Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal...

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Large Animal Surgery

Transcript of Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal...

Page 1: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Large Animal Surgery

Page 2: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

• All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations):– Use sterile surgical gloves – Don surgical masks– Use sterile instruments – Apply aseptic techniques

• Appropriate attention to the following will enhance the outcome of surgery (Guide for the Care and Use of Laboratory Animals: – Pre-surgical planning – Personnel training – Aseptic and surgical technique – Animal well-being – Physiological status

Large Animal Surgery

Page 3: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Pre-Surgical Planning

• Before beginning a surgical procedure there should be a meeting of the surgical team to develop a surgical plan. The surgical team should consist at least of the following:– Surgeon (may be more than one if complex procedure)– Anesthetist – Veterinarian – Surgical technicians – Animal care staff– Investigator.

Page 4: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Pre-Surgical Planning

• Regardless of the nature of the surgery, the surgical plan should identify • Personnel involved and their roles and training • Type of operative procedure • Equipment and supplies needed • Identify location of operating room • Preoperative health assessment • Intra-operative monitoring • Operative technique • Post-operative care • Need for antibiotics• A mechanism for keeping all relevant records.

Page 5: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Pre-Surgical Planning (Training)

• Depending on their roles, personnel should have adequate training in appropriate surgical technique including but not limited to: – Asepsis – Gentle tissue handling – Minimal dissection of tissue – Appropriate use of instruments – Effective hemostasis – Correct use of suture materials and patterns.

Page 6: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Surgical Facility Location• A dedicated surgical facility is required for large animals e.g. pigs,

goats, dogs, cats, rabbits. • When an area is being used for surgery, no other activity should

take place. In general the surgical facility should have the following components: – Animal preparation room– Instrument preparation room– Surgeon preparation room– Holding and recovery room– An operating room

• Lighting in the operating room should be bright, focused and non-glare. Lighting should be sufficient to perform the procedures but should not be make the operating area hot.

Page 7: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Surgical Facilities

• Animal preparation, e.g. clipping of hair, scrubbing, and anesthesia induction should not be performed in the operating room but rather in the animal preparation room.

• The surfaces in the room including floors, walls and ceiling must be non porous, sealed, durable and easily sanitized.

• The area should be maintained clean and free from clutter and access limited to people involved in the procedures being performed.

Page 8: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Surgical Facilities – Cleaning/Sanitizing

• A schedule for cleaning and sanitizing the rooms should be maintained and adhered to.

• Rooms should be cleaned “daily” i.e. at the end of the procedures on that day by damp dusting flat surfaces, lights and operating room furniture.

• Clean all organic debris with soap and disinfect after each surgery. • Wet vacuum or mop the floors at the end of the day. • Clean the scrub sinks and soap dispensers, and empty waste buckets. • A more though cleaning should be performed “weekly” including

wiping down walls, ceilings, cabinets and equipment with germicidal cleaning solution after removing organic debris and soiling.

Page 9: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Instrument Preparation

• Clean all instruments and materials prior to sterilization. • Dirt, blood and gross contaminants should be

completely removed as they compromise sterilization. • Always soak instruments in water with detergent

immediately after surgery to remove blood and debris, and to facilitate cleaning.

• In certain cases it may be necessary to use an ultrasonic cleaner “for difficult to clean” instruments.

• Rinse instruments thoroughly after washing to remove any residues from the cleaning agents. Dry and safely store the instruments after cleaning.

Page 10: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Instrument Preparation• Dry instruments and supplies should be loosely packed in

standard or special packs. Take special care to avoid damaging delicate instruments.

• Packs should be dated. • Sterilization indicators e.g. autoclave tapes or test cultures

should always be included. Note that autoclave tapes only indicate that the surface reached the required temperature.

• Packs should be stored in an appropriate manner after sterilization. Wrapped and sterilized packs are good for 6 months if properly stored. Storing packs in sealed in plastic bags prolongs their shelf life.

