CAL 1: Principles of aseptic and operative technqiue

Question 1

Give the NRC classification for a cystotomy with UTI

Answer 1

Contaminated Give prophylactic ABs Therapeutic post-op for established infection UTI should be resolved prior to elective procedures

Question 2

Give the NRC classification for an elective OVH, 6 month old bitch

Answer 2

Clean-contaminated No ABs

Question 3

Give the NRC classification for small flank excision of middle aged dog

Answer 3

Clean - no ABs (quick procedure and area can be prepped aseptically)

Question 4

Give the NRC classification for an ex lap in a dog with dehisence of an intestinal anastomosis –> peritonitis

Answer 4

Dirty Therapeutic ABs (confirm diagnosis via abdominal fluid aspiration but start empirical ABs and change later if needs be)

Question 5

Give the NRC classification for an ex lap with pancreatic biopsy

Answer 5

Clean No ABs (clean + short)

Question 6

Give the NRC classification for removal of FB from SI with subsequent spillage of intestinal contents

Answer 6

Contaminated (without spillage = clean-contaminated) Prophylactic ABs

Question 7

Give the NRC classification for amputation of a cat’s tail following traumatic sacro-coccygeal luxation

Answer 7

Clean - no ABs No open wound, close to anus BUT shouldn’t affect outcome if aseptic procedure is performed correctly

Question 8

Give the NRC classification for full thickness SI biopsies taken at laparotomy

Answer 8

Clean-contaminated Yes/no to giving prophylactic ABs. A first class surgeon wouldn’t use them in a healthy patient. Decision influenced by patient risk factors and surgical wound factors

Question 9

Give the NRC classification for lateral wall resection of the external ear canal in a dog with otitis externa

Answer 9

Contaminated Give prophylactic ABs - difficult to prepare ear canal aseptically to same effect as skin elsewhere. May have inflammation and established infection (=dirty) but this is elective so treat pre-existing infection before surgery

Question 10

Give the NRC classification for SC abscess after a bite wound in a cat

Answer 10

Dirty Therapeutic ABs (an abscess is an established infection). with adequate lancing, draining and lavage, the wound may heal without AB therapy being mandatory

Question 11

Give the NRC classification for placement of a cystotomy tube in a bitch with urethral obstruction

Answer 11

Clean-contaminated Yes/No prophylactic ABs - post-op AMs aren’t indicated since there will be contamination of the bladder from the presence of the cystotomy tube and use of AMs will simply select for resistant bacteria.

Question 12

Give the NRC classification for open fracture in radius of dog repaired the day after trauma

Answer 12

Dirty An open traumatic wound of >4-6 hours = dirty. With appropriate AB use and local wound care, wound infection should be no more likely than if a closed fracture were present.

Question 13

When is the most useful time to take a wound sample (from a microbiologists point of view)?

Answer 13

after wound debridement, fracture fixation and lavage.

Question 14

Give the NRC classification for placement of a lateral retinacular suture for stabilisation of the stifle after CCL rupture, performed by an experienced surgeon

Answer 14

Clean - no ABs Should be <60-90 minutes (experienced surgeon)

Question 15

Give the NRC classification for a dog with a traumatic laceration wound 2 hours previously when jumping a barbed wire fence

Answer 15

Contaminated Give prophylactic ABs With appropriate local wound care, post-op therapeutic ABs NOT required. En bloc debridement of wound would convert it to a clean wound for which no AM use is appropriate

Question 16

What are the 2 types of debridement?

Answer 16

En bloc and layered

Question 17

Describe en bloc debridement

Answer 17

in areas where there is adequate normal tissue to allow closure after, the whole affected tissue can be excised with a border of healthy tissue. This is ideal for the trunk and proximal limb where there is plenty of available skin to close the deficit.

Question 18

Describe layered debridement

Answer 18

more common than en bloc. Devitalised tissue is removed gradually in layers, to allow tissue conservation where possible. May be important for lower limbs where there is inadequate skin for en bloc.

Question 19

Give the NRC classification for bitch with pyometra with subsequent uterine rupture

Answer 19

Dirty (it involves acute purulent discharge) Give therapeutic ABs

Question 20

Give the NRC classification for resection of a gingival mass ina dog

Answer 20

Clean-contaminated Yes/no for giving prophylactic ABs Surgery of oral cavity is clean-contaminated. Not possible to prepare mucosal surfaces in the same way as skin. But excellent blood supply, antibacterial effects of saliva and warmth of oral cavity –> wound infections are rare in oral cavity

Question 21

Give the NRC classification for dog castration

Answer 21

Clean No ABs (short procedure, skin can be prepared aseptically)

Question 22

Give the NRC classification for cholescystectomy for a gallbladder mucocoele

Answer 22

Clean-contaminated (in absence of infection) Yes/no for prophylactic ABs

Question 23

Give the NRC classification for an ureteronephrectomy for an animal with chronic pyelonephritis refractory to medical therapy

Answer 23

Contaminated (because UTI) Give prophylactic ABs If it had developed into a renal abscess, it would be a dirty procedure. Withhold ABs until sample can be culutred. Low risk of contamination (infected site only entered during transection of distal ureter). Post-op ABs may be indicated if the animal has an established infecteion in the contralateral kidney or bladder.

Question 24

What is this instrument?

Answer 24

Mayo (Mayo-Hegar) needle holders

Question 25

What is this instrument?

Answer 25

Army Navy Hand Held retractor

Question 26

What is this instrument?

Answer 26

Aliis Tissue Forcep

Question 27

What is this instrument?

Answer 27

Adson thumb forcep

Question 28

What is this instrument?

Answer 28

Backhaus towel clip

Question 29

What is this instrument?

Answer 29

Metzenbaum scissors

Question 30

What is this instrument?

Answer 30

Poole suction tip

Question 31

What is this instrument?

Answer 31

Halstead mosquite haemostat

Question 32

What is this instrument?

Answer 32

No. 15 scalpel blade

Question 33

What is this instrument?

Answer 33

Mayo scissors

Question 34

What is this instrument?

Answer 34

DeBakey forceps

Question 35

What is this instrument?

Answer 35

Kelly Haemostats

Question 36

What is this instrument?

Answer 36

No. 11 scalpel blade

Question 37

What is the most appropriate instrument? linea alba incision during laparotomy

Answer 37

straight Mayo scissors

Question 38

What is the most appropriate instrument? making a long skin incision

Answer 38

scalpel handle 3 no.10 blade

Question 39

What is the most appropriate instrument? suction of lavage fluid from abdomen

Answer 39

Poole suction tip

Question 40

What is the most appropriate instrument? clamping a large tissue pedicle before ligation

Answer 40

Kelly haemostats

Question 41

What is the most appropriate instrument? occlusion of GIT lumen

Answer 41

Doyen intestinal forceps

Question 42

What is the most appropriate instrument? atraumatic bladder manipulatiion

Answer 42

stay suture (polypropylene) tagged with a haemostat

Question 43

What is the most appropriate instrument? retraction of tissue to be excised from the patient

Answer 43

Allis tissue forceps

Question 44

What is the most appropriate instrument? suction of thick fluid - e.g. mucous from a wound

Answer 44

Yankauer suction tip