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Abdominal Surgery Patient Prep

Views: 21615 - Comments: 18

Surgery assistant at DoveLewis, Sue Marcoe, demonstrates how to clip and prepare a patient for abdominal surgery.

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Suzanne Marcoe's picture
Suzanne Marcoe

Enrolled: 09/2011

Megan Brashear's picture
Megan Brashear

CVT VTS(ECC)

Enrolled: 07/2011

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Comments

Sarah Crisp's picture

I always use gloves and a small stack of dry gauze for the prepuce flush, which makes the process a lot cleaner. You never know what's going to flush out of there... seriously. It's also good to keep the patient as dry as possible to help retain body heat!

Sidenote: I hope everyone notices how cool our baby socks with bubble wrap are. Cute AND effective.

Megan Barclay's picture

Great video, I wasn't aware of the prepuce flush before seeing this, so I will be including this into all of my abdominal preps now. Also, leaving the sterile swabs over the surgical site while transferring is a good tip.
Love the socks. :)

Jennifer Boston's picture

I have a question about the betadine/alcohol combination. I was taught in school that the alcohol inactivates the betadine. A better combination is chlorhexadine scrub with alcohol?

Katrina Bowers's picture

I was always taught never to go back and forth even over the incision site. When watching the video, the gauze essentially comes in contact with the prepuce area and then back over the incision area. I was taught this is a big no-no. Just curious.

Megan Brashear's picture

Katrina, good points! As far as scrubbing back and forth, in human studies regarding skin prep they scrubbed back and forth over the incision site for 30 seconds before targeting outwards (it was a solution study - chlorhex vs iodine but in their procedures they scrubbed back and forth). The most important aspects of a scrub are to not cause damage to the skin (soft touch with your scrubs!) and CONTACT TIME. In this video, this is our rough prep, and some prepuce contact. The goal here is to get the hair clipped and start the cleaning solution contact time. In the surgery suite we perform another scrub wearing sterile gloves and using sterile gauze where the prepuce gets it's own separate scrub. Shoot me a message if you'd like to read any of those human scrubbing papers!

Megan Brashear's picture

Jennifer, there isn't any inactivation that happens, but there are various solution combinations. Our surgeons prefer the betadine and alcohol combo. More importantly, we have an extremely low surgical site infection rate here. As important as scrub choice is contact time with the incision site, operating room cleanliness, hospital cleanliness, and post-op care.

Israel Figueroa's picture

Never have heard of doing the prepuce flush!! But makes total sense will definitely include that in our pre surgical procedure thank you so much.

Christy  Laney's picture

I'm assuming this video has changed since the surgery in the video was a feline spay with no prepuce so the quiz should be updated to reflect the new video. :)

Megan Brashear's picture

Christy, thank you for bringing this to our attention! We are switching the video back to the appropriate dog video, not exactly sure how and when the swap happened but it is fixed and the quiz matches the video again.

Tracie Stol's picture

Hi Megan It looks like the video has gone back to the feline spay. Thank you so much for these wonderful videos and great quizzes.

Heather Darbo-McClellan's picture

I was under the impression that the most nosocomial studies suggest that you scrub 3 times before wiping with alcohol/saline. From what I have read it is for dwell/contact time to allow the scrub to stay in contact with the skin longer to kill organism. What are your thoughts and finding?

Chris Green's picture

Thanks for the great question! There is not a simple answer to your question, but here are a few tips. First of all, you should follow the directions provided by the manufacturer for the exact product you use. When we talk about dwell/contact time, you are absolutely correct that the longer the product is in contact with the skin the better. Here at DoveLewis, we tend to place a few gauze squares with betadine on the incision site to help get more contact time while we move the patient into the surgery suite for the surgical prep, as shown in the video. If you are using chlorhexidine, all of the long lasting effects are wiped away by alcohol, and therefore you should use alternating chlorhexidine scrub and solution instead. If you are using the traditional betadine and alcohol solutions for prep, you should follow a scrub-alcohol-scrub-alcohol-scrub-alcohol process. Just remember that the patient should be clean before starting your scrub, so you don’t need to aggressively scrub, but rather apply the solutions and allow the contact time to do its work. I hope this answers your question, let me know if you have any other questions!

Rachel Medo's picture

Hi Meghan,

Great question. We use bubble wrap and socks to keep patients extremities warm during surgery. You can think of it like mittens or extra thick socks for people!

Jessica Worsfold's picture

Hi,

I am curious as to why you alternate between the antiseptic and the alcohol?

In my education, clinical experience and career professional development, I have never been informed of this. We mainly prep with chlorhexidine gluconate 4% on our swabs with an aqueous solution poured over this (unless not appropriate we will use povidone iodine) and we use this prep until the site comes off clean, then following the chlorhexidine prep we use a tincture based solution on swabs (chlorhexidine 5%, distilled water and meths) to degrease and dry the surgical site. Interested to hear your response.

I also note you wet the peripheral hairs down as your doing your last concentric circle when required, but I believe this can cause the bacteria your trying to move outwards to drag onto the patients fur. We educate our students to wet down the hair first to reduce the need to wet down peripheral hairs as we go and this further prevents excess product being dragged onto the patients hair and when using cooling agents this reduces the risk of hypothermia to the patient.

Bobbie Lucas's picture

Hello Jessica,

These are great questions and I would be happy to answer them for you.

1- We use two different combinations of solutions depending on the animals skin type and whether or not there are any open wounds in the area where we are scrubbing. Here at Dove Lewis we are taught to use povidone iodine and alcohol for all patients unless they have sensitive skin or open wounds present. If the latter, we use diluted chlorhexidine scrub and solution as our alternating solution combo because it is less harsh on the skin and wounds. We are also taught to not overly soak our swabs so that the solutions don't pool anywhere, and so they evaporate/dry appropriately before beginning a procedure. In addition, the povidone iodine has been shown to cause mixed reactions when combined with a chlorhexidine solution on patients, which is why we use it in combination with alcohol instead.

2- At Dove Lewis, we perform 2 surgical scrubs- one in our prep room (as seen in video), and a second performed in the surgical suite immediately before the procedure with sterile gloves and sterile prep materials. During surgical scrubs, our main priority is to get the incision line as clean as possible. Therefore, we start in the center and work our way outwards to assist in pushing bacteria away from the line of incision. We are taught to touch any "dirty" areas last so we don't bring bacteria back into the surgical area; which is why you see us lightly wetting the peripheral hairs down (we don't drench the hairs) to prevent them from bouncing back into our surgical site; this is only done in prep so we don't have to worry about the hairs bouncing back during the sterile scrub int he surgery suite. Also, we have thorough heating (bair hugger, heated table, and warming bottles) during procedures to ensure the patient is kept dry and warm throughout.

I hope this answers your questions.

Take care,
Bobbie Lucas, Dove Lewis Surgical Assistant

Janice Bergeron's picture

I just watched the video and yook the quiz, they don't match. The video is a feline spay.