Page 11: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Surgeon Preparation• Prior to scrubbing hands, the surgeon should don a surgical

cap, facemask, surgical scrubs and appropriate shoes. Remove jewelry items and ensure that fingernails are trimmed short.

• Scrubbing should be thorough beginning at the tip of the fingers all the way to the elbows using a surgical scrub containing a germicide e.g. chlorhexidine. Vigor and exposure times are critical, 3-15 minutes or 5-20 brush strokes per surface, with at least two thorough scrubs and rinses.

• At the end of the scrub, dry hands with a sterile towel beginning at the tip of the fingers to the elbow. Rotate the towel and repeat the procedure on the other hand.

• After drying the hands, proceed to put on a sterile gown. Lift the gown, unfold away from the table, and insert your arms into the sleeves. The assistant closes the back of the gown, and the surgeon closes the waist tie.

Page 12: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Pre-Operative Preparation• Prior to surgery it is important that the subjects are properly identified. • Records needed include:

– Weight– Age– Sex– Colony history – Health status– Animals appropriately acclimated? This is generally 3-5 days rest after arriving from

the vendor. In some instances this period may need to be up to two weeks.• Perform a physical examination to determine if the animal is healthy. If

possible perform a complete blood count, blood chemistry and urine analysis. • If indicated, bathe the animal the day before surgery. • Withhold food for 6-12 hours before surgery. • Apply ophthalmic ointment to the eyes following induction of anesthesia to

prevent corneal drying. • Provide airway support, vascular access and provide pre-emptive analgesia as

indicated.

Page 13: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Skin Preparation

• Always prepare an area approximately three times the surgical area you will need.

• Preparation should take place in the animal preparation room. • Hair should be removed from the surgical site using clippers with #40

blade or a depilatory cream (depilatory creams can irritate the skin, so rinse the area thoroughly after using the cream)

• NOTE: If the area is grossly contaminated with organic debris, use soap and tap water to remove it prior to performing the preliminary skin preparation. The site is tentatively considered clean when:– Water beads as it flushes across the skin.

– A 4x4 gauze sponge passed over the site appears clean.• Final Skin Preparation Goals:

– 1) substantially reduce resident skin flora to prevent infection – 2) achieve residual antiseptic activity. It is not possible to completely sterilize

the skin.

Page 14: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Skin Preparation• After shaving and removing organic debris, follow by a surgical scrub

alternating between disinfectant (e.g. iodophors or chlorhexidine) and alcohol. – Iodophors (e.g. Betadine®, Prepodyne®, Wescodyne®) inactivate a wide range of

microbes but their activity is reduced in the presence of organic mater.– Chlorhexidine (e.g. Novalsan®, Hibiclens®) are rapidly bactericidal, persistent

and active against many viruses. They are active even in the presence of blood. – Note: antiseptic soaps and solutions must be kept in covered containers to avoid

contamination. Certain bacteria and fungi can survive in these products.• Sterile surgical gloves should be worn for the final skin preparation. Supplies,

including solutions, must be sterile.• A gauze sponge can be used for scrubbing. During the scrub, the process

should begin along the incision line and extend outward and never from outward (dirty) towards the center (clean). Do not go over the incision site with the same scrub.

• Continue until the skin has had 5 minutes of contact time with the antiseptic.• At the end of the scrub apply a coat of germicide. Reapply the germicide in

the operating room.

Page 15: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.
Page 16: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.
Page 17: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Surgical Considerations• Draping

– The decision to drape depends on the nature of the procedure being done. For extensive procedures it is necessary to drape. Drapes help to maintain a sterile field and preserve body heat. Faulty draping technique may increase contamination. Drapes must cover the animal and table.

• Heat loss– Anesthesia alters thermoregulation and reduces metabolism. Loss of heat

also occurs from open body cavity and evaporation of body fluids. Loss of heat can significantly prolong the duration of anesthetic, which in turn increases the risk of complications. Animals should always be kept warm with a hot water blanket.

