Preparation of the Surgical patient - Intro + Clipping

Preoperative considerations ..

• Routine/elective surgery

• Emergency

• Medical problems which contra-indicate surgery - diabetes

• Age of patient

What will vary from patient to patient?

Patient preparation

What must be considered during patient preparation?

Impact of the surgery for the patient

Why should such care be taken?

Morbidity and Mortality

Clipping around open wounds ..

• Avoid contamination of the wound

• Saline soaked gauze swab

• Sterile water soluble gel

Preoperative patient factors and treatment ..

• Advanced age

• Obesity

• Emaciation

• Hypoproteinaemia

• Therapeutic corticosteroids

• Clotting defects

• Organ failure

• Skin infection/infections remote from surgical site

Preoperative patient factors for emergency procedures ..

• Hypoventilation

• Dehydration

• Hypovolaemia

• Septicaemia

• Cardiovascular dysfunction

• Electrolyte or acid-base imbalance

What must all patients have during preparation?

All patients must have had a pre-anaesthetic examination performed by a veterinary surgeon

What initial sign measurements should be taken during patient preparation to provide the foundations towards patient monitoring?

• heart rate

• respiration rate

• temperature

• mucous membrane colour

• capillary refill time

Food restrictions ..

Normally approximately 8 hours prior to surgery for both cats and dogs

Water restrictions ..

No need for owners to restrict water intake

How should patients be given the opportunity to defecate and urinate prior to surgery?

• Take them for a walk

• Appropriate substrate in their litter tray

What areas will bowel and bladder evacuation, during patient preparation, reduce the risk of contamination?

• Surgical site

• Environment

Types of bowel and bladder evacuation ..

• enemas

• urinary catheterisation

Enemas are important for ..

Rectal or colonic surgery

If an enema is required what may the veterinary surgeon do?

Place a purse string suture in the anus

Urinary catheterisation may be required when ..

• Gentle manual bladder expression may be sufficient

• If not, catheterisation may be required

Why should bathing be considered for all patients undergoing surgery?

• Removes excess hair

• Removes skin debris

Negatives for bathing patient before surgery ..

• may increase hair shedding and microbial flora

Bathing should be considered for the following patient ..

• Heavily soiled patients

• Orthopaedic (implants)

Why is it important to ensure the patient is fully dry prior to surgery?

• Keeping them wet will decrease their temperature therefore making them cold

• Wet can get onto drapes and cause cross contamination

Influencing factors to clipping ..

• Site to clip

• Type of surgery

• The patient’s temperament

Advantages of clipping prior to surgery ..

• Will reduce anaesthetic time which is good if they are a high risk patient

Disadvantages of clipping prior to surgery ..

• May cause damage to skin

• Increase skin bacterial numbers at time of surgery

• Increase incidence of incisional infection (postoperative wound infection)

Types of hair removal ..

• Razors

• Depilatories

• Clippers (most common)

Razors ..

• shaving with a razor is rarely seen in practice

• Some may still do this to reduce stubble

• High risk of epidermal cuts which increase the risk of wound infections

Depilatories ..

• generally not effective

• Can cause skin reactions

• May be useful in small mammals

Clippers ..

• Lowest incidence of surgical site infections

• Care must be taken over technique

• Don’t allow them to get too hot

• Surgical clipper blades

What is essential for clippers to avoid causing damage to patients?

Maintenance

When using clippers, why is technique important?

Poor technique could result in trauma to the skin

Where should clipping take place?

In the preparation area

What should be done after the clippers have been used?

Disinfected after each use (sterilised)

Clipping technique - a two stroke method ..

• Initial clipping follows the lie of the hair to remove the bull

• Secondly clip against the lie of the hair to achieve a close surgical clip

Why should we ensure to be gentle when clipping?

To avoid clipper rash

What should we try to be when clipping?

• Neat

• Symmetrical

The clipped area should extend to ?cm from the incision site?

15 - 20 cm

Clipping around the eyes ..

• Avoid contamination

• Lacri-lube

Clipping other areas (not open wounds or eyes)

• Areas close to the surgical sire may be covered to prevent contamination

• Cohesive bandage/gloves/bags

Clipping birds ..

• Parting feathers (as alternative if possible)

• Pluck feather to encourage regrowth