Veterinary Surgical Nursing

1. Veterinary Surgical Nursing SKIN PREPARATION

2. Intro • Define Potential Incision Site/s • Clipping • Cleaning with detergent antispetic • Initial non-detergent antiseptic • Transport to theatre • Final non-detergent antiseptic

3. Abdominal Incisions Midline Beside midline (paramedian) rarely used Beside rib cage (paracostal for kidney & liver Sx Beside prepuce (paraprepucial) males only

4. Landmarks • Sternum • Manubrium cranially • Xiphoid caudally • Umbilicus • Midpoint of pubic bone (pubic symphysis) • Rib arch (costal arch)

5. Abdominal Incisions • On Midline • Beside midline (paramedian) • Beside rib arch (paracostal) • Beside prepuce (paraprepucial)

6. Abdominal Incisions paracostal paraprepucial paramedian midline

7. Desexing • Also called “neutering” • Male desexing • Castration • Orchiectomy • Gelding (horses) • Female desexing • Spay (or spey) • Ovariohysterectomy (OHE)

8. Cat Spay • Centered1/2 way downfromumbilicus • Cervix hardest to reach

9. Dog Spay • Centred1/3 way downfrom umbilicus • Ovaries hardest to reach

10. When to clip? • Before anaesthesia (within 12 hrs) • Slower • Requires more people • Difficult if animal uncooperative • Reduces time under GA (Caesarians!) • Hair can fall off coat • During anaesthesia • Quicker • Less people required • Good for uncooperative animals • Increases time under GA • Hair not allowed to fall off coat

11. How much to clip? • Ask the surgeon • Varies, 2-10 cm around expected incision (on all sides) • Keep it neat (for the owner)

13. How to clip • Use #40 clipper blade • First in same direction as hair growth • Then in opposite direction • May use lubricants/coolants • Done outside surgery • Vacuum hair

14. Clipping Open Wounds • Apply Sterile Lubricant (e.g. K-Y) into wound and onto surrounding hair • it will wipe & rinse out well • Clip an outside ring first • Then clip towards the wound • Finally clip wound margins last • Rinse wound with sterile saline

15. Open Wounds • Never allow antiseptic into wound • Unless specially diluted • That includes alcohol

16. Other clips • Cat castrations may be plucked of hair rather than clipped • General abdominal surgery clip from several cm cranial to xiphoid to several cm caudal to pubis, lateral to nipples • Orthopaedic clip is usually right around the whole limb onto body and foot • Trim long hairs that might later fall onto wound

17. Care of clippers • Use only sharp, clean blades • Blunt blades and broken teeth cause clipper rash and grazes • Clean only with commercially prepared solutions. • Clean before storage • Clean between cases • Use a new blade when blade hot

18. Antiseptics & Detergents • The 2 common antiseptics, chlorhexidine and povidone-iodine, each come in 2 versions • ‘Scrub’ • ‘Solution’

19. Antiseptics • ‘scrub’ - with detergent , then • ‘solution’ - without detergent

20. Skin Prep antiseptics • Initial prep’s are with water & detergent • To help clean skin • Final prep’s are without detergent • To ensure correct concentration of antiseptic

21. Basic Skin prep • Antiseptic Scrub • Antiseptic Solution

22. How do antiseptics differ? • If using povidone iodine 10% • Never rinse off • Needs prolonged contact • If chlorhexidine gluconate 4% • Binds to surface (keratin) layer of skin • So does not lose effectiveness when rinsed with saline or alcohol

23. Antiseptics in wounds & m mem. • Never use detergent version • Dilute • Povidone iodine 10% • Dilute 10% soln 1/10 to give 1.0% soln for wounds • Chlorhexidine diacetate 2% • Dilute 1/40 with sterile water to give 0.05% soln • Saline would cause crystals to form • In oral cavity 1% (1/20) may be used

24. Steps of Skin Prep • Wash hands • Clean with a detergent antiseptic • +/- alcohol applied by some vets • Apply a non-detergent antiseptic • Transport to theatre • Re-apply non-detergent antiseptic

25. Wash hands • Wash hands, either • Soap and water, or • Surgeons scrub antiseptic • May then either • Put on gloves, or • Use sponge forceps

26. Clean with detergent antiseptic • Use water-moistened cotton wool • Aseptic Prep technique: • Spiral from centre outwards • Discard cotton wool once reached periphery • Never return cotton wool back to centre • Continue until no more soiling of cotton wool • Do not scrub too vigorously • Inflames skin

27. Aseptic Prep technique

28. Aseptic Prep technique • Spiral outwards • Never back from out to in

29. Apply non-detergent antiseptic • Again use Sterile Prep technique • Use non-detergent antiseptic • Use dry sterilegauze swabs • They do not leave behind tags of cotton the way cotton wool does

30. Transport to theatre Remove excess antiseptic • If povidone iodine was used, ‘mop up’ with sterile gauze swab • If chlorhexidine was used, ‘mop up’ or rinse with saline

31. Reapply non-detergentantiseptic • Can use pump-spray bottle, or • Paint on

32. Variations • There is no one correct method • May use alcohol between detergent scrub and non-detergent solution • Each hospital will have its own protocol • May repeat some steps

33. Special prep areas • Mouth • Ear • Eye • Prepuce • Vulva • Foot

34. Oral Cavity Prep • Can only reduce bacteria a little • Sponge mucosa and teeth with dilute non-detergent chlorhexidine • 0.10% to 0.05%, i.e. 1/20 to 1/40 of normal solution • Might perform a dental prophylaxis if appropriate • Might be given a single dose of antibiotic at induction

35. Ear Prep • Clip • Generally clip both sides of ear flap (pinna) • If ear canal surgery clip side of face also • Antiseptics - ask surgeon • Usual skin prep on ear flaps but may need to plug the ear canals • Use of antiseptics in ear canal may depend on whether ear drum (tympanic membrane) is open or not

36. Eye Prep • Eyelid clipping • Apply sterile lubricanton and around eye (eg K-Y) • Ask surgeon about margins • Eyelid antiseptics • Rinse conjunctival recesses with warm sterile saline • Ask surgeon about antiseptics/ topical antibiotics • Non-detergent povidone iodine diluted to 0.1-0.2% (i.e. 1/50-1/100) may be used in prep for intraocular Sx • Chlorhexidine not used in eyes – even when diluted

37. Prepucial Prep • Syringe irrigation of prepuce with dilute non-detergent antiseptic • As for mucous membranes & open wounds

38. Foot Prep • Difficult to achieve asepsis in pads and under nails • Clip nails • Consider soaking whole foot in antiseptic for several minutes • Hold foot by placing a towel clamp into a long toenail

39. The End