surgical nursing. surgery classifications clean surgeries typically an elective surgery in a non-...

SURGICAL SURGICAL NURSINGNURSING

SURGERY SURGERY CLASSIFICATIONSCLASSIFICATIONS CLEAN SURGERIESCLEAN SURGERIES

Typically an elective surgery in a non-Typically an elective surgery in a non-contaminated, non-traumatic, & non-inflamed contaminated, non-traumatic, & non-inflamed surgical sitesurgical site EX: neuter, elective orthopedic surgeryEX: neuter, elective orthopedic surgery

CLEAN-CONTAMINATED SURGERIESCLEAN-CONTAMINATED SURGERIES Surgery involves the respiratory, GI, or Surgery involves the respiratory, GI, or

genitourinary system, such as a hollow organgenitourinary system, such as a hollow organ Enterotomy, cystotomy, enterectomyEnterotomy, cystotomy, enterectomy

SURGERY SURGERY CLASSIFICATIONSCLASSIFICATIONS CONTAMINATED SURGERIESCONTAMINATED SURGERIES

Similar to clean-contaminated surgeries, but Similar to clean-contaminated surgeries, but with leakage or a major break in sterile with leakage or a major break in sterile techniquetechnique EX: enterotomy, enterectomy, cystotomy, EX: enterotomy, enterectomy, cystotomy,

cholecystectomycholecystectomy

DRYDRY A hollow organ is rupturedA hollow organ is ruptured

EX: infected surgical site, septic peritonitis, abscess, EX: infected surgical site, septic peritonitis, abscess, ruptured GI, gallbladder, pyometraruptured GI, gallbladder, pyometra

PERIOPERATIVE PERIOPERATIVE ANTIBIOTICSANTIBIOTICS

Prophylactic antibiotics are used to Prophylactic antibiotics are used to decrease the risk of infection in clean or decrease the risk of infection in clean or clean contaminated surgeries. clean contaminated surgeries.

Antibiotics should never be given Antibiotics should never be given indiscriminately to animals undergoing indiscriminately to animals undergoing surgery because this contributes to the surgery because this contributes to the development of resistant strains of bacteriadevelopment of resistant strains of bacteria

INDICATIONS FOR INDICATIONS FOR PROPHYLACTIC ANTIBIOTICSPROPHYLACTIC ANTIBIOTICS Operative time is more than 90 minutesOperative time is more than 90 minutes Patient is at an increased risk for infectionPatient is at an increased risk for infection A hollow viscus is to be enteredA hollow viscus is to be entered Incision is in an area that is difficult to Incision is in an area that is difficult to

aseptically prepare (toe, ear)aseptically prepare (toe, ear) Orthopedic implantsOrthopedic implants Joint proceduresJoint procedures Consequences of infection could be Consequences of infection could be

devastatingdevastating

INCISION EVALUATIONINCISION EVALUATION Daily visual and palpable inspectionDaily visual and palpable inspection

Wound should be evaluated with respect to the Wound should be evaluated with respect to the surgical proceduresurgical procedure Elective procedures vs. contaminated woundsElective procedures vs. contaminated wounds

Abnormalities: usually seen 1-3 days Abnormalities: usually seen 1-3 days postoperativelypostoperatively RednessRedness SwellingSwelling DrainageDrainage dehiscencedehiscence

INCISION EVALUATIONINCISION EVALUATION REDNESS AND SWELLINGREDNESS AND SWELLING

Mild redness and swelling is to be Mild redness and swelling is to be expected with elective procedures, expected with elective procedures, usually no drainageusually no drainage

Contaminated wounds (laceration, Contaminated wounds (laceration, perianal wounds, etc) may often have perianal wounds, etc) may often have drainage, swelling, redness, and be drainage, swelling, redness, and be warm to the touch.warm to the touch.

