SURGICAL NURSING

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SURGICAL NURSING
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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

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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

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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

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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

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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.

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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

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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

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INCISION EVALUATION
MINIMAL REDNESS, SWELLING, DRAINAGE
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INCISION EVALUATION
REDNESS DUE TO TRACTION ON THE SKIN DISRUPTED
BLOOD VESSELS
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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

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INCISION EVALUATION
SEROMA
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INCISION EVALUATION
SCROTAL HEMATOMA
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INCISION EVALUATION

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

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INCISION EVALUATION
INFECTED SURGICAL WOUND
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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

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INCISION EVALUATION
COMPLETE DEHISCENCE OF AN ABDOMINAL INCISION
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INCISION EVALUATION

• Sutures/staples typically removed after 10-14
  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

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INCISION EVALUATION
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INCISION EVALUATION
HEALED INCISION
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Bandage Care

• Maintenance
• Keep clean and dry
• Plastic bag or water-resistant covering
• Dont 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

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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

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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)

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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.

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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-drainin
g-evil-humors.aspx
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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

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ACTIVE DRAINS JACKSON PRATT