1. SURGICAL NURSING

2. 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

3. 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  A hollow organ is ruptured  EX: infected surgical site, septic peritonitis, abscess, ruptured GI, gallbladder, pyometra

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

5. 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

6. INCISION EVALUATION  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

7. 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

8. INCISION EVALUATION MINIMAL REDNESS, SWELLING, & DRAINAGE

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

10. 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

11. INCISION EVALUATION SEROMA

12. INCISION EVALUATION SCROTAL HEMATOMA

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

14. INCISION EVALUATION INFECTED SURGICAL WOUND

15. 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

16. INCISION EVALUATION COMPLETE DEHISCENCE OF AN ABDOMINAL INCISION

17. INCISION EVALUATION  Sutures/staples typically removed after 10-14 days  E-collar may be necessary in patients that are licking, chewing at incision

18. INCISION EVALUATION

19. HEALED INCISION

20. 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  Serum accumulates in the spaces resulting in a seroma

21. 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)

22. 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

23. 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 http://www.veterinarypracticenews.com/vet-practice-news- columns/surgical-insights/the-art-of-draining-evil-humors.aspx

24. 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

25. ACTIVE DRAINS: JACKON PRATT