T5: Getting the Patient Ready for Theatre

Question 1

What are some procedures that may need to be performed to stabilise an animal?

Answer 1

• Clearing the airway
• Administration of oxygen via mask
• Intubation -may require lignocaine gel or spray
• Control of haemorrhage -apply direct pressure
• IV fluids

Question 2

What is the aim of pre-operative stabilisation?

Answer 2

to reduce the patient’s anaesthetic risk so that their chances of surviving surgery are increased.

Question 3

What is IPPV?

Answer 3

Intermittent Positive Pressure Ventilation

breaths performed manually by the nurse using the breathing bag or by a mechanical ventilator

Question 4

Name some situations where the vet may require the veterinary nurse to assist with controlling the patient’s ventilation during anaesthesia

Answer 4

• apnoea
• hypoventilation
• obesity
• thoracotomy
• muscle relaxant use
• diaphragmatic hernia

Question 5

What is hypoventilation?

Answer 5

• abnormally low alveolar ventilation (i.e. the volume of gas delivered to the alveoli each minute is less than normal)
• caused by a reduction in the tidal volume (size of breath) and/or a reduction in the respiratory rate.
• Hypoventilation can lead to hypercapnia (an increase in expired carbon dioxide levels).

Question 6

How may obesity cause breathing difficulties during anaesthesia?

Answer 6

• Subcutaneous, intrathoracic and abdominal fat deposits may prevent adequate expansion of the chest and lungs

Question 7

What type of ventilation is required during a thoracotomy?

Answer 7

• PPV -ongoing ventilation, not intermitent
• as the chest is opne, animal cannot breath for itself
• mechanical ventilator often used

Question 8

How may a diaphragmatic hernia interfere with a patients breathing during anaesthesia?

Answer 8

• diaphragm contributes little to the expansion of the lungs and even very light anaesthesia may cause severe ventilatory depression
  *

Question 9

When using manual IPPV, what is the maximum breath size?

Answer 9

not greater than 20cm H2O

Question 10

What is the normal ventilatory rate for:
Cats?
Dogs?

Adult horses?

Foals?

Answer 10

• 15 breaths/min (cats)
• 8 breaths/min (large dogs)
• 4-6 breaths/min (adult horses)
• 8-10 breaths/min (foals)

Question 11

Describe how you would place an IV catheter

Answer 11

• In either cephalic, jugular and medial and lateral saphenous veins.
• can be left for long periods of time (>72hrs) if properly maintained, and flushed w/ heparin saline every 4-6hrs.
• Immobilsed and hold off vein
• insert catheter w/ bevel up at 15degree angle
• look for flash of blood, reduce angle of catheter to parallel w/ vein
• advance, look for flash in chamber, advance fully
• tape and plug

Question 12

What is maintenance fluid rate?

Answer 12

2.5-3ml/kg/hr or 60ml/kg/day

Question 13

For neonates or presence of massive tissue injury, fluids rates should be increased by a factor of…?

Answer 13

1.3

Question 14

How quickly should a fluid deficit be replaced?

Answer 14

• over 48 hours:

half in the first 6-8 hours

three quarters after 24 hours

and the remainder by 48 hours

Question 15

Name the fluid used for routine fluid maintenance during surgery

Answer 15

Hartmann’s

Question 16

What characteristics should a canine blood donor have?

Answer 16

• current vaccinations
• tested negative for heartworm microfilaria
• be receiving heartworm prophylaxis
• not have received a blood transfusion
• PCV greater than 35% immediately prior to blood collection

Question 17

What characteristics should a feline blood donor have?

Answer 17

• tested negative to feline leukaemia virus and feline immunodeficiency virus
• be receiving heartworm prophylaxis.

Question 18

The volume of blood collected from the donor on each occasion should be limited to:

Answer 18

• 16ml/kg for greyhounds
• 12ml/kg for other dog breeds
• 10ml/kg for cats

Question 19

Name the antcoagulant used in blood collection bags

Answer 19

Citrate Phosphate 2x Dextrose with Adenine (CP2D-A)

Question 20

How may collected blood be stored?

Answer 20

• be stored for four weeks at temperatures of 2-6°C.
• Gentle agitation of the pack every day or so to mix the red cells, will optimise its condition.
• Blood for patients with thrombocytopenia should be stored at about 20°C and administered within 6 hours
• Refrigeration inactivates platelets.

Question 21

Which canine blood type are universal blood recipients?

Answer 21

DEA 1.1

can receive a first transfusion of any type without developing a transfusion reaction

Question 22

Clinical signs of a transfusion reaction include:

Answer 22

• pyrexia
• vomiting
• salivation
• trembling
• elevated heart rate
• urticaria (raised itchy areas of skin)
• hypotension (leading to shock)

Question 23

What does blood cross-matching involve?

Answer 23

• separation and washing of red cells from the donor and recipient.
• Donor cells are then mixed with the recipient’s plasma (“major cross-match”) and the recipient’s cells are mixed with the donor’s plasma (“minor cross match”).
• Incompatibility is indicated by aggregation (clumping) of the red cells.

Question 24

At what rate should you administer a blood transfusion?

Answer 24

• initial rate of transfusion is slow (0.2 ml/kg/minute for 20 minutes) and the patient is observed for signs of a transfusion reaction.
• A normovolaemic animal should not receive blood at a rate greater than 1.5 ml/kg/hour.

Question 25

How may you transport a patient into the theatre?

Answer 25

• manual carrying
• trolley
• stretcher
• hydraulic winches

You may need to bring anaesthetic pump and fluids (clinic depending).

Be careful to:

• not occlude breathing
• not to contaminate surgical site
• Keep animal warm

Question 26

A patient should be positioned in surgery so that:

Answer 26

• the surgeon has ample access to the surgical region
• the patient is comfortable
• swelling (oedema) of the feet does not occur because of constriction by ties
• leg ties are not placed in front of a venipuncture - because of the danger of producing a haematoma.

Question 27

What is dorsal recumbency?

Answer 27

animal placed on its back

Question 28

What is ventral recumbency?

Answer 28

animal placed on its abdomen/thorax

Question 29

What is lateral recumbency?

Answer 29

animal is placed on its side

Question 30

Name some positioning equipement

Answer 30

• sand bags
• ties
• v troughs

Question 31

Explan the final clean of the surgical area before surgery

Answer 31

• wash hands and gown/glove up
• first solution applied is an alcohol-based antiseptic (strongly bactericidal) this is then removed with gauze swabs in an aseptic manner
• final antiseptic to be applied is usually an iodophor or chlorhexidine solution (which is water based). These are not usually removed but left to dry on the skin