Usually resolves in 3-7 daysUsually resolves in 3-7 days

INCISION EVALUATIONINCISION EVALUATION

MINIMAL REDNESS, SWELLING, & DRAINAGE


REDNESS DUE TO TRACTION ON THE SKIN & DISRUPTED BLOOD VESSELS

INCISION EVALUATIONINCISION EVALUATION SeromasSeromas

Seromas are localized areas of Seromas are localized areas of fluctuant swellings secondary to fluctuant swellings secondary to extensive surgical dissection beneath extensive surgical dissection beneath the incision- the incision- may persist for weeksmay persist for weeks

Tissue planes could not be or were not Tissue planes could not be or were not adequately closedadequately closed Excessive motion occurs at the incision Excessive motion occurs at the incision

sitesite TX:TX: warm compress, +/- bandaging or warm compress, +/- bandaging or

drainage. Aspiration is usually not necessary drainage. Aspiration is usually not necessary and could result in infectionand could result in infection


SEROMA


SCROTAL HEMATOMA

INCISION EVALUATIONINCISION EVALUATION INFECTION OR CELLULITISINFECTION OR CELLULITIS

May occur 4-6 days post-opMay occur 4-6 days post-op Warm incisionWarm incision FeverFever RednessRedness DrainageDrainage

TX: TX: Warm compressesWarm compresses DrainageDrainage Systemic antibioticsSystemic antibiotics


INFECTED SURGICAL WOUND


DEHISCENCEDEHISCENCE Wound breakdown – a separation of all layers Wound breakdown – a separation of all layers

of an incision or wound.of an incision or wound. Early recognition is importantEarly recognition is important

Contributing factors to dehiscenceContributing factors to dehiscence Improper suture techniqueImproper suture technique Tension on the incision lineTension on the incision line InfectionInfection Seroma formationSeroma formation


COMPLETE DEHISCENCE OF AN ABDOMINAL INCISION


Sutures/staples typically removed after Sutures/staples typically removed after 10-14 days10-14 days

E-collar may be necessary in patients E-collar may be necessary in patients that are licking, chewing at incisionthat are licking, chewing at incision


HEALED INCISION

SURGICAL DRAINSSURGICAL DRAINS

Indications for a post-operative Indications for a post-operative surgical drainsurgical drain The incision is thought to be infectedThe incision is thought to be infected

The wound should be left open or a drain The wound should be left open or a drain should be insertedshould be inserted

Soft tissues can not be opposed to Soft tissues can not be opposed to obliterate dead spaceobliterate dead space Serum accumulates in the spaces resulting Serum accumulates in the spaces resulting

in a seromain a seroma

SURGICAL DRAINSSURGICAL DRAINS Drains are usually classified as either Drains are usually classified as either

ACTIVE or PASSIVEACTIVE or PASSIVE

The draining effect of The draining effect of passive systems is passive systems is based on gravitybased on gravity

The draining effect of The draining effect of active systems is active systems is based on negative pressure (suction)based on negative pressure (suction)

SURGICAL DRAINSSURGICAL 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

PASSIVE DRAINS: PENROSEPASSIVE DRAINS: PENROSE Drains should be Drains should be

removed as soon as removed as soon as the drainage the drainage decreases decreases significantlysignificantly

The drain should The drain should always exit ventrally always exit ventrally to allow gravity to to allow gravity to workwork

The drain should be The drain should be covered with a covered with a bandage & changed bandage & changed frequentlyfrequently

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

SURGICAL DRAINSSURGICAL DRAINS ACTIVE DRAINSACTIVE DRAINS

Thick-walled tubes of rubber or Silastic.Thick-walled tubes of rubber or Silastic. Multiple openings are present in the wall of Multiple openings are present in the wall of

the tube on the implanted end.the tube on the implanted end. Suction is applied to the outside end of the Suction is applied to the outside end of the

drain, and discharges are pulled through the drain, and discharges are pulled through the lumen of the tube. lumen of the tube.

Suction must be maintained for this type of Suction must be maintained for this type of drain to workdrain to work

The The JACKSON PRATT drain is a commonly JACKSON PRATT drain is a commonly used negative-pressure deviceused negative-pressure device

ACTIVE DRAINS: JACKON ACTIVE DRAINS: JACKON PRATTPRATT

surgical nursing. surgery classifications clean surgeries typically an elective surgery in a non-...

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