Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
VetNursing2 Surgical
Final Exam Review - From Preprinted Notes Sutures & Post-op done
| Question | Answer |
|---|---|
| Name four important things to remember about surgical instruments: | Major financial investment. Instruments must be used for their designated purpose. Improper use can damage or destroy them. Improper care can lead to damage, shortened lifespan, or contamination risk. |
| Instrument Components Tips | Easily damaged. Available in straight and curved. |
| Instrument Components Jaws | They have serrations (saw-like) teeth or flat surfaces. Serrations can be horizontal, vertical, or combination. Different arrangement of teeth (1x2, 2x3, etc.) or rows of teeth. Easily damaged. |
| Instrument Components Box lock (joint or hinge) | Ratcheting locking device. On instruments with ring handles. Improper use of these instruments will cause them to be particularly susceptible to damage. An area that absorbs great stress when in use and often the first area to degrade. |
| Instrument Components Shank or Shaft (Body) | Usually longest part of an instrument. Determines overall length. Depending on the length of the shank, instruments can range from 3 to 12 inches. |
| Instrument Components Ratchet | Found only on instruments with ring handle. Purpose is to lock an instrument jaw in a closed position creating a self-retaining grip on: vessels, tissues, suturing needles. Degradation is usually seen as the inability of the ratchet to remain locked. |
| Instrument Components Ring Holders | Control. Thumb and ring finger are placed in the rings. Thumb ring should not advance beyond the first knuckle. Ring on ring finger should not advance beyond the second knuckle. Index finger can rest on the shank to stabilize the instrument. |
| What is the purpose of so many different instruments? | Instruments designed for a specific purpose increase surgery efficiency and quality of work! |
| General goals of instrument use: | Cut tissue. Stop bleeding (crush tissue) or prevent fluid leakage. Handle tissue delicately to maintain normal architecture. Hold tissue in specific positions (visualization). Repair tissue or change anatomy. |
| Name 8 Instrument Categories. | Scissors, Hemostats, Needle Holders, Scalpels, Scalpel Blade Handles, Thumb Forceps, Retractors, Towel Clamps. |
| Scissors Operating Scissors | Operating scissors. Used to cut inanimate objects only, such as drape, suture. Named based on tips: sharp-sharp; sharp-blunt; blunt-blunt. Their design can be straight or curved. |
| Scissors True or False: Scissors should be used only for their intended purpose. | True |
| Scissors Mayo Scissors | Used for cutting large muscle masses, cartilage, non-delicate tissue. Blades are thick & about 1/3 the instrument length. Blades can be straight or curved. |
| Scissors Metzenbaum Scissors | Used for delicate surgical dissection. Blades are thin, delicate. Shaft is long and thin. Blades can be straight or curved. |
| Non-surgical Scissors Lister Bandage Scissors | Used only to cut bandage material. Have one blunt “footed” end to facilitate sliding under a bandage without damaging skin. |
| Non-surgical Scissors Suture Removal Scissors | Hook in one blade to cradle the suture for removal from the external skin. |
| Scissors Wire-Cutting Suture Scissors | Only be used to cut wire sutures! Small serrated teeth. |
| Staple Remover | Device for removing stainless steel staples from external skin. |
| Hemostats | There are many types, but only 5 styles are typically used. As the name implies they are used to aid in controlling hemostasis. Can have tips that are straight or curved. Serrations that are horizontal, vertical, or combination. |
| Hemostats HALSTEAD MOSQUITO FORCEPS | Generally used to clamp small vessels. Small jaws with fine horizontal serrations extending entire length of jaw. Straight and curved tips. |
| Hemostats KELLY HEMOSTATIC FORCEPS | Larger than mosquito forceps. Horizontal serrations are wider. Only extend ½ the length of the jaw. Curved and straight. Used on medium sized vessels or small tissue masses. |
| Hemostats CRILE HEMOSTATIC FORCEPS | Similar to Kelly forceps. Serrations extend entire length of jaw. Resemble large mosquito forceps. Curved and straight. Use on large vessels. |
| Hemostats ROCHESTER-CARMALT FORCEPS | Different from other hemostats. Horizontal and vertical serrations on the jaw near the tip (checkerboard). Multiple male-female groves down length. Large (8” long) Jaw about 3 ½”. Straight or curved. Used to clamp large vessels or large tissue masses. |
| Hemostats Ferguson Angiotribe | Similar to Carmalt Forceps except only has one male-female groove. Used to crush tissues at high risk of bleeding (arteries, uterus). |
| ALLIS TISSUE FORCEPS | Used for grasping tough tissue traumatically or tissue being removed. Claw-like tips. |
| NEEDLE HOLDERS | Only surgical instrument designed with specific intent of holding metal. Only instrument that should be used to hold needles or to place scalpel blades onto scalpel handles. Short jaws with roughened platform in the tips to allow for secure grip. |
| NEEDLE HOLDERS MAYO-HEGAR Needle Holder | Available in a variety of lengths, depending upon procedure and surgeon preference. No cutting blades, suture is cut with operating scissors. |
| NEEDLE HOLDERS OLSEN-HEGAR Needle holders | Scissors built into the jaws. Allows suture to be cut without reaching for a separate instrument. Inexperienced users may inadvertently cut suture material when trying to grasp the needle. |
| SCALPEL BLADE HANDLES #3 | Generally small animal, using blades numbered 10-19. Handles often have units of measurement on them as a reference (ie. size of mass removal). |
| SCALPEL BLADE HANDLES #4 | Handle is generally large animal: using blades numbered 20-29. Handles often have units of measurement on them as a reference (ie. size of mass removal). |
| SCALPEL BLADES #10 | Most common small animal blades used primarily for skin incisions. |
| SCALPEL BLADES #11- | Blade is tapered to a point, “stab” incisions. |
| SCALPEL BLADES #12 | Blade resembles a hook |
| SCALPEL BLADES #15 | Blade is half the size of a No.10 |
| How do you placing & remove blades on scalpel handle? | Blades are carefully slid on and off using a needle holder or blade remover. Always point away and down. Never use fingers! |
| Thumb Tissue Forceps | Used to grasp and retract tissue on a short-term basis. Tips can be toothed (traumatic) or smooth (atraumatic). Never tweezers! |
| DEBAKEY Thumb Forceps | Atraumatic forceps used only on delicate tissue. Tips have no teeth. Ridge or groove design. Designed as cardiovascular forceps. |
| TISSUE THUMB FORCEPS "Rat Tooth Forceps" | Straight shaft. Range in length from 5 to 12 inches. Tips may have 1X2 or 3X4 teeth. |
| RUSSIAN TISSUE FORCEPS | Traumatic, bulky tip. Generally used on skin or tissue that is being removed. |
| ADSON THUMB FORCEPS | Have a very narrow tip that broadens to a side shaft. Holding/manipulating delicate tissue. Have flat atraumatic serrations with no teeth. Used for holding dressing materials during surgery or dressing/packing wounds. |
| ADSON-BROWN Thumb Forceps | Tips have 2 parallel rows of nine shallow teeth. Holding/manipulating delicate tissue. Found in most general surgery packs. |
| RETRACTORS | Instruments used to retract or deflect tissue and other structures away from the surgical field. They can be hand-held requiring sterile team members to hold. Or self-retaining retractors which have a locking ratcheting mechanism to allow hands free. |
| HAND-HELD RETRACTORS Army - Navy Retractor | Double-ended with different lengths of blades on either end. No teeth causing little trauma. A heavy hand can result in pressure damage (if you don’t know your own strength!) |
| HAND-HELD RETRACTORS Senn Retractor | Double-ended, handheld retractor. Narrow, blunt blade on one end & toothed traumatic blade at the other end. The teeth may be sharp or blunt. Primarily used with surface tissue. |
| Self-Retaining RETRACTORS GELPI | Has single traumatic sharp-pointed tips. Useful in orthopedic surgery. |
| Self-Retaining RETRACTORS WEITLANER | Teeth in the jaw that can be blunt or sharp. Most commonly used during orthopedic surgery. It can be used in some soft tissue surgeries. |
| Self-Retaining RETRACTORS Balfour Retractor | Soft tissue surgery. Useful for abdominal procedures. Wide spreading retractor. Provides excellent visualization by keeping abdominal walls in lateral retraction and third blade retracts cranial wall. |
| Snook Hook | Assists surgeons in finding and exteriorizing uterine horn. |
| TOWEL CLAMPS | Used to secure sterile drapes to the patient. Some have a penetrating design: sharp pointed tips that pierce the patient’s skin to hold drape in place. Several kinds are available. Most commonly used are Backhaus. |
| GROOVE DIRECTOR | Designed to aid the “new” surgeon in making incisions on linea alba (the “white line” that is the center attachment of the abdominal muscles) and the visual line for spay incision. |
| Surgical “Sponges” | Gauze squares, called sponges. Included in sterile surgery packs. Quantity should be standardized. Often counted post-surgically so none are ever left in the patient. Often referred to by their size: 2X2,3X3, 4X4. |
| LAPAROTOMY “LAP” SPONGES | These pads are absorbent cloth sponges. Usually packaged separately in case of need. |
| INSTRUMENT STAND-MAYO STAND | Must be thoroughly cleaned. Including the feet, legs, and wheels. The tray itself is usually removable. |
