Veterinary Surgical Nursing and Operating Room Protocols Flashcards

Course Logistics, Grading Policies, and Academic Rules

  • Lecture and Laboratory Structure:

    • Laboratory sessions are strictly in-person for all enrolled students.

    • Students have the choice between attending in-person lectures or enrolling in the online lecture format. Online lecture participation frees up seating for students preferring face-to-face instruction.

    • Students registered for online lectures attend mandatory in-person laboratory sessions on Tuesdays in the designated laboratory building.

  • Faculty and Administrative Contact:

    • Program Head / Student Advisor: Office located in the main administrative building.

    • Laboratory Licensed Veterinary Technician (LVT): Dawn (office located two doors down from the Program Head).

  • Facility Access:

    • Student ID cards are required for electronic keycard access to the laboratory building.

    • Student IDs expire after 1 year1\,\text{year} and must be renewed if access declines.

  • Key Academic Calendar Dates:

    • Labor Day: September 7th. No lectures or laboratory sessions are held on Monday or Tuesday. No homework is assigned immediately following the holiday week, though preview material for the subsequent week is posted.

    • Fall Break: Scheduled in October.

    • Midterm Examinations: Administered immediately following Fall Break.

    • Thanksgiving Break: Scheduled in November.

  • Examination Policies:

    • Lecture Exams: Administered electronically via computer during designated lecture times (paper exams are strictly prohibited).

    • Lab Practical Exams: Administered in-person during designated laboratory times. No makeup examinations are permitted for laboratory practicals or final exams under any circumstances.

  • Grading Standards and Thresholds:

    • Passing Threshold: Students must achieve an overall grade of 75%75\% or higher to pass the course.

    • Dual-Section Requirement: Students must achieve at least 75%75\% in the lecture section AND at least 75%75\% in the laboratory section independently. Falling below 75%75\% in either section results in course failure.

    • Essential Skills: Graded on a Pass/Fail basis. All essential skills must be successfully completed to pass the course.

  • Homework and Quiz Guidelines:

    • Homework: Completed via workbook/online submissions. Due weekly on Sunday nights.

    • Late Homework Deductions:

    • 1 day late:−10%1\,\text{day late}: -10\%

    • 2 days late:−20%2\,\text{days late}: -20\%

    • 3 days late:−30%3\,\text{days late}: -30\%

    • After 3 days3\,\text{days}, late homework is awarded 0%0\% credit unless prior arrangements were made.

    • Quizzes: Due on Fridays (except Week 1, which is extended to Sunday). Quizzes and exams are never accepted late.

  • Artificial Intelligence (AI) Policy:

    • Unauthorized use of AI on any paper, homework, or assignment results in an immediate grade of zero (00).

    • When AI is explicitly authorized (e.g., specific case study assignments), the student must include a standardized AI statement specifying the AI platform utilized and its exact application.

  • Essential Skills Tracking (Salt House):

    • Student essential skills are recorded and tracked using the Salt House electronic management platform. Student login credentials are issued via automated email notification.

  • Attendance and Absences:

    • Lecture Attendance: In-person attendance is required. While missed lectures do not incur direct point deductions, lecture recordings or missing materials are not provided; students must obtain notes independently.

    • Laboratory Attendance Deductions:

    • 1 unexcused absence:Permitted without direct grade point penalty1\,\text{unexcused absence}: \text{Permitted without direct grade point penalty}

    • 2 to 3 unexcused absences:Overall course letter grade lowered2\text{ to }3\,\text{unexcused absences}: \text{Overall course letter grade lowered}

    • 4 or more unexcused absences:Severe grade reduction / Automatic failure of the course4\text{ or more unexcused absences}: \text{Severe grade reduction / Automatic failure of the course}

    • Tardiness: Students arriving late to lab must notify the instructor. Arriving prior to the instructor is not marked as tardy.

  • Campus Safety and Regulations:

    • NOVA Alert / Wellness system provides automated telephone, text, and email notifications for campus closures, delays, and "Code Purple" virtual lecture days.

