Patient prep

Question 1

surgical clip

Answer 1

use No. 40 or 50 clipper blade
disinfect with clippercide
use kool lube to cool the blade down
clip performed after patient is anesthetized (exception: shock and C-section cases)

Question 2

why should you not clip before anesthetizing?

Answer 2

clipping before anesthesia is associated with increased post op surgical site infection by 3x
razor burn and trauma increased infection risk

Question 3

how do you do a surgical clip?

Answer 3

clip a wide region around proposed surgical incision (at least 5-10 cm)
long thick hair: 1st. clip in same direction as hair grows, then against it
short hair: clip against direction hair grows
place clipper blade tips flat on skin (parallel to skin)
if clipping a non-intact integumentary site like laceration: pack with sterile KY jelly, wear gloves, use clean clippers

Question 4

clipping hair vacuum

Answer 4

have a designated vacuum that isn’t used for general cleaning supplies
may be central, shop vac, or dust buster
may gas sterilize the tips of vacuum
may use a lint roller
helps decrease contamination

Question 5

skin prep

Answer 5

performed to prevent infection due to intra-operative contamination
does not sterilize skin
don’t use scrub or alcohol in open wounds, eyes, and mm
contact time > technique
wear gloves
use non-woven gauze
avoid being harsh/rough on skin since it exfoliates deeper normal flora and increases risk of post-op SSI

Question 6

gross scrub

Answer 6

initial skin prep done in prep room to remove gross contamination
start with no specific technique then as contaminants are reduced switch to a motion technique (star, circular, or squeegee to move debris outward)

Question 7

how can you test if a surgical site is grossly cleaned?

Answer 7

grab a clean piece of gauze with either an antiseptic scrub, isopropyl alcohol, sterile isotonic solution and wipe incision site only
if gauze is clean, perform motion technique scrub 3 more times
if not clean, continue motion technique until site is clean

Question 8

final skin prep

Answer 8

surgical attire worn and performed in OR
walk around patient to evaluate scrub
5 min contact time of antiseptic
always wipe off scrub at end of prep
can finish by spraying diluted povidone-iodine solution or chlorhexidine solution on scrubbed site
alternate scrub with alcohol or saline

Question 9

final prep for extremities

Answer 9

extremities hung
if paw is not shaved, cover with glove and make a hanging loop with tape
if paw is shaved, soak paw in diluted antiseptic solution for 5 minutes
to hang a distally shaved paw: pass a nonabsorbable suture thorough interdigit webbing of digit 3 and 4, make knot at end of suture for hanging
apply towel clamp through interdigit webbing of digit 3 and 4, then make a tape loop on 1 of the ring handles of towel clamp for hanging