptics, chlorhexidine and
  povidone-iodine, each come in 2 versions
• Scrub
• Solution

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Antiseptics

• scrub - with detergent , then
• solution - without detergent

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Skin Prep antiseptics

• Initial preps are with water detergent
• To help clean skin
• Final preps are without detergent
• To ensure correct concentration of antiseptic

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Basic Skin prep

1. Antiseptic Scrub
2. Antiseptic Solution

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How do antiseptics differ?

• If using povidone iodine 10
• Never rinse off
• Needs prolonged contact
• If chlorhexidine gluconate 4
• Binds to surface (keratin) layer of skin
• So does not lose effectiveness when rinsed with
  saline or alcohol

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Antiseptics in wounds m mem.

• Never use detergent version
• Dilute
• Povidone iodine 10
• Dilute 10 soln 1/10 to give 1.0 soln for wounds
• Chlorhexidine diacetate 2
• Dilute 1/40 with sterile water to give 0.05 soln
• Saline would cause crystals to form
• In oral cavity 1 (1/20) may be used

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Steps of Skin Prep

• Wash hands
• Clean with a detergent antiseptic
• /- alcohol applied by some vets
• Apply a non-detergent antiseptic
• Transport to theatre
• Re-apply non-detergent antiseptic

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Wash hands

• Wash hands, either
• Soap and water, or
• Surgeons scrub antiseptic
• May then either
• Put on gloves, or
• Use sponge forceps

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Clean with detergent antiseptic

• Use water-moistened cotton wool
• Aseptic Prep technique
• Spiral from centre outwards
• Discard cotton wool once reached periphery
• Never return cotton wool back to centre
• Continue until no more soiling of cotton wool
• Do not scrub too vigorously
• Inflames skin

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Aseptic Prep technique
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Aseptic Prep technique

• Spiral outwards
• Never back from out to in

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Apply non-detergent antiseptic

• Again use Sterile Prep technique
• Use non-detergent antiseptic
• Use dry sterile gauze swabs
• They do not leave behind tags of cotton the way
  cotton wool does

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Transport to theatre

• Remove excess antiseptic
• If povidone iodine was used, mop up with
  sterile gauze swab
• If chlorhexidine was used, mop up or rinse with
  saline

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Reapply non-detergent antiseptic

• Can use pump-spray bottle, or
• Paint on

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Variations

• There is no one correct method
• May use alcohol between detergent scrub and
  non-detergent solution
• Each hospital will have its own protocol
• May repeat some steps

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Special prep areas

• Mouth
• Ear
• Eye
• Prepuce
• Vulva
• Foot

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Oral Cavity Prep

• Can only reduce bacteria a little
• Sponge mucosa and teeth with dilute non-detergent
  chlorhexidine
• 0.10 to 0.05, i.e. 1/20 to 1/40 of normal
  solution
• Might perform a dental prophylaxis if appropriate
• Might be given a single dose of antibiotic at
  induction

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Ear Prep

• Clip
• Generally clip both sides of ear flap (pinna)
• If ear canal surgery clip side of face also
• Antiseptics - ask surgeon
• Usual skin prep on ear flaps but may need to plug
  the ear canals
• Use of antiseptics in ear canal may depend on
  whether ear drum (tympanic membrane) is open or
  not

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Eye Prep

• Eyelid clipping
• Apply sterile lubricant on and around eye (eg
  K-Y)
• Ask surgeon about margins
• Eyelid antiseptics
• Rinse conjunctival recesses with warm sterile
  saline
• Ask surgeon about antiseptics/ topical
  antibiotics
• Non-detergent povidone iodine diluted to 0.1-0.2
  (i.e. 1/50-1/100) may be used in prep for
  intraocular Sx
• Chlorhexidine not used in eyes even when diluted

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Prepucial Prep

• Syringe irrigation of prepuce with dilute
  non-detergent antiseptic
• As for mucous membranes open wounds

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Foot Prep

• Difficult to achieve asepsis in pads and under
  nails
• Clip nails
• Consider soaking whole foot in antiseptic for
  several minutes
• Hold foot by placing a towel clamp into a long
  toenail

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The End
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