SURGICAL NURSING. SURGERY CLASSIFICATIONS CLEAN SURGERIES Typically an elective surgery in a non-...
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Transcript of SURGICAL NURSING. SURGERY CLASSIFICATIONS CLEAN SURGERIES Typically an elective surgery in a non-...
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
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
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
INCISION EVALUATIONINCISION EVALUATION
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
INCISION EVALUATIONINCISION EVALUATION
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
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