Patient Clip & Prep

What is a vet techs role in preparation of the patient prior to surgery?

Clipping

Prepping

Positioning

What is the primary goal of prep before surgery?

to minimize patient exposure to bacteria

better surgical outcomes

fewer complications

Techs enhance ____,___ and ____ of the practice

efficiency, productivity, proficiency

complete elimination of microbial viability (bacteria, viruses, spores)

sterilization

destruction of MOST pathogenic organisms on inanimate objects

disinfection

prevent growth or action of microorganisms on living tissue by inhibiting activity or killing them (not sterilized)

antisepsis

living organism too small to be seen with the unaided eye.

microbe and microorganism

microbe capable of causing disease.

pathogen

the detrimental result of invasion by pathogens.

infection

infection acquired during hospitalization or during attendance at any veterinary medical facility

nosocomial

What should happen with extremely dirty dogs before surgery?

bathe the day before surgery, ensure the hair is dry prior to anesthesia (hypothermia), ensure animal is free of external parasites (fleas, capstar)

Solid food should be withheld from the patient at least ____ hours prior to procedure

6

why withhold food prior to surgery?

decreased risk of regurgitation and aspiration

withholding food may differ in what animals

young puppies and kittens, 6-12 weeks old, they are prone to hypoglycemia

NPO

nothing per os (by mouth)

Always walk outside just prior to procedure

urinate, defecate, prevent contamination in OR

you should perform ___ ____ expression as long as no contraindications (abdominal trauma, bladder surgery)

Urinary bladder

always double and triple check that the appropriate procedure is being prepped for ESPECIALLY the __ ___ if the surgery involves an extremity

correct limb

Key points for clipper use

pencil grip

#40 clipping blade (closer cut)

hair should be removed _____ ___ __ or direction of hair growth

AGAINST the grain (closer cut)

what is the goal when removing hair

goal is to allow for skin preparation and minimize intraoperative contamination

At LEAST ____ clipper blade widths from the area of the proposed incision, preferably more

2

2 clipper blade width hair removals allows for

ancillary procedures or change in plan

chest tube, drain placement

Hair removal in orthopedic procedures

hanging leg technique

hair removed circumferentially

vacuuming of hair

most effective way to remove clippings

coarse cut

Fine cut

for hair removal cut along the edge of clipped area at ____ degrees to hair growth for a crisp even edge

90

for hair removal use ___ ___ on skin to facilitate a close clip on loose or wrinkly skin

counter tension

what is a purse string suture used for?

applied around anal opening to prevent leakage of fecal material during surgery, perineal surgery, hind limb orthopedic procedures, DO NOT forget to remove

Purse string suture

new blades should be cleansed in ____ ___ to remove protective film

blade wash

blades should be what after each use

brushed to remove hair, disinfected, lubricated

skin CANNOT be _____ but is made _____ with the use of antiseptics

sterilized, antiseptic

most commonly used antiseptics

chlorhexidine

povidone-iodine

the skin is made 'antiseptic' in two stages

initial 'rough' prep in surgical prep area and final 'sterile' prep: once positioned for surgery in surgical suite

what are 5 desirable properties of surgical site prep

- Wide spectrum of antimicrobial activity - Low tissue toxicity - Inexpensive/readily available - Residual activity - Works well in presence of organic activity

Characteristics of povidone iodine

Cheap - Broad spectrum - "Okay" residual activity - Low tissue toxicity - Will stain clothing/fur - Inactivated by inorganic debris - Generally diluted 50:50 with water when used as a scrub.

characteristics of chlorhexidine gluconate

Good activity in organic debris - Very good residual activity - Broad spectrum - Low tissue toxicity... except mucous membranes: Keep away from eyes and mouth! - Does not stain clothing - Generally diluted 60:40 with water for scrubbing

Commonly used to "rinse" the surgical site and remove the detergent. - Not completely necessary

rinsing agents

2 types of rinsing agents

70% isopropyl alcohol and sterile saline

70% isopropyl alcohol

Antibacterial - Dries quickly.... But may cool patient. - CAUTION when using cautery.... Flammable.

sterile saline

no antimicrobial activity

non flammable

For abdominal procedures where the prepuce will be "draped in," the prepuce should be flushed with

dilute betadine

Initial scrub performed with exam gloves while in

prep area

Final scrub performed once in surgical suite and after patient is

positioned for surgery

Sterile gloves - Sterile gauze, prep basin - "New" scrub solution - "Clean" hand, "dirty" hand

What is the starting point for scrubbing patterns?

Start over the area of the proposed incision and work towards the periphery.

What motion should be used when scrubbing?

Use a circular motion.

What should you do if the sponge or gauze touches hair or a contaminated site?

Do NOT go back over the incision area, discard the sponge/gauze.

how much to scrub

Most important consideration: Contact time of scrub with skin (see manufacturer recommendations). - Usually ~ 5 minutes - Sponge/Gauze comes away "clean" with no residue or dirt

What is a rinsing agent for sterile prep?

Alcohol or saline

What is used to remove scrub detergent if a rinsing agent is not used?

Dry gauze or a sterile huck towel

Circular motion from center out, clean hand/dirty hand

dry gauze

Unfolded and sterilely placed over entire surgical site and "patted" à Do not slide!

huck towel

What is a common solution used by some surgeons after a sterile scrub?

Povidone iodine

What is a characteristic of the povidone iodine solution used by surgeons?

It is usually without detergent and at a slightly higher concentration.

How is the povidone iodine solution typically applied?

Usually applied with a spray bottle.

What is the recommended method for applying povidone iodine solution on the skin?

Allowed to dry on the skin.

In general, don't mix ______ products with ______ products

chlorhexidine, iodine

reaction to scrub?

More common with iodine Usually presents as patchy to diffuse urticaria Benadryl?

Razor burn?

From dull or dirty blades Pressing too hard or bad angle Blades too warm

What is the hanging leg technique used for?

Most extremity orthopedic or soft tissue procedures.

What advantage does the hanging leg technique provide during surgery?

Allows the entire extremity to be draped in and manipulated.

What is a benefit of the hanging leg technique related to muscle fatigue?

It helps with fatigue of muscles for fracture reduction.

What is another name for the hanging leg technique?

Traction.

goals of patient positioning

Patient is secure Surgeon can access surgical site(s) in a adequate manner Anesthesia team can access patient, fluid lines, monitoring equipment, etc

maintaining a sterile field

After the sterile prep is performed Draping Controlled traffic in OR

quarter drape

final result of draping in surgery

Minimal skin exposure - Multiple layers - Waterproof barrier to prevent strike through