6. Patient Preparation and Draping Flashcards
When preparing a patient, how do we remove hair?
clipping is performed in the induction area once the patient has been stabilized under anesthesia - be comfortable with their lvl of anesthesia b4 manipulating
An old green scrub gown or lab coat is usually worn went he patient is being clipped
Hold the clippers in a pencil grip - grip permits the greatest amount of control and maneuverability, clipper blade should lie flat on patient’s skin for the closest clip
Hand not holding clipper can tense skin to encourage as easy a movement as possible for clipper
Ensure area clipped is neat, tidy, symmetric
Clippers need to be cleaned and oiled as directed on product instructions
How much hair do you remove for surgery?
Clip more vs less - in long hair, you can clip hair that may fall onto field
Amount removed depends on sx performed
General soft tissue injury ex, rule of thumb is to clip two clipper blade widths in every direction from proposed incision site
in orthopedic sx, patient is clipped more extensively (joint above to joint below) - limb needs to be clipped circumferentially to allow complete lime draping and manipulation
Do not use clippers on scrotum, cause clipper burn
Why is brushing loose hair away from the clipped site not acceptable?
Must be vacuumed - won’t collect it all, hair aerosolized easily
How do we clip LA?
determine the incision site - surgeon’s specificiations
Standing bovine - clipped prior to entering sx usin a #40 blade
Equine - clipped once the animal has been anesthetized In the induction area
How might we cause clipper burns?
clipper blades are dull
technique is harsh
excessive pressure is used
What do we check on clipper blades before use?
Chipped or missing teeth, rust, anything else that may hinder their performance
What negative effects can irritation of the skin cause?
inhibit sx site healing if over sx site
Promote bact growth leading to possible infection of sx site
Promote excessive licking which compromises healing process
What is the protocol for cleaning clippers?
After using clippers spray w/ clippercide
remove all debris from clippers + blade w/ a brush
Remove blade from the clipper
Place dirty blade and brush in to barbicide - keep on for min 10m
When placing a new blade on clipper from the barbicide, wipe the blades dry w/ a cloth removing any excess liquid and spray w/ clippercide
When prepping a patient, why is expressing the bladder
Urinary bladder should be manually expressed prior to performing the surgical skin prep
Will help to prevent iatrogenic trauma to the bladder when the abdomen is entered
Bladder expression is necessary to prevent patient from peeing during surgical procedure
if urinate during sx, will soak table linens, fur and skin - will cause urine scald if laying in there for long time
Inc risk of contamination of sx wound if urination occurs post operatively
What is the manual bladder expression technique?
bladder expressed w/ patient either in dorsal or lateral recumbency
Some type of receptacle like kidney bowl to collect urine - done to avoid saturating fur w/ urine or having urine pool under animal
use gentle, constant pressure rather than a pulsating action when applying pressure to bladder
What is the purpose of a surgical site prep
to render the skin as clean as possible to minimize risk of wound infection
Multiple options of antiseptics, rinsing agents, and applicators that can be used to prepare the skin for surgery
What are two antiseptics used in surgical site preparation?
Providone-iodine
chlorhexidine gluconate
What are the differences btw povidone-iodine and chlorhexidine gluconate?
Povidone-iodine: Bacteri/viralc/fungicidal and fungistatic - residual effect
Relatively low tissue toxicity
Generally dilute 50:50 w/ water as patient scrub
CHLORHEX: bactericidal action against 30 bact genera, viri/fungicidal - residual effect
Low tissue toxicity - except for MM
generally 60:40 w/ water
What are some rinsing agents for surgical site preparation?
70% isopropyl alcohol
Sterile water or saline
What are some properties of 70% isopropyl alcohol as a rinsing agent?
effective against most G- bact
coagulates proteins, so contraindicated on open wounds and MM
Enhances residual properties of chlorhex
Rapid evaporating - hypothermia
Do not use if electrocautery will be used intraoperatively
What are some properties of sterile water/saline as a surgical site preparation
removes detergent but has no antimicrobial properties
used to prep open wounds, compound fractures, or MM when alcohol is contraindicated
What are some surgical site preparation applicatiors
Gauze sponge
Cotton balls/tipped applicators - when only prepping small areas
Spray bottles - only for final pain solution, messy
How do you prep a male dog for abdominal procedures?
Required when prepuce will be in the draped surgical field and performed prior to beginning the surgical site prep
After all hair removed from prepuce, sheath must be flushed to remove potential contam as followed:
1. combine 1ml of providone-iodine sol. w/ 9ml of water
2. insert syringe tipe into prepuce, inject 5ml of sol.
3. Pinch prepuce around syringe tip b4 removing syringe
4. Gently massage sol. in the prepuce
5. Place towel over end of prepuce to absorb sol.
6. Release the pinch hold on the prepuce
7. Repeat process w/ remaining 5ml sol.
What two types of patterns are there for scrubbing
target: bullseye pattern, abdominal, thoracic, neurological procedures
Orthopedic: added step of covering foot w/ exam glove - caution to avoid creating a tourniquet w/ tape holding the exam glove in place