| ORTHOPEDIC INSTRUMENTS Bone Curettes | Used to ‘harvest” bone graft material, shape bony surfaces, scrape away bony/fibrous tissue, or debulk. |
| ORTHOPEDIC INSTRUMENTS Bone Forceps | Designed to hold bone fragments together during fixation procedures. |
| ORTHOPEDIC INSTRUMENTS RONGEURS | French for rodent or "gnawer.” Used to break up bone pieces for grafting purposes. Open a window to access tissue underneath. |
| ORTHOPEDIC INSTRUMENTS GIGLI SAW | Braided wire used to manually cut bone. |
| What is a Laparotomy? | An abdominal operation. A surgical incision into the abdominal cavity, for diagnosis or in preparation for surgery. |
| List the four steps (in order) for cleaning surgical instruments: | Presoaking (cold water), decontaminating, ultrasonic cleaning, sterilization |
| What are four things to remember in regard to presoaking? | Never hold dirty instruments in a dry container instead soak them in distilled water with/without a instrument pre-soak enzyme. Instruments should be unlocked (ratchets/boxlocks). Avoid soaks over 10 minutes in tap water. Rinse with cold, distilled water. |
| What does decontamination of instruments entail? | It is the manual cleaning in a gentle detergent with a soft bristle brush under running water. |
| What do we need to know about the ultrasonic cleaner? | Per manufacturer's instruction, it should contain its particular cleaning solution (changed weekly) diluted with distilled water. It is 16 times more efficient than manual scrubbing (but should not replace it). Removes microscopic debris. Cover. |
| Name some important things to remember when drying instruments. | After rinsing with distilled water, dry on a lint-free cloth covered with a second cloth and pat dry with boxlocks open. Do not air dry to avoid water spots, stains, and rust. |
| When is the best time for instrument inspection and lubrication? How should this be done? | After they have been decontaminated, ran through the ultrasonic cleaner, and thoroughly dried. Verify tips meet, ratchets lock, hinges work smoothly, etc). Remove instruments that are pitted, discolored, rusty, or not functioning correctly. Lubricate. |
| What do the various colors of staining on surgical instruments indicate? | Orange/Brown stains: tap water, cleaning solution, or dried blood. If rust, use eraser test (when pitted remove). Black: acid reaction during autoclaving. Dark brown: dried blood (contamination risk/can chemically damage instrument)-removed |
| Pack Wrapping Wrapping | All instruments should be double wrapped with paper/cloth material specifically designed to wrap instruments. Do not use Huck or hand towels. |
| Pack Wrapping Order of Pack | Larger/heavier instruments should be on the bottom of packs or trays. Lighter more delicate ones should be on top. Place a sterilization strip in the middle of the pack. |
| Pack Wrapping Exterior of the Pack | Sterilization tape is used on the outside. Three important pieces of information should be written on the tape with permanent marker: type of instrument pack, the date, and the initials of the wrapper. |
| Pack Wrapping Sort & Organization | Organize straight instruments biggest to smallest and curved instruments biggest to smallest. If completing a Neuter/Ovariohysterectomy Pack, slide the spay hook through the handles according to pack "recipe." Center on the wrap in "diamond" position. |
| Pack Wrapping Open/Unlocked | All instruments should be open (not locked) inside the pack, so that the steam of the autoclave can penetrate all surfaces. Towel clamps are the exception. |
| Pack Wrapping Surgical Pack "Recipes" | These will vary with specific procedure needs and surgeon preference. General Pack Formula: Surgical instruments of specific procedure, gauze squares +/- laparotomy sponges, sterilization indicator, +/- surgical blade, +/- suture material |
| Pack Wrapping Name three types used in veterinary medicine. | SMS Polypropylene (single use), woven (reusable), paper/plastic pouches (single use). |
| What is one way to fold surgical linens and why is it done that way? | "Accordion" folding is one method of folding surgical linens prior to packing for sterilization. Such folding allows the drape/towel/gown to unfold itself when lifted by the edges. This minimizes risk of contamination after it has been sterilized. |
| Autoclave use | Allow "breathing room" for steam to move around during sterilization. Racks/shelves allow for proper spacing of packs and pouches. The outer layer of the packs should not be wet after the cycle is complete. Store in designated closed cupboard. |
| What could cause surgical packs/pouches to be wet after a completed autoclave cycle has been run? | The drying cycle is inappropriate or packs and pouches were too tightly packed. |
| Paper pouches in the autoclave | Never stack them on top of each other. Place them vertically (rack), or horizontally with the paper layer up so steam can evaporate. |
| Two things to remember when loading the sterilizer: | Allow steam penetration throughout all surfaces-do not pack too tightly, use mesh trays to separate from surfaces. Prevent condensation of water-lie pouches and packs on edge (do not stack horizontally), and dry completely before storing. |
| Expiration Times For Sterile Packs Single-wrap muslin | Closed Cabinet- 1 week Open Cabinet- 2 days |
| Expiration Times For Sterile Packs Double-wrap muslin | Closed Cabinet- 7 weeks Open Cabinet- 3 weeks |
| Expiration Times For Sterile Packs Single-wrap crepe paper | Closed Cabinet- 8 weeks Open Cabinet- 3 weeks |
| Expiration Times For Sterile Packs Single muslin, sealed in polyethylene | Closed Cabinet- Indefinitely Open Cabinet- 9 months |
| Expiration Times For Sterile Packs Heat-sealed plastic-paper pouches | Closed Cabinet- Indefinitely Open Cabinet- 1 year |
| Define sterile: | absence of any living microbes or spores |
| Define Asepsis: | absence of any microbes that cause infection |
| Define Surgical conscience: | Commitment of veterinary team to adhere strictly to aseptic technique. Acknowledge breaches in technique and correct contamination (even if there are no witnesses). |
| Sterile field | Any area (person, table, patient) that has been covered with a sterile barrier (sterile gown, table cover or drape). Area above and around a sterile pack Can’t be entered or touched by a non-scrubbed person. Fluid strike-through breaks sterility. |
| Before “scrubbing in” for surgical assisting remember these six things: | EAT! (Complex carbs and/or protein. Drink water! Pee! Shower. No perfume! (Can make smelling anesthetic leak difficult). Wear clean scrubs with shirt tucked in. (Helps reduce your skin cells from shedding onto Sx site. |
| During surgery - surgical caps & masks are worn by ___ _____ who are in the surgery suite | all people |
| Caps cover the hair to reduce airborne contamination with _____, _____. Caps and masks should be put on before ____-_____ prep. | dander, hair hand washing prep |
| What is most commonly used to cover both long & short hair? | Bouffant caps |
| Hoods are useful for people who have: | beards or sideburns |
| If you have really short hair a ___ may be suitable cover. | cap |
| Why do we wear masks in the surgical suite? | Masks help stop droplets from being spread. Keep splashes & sprays from reaching mouth & nose of person wearing mask. Remember to pinch metal band tightly across nose. |
| Three hygienic things to remember before scrubbing in? | Fingernails need to be short, no artificial nails/nail polish, remove: rings, watches, jewelry |
| SURGICAL HAND SCRUBBING | Treat each finger as having a tip & 4 sides. Scrub each surface of each finger. Scrub palm, back, sides of the hand. |
| SURGICAL ARM SCRUBBING | Imagine the forearm as having 4 sides. Scrub each side! |
| After scrubbing hands & arms (5 minutes), what should you do? | Drop brush. Rinse hands, forearms. Hands are ALWAYS kept above elbows (during and after hand scrub). Let excess H2O drip off elbows. Do not touch faucets with hands to turn off water! |
| TOWEL DRYING Step 1 | With a sterile towel. Dry one hand. Holding towel away from the body. |
| TOWEL DRYING Step 2 | Move the towel down to dry the arm. Use only the top end of towel. |
| TOWEL DRYING Step 3 | The dry hand now grasps the dry end of the towel. |
| TOWEL DRYING Step 4 | The other hand & arm are dried. Note hands do not switch sides of the towel during the process. |
| Hand Rubs | Ethanol based hand sanitizer. Alternative to traditional scrub, may be more effective! Better skin health of personnel, carry less bacti. Chlorhexidene resistance has been reported. Follow manufacturers directions (2 minutes or more). |
| gloving: CLOSED, OPEN & ASSISTED Surgical gloves are ..... | sterile & individually wrapped |
| Sterilized towels, gloves, & gowns need to be opened & readied | before surgical hand scrubbing. |
| Sterilized gloves are always packaged: | palm up |
| CLOSED GLOVING (no skin exposed in process) | Begins with donning of surgical gown. Allows personnel to glove themselves. Maintain distance from sterile glove pack to prevent contamination of gown. Keep fingers inside sleeve of sterile gown at all times!! |
| Once closed gloving is complete, | the gown cuffs should be completely covered by the gloves |
| OPEN GLOVING | Used when hands need to be sterile. But no gown is needed for procedure. One hand is inserted into glove opening. Taking care not to touch outside of glove, cuff only. Folded cuff, so ultimately that will be on skin side. |
