Soft  Tissue  Surgical  Nursing  Learner’s  Guide  

 

©2014.  Veterinary  Nurse  Solutions  Pty  Ltd.         V1.0                                 Page  13  of  47  This  publication  is  subject  to  copyright  and  may  not  be  made  available  to  any  other  person,  other  than  the  registered  student.  

TOPIC  3  –  Gastrointestinal  Surgical  Procedures  This   topic  will   cover   some  abdominal   surgical   procedures   seen  outside  general   practice.   It   is   not   an  exhaustive  list  and  it  is  recommended  you  do  wider  reading  that  suggested.    

 

Refer  to  your  Surgical  Textbooks  You  should  refer  to  your  veterinary  surgical  textbooks  available  to  you  for  further  procedural  information  on  all  the  surgeries  listed  within  this  topic,  as  well  as  ones  that  are  not.    Veterinary  Surgery  Small  Animal,  Vol  1  Karen  M  Tobias  &  Spencer  A  Johnson  Elsevier,  2012    Small  Animal  Surgery  Teresa  Fossum  Elsevier,  2012    

Study  Notes  Referring   to   the   textbooks   and   Learner’s   Guide,   write   your   own   summary   of   the  information   in   the   textbook/this   section   of   the   Learner’s   Guide.   Place   your   notes  behind  this  topic.  You  must  know  this  information  for  your  assessments  and  exams  -­‐  so  don’t  skip  on  writing  your  own  notes. Use the checklist at the end of this topic to ensure you have learnt everything required for this topic’s assessments and the final exam.

 

 

Laparotomies  

Laparotomies   are   surgeries   that   open   the   abdominal  cavity,   often   for   a   specific   procedure   to   be   undertaken,  but   also   as   an   exploratory   procedure.   Exploratory  laparotomies   (or   ex-­‐laps)   can   be   performed   for   many  reasons   but   they   are   usually   indicated   for   diagnostic  reasons  such  as  obtaining  biopsies  of  the  internal  organs.  They  can  also  be  performed  for  curative  reasons,  such  as  repairing  traumatic  damage  to  an  organ.  A   laparotomy  is  also   the   starting   point   for   procedures   such   as  splenectomy  or    gastropexy.  

Surgical  Instrumentation  

A  laparotomy  doesn’t  require  a  massive  amount  of  specialised  instrumentation.  Usually  a  full  general  surgical  kit  is  enough  and  a  self-­‐retaining  abdominal  retractor  like  a  Balfour  retractor  should  be  made  available.  This  will  allow  the  surgical  team  a  better  view  of  the  abdominal  contents.  If  your  clinic  has  a  suction  unit  this  should  also  be  set  up.  

If  biopsies  are  going  to  be  taken,  then  you  will  need  the  associated  equipment  and  sample  pots.   If  a  further  procedure  is  going  ahead,  for  example  a  gastropexy,  splenectomy,  intestinal  resection,  you  will  need  instrumentation  ready  for  those.  

SAMPLE O

NLY

Soft  Tissue  Surgical  Nursing  Learner’s  Guide  

 

©2014.  Veterinary  Nurse  Solutions  Pty  Ltd.         V1.0                                 Page  21  of  47  This  publication  is  subject  to  copyright  and  may  not  be  made  available  to  any  other  person,  other  than  the  registered  student.  

→ Tachycardia  → Pale  or  muddy  mucous  membranes  → Weak  femoral  pulses  → Distended  and  tympanic  abdomen  (when  you  tap  it,  it  sounds  hollow,  like  a  drum)  

 

You  may  also  feel  an  enlarged  spleen,  and  possibly  see  cyanosis.  

Preparation  for  Arrival  

When   a   suspected   or   known   GDV   is   arriving   there   are   certain   things   you   should   prepare   for   the  patient’s  arrival.  