    • Smoking and vaping are strictly prohibited across campus grounds.

    • Mobile phones must be turned off/put away during classes and labs.

    • Smartwatches are strictly prohibited during clinical vital sign assessments (heart rate and respiratory rate monitoring).

    • Calculators are required for examinations; mobile phones cannot be used as calculators.

Laboratory Attire and Personal Equipment Requirements

  • Lab Coat Requirements:

    • Clean white lab coats are mandatory for all laboratory sessions.

    • Donated coats are available in marked bins outside department offices and must be laundered prior to use.

  • Strict Footwear Dress Code:

    • Prohibited Footwear: Flip-flops, moccasins, UGG boots, backless shoes, high-heeled boots, open-toed shoes.

    • Permitted Footwear: Regular closed-toe shoes. Crocs are permitted ONLY if they lack holes (completely covering the foot and toes), though students assume the risk of exposure to urine, blood, feces, or sharp instruments.

  • Gloves and Hypersensitivity Protocol:

    • Students are required to purchase a dedicated box of non-latex gloves.

    • The instructor has a severe, life-threatening latex allergy (anaphylactic airway closure). Latex gloves are strictly prohibited in the primary instructional space during gloving demonstrations.

  • Required Personal Clinical Gear:

    • Stethoscope (must be labeled with the student's name).

    • Bandage scissors.

    • Penlight.

    • Simple analog/digital watch with a second hand (smartwatches prohibited).

    • Digital thermometer (required for VET 105).

Operating Room Design, Setup, and Maintenance

  • Ideal Operating Room (OR) Configuration:

    • Minimalist design engineered to limit dust accumulation, surface contamination, and air turbulence.

    • Permissible Equipment: Anesthesia machine, operating table, cautery unit, suction machine, surgical lights, IV pumps, monitoring equipment, and dedicated waste/sharps bins.

    • Storage Requirements: All surgical packs, drapes, hats, and gowns must be stored inside closed cabinets (metal/glass or sealed plastic). Open shelving and unsealed cardboard storage boxes are strictly prohibited.

    • Pass-Through Cabinets: Dual-sided cabinets that allow sterile packs and supplies to be stocked directly from the prep/autoclave room into the OR without opening OR doors.

    • Door Protocols: OR doors must remain closed at all times except during necessary patient and personnel movement.

  • Unacceptable OR Features:

    • Presence of coffee pots, rocking chairs, open laundry hampers, loose cardboard boxes, blood analyzers, or non-surgical storage items.

  • Pre-Surgical Setup Protocols:

    • All equipment and supplies must be completely assembled and tested BEFORE the patient is anesthetized.

    • Anesthesia Machine Pre-Check: A full leak test must be performed prior to patient hookup. Oxygen tanks, soda lime canisters, and anesthetic gas vaporizers must be verified full and unexpired.

    • Emergency Crash Cart Protocols:

    • Crash carts (whether mobile carts or tackle boxes) must remain fully stocked with emergency drugs and airway equipment.

    • Carts are sealed with indicator tape marked with staff initials. If the tape seal is broken, the cart must undergo immediate inventory and restocking.

    • Patient Warming and Positioning: Heated operating tables, circulating warm water pads, or trough positioners must be pre-warmed and prepared.

    • Surgical Lights and Specialty Units: Surgical lights must be tested and aligned over the site; cautery and suction units tested; suction collection buckets in place.

    • Patient Identification: Microchips, microchip scanners, and surgical tattoo equipment prepared.

  • Operating Room Sanitation Protocols:

    • Dedicated Cleaning Equipment: The OR must have its own dedicated wet broom (rubber broom/Swiffer), mop, and bucket. Cleaning equipment used in kennels or general hospital areas must never enter the OR.

    • In-Between Patient Cleaning:

    • Remove all soiled drapes, instruments, and single-use items.