| Open Gloving Touch non-sterile to non-sterile | Touch non-sterile to non-sterile. Glove is pulled on by grasping cuff fold with other hand. Cuff is still folded. Glove is on well enough to allow use of hand. |
| Open Gloving Touch sterile to sterile | Touch sterile to sterile. Next… Gloved hand is placed between cuff & palm. To assist gloving other hand. Protects gloved hand from accidentally touching exposed arm. |
| Open gloving Last step | Cuff can now be unfolded. Adjustments can be made to gloved fingers. Touch only the sterile areas of gloves. |
| Assisted gloving Step 1 | Requires an already gloved sterile team member. They need to stretch the cuff of the glove wide open. Palm towards you. Location of the gloves thumb obvious. Assistant can avoid touching your hand by keeping their own thumbs pointed out and away. |
| Assisted gloving Step 2 | As your hand is slipped into the glove. Assistant pulls the cuff of the glove up over the cuff of the sleeve. Repeat procedure for other hand. |
| How do you remove gloves aseptically? | Non-sterile assistant grasps glove and gown cuff together. Without touching the gown sleeve. Glove is pulled off inside out. |
| Assisted gloving preferred method to re-glove | As the glove is removed the gown is pulled over the fingers. The edge of the gown cuff is now considered contaminated. |
| Opening sterile pack pre-scrub for sterile hand towel availability - Step 3 | When opening a pack… Always open the flap away from you first. Keep arm off to side, never directly over the pack. Now open other 3 sides. Touching only the corners of the wrap on outside surface. |
| Opening sterile pack pre-scrub for sterile hand towel availability - Step 2 | Individually packaged sterile gloves can now be opened onto the sterile gown & towel with package positioned at edge of sterile field, it’s opened symmetrically. Gives contents enough forward momentum to fall onto sterile field w/o reaching over. |
| Opening Sterile Pouches | Top of package is peeled open in a “pull apart” motion part (don’t use wrists). A person in sterile gloves can grasp sterile item and remove the rest of the way. Or person opening package can open upside down dropping small item onto sterile field. |
| Maintaining Sterility | Entire surgical team to be aware of sterility. Non-sterile personnel only touch non-sterile items and never reach across/lean over sterile fields. Scrubbed-in staff only touch sterile items/areas and always face sterile field. |
| Never ignore any “break” in sterility because: | it needs to be corrected! |
| Conversation should be | Kept to essential! Less aerosol contamination and reduces distraction of surgeon and assistant. |
| Proper donning of surgical gown: | Lift the folded gown out of the package (don’t let it unfold). Same technique is used when picking up sterile folded towels or patient drapes. Reduces risk of accidental contamination. |
| Gowning Step 1 | Step away from the table. Make sure there’s enough space to gown without touching a surface, risking contamination. Neckline is ID’d & held while armholes are found. Gown is held away from the body by inside shoulder seams & allowed to unfold. |
| Gowning Step 2 | Both arms are advanced into the sleeves, simultaneously. Hands are not allowed to pass all the way through the cuffs. Allows for “closed gloving." |
| Gowning Step 3 | Non-sterile assistant pulls the gown over the shoulders. They must carefully tie the back of the gown at the neck & waist. |
| Gowns are sterile in front: | from the chest to the level of the sterile field |
| Sleeves are sterile from : | 2 inches above elbow to top edge of cuff |
| Neckline, shoulders, and cuff of sleeves may be contaminated by perspiration, so they are considered: | Not sterile |
| Back of gown never considered sterile because: | Can’t be constantly observed |
| Lower portion of gown (below table) is considered: | contaminated |
| Cuffs (inner) of gown are considered contaminated because: | hands have passed through them |
| Classification of Wounds is based on the degree of contamination. Name two contaminants. | Bacteria and other organisms Foreign Material |
| What are the four classification of wounds? | Clean Wound, Clean Contaminated Wound, Contaminated Wound, Infected Wound |
| Explain Clean Wound: | Surgical wounds made under aseptic conditions: antibiotics not indicated. Primary closure (sutures, staples, etc). |
| Explain Clean Contaminated Wound: | Aseptic surgical procedure, contaminated with GI, Urinary, Respiratory tracts. Region is cleaned (lavaged) during sx. Occasionally, wounds are classified as clean contaminated after appropriate, rapid care. Prophylaxis antibiotics given before infection. |
| Explain Contaminated Wounds | Wound with heavy contamination of foreign material; compromised tissue in wound. (Bite wounds, Oral wounds) Antibiotics always indicated. Lavage and debridement are usually indicated. |
| Explain Infected Wound | Inflammation, high bacteria count, purulent exudate, necrotic tissue present. Lavage and debridement always indicated. Antibiotics (ideally culture taken prior) are always indicated. |
| Wound Descriptions Puncture Wounds | Self explanatory: Never closed. |
| Wound Descriptions Lacerations | Tearing of tissue |
| Wound Descriptions Incision | Surgical cut of tissue |
| Wound Descriptions Abrasion | Erosion of tissue surface |
| Wound Descriptions Degloving | Separation of Dermis from subcutaneous tissues. |
| Phases of Wound Healing List the four phases of healing: | Inflammatory phase (6-8 hours), Debridement phase (6 hours - 5 days), Granulation phase-includes the Contraction & Epithelialization Phase (5-10 days), Maturation phase. |
| Describe the Inflammatory Phase of Wound Healing Initial Response to injury | Vasoconstriction followed by vasodilation. (Fibrinogen, Clotting factors, Platelets aggregation), and Inflammatory mediators (Neutrophils & Macrophages) Neutrophils & Macrophages |
| Describe the Debridement Phase of Wound Healing "Clean-up Phase" | Rid the wound of Necrotic tissue & Bacteria through Neutrophils (Protease, elastase, and Oxygen free radicalsj) and Macrophages. |
| Describe the Granulation Phase of Wound Healing Repair Process | (No infection, No necrotic tissue). Fibroblasts (Collagen forms the scar) and Capillaries regrow. Healthy granulation tissue is pink, shiny and bleeds easily. |
| Describe Contraction Phase of Wound Healing Reduction in size of wound | Myofibroblasts (Actin/myosin) |
| Describe Epithelialization Phase of Wound Healing Skin grows back! | Epithelial cells. Proliferation and differentiation. Quality will not be as good as original. Sweat glands and hair follicles are not replaced if damaged. |
| Name five wound factors that affect healing. | Poor blood supply. Edema. Dead space with accumulation of fluid- exudate, hematoma, seroma (this is a culture plate for bacteria!). Infection. Foreign bodies or debris present. |
| Name seven patient factors that effect healing | Geriatric age, Malnutrition (low protein levels), Systemic disease (liver/kidney failure), Endocrinopathy (hypothyroidism, diabetes mellitus, Cushings disease), Obesity, Cancer and its treatments, Self-trauma (licking.chewing sutures or wound site). |
| Wound Management Name the six steps (in order): | Wound evaluation, clipping, cleaning, wound evaluation, closure?, bandaging? |
| Wound Management Clipping | Sterile water soluble lubricant placed in wound. Prevents hair from lodging in wound. Wear gloves!! Prevent nosocomial infections in wound. Clip Wide. |
| Wound Management Flushing | Flush with large amounts sterile saline. Hair removal. Debris removal. 18g needle on 35cc syringe gives ideal flushing pressure. |
| Wound Management To Close or Not to Close..... | Primary closure: closed immediately. Delayed primary closure: closed after 1-3 days. Secondary closure: closed after 5-7 days. Secondary intention healing ( no suturing done) |
| Describe Primary Closure Closed immediately | Minimal contamination. Wound present less than 6 hours. (Golden Period) Minimal tension. Good hemostasis. |
| Describe Delayed Primary Closure Closed after 1-3 days | 3 to 5 days after wound, it is closed. Reasons to Delay: Severe contusion, Severe contamination. Care before closure: Debridement, Bandage. |
| Define Debridement: | Removal of necrotic tissue. |
| What is surgical debridement? | Resection to healthy tissue using scalpel or scissors. |
| What is mechanical debridement? | Adherent Bandage: 4x4. Dry to dry. Wet to dry. Absorbent layer. |
| Why do we use Tie on Bandages? | Difficult area to bandage. No tape. Belt-loop sutures are placed in skin. These remain in place. Bandage is tied to these and changed as needed. “Artificial Skin” Dressings. |
| Why do we use drains and name the two forms. | Placed to prevent fluid from collecting in wounds that are surgically closed. Passive drain: Penrose. Active drain: vacuum present. |
| What is a Penrose Drain? How do we care for them? | Gravity dependent. Exit hole. Suture. Inexpensive. Needs care 2-3x/day. Warm compress. Cleaning of sites. Prevent animal from chewing. Removed after 3-5 days. |
| What is an Active Drain? What are the benefits? | Vacuum present. Efficient, No gravity, Less chance of infection, More difficult to maintain. |
| What is Secondary Intention Healing? | Severe contamination. Severe soft tissue trauma. Can not close without tension. Granulation tissue only. No suturing of skin. |
| Define Dehiscence and name three possible causes: | Necrosis of tissue around suture site: Due to infection, Due to tension on sutures, Due to allergic reaction to suture material |