→ Oxygen  supplementation  o Have   an   oxygen   source   set   up   with   a  mask   for   delivery.   An   anaesthetic  machine   is  

ideal.  → Fluid  set  up  

o Set  up  two  bags  of  0.9%  saline  with  primed  giving  sets.  o If  a  colloid  is  available,  prepare  it  and  keep  it  with  the  other  equipment.  Colloids  are  

expensive,  so  your  vet  may  not  want  it  set  up  until  they  decide  to  administer  it.  → IV  catheter  

o Prepare  large  bore  catheters,  skin  prep  and  tape.  You  want  large  bore  catheters  ready  to  enable  rapid  fluid  infusion.  

→ Stomach  tubes  o Have  a  couple  of   stomach   tubes   ready   for  decompressing   the  stomach.  At   least   two  

will  be  required,  and  it  is  advisable  to  have  some  different  sizes  available  as  well.  o Have   a   roll   of   Vet   Wrap/Elastoplast   ready   to   use   as   a   mouth   gag;   check   that   the  

stomach  tube  will  pass  through  the  middle.  o Have  some  smaller  Elastoplast  to  tape  the  mouth  gag  in  place  if  this  is  what  your  vet  

prefers.   Some   will   just   hold   the   muzzle   shut.   You   will   also   need   this   to   mark   the  stomach  tubes.  

o Sedation  may  be  required  for  some  patients.  o Buckets  and  old  towels  o Exam  gloves  for  those  handling  the  stomach  tubes  o Water-­‐based  lubricant  for  the  tube  end  o Warm  water  for  lavage.  A  funnel  to  fit  into  the  end  of  the  stomach  tube  and  a  jug  can  

help  facilitate  this.  → Sedatives  

o Have  needles  and  syringes  out,  along  with  necessary  drugs.  o If  the  patient’s  weight  is  known,  it  is  advisable  to  have  drug  dosages  worked  out  and  

drawn  up.  o Suggested  sedatives  include  

§ Diazepam  0.2mg/kg  IV  and  ketamine  10mg/kg  IV  –  titrated  to  effect  § Fentanyl  4.0µg/kg  IV  with  diazepam  0.2mg/kg  IV  § Midazolam  can  be  used  in  place  of  diazepam.  § Do  not  draw  up  diazepam  until  ready  to  use.  The  active  ingredient  will  bind  to  

the  plastic  syringes  and  only  non-­‐active  ingredients  will  be  administered.  

SAMPLE O

NLY

Soft  Tissue  Surgical  Nursing  Learner’s  Guide  

 

©2014.  Veterinary  Nurse  Solutions  Pty  Ltd.         V1.0                                 Page  27  of  47  This  publication  is  subject  to  copyright  and  may  not  be  made  available  to  any  other  person,  other  than  the  registered  student.  

 

Knowledge  Checklist  Ensure   that   your   study   notes   include   the   following   points,   as   a   good  underpinning   knowledge   of   all   of   this   information   is   required   in   order   to  successfully  complete  your  assessment  tasks,  including  the  examinations.    

Topic  3  Learning  Objectives  Section   Knowledge  Checklist  Laparotomy   r Definition/What  it  is  

r Objectives  of  surgery  r Instrumentation  required  

r Disposable  supplies  required  r Patient  preparation  r Procedure  description  r Patient  considerations  r Post  Op  Care  

Gastrotomy   r Definition/What  it  is  

r Objectives  of  surgery  r Instrumentation  required  

r Disposable  supplies  required  r Patient  preparation  r Procedure  description  r Patient  considerations  r Post  Op  Care  

Enterotomy   r Definition/What  it  is  

r Objectives  of  surgery  r Instrumentation  required  

r Disposable  supplies  required  r Patient  preparation  r Procedure  description  r Patient  considerations  r Post  Op  Care  

Intestinal  Resection   &  Anastomosis  

r Definition/What  it  is  

r Indications  for  r Intussusception  definition  r Clinical  signs  of  intussusception  r Instrumentation  required  

r Disposable  supplies  required  

SAMPLE O

NLY