Surgical Assisting Procedures - Veterinary Assistant II

Chapter 42: Surgical Assisting Procedures

Chapter 42 Objectives

  • Describe how to maintain asepsis during surgical procedures

  • Explain how to maintain and record in a surgical logbook

  • State the importance of a sterile surgical suite

  • Explain how to assist with anesthesia preparations and inductions

  • Demonstrate how to properly restrain the patient for intubation

  • Demonstrate how to properly clip and prepare the patient for surgery

  • Demonstrate how to properly handle and open sterile surgical packs

  • Demonstrate how to properly prepare surgical drapes, gowns, instrument packs, and towel packs for surgical procedures

  • Demonstrate how to use an autoclave for sterilization procedures

  • Describe how to properly assist the surgeon in gowning

  • Explain how to place and maintain patient monitors

Chapter 42 Objectives (continued)

  • Explain the planes of anesthesia

  • Discuss how to properly monitor a patient during anesthesia and postoperative recovery

  • Explain how to set up, maintain, and disconnect the anesthesia machine

  • Describe the difference between rebreathing and non-rebreathing anesthesia systems

  • Discuss how to properly fill the vaporizer and soda lime components of the anesthesia machine

  • Identify the components on the anesthesia machine

  • Explain how to select appropriate-sized rebreathing bags for the patient

  • Explain how to properly test the functions of the anesthesia machine

  • Explain how to make adjustments to the anesthetic flow of gases during induction, maintenance, and recovery phases

  • Describe the anesthesia and surgical report

  • Explain how to properly glove and gown for surgical assisting

Chapter 42 Objectives (continued)

  • Discuss how to properly extubate a patient during recovery

  • Explain how to review the postoperative care of a patient

  • Explain how to complete a suture removal appointment

  • Explain how to clean and maintain the surgical suite

Introduction

  • Surgical assisting requires the veterinary assistant to be able to understand and maintain aseptic techniques.

  • Asepsis: the absence of bacteria, viruses, and other microorganisms.

  • Aseptic techniques: precautions taken to prevent contamination and infection of the surgical site.

  • Aseptic technique is essential in the surgical suite.

  • Any break in asepsis may lead to:

    • Potentially life-threatening patient infection

    • Delayed healing

    • Patient death

  • Breaks in asepsis may occur at:

    • Patient level

    • Healthcare team level

    • Surgical suite level

    • Instrument level

Surgical Asepsis

  • Goal of surgical aseptic technique: To prevent any microorganisms from entering a patient during procedures such as:

    • Surgical incision

    • Inhalation

    • Intravenous anesthesia administration

  • The skin is the first barrier to entry of microorganisms.

  • Situations that increase the risk of exposure include:

    • Lengthy procedures

    • Deep body cavity procedures

    • Procedures involving immunocompromised patients

    • Orthopedic surgeries

Disinfection and Sterilization Techniques

  • Proper techniques reduce the number of living organisms in the surgical environment.

  • Goal of disinfection and sterilization techniques: To maintain the utmost sterility of all objects that come into contact with the patient, including:

    • Patient

    • Anesthetic equipment

    • Surgery table

    • Surgical instruments

    • Surgical preparation equipment

    • Staff members

  • Ventilation and airflow of the surgical suite are crucial:

    • Must be separate from the rest of the hospital.

    • Surgical suite doors should be kept closed during all procedures.

    • Foot traffic should be minimized to reduce the risk of spreading microorganisms.

  • Only sterile procedures should be performed in the surgical suite:

    • Clean procedures, like wound management, unblocking urinary obstructions, and dental cleaning procedures, should be performed in the treatment area, as they carry a greater risk of organisms and infection presence.

Surgical Logbook

  • Surgical logbook: A record of details pertaining to all surgeries performed in the veterinary facility, kept in the surgical suite, with entries recorded prior to and after the completion of the procedure.

Components of the Surgical Logbook

  • Details included:

    • Date of procedure

    • Client Name

    • Patient Name and/or Patient ID number

    • Patient Breed and Species

    • Patient Sex

    • Weight

    • Procedure(s) performed

    • Preanesthetic medications administered (dosage and route included)

    • Anesthetic medications administered (dosage and route included)

    • Surgical assessment score

    • Initials of veterinary nurse and assistant

    • Initials of veterinarian who performed the procedures

    • Length of surgical time

    • Laboratory specimens obtained (if applicable)

    • Other surgical comments

Forms Included in the Patient Medical Record

  • Surgical consent form

  • Surgical fee estimate

  • Anesthesia report (summary of the anesthetic event)

  • Surgical report (summary of surgical procedure, includes surgical methods, observations, materials used, postoperative care prescribed, and other important information)

  • Recovery report (summary of anesthetic recovery event)

Anesthesia Monitoring Log

  • Anesthesia Monitoring Log: Provides details of the patient’s status through induction, maintenance, and recovery stages of anesthesia.

  • Components of the anesthesia monitoring log include:

    • Preanesthetic drugs (dosage, route, time of administration)

    • Induction drugs (dosage, route, time of administration)

    • Analgesic drugs (dosage, route, time of administration)

    • Anesthetic drugs (dosage, route, time of administration)

    • Patient vital signs, including:

    • Heart rate

    • Respiration rate

    • CRT / MM

    • Blood pressure

    • ECG rhythm

    • End tidal CO2

    • Reflexes (jaw tone, palpebral reflex, corneal reflex)

    • Length of anesthesia

    • Initials of anesthetist

Surgical Suite Maintenance

  • The surgical suite should be the cleanest area of the veterinary facility, with cleaning equipment designated for surgical suite use.