| How often should bandages be changed to facilitate debridement? | Every day. Once or twice a day. Sponges in dead space. |
| Beneficial Effects of Bandaging a Wound Name five: | Protects from further contamination. Prevents wound desiccation. Prevents hematoma & seroma formation. Immobilizes wound & prevents cellular disruption. Immobilizes bone fragments/ joints to prevent further damage. |
| Beneficial Effects of Bandaging a Wound Name five more: | Minimizes surrounding edema. Absorbs wound exudate & debris. Promotes retention of co2. Creation of acid environment which facilitates o2 dissociation. Keeps wound warm facilitating healing. |
| Basic Bandaging Layers Name the three with brief description: | PRIMARY (1o) - Contact layer. SECONDARY (2o) - Padded layer. TERTIARY (3o) - OUTER OR FINAL LAYER. |
| Basic Bandaging Layers PRIMARY LAYER | Primary layer is in contact with skin or wound. May be adherent or non-adherent. Held in place with roll gauze. |
| Basic Bandaging Layers SECONDARY LAYER: PADDING | Secures contact layer to wound. Provides an absorptive layer. Provides support to an extremity. Can be used to apply pressure to a wound & compress any dead space preventing hemorrhaging. Extra padding indicated over bony points (elbows). |
| Basic Bandaging Layers TERTIARY Layer | Composed of roll gauze 2-3 layers and porous. Adhesive tape or elasticized tape (Vetwrap) cover. Provides protection to the padded 2o layer of outer layer becomes wet… the entire bandage must be changed immediately. |
| STEPS IN BANDAGE PLACEMENT 1. Stirrups | Anchoring tape strips. Placed on distal aspects of the limb. Usually placed medial and lateral aspects (but can be moved if wound). Never place circumferentially! A tongue depressor placed between the strips, prevents adherence to each other. |
| STEPS IN BANDAGE PLACEMENT 2. Primary Layer (if wound) | Nonadherent bandages (Telfa pads) used to cover wound to protect-no additional benefits. Nonadherent/semi-occlusive bandages available. Vaseline impregnated gauze: material allows fluid to absorb in intermediate layer. Keeps wound moist. |
| STEPS IN BANDAGE PLACEMENT 3. LIMB IS WRAPPED IN 2O LAYER of Padding | Should extend above & below at least one joint if fracture (immobilization needed). Always wrap distal to proximal in small animals. Compress tightly with conforming roll gauze (never pull on any material with elastic, simply lay on patient). Unroll neede |
| Moist tissue is: | happy tissue! |
| How to Hold Bandage Material | Correct! Loose end under roll (loose end lies flat on palm). Incorrect: Loose end over roll (roll lies on palm). |
| STEPS IN BANDAGE PLACEMENT Vetwrap, Elasticon or Medical tape. | Water/trauma resistant layer. Do not apply tension in elastic containing material. Lay it on the patient! Overlap 50% the width of previous to minimize constrictive points with all layers. Water-proof Medical tape can be used to secure loose ends/edges. |
| Common Bandages ROBERT JONES | Provides rigid stabilization due to extreme compression of thick cotton secondary layer. Temporarily immobilizes a fractures distal to elbow/stifle. Must extend one joint above and below fracture. Roll Gauze/Vet wrap firmly over cotton layer. |
| Common Bandages MODIFIED ROBERT JONES | A simple padded bandage. Less bulky, used to reduce post-operative swelling of limbs, cover wounds, support muscle injuries. Provides little or no splinting of the limbs. Less padding is used in the 2o layer. Cast padding is used vs roll cotton. |
| Common Bandages DISTAL LIMB SPLINTS | Aluminum, cast material, thermoplastics, light weight wood, Hexalite, casting tape, newspaper. More custom fitted the less risk of pressure sores or fulcrum points. |
| Application of Splints Build Modified Robert Jones bandage with great padding over/around pressure points, then: | Fit splint to patient: spoon splints on caudal limb, all others lateral limb. Padding should extend 1-2” proximal to splint. Reflect stirrups on splint & secure with 3-5 layers of stretch gauze. No “dead space” between padding/splint. Place outer wrap. |
| Common Bandages CASTS: Most commonly used material? | Fiberglass casting tape. |
| Common Bandages CASTS: How to Apply: | Tape stirrups applied then stockinette. 2o layer of casting material applied firmly/not tightly. Can be “clam shelled” by cutting it lengthwise. Reduces compression. Two halves taped together. Stockinette ends & tape stirrups reflected over the cast. |
| Common Bandages CASTS: How to Remove: | “Stryker” saw used to split open. Start on medial or lateral surface. Cut continued under the foot & around caudal ½ of the cast can also be used alone as a custom-fitted splint. |
| Common Bandages Chest & Abdominal Bandages | Applied in the standard 3 layers from cranial to caudal without constriction of chest/abdomen. To control internal abdominal bleeding “belly band” layers applied more firmly. Rolled towel used to reinforce along midline before protective vet wrap. |
| Common Bandages Head Wraps: Indications | Protect wound to pinna or after aural hematoma surgery. Wound to face. |
| Common Bandages Head Wraps: How to apply. | Apply very long stirrups to each edge of pinna-sticky side on concave surface. Place gauze stack between head & pinna. Reflect pinna over gauze stack-over the top of head and around head. Add padding/stockinette securing layers in figure “8.” Hole |
| Common Bandages Tail Wraps | Care for wound in usual manner. Start with stirrup on at least one side and apply a light layer of roll gauze. Pipe wrap can be applied/secured w/layer of roll gauze. Then outer wrap. |
| Common Bandages Tail Wraps: Complications due to inappropriate application. | Bandage too tight (constriction). Bandage too lose (abrasions). Inadequate padding (pressure necrosis). Poor fulcrum points (bone damage). Never start wrap at a joint. |
| Common Bandages Tail Wraps: Complications due to client compliance. | Allowing bandage to get wet. Would tighten. Leaving bandage on for too long (failure to return for planned appt)/(reluctance to return for dressing change-costs.) Overexercise in bandage. Not removing water-proof bags & allowing bandage to breathe. |
| Bandage Monitoring Instructions For Clients Your pet has been sent home with a bandage/splint today. Please keep the bandage: | Dry and clean. If it is wet/dirty outside, please put a baggie around the bottom of the bandage while walking outside. Remove baggie as soon as you get inside. Leaving the baggie on will cause moisture to build up inside and dampen bandage (Paws sweat!). |
| Your pet has been sent home with a bandage/splint today. Keep on leash to: | toilet outside. Otherwise pet should be resting. (No jumping on/off furniture!) (No off-leash time outside) |
| Your pet has been sent home with a bandage/splint today. If the bandage gets wet or: | damaged, please bring your pet in to have the bandage changed. Leaving a wet bandage on can cause chafing and cause bacteria to build up under the bandage. This is painful for your pet, prolongs healing time, and increases your cost. |
| Your pet has been sent home with a bandage/splint today. The bandage should not: | be loose or move from original placement. |
| Your pet has been sent home with a bandage/splint today. Damage to the bandage can: | cause the arm/leg to get twisted in the bandage and cause injury and/or delayed healing. |
| Your pet has been sent home with a bandage/splint today. Check the toes: | twice daily. Please notify us right away if the toes feel cool/cold to the touch. There is an odor or the pet is uncomfortable. Also let us know if there is swelling. You will notice the toes starting to spread apart when there is swelling. |
| Your pet has been sent home with a bandage/splint today. Use an e-collar if: | your pet is chewing at the bandage. May be removed for feeding time only. |
| Your pet has been sent home with a bandage/splint today. Bandages should be changed: | 5-7 days or immediately if wet or damaged. |
| Your pet has been sent home with a bandage/splint today. Please call us if: | you have any questions or concerns at any time! |
| Common Bandages ROBERT JONES: Test by sound. | Protective tape can be used to secure top & bottom. Should feel solid: sound of a ripe melon when thumped. |
| Common Bandages ROBERT JONES are not suitable for | humeral/femoral fractures. |
| Common Bandages DISTAL LIMB SPLINTS: Indicated for temporary immobilization or rarely definitive stabilization of | certain fractures: Distal radius & ulna, carpus, tarsus, metacarpals & metatarsals, phalanges |
| Common Bandages CASTS: Pros | Light weight, extremely rigid, set rapidly, have good ventilation & waterproof |
| Common Bandages CASTS: Indications | Stabilization for certain fractures distal to the elbow or stifle. Used for immobilization of limbs to protect ligament or tendon repairs. |
| Common Bandages CASTS: Must wear: | gloves to apply and work quickly to perfect fit before it sets. Do not open until absolutely ready! |
| Common Bandages CASTS: Unsuitable for: | humeral or femoral fracture |
| Common Bandages CASTS: Primary layer is | Stockinette |
| Common Bandages CASTS: Do not apply if ___ is present. | open wound |
| Common Bandages CAST is applied instead of 3rd layer, uses | minimal padding, & should be monitored weekly |
| Common Bandages CAST remember to apply ___ | Protective vet wrap applied as final step to cast application. |
