SURGICAL NURSING

SURGERY CLASSIFICATIONS  CLEAN SURGERIES  Typically an elective surgery in a non- contaminated, non-traumatic, & non-inflamed surgical site  EX: neuter, elective orthopedic surgery  CLEAN-CONTAMINATED SURGERIES  Surgery involves the respiratory, GI, or genitourinary system, such as a hollow organ  Enterotomy, cystotomy, enterectomy

SURGERY CLASSIFICATIONS  CONTAMINATED SURGERIES  Similar to clean-contaminated surgeries, but with leakage or a major break in sterile technique  EX: enterotomy, enterectomy, cystotomy, cholecystectomy  DRY(aka DIRTY)  A hollow organ is ruptured  EX: infected surgical site, septic peritonitis, abscess, ruptured GI, gallbladder, pyometra

PERIOPERATIVE ANTIBIOTICS  Prophylactic antibiotics are used to decrease the risk of infection.  Antibiotics should never be given indiscriminately to animals undergoing surgery because this contributes to the development of resistant strains of bacteria

INDICATIONS FOR PROPHYLACTIC ANTIBIOTICS  Operative time is more than 90 minutes  Patient is at an increased risk for infection  A hollow viscus is to be entered  Incision is in an area that is difficult to aseptically prepare (toe, ear)  Orthopedic implants  Joint procedures  Consequences of infection could be devastating

INDICATIONS FOR PROPHYLACTIC ANTIBIOTICS  Antibiotics should be given at least 20 minutes before the procedure  Antibiotics should not be given 6-24 hours post-operatively unless there is infection present.

INCISION EVALUATION  Twice daily visual and palpable inspection  Wound should be evaluated with respect to the surgical procedure  Elective procedures vs. contaminated wounds  Abnormalities: usually seen 1-3 days postoperatively  Redness  Swelling  Drainage  dehiscence

INCISION EVALUATION  REDNESS AND SWELLING  Mild redness and swelling is to be expected with elective procedures, usually no drainage  Contaminated wounds (laceration, perianal wounds, etc) may often have drainage, swelling, redness, and be warm to the touch.  Usually resolves in 3-7 days

INCISION EVALUATION MINIMAL REDNESS, SWELLING, & DRAINAGE

INCISION EVALUATION REDNESS DUE TO TRACTION ON THE SKIN & DISRUPTED BLOOD VESSELS

INCISION EVALUATION  Seromas  Seromas are localized areas of fluctuant swellings secondary to extensive surgical dissection beneath the incision- may persist for weeks  Tissue planes could not be or were not adequately closed  Excessive motion occurs at the incision site  TX: warm compress, +/- bandaging or drainage. Aspiration is usually not necessary and could result in infection

INCISION EVALUATION SEROMA

INCISION EVALUATION SCROTAL HEMATOMA

INCISION EVALUATION  INFECTION OR CELLULITIS  May occur 4-6 days post-op  Warm incision  Fever  Redness  Drainage  TX:  Warm compresses  Drainage  Systemic antibiotics

INCISION EVALUATION INFECTED SURGICAL WOUND

INCISION EVALUATION  DEHISCENCE  Wound breakdown – a separation of all layers of an incision or wound.  Early recognition is important  Contributing factors to dehiscence  Improper suture technique  Tension on the incision line  Infection  Seroma formation

INCISION EVALUATION COMPLETE DEHISCENCE OF AN ABDOMINAL INCISION

INCISION EVALUATION  Sutures/staples typically removed after days  Commonly done by the veterinary technician  Requires special suture removal scissors or staple removal device  E-collar may be necessary in patients that are licking, chewing at incision

INCISION EVALUATION

HEALED INCISION

21 Bandage Care  Maintenance  Keep clean and dry  Plastic bag or water-resistant covering  Don’t let moisture accumulate under plastic bag  Check toes twice a day (limb bandage)  Check for swelling or coldness  Complications  Swollen toes can mean the bandage is too tight  Wet, dirty bandage can lead to infection  Too-tight bandage can lead to vascular compromise with skin death and sloughing

SURGICAL DRAINS  Indications for a post-operative surgical drain  The incision is thought to be infected  The wound should be left open or a drain should be inserted  Soft tissues can not be opposed to obliterate dead space  The wound is large/large amounts of tissue rescected  Serum accumulates in the spaces resulting in a seroma

SURGICAL DRAINS  Drains are usually classified as either ACTIVE or PASSIVE  The draining effect of passive systems is based on gravity  The draining effect of active systems is based on negative pressure (suction)

SURGICAL DRAINS   PASSIVE DRAINS   Soft, thin-walled, collapsible, latex rubber tubes named PENROSE DRAINS are most commonly used in veterinary medicine   Discharge escapes by moving along the outside of the drain.   Cleanliness is important because the hole and drain can act as an avenue for ascending infections. The open end should be covered.

PASSIVE DRAINS: PENROSE  Drains should be removed as soon as the drainage decreases significantly  The drain should always exit ventrally to allow gravity to work  The drain should be covered with a bandage & changed frequently columns/surgical-insights/the-art-of-draining-evil-humors.aspx

SURGICAL DRAINS  ACTIVE DRAINS  Thick-walled tubes of rubber or Silastic.  Multiple openings are present in the wall of the tube on the implanted end.  Suction is applied to the outside end of the drain, and discharges are pulled through the lumen of the tube.  Suction must be maintained for this type of drain to work  The JACKSON PRATT drain is a commonly used negative-pressure device

ACTIVE DRAINS: JACKSON PRATT