Perioperative Nursing Notes

Pre-Operative Nursing

• Clinical exam.
• Prepare for anaesthesia.
• Anaesthesia plan, Analgesic plan, Antibiotic plan.
• Induction.
• Surgical clip and surgical skin scrub and preparation.
• Move to theatre.

Intra-Operative Nursing: Sterility and Asepsis

• Surgical area is restricted to be free of micro organisms.
• Asepsis is achieved through:
  • Cleaning with detergent.
  • Disinfecting with hospital-grade disinfectant (virucidal, bactericidal, non-staining, non-corrosive).
  • Appropriate waste disposal (biological waste bags, sharps containers).
  • Strict dress code.
  • Proper patient prep.
  • Proper hand scrubbing.
  • Sterilizing instruments.
  • Aseptic surgical technique.

Intra-Operative Nursing: Sterile Field

• All items introduced onto a sterile field should be opened, dispensed, and transferred by methods that maintain sterility.
• Sterile Considerations for Personnel:
  • Gowns: Sterile at sleeves and front from waist to below neck. Not sterile at neckline, shoulders, above 5cm above elbows, cuffed sleeves, below waist, or back.
  • Keep hands in sight and above waist level.
  • Keep hands away from face, elbows close to sides.
  • Avoid folding arms.
  • Avoid gown touching unsterile surfaces, including footstools.
• Drapes:
  • Should cover entire animal.
  • Unscrubbed personnel should not reach over drapes.
  • Wet drapes are considered contaminated.
  • Only top surface of draped table is sterile.
  • Discard items falling over edge.
  • Avoid touching anything hanging below table.
  • Do not move drapes that have fallen below table.
• Moisture Contamination:
  • Protect sterile areas from moisture.
  • Lay sterile packages on dry areas.
  • Discard or resterilize damp packages.
  • Discard packages that fall on the floor.
• Movement around Sterile Field:
  • Unscrubbed personnel must face sterile area when passing, keeping a wide margin of safety.
  • Scrubbed personnel pass each other back-to-back.
  • Avoid wandering or leaning on sterile areas.
  • Contamination occurs if sterile person/item touches unsterile person/item/surface.
• Sterile Packs:
  • Check for tears, holes, worn package, sterile indicators, broken seals, and expiry date.
  • Use double-wrapped packages.
  • Lay packs so flaps face up.
  • Open outer layer to create barrier.
  • Open inner wrapper, lifting distal flap away.
  • Use inside of inner wrapper as sterile field.
  • Edges of wrappers are not sterile.
  • Avoid reaching over the sterile field.
• Opening Sterile Items:
  • Circulator places hands under cuff when opening package.
  • Scrubbed personnel lift item without touching edges.
  • Avoid flipping items onto sterile field.
  • Use sterile technique to remove items.
• Sterile Flush:
  • Hold bowl away from sterile table.
  • Non-sterile personnel must not touch bowl or lip of flush bottle.
  • Discard remaining fluids after opening; caps cannot be replaced.
  • Avoid splashing.
• Surgical Assisting:
  • Minimize talking.
  • Avoid sneezing and coughing.
  • Those with colds should not scrub in.
  • Maintain sterility.
  • Manage instrument table.
  • Pre-empt surgeon's needs.
  • Pass instruments handle first.
  • Gentle tissue handling.
  • Maintain haemostasis and keep tissues moist.
  • Instrument and swab count.
  • Manage sharps.
• Swab Count:
  • Counted thrice: By packager, before surgery, and at skin closure.
  • Use radio-opaque swabs.
• Needle/Instrument Counting:
  • Assistant and surgeon should keep track of needles and count them in and out.
  • Ensure all instruments are accounted for.
• Instrument Handling:
  • Pass instruments handle first.
  • Hold instruments correctly (needle drivers, forceps).
• Maintain Homeostasis:
  • Use haemostats, cautery, swabs, ligatures.
  • Keep tissue moist with warm sterile saline.
  • Keep drapes dry; blot instead of wipe.

Post-Operative Nursing

• Aims:
  • Successful recovery from anaesthetic and surgery.
  • Successful return home.
  • Uncomplicated, comfortable, stress-free and speedy return to normal.
• Preparation:
  • Clean and pre-warmed cage with soft bedding.
  • Drip stands, medications.
• Actions:
  • Prepare receiving cage.
  • Transport patient to receiving cage.
  • Extubation.
  • Adequate oxygenation and warmth.
  • Fluid therapy and pain relief.
  • Ablutions, exercise, and physiotherapy.
• Patient Transport:
  • Use trolley for least effort and trauma.
  • Use stiff board for spinal patients.
• Extubation:
  • Ensure patent airway.
  • Leave tube in as long as possible.
  • Wait for cough and swallow reflexes.
  • Observe for 5-10 minutes; ensure SPO2 > 95%.
• Temperature Control:
  • Active (Bairhugger, heated cage floors, hot water bottles, saline bags) and passive (blankets, space blankets) heating.
  • Monitor temperature every 30 minutes, then hourly for 2-4 hours.
  • Maintain warming for 12 hours; avoid burns.