| Chest & Abdominal Bandages If used as a compression bandage: | It should remain in place 1 to 2 hours, maximum 4. After 1o layer is placed on the wound, padded 2o layer is applied. Apply a gauze 3O layer followed by protective vet wrap. |
| Common Bandages Tail Wraps: Important to remember. | Tail wraps are tricky!!!! They need to be lightweight to stay in place, but function to protect tail from repeated trauma of exuberant wagging! |
| Bandage Complications What are three signs of patient discomfort? | Licking/chewing toes or bandage. Increased lameness. Foul odor from bandage. |
| Needle holders are designed to hold metal. True or False: Needle holders are the only instrument that should be used to place a blade onto the handle & to remove the blade. | True |
| Step one in passing a loaded scalpel handle: Scalpel blade is pointed ___ the assistant, with the cutting edge of the blade facing ___ from the hand. | toward, away |
| Step 2 in properly passing loaded scalpel handle: thumb & index finger should hold the handle w/ the hand in a ___ position. ___ of the hand follows as the handle is passed into the waiting hand of the surgeon. | supinated, pronated |
| Define supinated. | turned or held so that the palm or sole is facing upward or outward. |
| What does pronated mean? | turned or held so that the palm or sole is facing downward or inward. |
| Needle holder is placed ___ into needle curve for secure and controlled handling. | 2/3 |
| Remember the surgeons dominant hand when passing threaded needle and needle holder. RH surgeon = point of needle facing ___, LH surgeon = point of needle facing ___. | left, right |
| Ring-handled instruments should have the ___ ratchet ___ before the instrument is passed. | first, closed |
| Then ring handles should be facing the ___ and the tip of the instrument facing the ___. The box lock should be held between the ___ and ___ finger, with the shaft of the instrument stabilized by the remaining fingers of the delivering hand. | thumb, index |
| Curve-Tip Instrument The curve of the instrument should face the ___ holding the instrument. | |
| Instruments without ring handles Hold the instrument with the tips facing the ___. The other end should be held firmly with ___ and ___ finger while remaining fingers stabilize the instrument. | floor, thumb, index |
| Soaked sponge count can serve as estimate of blood loss. 3x3 square = ___, 4x4 square = ___. | 6 mL, 10 mL |
| Suction is extremely useful in what four types of surgical procedures? | intestinal, abdominal, exploratory, bladder surgery |
| ___ suction tip is attached to a ___ hose, the surgeon hands the other end of the hose to a non-sterile assistant in order to attach it to the suction unit. | sterile |
| Cautery and suction are secured with ___ ___ ___ to the drape approximate to the surgical field. | Allis tissue forceps |
| Equipment Count ___ duty of Sx assistant | 1st |
| Equipment Count How many are present at beginning of procedure must be determined before the ___ ___. | first cut |
| Equipment Count Before the site is closed, a ___ ___ should be done. | 2nd count |
| Most ___ ___ have space to record initial instrument count & instrument/sharps count at closure. | anesthesia logs |
| True or false: the circulating nurse helps the Sx assistant keep track of instruments removed from the sterile field and # of sharps used. | True |
| Sponge count As used, discarded in a dedicated ___ ___ or kick bucket. Should be located off the sterile field or back table. | sponge bowl |
| Always ___ discarded sponges when counting them. | unfold |
| Four Corner Draping The function of draping is to ___ the sterile surgical site from contaminated areas of the patient. | separate |
| The drape should be floated above the patient and placed in the appropriate position. When applying the drapes make sure the sterile drape is in between the surgeon's ___ gown and the ___ (undraped) surgical table. | sterile, unsterile |
| True or false: Don't drag the sterile drape along the patient's contaminated body. Better to place the drapes closer than too far away from the surgical site. | True |
| True or False: The drape should only be adjusted minimally once it has been laid onto the patient. If the drape needs to be adjusted it should only be moved in a direction AWAY from the sterile surgical site and NEVER towards the sterile site. | True |
| Drapes are secured to each other and the patient's skin with ___ ___ ___. | Backaus towel clamps |
| A fenestration is cut into the final drape based on the size of the four quarter drape opening. This is done ___ its placed on the patient. | before. Otherwise, it would be contaminated. |
| Goals of fluid support during surgery. Name three: | Maintain patient blood pressure (#1). Achieve patient ideal homeostasis for fluid, electrolyte, and glucose needs. Maintain emergency IV access. |
| Hypotension Is defined as a MAP (Mean Arterial Pressure) of ___ 60 mm Hg. | less than (<) |
| Four signs of a MAP (Mean Arterial Pressure of <60 mm Hg (Hypotension) are: | Kidney failure. Pancreatitis. Heart arrhythmias. Cognitive dysfunction. |
| Mean Arterial Pressure MAP = ___ systolic + ___ diastolic. MAP of 60 mmHg is considered the minimum needed for organ perfusion. | 1/3, 2/3 |
| What is the most commonly selected fluid therapy during anesthesia? Name two other possibilities. | Isotonic Crystalloid. Lactated Ringers, 0.9% Saline. |
| No additive should be added to fluid therapy solutions during anesthesia (except glucose) because: | During anesthesia, high perfusion rates are used. This could result in dangerous amounts of drugs to be given. |
| Fluid Therapy During Anesthesia What five additives should not be in fluid bags during anesthesia? | Potassium, metoclopramide, vitamin B, antibiotics, insulin |
| Fluid Therapy During Anesthesia Common fluid rate during anesthesia for cats? | 3mL/kg/hr |
| Fluid Therapy During Anesthesia Common fluid rate during anesthesia for dogs? | 5mL/kg/hr |
| Potassium given at rapid IV rate will do what to the heart? | stop it |
| Bolus Sometimes the DVM will order an IV “bolus.” What are five examples? | A volume of fluid or medication to be given rapidly. Usually over a period of less than 20 minutes. These fluids should never have any additives! Could be used to treat shock/hypotension. Specific medication protocol: (dextrose, lidocaine, etc.). |
| IV Fluid Delivery A Macrodrip set usually delivers __ drops/mL, but a Microdrip set almost always delivers __ drops/mL. | 15, 60 |
| Macrodrip tubing is wider so it produces ___ drops. It is the tubing commonly used in routine IV admin. Such infusion of IV fluids should not contain sensitive medication. Macrodrip tubing comes in 3 sizes: _ gtt/mL, _ gtt/mL, and _ gtt/mL. | larger, 10, 15, 20 |
| 10 gtt/mL means: | 10 drops = 1mL gtt is abbreviation for Latin guttae = drops |
| What is the most common cause of IV fluid contamination? | Contamination of the spike when inserting it into the fluid bag. |
| Safety First Flush IV catheter after ___ disconnection of fluids or ___ administration. | every, drug |
| Maintain ___ technique with all catheter and fluid line handling. | aseptic |
| Clean al injection ports with ___ before use. | alcohol |
| Disconnect IV catheters as ___ as possible. | little |
| Monitoring Fluid Therapy Patient should be checked ___ for no evidence of extravasation of fluids at catheter region. Pump is delivering fluids at the correct rate for DVM orders. Respiratory rate is within normal limits /effort. | hourly |
| Monitoring Fluid Therapy Patient should be checked q. ___ hrs for: Evidence of overhydration. Physical exam. Auscult lungs. | 4 |
| Volume Overload Respiratory Signs: Name three: | Wet lung sounds, Tachypnea/dyspnea, Cough |
| Volume Overload Cardiac: Name two: | Tachycardia, Hypertension |
| Volume Overload Body Tissue: Name two: | Weight gain-more than 10% from entry weight, Tissue edema-conjunctiva; limbs, ventrum. |
| Responsibilities of Surgical Techs Name five: | Proficient knowledge of the: surgical procedure, instruments, aseptic/sterile technique and Anticipation of: surgeon's and patient's needs. |
| Responsibilities of the Circulating Nurse Name four: | Setting up and breaking down operating room (OR). Anesthesia monitoring/anesthesia record. Assist the surgeon & scrub nurse. Post-operative care of the patient. |
| Responsibilities of Scrub "Nurse" Name six: | Sterile draping. Maintain orderly surgical field. Organize instrument table. Count sponges & instruments @ beginning of sx & before cavity closure. Pass instruments/supplies to surgeon. Assist surgeon: tissue handling, hemostasis, suction, retraction. |
| Responsibilities of Scrub "Nurse" Name four: | Keep tissue moist throughout procedure. Save/Label all specimens collected during surgery & submit to lab as appropriate. Collect all "sharps" throughout procedure. Initiate surgical report. |
| Feline Neutering What is another name? Define procedure. | Orchiectomy. Surgical removal of the testicles. |
| Feline Neutering Purposes: Name three. | Prevention of reproduction. Behavior modification of male cat. Treatment of disease related to the testicles. |
| Feline Neutering Instrumentation: | laceration pack |
| Feline Neutering Positioning: | Lateral or dorsal recumbency with legs tied forward. |
| Feline Neutering Patient Prep: | Usually scrotum is plucked. |
| Feline Neutering Draping: | Single fenestrated drape. |
| Feline Neutering Procedure: | Scrotal incision. Testicles are exteriorized. Spermatic cord and vessels are knotted or ligated. Cord is transected. Scrotum is left open. |