  • Designated clean area outside of surgical suite:

    • Contains sink for surgical scrub

    • Area to gown and glove

  • Sanitation and maintenance procedures:

    • Perform sanitation between procedures by:

    • Removing used surgical instruments and laundry

    • Sanitizing all surfaces used

    • Final sanitation and disinfection of the surgical suite must occur at the end of the day.

    • Patient preparation occurs in the treatment area before careful movement to the surgical suite.

Ceiling and Wall Sanitation

  • Perform sanitation techniques in a top-to-bottom manner to avoid dust and debris falling onto surfaces.

    • Ceilings:

    • Spot cleaned daily, mopped weekly with designated cleaning equipment.

    • Ventilation fan filters changed weekly.

    • Walls:

    • Spot cleaned after every surgery.

    • Cleaned daily at the end of the day.

Counter and Shelf Sanitation

  • Disinfect countertops, tabletops, shelves, sinks, and waste containers daily.

  • Spot cleaning on necessary items should be conducted between procedures.

  • Empty medical waste containers when full and at the end of each day.

Floor Sanitation

  • Mop floors daily using designated cleaning equipment.

  • Wash mop heads weekly with hot water and bleach.

  • Use a dual mop method:

    • One bucket with fresh warm water for mop rinsing.

    • Another bucket with disinfectant solution.

  • Mop from the furthest area of the surgical suite working towards the door.

Equipment Sanitation

  • Clean and disinfect all surgical equipment following manufacturer’s recommendations.

  • Permanent fixtures:

    • Wipe down and clean daily (e.g., surgical lights).

    • Disinfect the surgery table after each use (top surface, edges, bottom surfaces, and base).

    • Disinfect the Mayo Stand after each use (elevated tray for surgical instruments).

    • Disinfect restraint devices after each use.

    • Ensure that any disinfectant used in the surgical suite is safe for patient contact.

Preanesthetic Patient Care

  • Surgical patients are admitted on the morning of the procedure:

    • Complete consent form, fee estimate, and review of procedures.

    • Complete pre-surgical bloodwork and physical exam.

  • Ensure the patient has been fasted prior to surgery to reduce the risk of vomiting during anesthesia:

    • Fasting recommendations:

    • Monogastric:

      • Adult patients: 6-12 hours

      • Juvenile/neonates: less than 6 hours

    • Ruminants and horses: Do not require fasting.

    • Emergency surgeries are scheduled based on severity.

Preanesthetic Physical Exam

  • Performed by the veterinary nurse and veterinary assistant:

    • Evaluates all body systems.

    • Assesses vital signs.

    • Determines overall health status of the patient.

    • Assigns ASA Physical Status Classification.

ASA Physical Status Classification

  • ASA: American Society of Anesthesiologists.

  • Numerical classification indicating anesthetic risk, based on:

    • Age

    • Presence of systemic disease (compensated or uncompensated)

    • Emergency status.

ASA Patient Status Classification Breakdown

  • Class I: Minimal risk; normal, healthy patient.

  • Class II: Slight risk; very young, geriatric, underweight or obese patients; slight systemic disease without clinical signs.

  • Class III: Moderate risk; moderate systemic disease; slight clinical signs observed; compensated disease.

  • Class IV: High risk; severe systemic disease; moderate to severe clinical signs; uncompensated disease.

  • Class V: Grave risk; moribund patient; may die with or without surgery within 24 hours.

  • Class E: Emergency procedure; can be assigned to any patient status classification.

Anesthetic Plan Considerations

  • ASA patient status classification affects:

    • Presurgical bloodwork

    • Preanesthetic drugs

    • Induction and anesthetic drugs

    • Surgical monitoring.

  • Purpose of preanesthetic drugs:

    • Calm the patient

    • Provide analgesia

    • Reduce the quantity of anesthesia necessary

    • Mitigate side effects of other drugs.

Fluid Therapy

  • Protocols vary based on patient and surgical case.

  • IV catheter placement:

    • Provides access to the bloodstream for administration of anesthesia, analgesia, emergency medications, and IV fluid therapy.

    • Typically placed during preanesthesia preparation.

  • IV Fluid Therapy:

    • Maintains hemodynamic stability (stable blood pressure, cardiac output, and tissue perfusion).

    • Supports organs involved in drug metabolism and excretion.

    • Aids in hydration status and temperature regulation.

Types of IV Fluids

  • Isotonic crystalloid fluids: Same concentration of dissolved molecules as blood plasma (electrolytes and sugar).

    • Examples:

    • Lactated Ringer’s Solution (LRS)

    • 0.9% NaCl (Normal Saline).

  • IV Fluid Rate:

    • Canine: 5 mL/kg/hr

    • Feline: 3 mL/kg/hr

    • Dehydrated patients may require a higher rate.

    • Patients with renal or cardiac disease may need a reduced rate.

    • Neonatal patients may require a 5% Dextrose additive for stabilizing blood glucose levels during procedures due to a higher metabolic rate.