03: Assistant Surgeon

Levels of clean for inanimate objects

Disinfection and sterilization

Levels of clean for live tissue

Asepsis and sanitization

Disinfection v sterilization

Disinfection destroys MOST microbes on an inanimate object, sterilization destroys all inanimate objects

Asepsis v sanitization

Asepsis kills surface microbes, sanitization reduces microbes to a “safe” level

Common sources of contaminants

• Patient flora

• Sx team and PPE failure

• Environment (OR)

• Improperly sterilized instruments

• Post-op handling and housing

How do you choose your disinfectant

Based on what you want to kill and where it is

Disinfectant that is not inactivated by organic debris

H₂O₂

What is the most important part about using disinfectants

Contact time

What do you need to do before you sterilize something

Clean it

Standard method for instrument sterilization

Steam

Sterilization method used for delicate, heat sensitive instruments

Liquid chemicals

Sterilization method used for specialized instruments

Dry heat

Sterilization method used for large amounts of disposables

Plasma and ionizing radiation

How do you know if your instruments are sterilized

Sterilization indicator in the pack

Why is it so important that your instruments are sterile

Neither you or the patient can be sterilized, but at least your instruments can be

Who is responsible for the pre-op physical exam

Assistant surgeon

Why do we care about fear free handling for surgery

Fear, anxiety, and stress have been shown to lower immune responses and delay healing

Gentle control

Strategic method of positioning and restraining a patient comfortably that reduces fear, anxiety, and stress

Touch gradient

Maintaining continuous physical contact and slowly increasing touch intensity

Things that go on the instrument table

• Jr sx pack

• Prep bowl

Things that go on the prep table

Everything else

Where does the rabies vax go

Right rear

Where does the DHLPP or FVRCP vax go

Right front

What should you do before you microchip an animal

Scan to make sure they don’t already have one

How far down should you clip for a spay

Xiphoid to pubis

When would we not express a bladder before spaying a patient

If she is pregnant

How do we tie in a patient for surgery

With two points of contact distal to the carpus/tarsus

Once you are scrubbed in, what is the sterile box that you can keep your hands in

Armpits to belly button

Once you are sterile how do you pass another sterile person

Back-to-back

Primary ways the assistant surgeon provides assitance

• Predict their needs

• Assist with dabbing blood, holding things, cutting suture

• Be prepared to take over