| Feline Neutering Special Notes: | A "closed" procedure. Peritoneum is not entered. Skin is not closed. Procedure may not be performed in OR. |
| Canine Neutering What is another name? Define procedure: | Orchiectomy. Surgical removal of the testicles. |
| Canine Neutering Purpose: Name three. | Prevention of reproduction. Behavior modification of male dog. Treatment of disease related to the testicles. |
| Canine Neutering Instrumentation: | Soft-tissue pack |
| Canine Neutering Positioning: | Dorsal recumbency with legs tied abducted. |
| Canine Neutering Patient Prep: | Pre-scrotum shave & aseptic prep (scrotum is not shaved). |
| Canine Neutering Draping: | 4-Corner or single fenestrated drape |
| Canine Neutering Procedure: Pre-scrotal incision is made (Open Castration) | Testicles are pushed from the scrotum up into incision. Tunics are incised and spermatic cord and vessels are ligated. 3 clamps are applied and 2 ligatures are placed (one between each set of clamps). Skin is closed in routine 3 layer closure. |
| Canine Neutering Procedure: Pre-scrotal incision is made (Closed Castration) | A faster procedure & peritoneum is not opened. Much greater risk of bleeding due to ligature slippage. |
| Abdominal Procedures Name seven examples: | Ovariohysterectomy, Gastrotomy or Enterotomy, Intestinal resection & anastomisis, Cystotomy, Cesarean section (C-section), Gastric Dilation Volvulus (GDV), Exploratory Laparotomy. |
| Abdominal Procedures Positioning: | Dorsal recumbency with legs tied abducted. |
| Abdominal Procedures Prep: | Ventral abdomen is clipped from xiphoid to pubis (&wide). Urinary bladder is emptied (except cystotomy). Aseptic technique. Four-corner & fenestrated drape. |
| Abdominal Procedures Instruments | Soft-tissue pack or "Spay pack", retractors, suction |
| Ovariohysterectomy Another term? | Spay |
| Ovariohysterectomy Definition: | Surgical removal of ovaries & uterus |
| Ovariohysterectomy Purpose: Name three. | Prevention of reproduction. Behavior modification of female. Treatment of disease related to the ovaries or uterus. |
| Ovariohysterectomy Common questions: List five with answers. | Should my pet have one litter first? NO. Will my pet become obese after surgery? NO. Is my pet too old to be spayed? NO. How old does my pet need to be to be spayed? 6 months Can my pet have a tubal ligation? Mammary tumor & pyometra risk would persist. |
| Ovariohysterectomy Procedure: | Mid-abdominal incision through linea alba caudal to umbilicus. Spay hook captures left uterine horn. Broad ligament is torn to visualize ovary. Ovarian vessels are clamped and ligated. Repeat on right. Uterine body is clamped above cervix and ligated. |
| Ovariohysterectomy Closure | Body wall is closed in 3 layer closure: Linea alba, subcutaneous tissue, subcuticular or skin. |
| Ovariohysterectomy Special Note: | Subcuticular sutures have the advantage of no suture removal later. Subcuticular sutures have the disadvantage of less strength than skin sutures & no follow-up visit. |
| Cesarean Section (C-section) Indications: | Dystocia: uterus exhaustion, oversized fetuses, abnormal fetuses, pelvis canal abnormality. |
| Cesarean Section (C-section) Instrumentation | Soft-tissue pack, suction. Extra hemostats & towels. Extra personnel for neonate care. |
| Cesarean Section (C-section) Procedure | Uterine horns are gently exteriorized & packed with warm sterile NaCl sponges. Uterus is incised & each fetus is gently pushed into opening. Amnion is broken, umbilical cord is clamped & ligated. Fetus is immediately passed out to circulating nurse. |
| Cesarean Section (C-section) Procedure: Special Notes | Care to not let amnion into abdomen is very important. Scrub nurse remains focused on the dam the entire procedure. |
| Cesarean Section (C-section) Closure | After all fetus & placenta are removed, uterus is closed (if OVH will not be performed). Abdomen is lavaged. Routine 3 layer closure, care not to suture mammary glands. |
| Intestinal Resection & Anastomosis Also known as? Define procedure. | R & A. Surgical removal of a section of intestines followed by reestablishment of remaining sections. |
| Intestinal Resection & Anastomosis Purpose: | Removal of necrotic or diseased bowel. |
| Intestinal Resection & Anastomosis Instrumentation: | 2 soft tissue packs, Balfour retractor, Doyen clamps (or assistant fingers), lap sponges. |
| Intestinal Resection & Anastomosis Procedure | Mid-line abdominal incision. Damaged section of bowel located & vascular supply carefully evaluated. Atraumatic clamps are placed on region to be resected & vessels are ligated. |
| Intestinal Resection & Anastomosis Procedure (cont) | Damaged section of intestine is removed. New ends are aligned and carefully sewn together, then careful inspection for leaks is made. Abdomen is lavaged. New instrument pack & new sterile gloves are used to close the abdomen in 3-layer closure. |
| Cystotomy Indication | Removal of uroliths, tumors, anatomic defects |
| Cystotomy Definition | Surgical incision into the urinary bladder |
| Cystotomy Instrumentation | Soft-tissue pack and "bladder spoon" |
| Cystotomy Procedure | Midventral abdominal incision caudal to umbilicus. Urinary bladder isolated w/ saline moistened lap sponges. Stay sutures placed-improved handling. Incision made & bladder suctioned. Stones/tumors removed/cultures collected. |
| Cystotomy Closure | Bladder is closed, stay sutures removed. Routine 3-layer closure of abdomen. |
| Tail Amputation: Docking Legality | Banned in most of Europe, AVMA considers docking purely cosmetic & not recommended. |
| Tail Amputation: Docking True or False: 17 breeds are born with naturally "bobbed" tails. | True |
| Tail Amputation: Docking Potential Complications: name four. | Pain & Stress to neonates. Infection to spinal cord (meningitis). Nerve damage. Abnormal social interactions among dogs. |
| True or False: Tail amputation is occasionally medically necessary for trauma or tumor removal. | True |
| Lavage | Washing out of a body cavity, such as the colon or stomach, with water or a medicated solution. |
| Subcuticular | Beneath the cuticle or epidermis. |
| Exteriorize | To transpose an internal organ to the exterior of the body. |
| Anastomosis | The surgical connection of separate or severed tubular hollow organs to form a continuous channel, as between two parts of the intestine. |
| Resection | removal, as of an organ, by cutting; called also excision. |
| Gastrotomy | incision into the stomach. |
| Laparotomy | incision through the abdominal wall. |
| Ovariohysterectomy | Surgical removal of both ovaries and the uterus. |
| Castration | excision of the gonads |
| Stay suture | temporary surgical sutures which are placed during operation to hold or manipulate the operating area. |
| Ligation | application of a ligature. |
| Necrotic | Dead; referring to death of cells or tissues. |
| Dystocia | period of non-progression of labor |
| Atraumatic | not producing injury or damage. |
| Cystotomy | incision into the urinary bladder |
| Enterotomy | Incision into the intestine. |
| Surgery - Orthopedics Pre-operative care | Fully evaluated for health status. Fully evaluated for all injuries. Stabilized: Treated for shock, pain, life threatening injuries, fractures temporarily immobilized to prevent further injury or pain. |
| Terms to Know Nonelective | a surgical procedure recommended by the veterinarian due to physical exam findings or findings from other diagnostic tests such as x-rays or blood work. |
| Terms to Know Elective | It simply means that the surgery can be scheduled in advance. It may be a surgery you choose to have |
| Terms to Know ACL (Anterior Cruciate Ligament) | One of the key ligaments that help stabilize the knee joint. The ACL connects the femur to the tibia. It's most commonly torn during activities that involve sudden stops and changes in direction. |
| Terms to Know Luxation | dislocation |
| Terms to Know Reducible | capable of being reduced |
| Terms to Know Callus | the bony healing tissue which forms around the ends of broken bone. |
| Terms to Know Non-union | A serious complication of a fracture and may occur when the fracture moves too much, has a poor blood supply or gets infected. |
| Terms to Know Malunion | A clinical term used to indicate that a fracture has healed, but that it has healed in less than an optimal position. This can happen in almost any bone after fracture and occurs for several reasons. |
| Terms to Know Open reduction | where the fracture fragments are exposed surgically by dissecting the tissues. |
| Terms to Know Closed reduction | is the manipulation of the bone fragments without surgical exposure of the fragments. |
| Surgery - Orthopedics Six Considerations for Care Plan | Age of animal. Temperment of animal. Profession of animal. Owner compliance issues. Weight of animal. Cost of care. |
| Fracture Assessment Name five: | Bone involved in fracture. Open vs Closed fracture. Location of fracture on bone. Type of fracture. Reducible vs non-reducible |
| Fracture Assessment Radiographs | (minimum 2 views always) Pre-operative & Post-operative. Center beam over fracture site. Include joint above and below fracture sites in views. Usually sedation/anesthesia needed. Vies through bandages possible, but not ideal. |
| Physiology of Bone Remodeling | Constantly being formed & resorbed. Atrophy of bone occurs when little weight is applied (casts & plates). Excess stress can cause growing bones to stop growing. Excess stress in mature bone causes hypertrophy. Uneven stress causes “bowing” in both. |