    • Wipe down surgical table (including underside), surgical lights, dental X-ray tube heads, blood spills on floors, monitoring cords, and trash cans.

    • Replace patient monitoring connectors, fluid lines, and warming blankets.

    • Daily and Deep Cleaning:

    • Deep cleaning required weekly or prior to clean orthopedic/specialty procedures.

    • Protocol: Remove all moveable equipment from the room, scrub walls, ceiling fixtures, and floors. Wipe down every piece of equipment before returning it to the room.

    • Anesthesia Equipment Sanitation:

    • Wipe down anesthesia machines, rebreathing tubes, reservoir bags, monitoring probes (SpO2SpO_2, temperature), and laryngoscope blades immediately after use.

  • Clean vs. Dirty Surgical Suites:

    • Clean Surgery Suites: Reserved strictly for aseptic procedures like orthopedics (total hip, knee, or elbow replacements).

    • Dirty Surgery Suites: Designated for procedures with high bacterial loads, such as gastrointestinal (GI) foreign body removals, pyometra surgeries, or infected wound debridement.

  • Tacky/Sticky Mats:

    • Multi-layered adhesive mats placed at OR entrances or chemo/oncology prep areas to catch debris and containment hazards. Top sheets are peeled off and disposed of in biohazard waste.

Surgical Team Roles and Legal Scope of Practice

  • Sterile (Scrubbed-In) Personnel:

    • Attire: Clean scrubs, cap/hair bonnet, mask, shoe covers, surgical hand scrub, sterile gown, and sterile gloves.

    • Surgeon: Performs the surgical procedure. Touches ONLY the patient's sterile scrubbed prep area and sterile instruments/drapes.

    • Surgical Assistant: Assists surgeon directly. Touches ONLY sterile instruments, drapes, and supplies.

  • Non-Sterile Personnel:

    • Attire: Clean scrubs, cap, mask, shoe covers (no sterile gown or sterile gloves).

    • Circulating Assistant: Preps the patient, performs final skin scrub, opens sterile instrument packs/gloves for scrubbed team, fetches extra supplies, handles non-sterile equipment.

    • Anesthetist / Anesthesia Technician: Focuses exclusively on patient monitoring, vital sign recording (every 5 minutes5\,\text{minutes}), and anesthetic depth maintenance. Must never abandon an anesthetized patient.

  • Legal Scope of Practice (LVT Suturing Regulations):

    • Virginia: Licensed Veterinary Technicians (LVTs) are legally permitted to perform skin and subcutaneous (subQ) closure only. LVTs cannot perform gingival/gum suturing.

    • Michigan: LVTs can perform skin/subQ suturing, tooth extractions, and gingival suturing.

    • Illinois: LVTs can perform gingival suturing, but cannot perform tooth extractions.

The Sterile Field and Aseptic Rules

  • Sterile Field Boundaries:

    • Patient Site: The scrubbed, draped incision site projected vertically upward to the ceiling.

    • Instrument Tray / Mayo Stand: The top surface of the tray/table covered with sterile drapes, projected vertically upward to the ceiling.

    • Scrubbed Personnel Boundaries:

    • Sterile Area: Front of the body from WAIST to SHOULDERS, and arms from ELBOWS to FINGERTIPS.

    • Hands must be kept above waist level and folded in front of the chest when idle.

    • Non-Sterile Area: Back of the body, area below the waist, shoulders, neckline, head/cap, and underarms/sides.

  • Movement and Behavior Protocols in the OR:

    • Facing the Field: Scrubbed personnel must always face the sterile field. Never turn back toward a sterile area.

    • Passing Rules:

    • Sterile person passing Sterile person: Move Face-to-Face OR Back-to-Back.

    • Non-sterile person passing Non-sterile person: Maintain non-sterile boundary.

    • Non-sterile personnel must never step between a sterile person and the sterile field, nor reach over a sterile tray/field.

