Page 295 - Zoo Animal Learning and Training

Chapter 14 Surgical Room Skills 279

Reflection Learning Exercise

The surgical procedure is often thought of as Have a discussion with the veterinarian and
routine. A person gets used to the many steps and technician about surgical emergencies. What
actions required to help with a successful surgery. have they seen, what did they do, how would they
How will you keep sharp when assisting with these like you to assist if one should happen?
many steps and not get lackadaisical about a
“routine” surgery?
Client Communication

Review postoperative patient care with clients. Home care
Post‐Surgical Emergencies will often determine how well the animal heals. Owners
will need complete and understandable instructions in
order to help their pet’s recovery. Go over the discharge
Good communication with all the team members is instructions as per the protocols established at your prac-
essential as you move through the steps it takes to pre- tice. This should be done in a manner that is friendly so as
pare for a surgery. to invite questions and knowledgeably to garner
Anesthetic complications can occur in the recovery confidence. The highlights of most surgical discharge
phase just as quickly as during the other phases of sur- instructions are pain medications, incision care, exercise
gery. Patients can become unable to oxygenate and restrictions, and when to call the clinic if trouble should
develop hypoxemia when the oxygen is discontinued, arise. A follow‐up call the day after discharge will help the
or the endotracheal tube is removed, and the airway patient by catching anything that may be amiss early.
isn’t patent. The mucous membrane color will darken
and eventually turn blue if the patient isn’t re‐intu-
bated and oxygen supplied. Oxygen can come from an Removing Sutures
ambu bag (see Figure 4.17, upper right corner) or
from an oxygen tank. Yell for help as full CPR may be The usual incision closure is a buried suture technique
required. using absorbable suture material that does not require
Hypotension is often brought on by a loss of blood removal as the body will absorb it. On occasion, external
causing a drop in blood pressure. This is usually caught sutures are placed and the suture material is non‐absorb-
while the patient is still in surgery and treated by able and must be removed 7–10 days after the surgery.
increasing the volume of IV fluids or administration of There are two types of suture material used in veterinary
blood products. The treatment usually extends into medicine: synthetic or natural fibers much like thread or
the post‐surgical recovery period. Blood pressure cuffs stainless‐steel staples. Staples are removed using a special
and perfusion parameters like mucous membrane type of removal clip that is slid under the center of the
color and capillary refill times are used to monitor the staple and squeezed (Table 14.3). This flares or springs
patient. the staples out so they can be “unhooked” from the skin.
Cardiac arrhythmia or cardiac arrest can occur and go The “thread‐like” suture material can be removed with a
unnoticed during the recovery period if the heart isn’t small scissors or a specially designed suture removal
auscultated regularly. Abnormal heart sounds, arrhyth- scissors. One of the scissor blades has a hook that can be
mias, irregular pulse, loss of pulse, and very slow or very slipped under one side of the knot and then closed to
fast heart rates must be reported immediately as these cut the suture. Pull on the knot to remove the suture
can indicate heart failure. completely. Never cut both sides of the knot as it will
Incision site dehiscence is when the sutures have let leave a half‐moon piece of suture inside the patient.
go either in the muscle layer or skin layer. This is an Suture removal appointments are made the day the
extreme emergency and the veterinarian needs to be patient is discharged. The veterinary will evaluate the patient
alerted immediately. Internal bleeding can also occur if upon arrival and either take the sutures out himself/herself
a sutured blood vessel leaks. Pale mucous membranes or ask the veterinary technician to do so. The assistant’s job
and slow capillary refill are signs of bleeding. Sometimes at this point is to restrain and distract the patient for the
a large bruise will show around the incision site. Again, procedure. This is usually painless although some animal
alerting the veterinarian if these signs are noted is may still be a bit sore and it can aggravate the area. Be pre-
important. pared to keep the patient from biting or scratching.
Once all the surgeries are completed for the day it is Some clinics may have these pieces of equipment and
time to put the surgery suite in order once more! other may not. The explanation is included in Table 14.3.