| Physiology of Bone Fracture Repair | Normal repair requires bone ends to touch (apposition) and no movement to occur between bone ends (immobilization) until healing is complete. Fracture repair (with immobilization) takes 4-6 weeks in healthy mammal. |
| Steps of Bone Repair Step 1 | Blood clot forms between break. |
| Steps of Bone Repair Step 2 | Granulation tissue (fibroblasts & capillaries) enter blood clot. |
| Steps of Bone Repair Step 3 | Osteoblasts rapidly divide & form callus |
| Steps of Bone Repair Step 4 | Callus bridges fracture & mineralizes |
| Steps of Bone Repair Step 5 | Remodeling returns bone to normal architecture with use. |
| Bone Repair Essentials Name three: | Immobilization, blood supply, sterile environment |
| Bone Repair Essentials Immobilization | Movement between bone fragments prevents callus bridge (non-union) |
| Bone Repair Essentials Blood Supply | If bone fragment has no blood supply healing can not occur (sequestrum). |
| Bone Repair Essentials Sterile Environment | Infection at fracture can prevent healing (non-union). |
| Types of Fractures Simple | Skin unbroken |
| Types of Fractures Open or Compound | Skin broken (high risk for infection) |
| Types of Fractures Comminuted | Splintered or crushed bone |
| Types of Fractures Greenstick | Occurs in young, only one side of the bone is broken |
| Types of Fractures Physeal (Salter) | Occurs in young, fracture at growth plate. |
| Surgical Fracture Repair Internal Fixation | Rigid fixation placed under the skin |
| Surgical Fracture Repair External Fixation | Rigid fixation placed through the skin to the bone (remains on outside of skin). |
| Internal Fixation Name five pieces of hardware. | Screws, pins, plates, wires, interlocking nails. |
| Bone Plates | Variety of shapes and sizes. Designed for use with various screws. Made of titanium. Most stable fixation if adequate screw purchase. |
| Interlocking nails | Long “nail” is driven into intramedullary cavity and held in location by screws. Provides good stabilization. Moderate manipulation of soft tissue. |
| Intramedullary Pin (IM Pin) | Pin driven into intramedullary cavity as open or closed surgerical approach. Not as rigid as other techniques. Pins may migrate. Inexpensive. Easy to perform. |
| Orthopedic Wires | Add stability to other techniques. Poor stability used alone (risk of wire breaking). |
| Orthopedic Wires Kirschner wires | Precut lenghts. Trocar end. |
| Orthopedic Wires Cerclage wire | Can be passed around bone. Can be passed through drilled holes. |
| External Fixatures Name three: | Casts. Kirschner-Ehmer fixation (KE). Ring Fixation. |
| KE Apparatus | Pins are threaded into or through bone. Pins are attached to external bar with nuts, bolts or aluminum rings. Adjustable. Need frequent appointments for monitoring and care of device. Inexpensive (vs. plates). Patient comfort / aesthetic issue. |
| Cruciate Repair | Anterior Cruciate Ligament injury or “football player knee.” Rupture of the CCL (ACL) leads to unstable stifle, pain and arthritis. Injury usually occurs with hyper-extension or severe internal rotation of joint. |
| Anterior Cruciate Repair Intracapsular Repair | Replace ligament with suture, patellar tendon or fascia lata inside joint. Anchored to tibia. |
| Anterior Cruciate Repair Extracapsular Repair | Suture material outside joint replaces function of ligament. Passes thru deep fascia surrounding fabella. Anchored to tibia. |
| Anterior Cruciate Repair TPLO (tibial plateau leveling osteotomy) | Surgical resection of tibia to change stifle mechanics Requires certification. |
| Onychectomy (Declaw) Elective Surgery | To prevent damage to furniture/woodwork due to cat (or dog) scratching (normal behaviors). The AVMA discourages this surgery for behavioral reasons. |
| Onychectomy (Declaw) Encourage Alternatives | Trim nails q. 2 weeks (+/- nail caps). Provide acceptable scratching surfaces. Train animals to acceptable surfaces with rewards. |
| Onychectomy (Declaw) Things to remember if performing this surgery: | Laser surgery is less painful than other techniques. Aggressive pain control is needed. Risk of painful, subcutaneous regrowth if all of bone of 3rd phalanx is not removed. Cats must be kept indoors for animal safety (unable to climb). |
| Suture Material Purposes (3)? | Hold together wound edges until the wound has healed sufficiently to withstand stress. Permanent ligation of vessel. Replace tendon function. |
| Suture Material Ideal Material will (5) | Hold knots well. Cause minimal inflammatory response. Does not allow micro-organism growth or lith formation. Maintains tensile strength for needed time period. Inexpensive. |
| Suture Material Classification Name three: | Origin, Absorbability, Structure |
| Suture Material Classification Origin: | Natural, Synthetic, Metallic |
| Suture Material Classification Absorbability: | Absorbable or Non-Absorbable |
| Suture Material Classification Structure | Monofilament or Multifilament: Braided/Twisted |
| Suture Material Classification: Origin Natural | Silk, linen, catgut |
| Suture Material Classification: Origin Synthetic polymer | polypropylene, polyester, polyamide, nylon, polyglactin 910 |
| Suture Material Classification: Origin Metallic | stainless steel |
| Suture Material Classification: Origin: Natural Attributes and Examples: | Biologic origin. Cause intense inflammatory reaction. Examples: "catgut:" purified collagen fibers from intestine of healthy sheep or cows. Chromic: coated "catgut." Silk. |
| Suture Material Classification: Origin: Sythetic Attributes and Examples | Synthetic polymers. Do not cause intense inflammatory reaction. Examples: Vicryl, Monocryl, PDS, Prolene, Nylon. |
| Suture Material Classification: Absorbability Absorbable: | catgut, polydioxanone, polyglycolic acid. Used for deep tissues, membranes, & subcuticular skin closure. |
| Suture Material Classification: Absorbability Non-Absorbable: | Polyester, nylon, stainless steel. Used for skin (removed). Some deep structures: tendons, vessels, nerve repair (not removed). |
| Suture Material Classification: Absorbability Absorbable: Attributes & Examples | Degraded and eventually eliminated in one of two ways: via inflammatory reaction utilizing tissue enzymes or via hydrolysis. Examples: "catgut," chromic, Vicryl, Monocryl, PDS. |
| Suture Material Classification: Absorbability Non-Absorbable: Attributes & Examples | Not degraded, permanent. Examples: Prolene, Nylon, Stainless steel, Silk: not a truly permanent material. Known to be broken down over a prolonged period of time--years. |
| Suture Material Classification: Structure Monofilament: | Polyproylene (N), Polydioxanone (A), Nylon (N) |
| Suture Material Classification: Structure Multifilament | Catgut (twisted)(A), Polyester (N), Silk (Braided)(A) |
| Suture Material Classification: Structure Monofilament: Attributes & Examples | Grossly appears single stranded, fibers run parallel, minimal tissue trauma, resists microorganisms. Ties smoothly. Requires more knots than multifilament suture. Possesses memory. Examples: Monocryl, PDS, Prolene, Nylon |
| Suture Material Classification: Structure Multifilament: Attributes & Examples | Fibers are twisted or braided together. Greater resistance in tissue. Provides good handling and ease of tying. Fewer knots required. Examples: Vicryl (braided), Chromic (twisted), Silk (braided) |
| Suture Material Classification: Absorbability Absorbable: "Catgut" | Proteolytic enzymes. Degrades in days. |
| Suture Material Classification: Absorbability Absorbable: Vicryl & Monocryl | Hydrolysis. Degrades in weeks to months. |
| Suture Material Classification: Absorbability Absorbable: PDS | Hydrolysis. Degrades in months. |
| Suture Material: Size | Sized according to diameter with “0” as reference size. Numbers alone indicate progressively larger sutures (“1”, “2”, etc). Numbers followed by a “0” indicate progressively smaller sutures (“2-0”, “4-0”, etc). |
| Suture Material So what type should I use? Interrupted/Exposed skin: | Nylon & Polyprolene. Dog skin 2-0 or 3-0. Cat skin usually 3-0. |
| Suture Material So what type should I use? Buried or Subcuticular: | May use either nonabsorbable, or absorbable materials. |
| Needles How are they classified? | According to shape and type of point. Curved or straight (Keith needle). Taper point, cutting, or reverse cutting. |
| Surgical Needles Curvature | Most common, general use in all tissues: 3/8 & 1/2. Other choices: 1/4, 5/8, J-shaped, S-shaped. |
| Needles Curved | Designed to be held with a needle holder. Used for most suturing. |
| Needles Straight | Often hand held. Used to secure percutaneously placed devices (e.g. central and arterial lines). |
| Percutaneous definition | Through the skin. |
| Needles Taper-point | Round body. Used to suture soft tissue, excluding the skin. Examples: GI tract, muscle, fascia, peritoneum. |
| Needles Cutting needle | Triangular body. Sharp edge toward inner circumference. Used to suture skin or tough tissue. |
| Needles Reverse Cutting needle | Cutting surface is on outer edge (less trauma). |
| Needle Attachment End Eye | Single or French or Spring |
| Needle Attachment End Swaged or Eyeless | Suture is built into needle by manufacturer. Less tissue drag. More $. |
| Suture Packaging Single-Use | Sterile by gamma radiation. Expiration date on box or package. Resterilization must be by ethylene oxide gas. |
| Suture Packaging Cassette | Inexpensive. Higher risk for contamination and knotting. |