    • Coughing / Sneezing Protocol: Look straight down toward the chest/mask and step back. Never turn the head to the side, as respiratory droplets will escape through the side vents of the mask.

    • Sterile Packaging and Handling:

    • Supplies wrapped in paper, cloth (muslin), or peel-pouch packaging.

    • Hands must be completely clean and dry. Wet hands cause "wicking" (capillary action drawing surface microorganisms through wet paper/cloth into the sterile interior).

    • Heavy orthopedic equipment must be passed directly into the hands of a sterile team member rather than dropped onto a table.

Aseptic Terminology and Levels of Sanitation

  • Aseptic Terminology Definitions:

    • Medical Asepsis: "Clean technique" used to reduce microbe numbers during non-surgical procedures (e.g., medication administration, enteral tube feeding).

    • Surgical Asepsis: "Sterile technique" used to eliminate all microorganisms from an area or object during invasive procedures.

    • Asepsis: Complete absence of pathogenic microorganisms.

    • Pathogens: Microorganisms capable of causing disease.

    • Normal Flora: Resident microorganisms normally living on skin/mucous membranes that can act as opportunistic pathogens if introduced into sterile body cavities.

    • Contamination: Introduction of non-sterile material onto a sterile object or area.

    • Infection: Invasion and multiplication of pathogenic microorganisms within body tissues.

    • Lavage: Therapeutic flushing of a body cavity or wound with sterile fluid (e.g., abdominal lavage during GI surgery).

    • Nosocomial Infection: Hospital-acquired infection contracted during hospitalization or surgical care (e.g., MRSA).

    • -cidal: Antimicrobial agents that kill targeted organisms (e.g., bactericidal, virucidal, fungicidal).

    • -static: Antimicrobial agents that inhibit the growth or replication of targeted organisms without killing them (e.g., bacteriostatic).

  • Hierarchy of Cleanliness (Highest to Lowest Level):

    1. Sterility: Complete destruction/elimination of all living organisms, including bacterial spores.

    2. Disinfection: Destruction of most vegetative pathogenic microorganisms on inanimate surfaces (does not guarantee elimination of spores).

    3. Antiseptic Sanitation: Reduction of microbial load on living tissues.

    4. Sanitation: Cleaning measures designed to promote hygiene and health.

    5. Cleaning: Physical removal of visible organic and inorganic dirt/debris (lowest level).

  • Organic Material Impact:

    • Definition: Any biological matter originating from a body (feces, saliva, blood, hair, urine, tears, skin cells).

    • Impact: Deactivates or significantly reduces the efficacy of many chemical antiseptics and disinfectants. Physical cleaning to remove organic debris MUST precede disinfection.

Chemical Antiseptics and Disinfectants

  • Chemical Safety and Contact Time Rules:

    • Contact Time: The mandatory duration a chemical agent must remain wet on a surface or skin to achieve its specified microbicidal kill rate.

    • Chemical Mixing Warning: NEVER mix chemical cleaners. Mixing quaternary ammonium compounds (Roccal/KenneSol) or detergents with bleach produces toxic mustard gas.

  • Antiseptics (Applied to Living Tissues):

    • Iodine / Povidone-Iodine:

    • Efficacy: Effective against vegetative bacteria; INEFFECTIVE against bacterial spores.

    • Applications: Ocular surgical prep (diluted aqueous solution is non-irritating to eyes compared to chlorhexidine), joint lavage, wound therapy, surgical hand scrubs.

    • Formulations: Tinctures (iodine dissolved in alcohol), Iodophors (iodine bound to a carrier molecule for slow release), Aqueous solutions, and Scrubs.

    • Cytotoxicity: Undiluted iodine is cytotoxic (kills healthy tissue cells). Proper dilution enhances bactericidal activity and reduces tissue toxicity.

    • Residual Activity: 4 to 6 hours4\text{ to }6\,\text{hours}. Highly inactivated by organic material (blood, urine, hair).