• Fluid loss– Animals can experience extensive fluid loss during surgery. Fluid loss occurs

primarily as a result of evaporation from body cavities and due to blood loss. Reduce intra-operative fluid loss by irrigating the operative field with warmed sterile saline, and by administration of warm, sterile isotonic fluids parenteraly during the surgery. Control blood loss during surgery by cauterizing or ligating potential bleeders. Monitor water and food intake, body condition and animal weight post-surgically.

Page 18: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Intra-Operative Procedures• Animals should be monitored every 15 minutes to ensure that the animal is alive

and doing well. It is critical that assessment not completely rely on instrumentation to monitor the animals.

• Check the color of the mucus membranes, response to reflexes, heart and pulmonary functions. Instruments can be used to monitor level of oxygenation, expired carbon dioxide, electrocardiogram, and temperature.

• Select the correct surgical instruments for the procedure to be performed. Surgical instruments should be handled to minimize contamination for example placing on sterile drape, segregation according to function helps insure sterility for example instruments used on the skin should not be used within the abdominal cavity.

• Tissues should be handled gently avoiding unnecessary trauma or drying out. Only minimal dissection with appropriate instruments should be done. Blood vessels that are likely to bleed should be ligated. Avoid contamination of incisions sites.

Page 19: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Intra-Operative Procedures• Wounds should be closed with appropriate suture material and techniques using

the right kind of needles. Non-cutting (atraumatic) taper point or round needles have no cutting edges and should be used for soft tissue like peritoneum, intestines, kidney etc. Cutting or reverse cutting needles provide a cutting edge through dense, difficult to penetrate tissues like skin.

• In general absorbable sutures (e.g. cat gut, vicryl®, dexon®) should be used for soft tissues. Blood vessels should be ligated with slowly absorbable (e.g. vicryl®, dexon®, PDS®, maxon®) or non-absorbable sutures (e.g. nylon, silk). Non-absorbable sutures (e.g. ethilon®, prolene®, dermalon®), surgical glue or stainless steel wound clips and staples should be used for the skin. Good surgical techniques will prevent post-surgical complications like infection, hemorrhage or even death. Proper surgical and post-surgical records should be maintained.

• Non-absorbable suture materials used to close skin wounds should be removed as soon as the wound is healed (7-10 days) or within two weeks, whichever occurs first.

Page 20: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Post-Operative Management

• Administer warmed sterile isotonic fluids and keep the animals warm using hot water blankets, hot water bottle or heat lamp (avoid burns).

• Animals should be checked frequently preferably every 10-15 minutes, and turned from side to side until recovered.

• Monitor recovery from anesthesia closely and be prepared to provide respiratory support.

• In the pre-surgical planning phase you should have discussed with the veterinarian anticipated outcomes, for example how long it will take the animal to recover from anesthesia post-operatively, what to expect and what not to expect. Is there bleeding from the incision site? Is the color of the animal’s mucus membranes pink (good) or is it bluish (bad)? Do you anticipate lameness e.g. after orthopedic surgery or not?

Page 21: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Post-Operative Management• Monitor food and water intake after recovery from anesthesia and

provide nutritional support. • Is the incision site swollen? Is there discharge from the site? Swelling,

discharge and discoloration of the incision site signals the need for veterinary attention.

• Does the animal have a fever? If the animal has a fever consult a veterinarian so treatment plan can be initiated.

• Administer analgesic and check for signs of discomfort or pain. The principal investigator is responsible for ensuring that post-procedural care is provided as described in the approved animal use protocol.

• The post-procedural monitoring and care plan should be developed in consultation with the veterinary staff. The surgical plan should include when animal is expected to return to normal behavior. If there is any question as to whether or not the animal is doing well consult a veterinarian immediately.

Page 22: Large Animal Surgery. All survival surgery must be performed using aseptic techniques (Animal Welfare Act regulations): – Use sterile surgical gloves.

Quick Tips• Always Check Endotracheal tube for leaks. • Do a dry run with a “dummy” on the anesthesia machine • Have emergency medications ready• Extra Sterile instruments and towels • Keep Animal Warm…check temp post surgery• Read Protocol• Constantly Check Pulse Ox. with Animal vitals• Keep good notes and records