| Other Closing Options Staples: Preloaded into staplers designed for specific use. | External Staples: Stainless steel. Require special staple remover. Internal Staples: Stainless steel. Will place an entire row of staples at once for specialized needs. Lung lobe removal. Liver lobe removal. Intestinal anastomosis. $$$ |
| Other Closing Options Tissue Glue | Cyanoacralate. Can be used in place of 5-0 sutures in wounds smaller than 3cm. Can be used in addition to skin suture. Stings! Needs anesthetic or anesthesia. Tissue edges need to be dry for adhesion. |
| Other Closing Options Artifical Skin (Tegaderm) | Used in addition to sutures to maintain sterility. Spinal cord surgery. Works well in birds and reptiles. Limited use in dogs and cats. Open wound management. Change q 3 days. $$ |
| Suture Patterns Name two categories: | Interrupted & Continuous |
| Suture Patterns Interrupted | A knot is tied after each tissue apposition. Very strong. Time consuming. |
| Suture Patterns Continuous | A knot is tied at beginning and end of line. Rapid, but if knot opens or suture snaps, entire line will open up. |
| Simple Sutures Simple interrupted stitch | Single stitches, individually knotted (keep all knots on one side of wound). Used for uncomplicated laceration repair and wound closure. |
| Simple Sutures Simple continuous | Suture line is perpendicular to incision on surface. Diagonal on dermal side to start next stitch. |
| Knots Instrument ties: | Knots can be tied with instruments or by hand depending on the need, but these ties are faster, less wasted suture material, and firmer knots. |
| Needle Holder How do we hold them? | Thumb and ring finger into needle holder's rings, not your middle finger. |
| Needle Holder What finger stabilizes the instrument by resting on the shaft? | Index finger |
| Needle Holder Where do we grasp the curved needle? Name three parts to the curved surgical needle. | 2/3s of the way back from the point. Point, Body (shaft), Swaged end |
| Cutting Skin Sutures Things to remember when assisting the surgeon: | Leave 3-4 mm tail (amount of suture left above knot). It is left to prevent loosening or undoing of sutures. Always ask the surgeon the desired length tail before cutting. |
| Cutting Deep Sutures Thing to remember when assisting the surgeon. | Buried sutures are left within the body. Cut the suture on the knot, leaving no tail behind. REMEMBER: Always ask the surgeon the desired length of suture tail before cutting!! |
| Forceps How to grasp and use them: | Grasp forceps between thumb & middle finger, while index finger is used for stabilization. If possible, use forceps to grasp dermis, rather than epidermis or skin surface itself. This helps prevent marking & injuring of skin at wound edge. |
| Tying Sutures Important things to remember: | Tightly tied sutures can cause ischaemia & wound edge necrosis. Gentle but firm knots & minimal wound tension will minimize these factors. Remember, keep skin edges everted, NOT inverted. |
| Tying Sutures Braided Material | With material such as Silk, a 3rd throw (replicating the first) would be placed to secure the knot. |
| Tying Sutures Monofilament Material | If slippery material such as nylon are being used, one should place five to six throws of alternating construction in order to minimize knot slippage. |
| Sutures When can they be removed? | In veterinary medicine (mammals), suture removal is generally in 10-14 days. Low tension wounds can be removed in 7 days. If delayed wound healing (patient on chemotherapy) (21-28 days). Evaluate incision for healing carefully before removing. |
| Suturing "Cheat" For quick securing of a device to skin: nasal oxygen, feeding tube, indwelling urinary catheter: | A tape “butterfly” is placed on device, a 20g needle is threaded through skin and tape, suture material is run backward through needle and secured with hand or instrument tie. |
| Anesthesia Recovery Period Define. Name three possible anesthesia complications | Period from cessation of anesthesia to normalization of vital signs and consciousness. Hypothermia, Prolonged recovery. Emergence Delirium (vs. Pain) |
| Complication Related to Surgery Name four: | Hemorrhage. Seroma. Dehiscence. Self-trauma. |
| Complication Related to Surgery Hypothermia: Causes | Loss of thermoregulation due to anesthetic agents, central action, loss of shivering, cold oxygen, hypotension, IV fluids, shave and surgical prep, open abdomen, abdominal lavage with room temp fluids |
| Complication Related to Surgery Hypothermia: Consequences | Prolonged recovery, increased infection rates, delayed wound healing, coagulation disorders, patient discomfort. |
| Complication Related to Surgery Hypothermia: Prevention/Treatment | Minimize wetting of patient, water blanket or Bair hugger (not electric pad), hot water bottles or bean bags, hot towels from dryer, IV line warmer, ventilation warmer, warm lavage fluids, socks, blankets, bubble wrap or jacket. |
| Complication Related to Surgery Delirium: | Post-anesthesia excitement phase. Easily confused with or compounded by patient pain. Exaggerated, uncontrolled movements. Vocalizing. Hyper-response to noise or light. Risk for self-trauma. |
| Complication Related to Surgery Delirium: Treatment | Hold or “papoose” animal until event passes. Medication. Reversal agents. Sedatives (valium). Increased analgesia. Protect from self-trauma. Helmets. Padded recovery area. |
| Complication Related to Surgery Prolonged Recovery: Causes | Excessive anesthesia. Hypotension. Hypoglycemia. Hypothermia. Patient disease (abnormal drug metabolism): brain disease, liver disease, renal disease. |
| Complication Related to Surgery Prolonged Recovery: Treatment | Physical stimulation, Ventilation, Fluid support, Reversal agents, Warming measures, IV dextrose (diluted) if hypoglycemic. |
| Complication Related to Surgery Hemorrhage: Incision check | Routinely inspected for evidence of bleeding, q 4hr |
| Complication Related to Surgery Hemorrhage: Confirmed | Direct pressure (5 min) or apply bandage, clean after bleeding stops (blood is a culture medium) then determine if hemorrhage is significant: PCV may not drop for 4-6 hours, HR, RR, pulse quality, Ultrasound, Abdominocentesis, Assess clotting status, |
| Complication Related to Surgery Hematoma: What is it? Complications? | Blood collecting under the skin. At risk for discomfort, infection, delayed healing, unhappy client |
| Complication Related to Surgery Hematoma: Treatment? | Warm, moist compresses TID. Prevent self-trauma. Occasionally drained and then pressure wrapped or sutured (ie aural hematoma). |
| Complication Related to Surgery Seroma: | Collection of serum in a pocket under the skin. Usually associated with excess dead space or self-trauma (scratching). Drainage usually not helpful, will return. Warm, moist compresses TID will help resolve. |
| Penrose Drain What are they? | Gravity dependent drain. Exit hole must be ventral. Needs care 2-3x/day. Warm, moist compress 5 min. Cleaning of sites to encourage drainage. Prevent animal from chewing. Removed after 3-5 days. |
| Complication Related to Surgery Dehiscence | Necrosis of tissue around suture site. Due to: infection, tension on sutures, allergic reaction to suture material. |
| Bandage Care Five things to remember: | Bandages, splints and casts must be kept clean & dry. Wet bandages can lead to skin infections, necrosis or sepsis. Bandages must be allowed to “breathe.” Plastic covers for a few minutes at a time. Bandages should be evaluated QID, toes checked. |
| Complication Related to Surgery Self-Trauma | Self-trauma must be prevented. First, ask why? And Correct any problems! Pain? Poor perfusion? Proper application of bandages. Elizabethan and Buster collars (Sell the collar!) T-shirts, boxer shorts. Detracting sprays/creams (Bitter Apple). |
| Client Education: Home care & Monitoring Post-op Discharge Appointment | In a quiet room-not lobby/parking lot. Don't have pet in room, but tell owner the pet will be brought in when instructions are complete. Give owner handout and a pen ! (so that they can take notes). Carefully point out important points on handout. |
| Client Education: Home care & Monitoring Post-op Discharge Instructions | Give demonstrations on live animal/show videos: Med admin, Wound/Drain care, Elizabethan Collars use. Make recheck appts w/ client before they leave when possible. “Custom fit” written instructions for specific pet (include pet name and recheck appt). |
| General Post-anesthesia Instructions | Meds due & how to give. Confine to safe area: pet can’t fall down stairs, slip on floors, become cold. Limit bathroom breaks: leash walks first 7 days. First meal: ½ normal amount. Incisions checked 3x /day: Swelling, Discharge, bleeding, Missing Sutures |
| General Post-anesthesia Instructions Side effects to watch for: | Vomiting/diarrhea, Anorexia, Whining/ signs of discomfort, Lethargy, Shivering |
| Elizabethan Collars | DO NOT call them “The Cone of Shame!” Doesn’t seem caring/respectful of patient. Makes owner feel guilty for seeking care. Encourages owner to be non-compliant with use. Emphasize constant use…but monitor carefully that pet is able to eat/drink OK. |
| Follow-up Monitoring | Encourage owner to call w/ questions/if they need to return for demonstration (i.e. giving pills). Make recheck appointments before they leave. Call them 1-2 days to check-in. Shows team cares! Catches problems early. |
Created by:
Raevyn1
Popular Veterinary sets