44 California Veterinarian • May–June 2018 cvma.net

Heidi Reuss-Lamky, LVT, VTS (Anesthesia & Analgesia, Surgery) | CVMA Fall Seminar Speaker   By

The Role of the Veterinary Surgical Scrub Technician

Often described as the surgeon’s primary assistant, veterinary surgical scrub technicians (VSST) play an important role as part of the

surgical team. Notable features of a great VSST include familiarity with the surgical procedure, surgeon’s preferences and needs, as well as the ability to anticipate, even when things go wrong. VSSTs can augment the veterinarian’s recommendations to the client surrounding their pet’s surgical procedure as well as assist with client education during all phases of care (pre, intra, and postoperative).

Preoperative ResponsibilitiesThe VSST can review the preventative health care status and obtain a patient history, where risk factors such as allergies or potential drug interactions between prescribed current medications and anesthetic drugs can be identifi ed.1 A thorough physical exam is necessary to detect comorbidities or determine if breed-specifi c challenges (e.g., brachycephalic airway disease) will impact the plan. History and physical exam fi ndings will dictate preoperative work up requirements such as blood work or other advanced imaging modalities. VSST communications with the client may entail fasting instructions, timing of prescribed medications, and resuscitation orders.

Surgical checklists can be used to track all aspects of perioperative care, including diagnostics, procedures and anesthetic requests, sample collection, and outline postoperative requirements so that critical tests, treatments, and participant team roles are clear.2 Since communication issues play a factor in 80 percent of surgical errors, surgical checklists can dramatically decrease postoperative morbidity (36 percent) and mortality (48 percent) while improving teamwork, overall outcomes, and increasing patient safety.1, 3

Intraoperative ResponsibilitiesThe VSST may organize the surgical case load for the day, as well as ensure the operating room (OR) is clean and disinfected prior to beginning surgery. Prior to the procedure, the VSST assembles all surgical supplies and equipment in a chronological use order, while assessing each item for sterility. The VSST oversees surgical patient preparations, ensures trauma-free hair removal, application of appropriate

topical antiseptics, administration of perioperative antibiotics, and assists with proper patient positioning once inside the OR. The VSST may facilitate gowning and gloving of the surgical team while surveying for breaks in sterile technique. Intraoperatively, the VSST should ensure the instrument table is kept organized and clean, and track sponge counts and sharps in addition to assisting with hemorrhage control, retracting, or moistening tissues and cutting sutures. Memorization of the surgical procedure allows the VSST to anticipate the surgeon’s next move and

“Notable features of a great VSST include familiarity with the surgical procedure, surgeon’s preferences and needs, as well as the ability to anticipate, even when things go wrong.”

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Heidi Reuss-Lamky, LVT, VTS (Anesthesia & Analgesia, Surgery)

Heidi Reuss-Lamky has over 25 years of surgical expertise and is affi liated with Oakland Veterinary Referral Services in Bloomfi eld Hills, Michigan. She is a Fear Free certifi ed professional, earned a VTS in anesthesia, and was a founding member of the Academy of Veterinary Surgical Technicians. She is an active member of many professional organizations, an accomplished author and lecturer, and is the proud recipient of the 2013 NAVC Dr. Jack L. Mara Memorial Lecture award.

References1. Browning, Danielle, and Tobias, Karen, “Preoperative Roles and Responsibilities of the Veterinary Surgical Nurse,” Today’s Veterinary Technician, Vol. 1, No. 4, 2016, pp7–15 2. Frankel, C., “Veterinary Medicine Needs Checklists,” Cliniciansbrief.com, pp. 60–62, February 2017 3. Haynes, AB, et.al., “A surgical safety checklist to reduce morbidity and mortality in a global population,” New England Journal of Medicine, 2009; 360; 491–499. 4. Liska, Wm D., “Technician Utilization in a Surgery,” Proceedings American College of Veterinary Surgeon’s Symposium, Nashville, TN, pp 745–748

recognizing complications beforehand can improve response time. As such, it is benefi cial if team members are cross-trained with anesthesia technicians for this role.4

Postoperative ResponsibilitiesThe VSST may also be responsible for discharging surgical patients. Appointments should be scheduled with pet owners to ensure ample time for verbal instructions, and to allow clients to view the surgical wounds and learn to care for bandages, drains, or other wound dressings. Furthermore, clients should be taught to administer antibiotics, pain medications, or sedatives in

a timely fashion, and be provided tools to prevent wound molestation (Elizabethan collars, ThundershirtTM, bandage covers (e.g., Medipaw®)), and ambulation assistance (e.g., slings or harnesses). Discharge folders organized with the doctor’s postoperative care instructions, drug inserts for prescribed medications, and handouts addressing common perioperative areas for concern (appetite changes with bland diet recommendations, elimination changes, bedding, and housing requirements) as well as information on how to keep the pet restricted and occupied during extended periods of rest (activity toy handout) can also be included.

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