Lecture 3 - Prepping Patient for Surgery Flashcards
What are some surgical risk assessments associated with the patient?
Age, type/extent of primary disease, general physical status, associated illnesses
What are some surgival risk assessments associated with intervention?
Technically feasible, duration, invasiveness, urgency
What are some surgical risk assessments associated with the team?
Training, equiment, facility
In human medicine, _____% of surgical complications are related to technical/judgement errors.
47-96%
What are 4 things that should happen in the preoperative client communication process?
- Client should be informed of ALL options
- Client should be given a written estimate
- Client should sign a consent form (surgery, anesthesia, risks)
- Client should keep their insurance company in the loop about what is happening with their pet (if applicable)
What are the prognoses from best to worst?
Excellent, Good, Fair, Guarded, Poor
What is an excellent prognosis?
Minimal complications, return to function
What is a good prognosis?
Potential for complications, return to function
What is a fair prognosis?
Complications possible, unlikely to be functional
What is a guarded prognosis?
Unknown or variable outcome
What is a poor prognosis?
Severe complications likely, death, not functional
What is the proper attire while you’re in the prep room?
Surgical scrubs with lab coat
What purpose does your lab coat serve?
Protects scrubs from dirt hair, etc.
What should you do with your lab coat prior to starting the surgical scrub on the patient?
remove it
What things should you put on prior to starting the surgical scrub on the patient?
Cap, mask, show covers, exam gloves
What should you use for hair removal on a patient?
Clippers (NOT razor)
When could you maybe get away with not clipping hair for surgery?
If it is very thin
Why shoudl you avoid traumatizing the skin when clipping hair?
To decrease surgical site infection (SSI)
When should hair be removed and why?
Immediately prior to surgery, less chance for skin infection
Why should a wide region of hair be clipped?
To accommodate incision extension if needed, and for drainage areas
What size blade should be used for clipping hair?
40
How should the clippers be held?
Flat against the skin, pencil grip
Which direction should hair be clipped in?
Initially with growth, then against
How far from each side of the incision should hair be clipped?
15-20 cm on either side
What should be used to remove clipped hair?
vacuum
What things should an ideal antiseptic kill?
Bacteria, fungi, viruses, protozoa, spores
T/F: The ideal antiseptic doesn’t have to be hypoallergenic
False
The ideal antiseptic should be _____ and able to be used repeatedly safely.
nontoxic
The ideal antiseptic should have _____ activity.
residual
T/F: The ideal antiseptic should not be absorbed.
True
When should saline be used to prep a surgical site?
When there are open wounds
What are some solutions used for prepping a surgical site?
Iodine-based, chlorhexidine gluconate, 0.9% saline, dura prep, alcohol, ophthalmic prep
How should the prepuce be prepped in dogs?
Flush with 1:40 chlorhexidine solution
How should the prepuce be prepped in horses?
Suture closed or purse string
Why do we need to worry about the prepuce in surgical prep?
There is a potential for urine to leak into the surgical field if the prepuce is not prepped correctly
How do you prep the anus for surgery and why do we worry about this?
Purse string or pack with 4x4s; prevent fecal matter from going into surgical site
What should we do to the bladder before surgery?
Empty it manually or by cystocentesis
What is the proper patient scrub technique called and what does it mean?
clean hand, dirty hand;
One hand is used in the prep canister and then passes to the hand that will be scrubbing
What is the procedure for scrubbing a patient?
- Start in the center of the field and work outward
- 3 chlorhex scrubs (minimum)
- Rinse with 70% alcohol in between each
- Total scrub must be on the skin for at least 3 min
- Repeat as many times as needed if patient is still dirty
What should you do if you need to go back to the center during a scrub?
Use a new sponge
What should you do with the sponge if you touch hair or a very dirty region?
throw it away
Where should excess solution from the scrub sponge be squeezed?
Into the trash, NOT the prep canister
What is the contact time for scrub once the patient is clean?
At least 3 min
When are local blocks placed?
After scrubbing, before final scrub
What is the goal of draping?
To cover the patient and surgical table to where there is no potential for contamination
Why is it important to know how a drape is folded?
It decreases risk of contamination when opening the drape
What side should the drape be placed on first?
Between you and the patient, then cranial and caudal, then walk around to the other side
Drapes can be moved _____ to/from the incision, not _____.
away, towards
What instrument should be used to secure huck towels?
Backhaus (penetrating) towel clamps
What instrument should be used to secure the paper drape?
Lorna-Edna (non-penetrating) towel clamps
What should be used to cut the fenestration on the drape?
mayo scissors
What type of prep is used for orthopedic surgery and why?
hanging leg prep; need to be able to touch all sides of the limb
In large animals, how can the surgery site be scrubbed in a way that is different from small animal?
Can work from incision outwards in linear lines instead of circles, may rinse directly from alcohol bottle
How should alcohol be poured on large animals?
Liquid should flow away from incision site
Small animal positioning should be done in a way that avoids _____.
tension on limbs and thorax
What objects can be used to help position the animal?
Ties, sandbags, tape, vacuum assisted devices
Why should the animal’s limbs be tied gently to the table?
If the animal moves there is restraint;
Lowers risk of contamination to sx site if animal becomes light;
Poor positioning will make surgery more difficult
What are general prep steps for horses?
Grooming, picking out hooves, removing shoes/wrapping feet, rinsing mough, bandaging limbs
Patients that weigh _____ have an increased chance of complications
> 500#/227 kg
What can poor positioning of large animals lead to?
Trauma, myopathy, and neuropathy
How should horse legs be positioned for surgery?
Supported so that they are not hanging
What are some complications associated with gluteal muscles in large animals?
Rhabdomyolysis, myelomalacia
What are some complications associated with post-anesthetic neuropathy in large animals?
Lateral recumbency, radial nerve, femoral nerve, facial nerve