    • Species Sensitivity: Can cause contact dermatitis in small animals. Large animals (horses) have thicker skin with reduced histamine responses, lowering local skin reactions, but systemic absorption can cause thyroid dysfunction.

    • Chlorhexidine:

    • Efficacy: Broad-spectrum against bacteria, molds, yeast, and viruses. Fast-acting with long residual activity.

    • Organic Resistance: Less affected by organic material than iodine.

    • Dilution Hazard: Mixing chlorhexidine with electrolyte solutions (such as Lactated Ringer's Solution / LRS) causes precipitation (chunk formation). Dilute only with sterile water or normal saline (0.9% NaCl0.9\%\,NaCl).

    • Formulation Rules: Use chlorhexidine SCRUB for surgical skin prep; use chlorhexidine SOLUTION for open wound irrigation or cavity flushing (scrub leaves soap residue in tissues).

    • Hydrogen Peroxide (H2O2H_2O_2):

    • Concentration: 3%3\% solution. Highly light-sensitive (degrades rapidly into water if exposed to light; stored in opaque brown bottles).

    • Mechanism: Microbicidal action via oxidation (visible foaming/bubbling).

    • Cytotoxicity: Highly cytotoxic to healthy granulation tissue. Prevents wound healing and damages new tissue cells. Utilized in body modification scarification to inhibit healing.

    • Specific Clinical Use: Highly effective for removing dried blood stains from patient fur following venipuncture or surgery. Do NOT apply directly to surgical incisions.

    • Alcohol:

    • Efficacy: Rapid microbicidal action via protein denaturation.

    • Limitations: Rapid evaporation yields negligible residual activity.

    • Contraindications: Extremely painful and cytotoxic when applied to open wounds, body cavities, or mucous membranes.

    • Phenols (Historical):

    • Historically used as antiseptics; completely replaced in modern practice by safer, more effective compounds.

  • Disinfectants (Applied to Inanimate Objects):

    • Quaternary Ammonium Compounds (Quats):

    • Mechanism: Cationic surface-active reaction against bacteria and viruses; weak against spores.

    • Characteristics: Non-toxic to surfaces.

    • Examples: Roccal-D / Roccal.

    • Household Phenols:

    • Examples: Lysol, Pine-Sol.

    • Efficacy: Effective against bacteria; limited activity against viruses and fungi.

    • Toxicity: EXTREMELY TOXIC to cats, rodents, and rabbits. Surfaces cleaned with phenols must be completely dry before animal exposure.

    • Aldehydes:

    • Formaldehyde: Highly toxic, carcinogenic, and severe respiratory tract irritant. Requires exposure badge monitoring in research facilities.

    • Glutaraldehyde (Cidex):

      • Used for "cold sterilization" of instruments, dental equipment, and flexible endoscopes.

      • Immersion Time: Requires 20 minutes20\,\text{minutes} of continuous immersion for high-level disinfection/sterilization.

      • Inactivated by organic material.

      • Rinsing Requirement: Instruments MUST be thoroughly rinsed with sterile water before patient contact to avoid chemical tissue burns.

      • Shelf Life: Dual-component mixture lasting 14 to 28 days14\text{ to }28\,\text{days} post-activation.

    • Chlorides (Sodium Hypochlorite / Bleach):

    • Requires daily dilution; diluted working solutions degrade after 24 hours24\,\text{hours}.

    • Accelerated Hydrogen Peroxide (Rescue):

    • Primary disinfectant of choice in modern veterinary practice.

    • Efficacy: Virucidal, bactericidal, fungicidal. Kills Parvovirus, Ringworm, Kennel Cough, Influenza, and Coronavirus.

    • Safety: Non-toxic to tissues/respiratory tract; certified Fear Free disinfectant (odorless/non-irritating).

    • Wipe vs Spray: Wipes contain a higher chemical concentration than sprays and can cause skin whitening/drying on human hands.

    • Contact Time: 5 to 10 minutes5\text{ to }10\,\text{minutes} depending on target pathogen and surface porosity.