Dog/Cat Patient preparation All steps are done prior to any anesthesia. This will allow the surgical team to use less anesthesia for the actual procedure which is important to minimize any anesthesia that depresses the puppies. The mid-to caudal abdomen should be shaved and scrubbed. Positioning The patient is placed in dorsal recumbency with the legs securely fastened to the surgical table to prevent rotation during surgery.
Tools Spay pack, Scalpel blade, Suture material, 1-2 extra packs of sterile hand towels for the surgeon to hand off puppies to the surgical assistant, A pre-warmed tub for puppies once they are stable, Bulb syringe and several pipettes to suction out nares and oral cavity of fluid, A few hemostats for clamping and tying off umbilical cords, Umbilical tape or suture material, Several hand towels for the treatment table to clean off puppies, Dopram injectable (We keep ours in the crash box) along with a handful of tuberculin syringes, An extra anesthesia machine that has been flushed with oxygen for oxygen flow-by if needed.
Puppies/Kittens: Post Removal: The first things the assistants must do upon receiving the pups is to rub them gently yet vigorously in a towel. This stimulates them to breathe. They also need to be gently shaken to remove fluid from their lungs. The nurses use a special bulb syringe to suction fluids from pups that aren’t eliminating fluid from shaking and rubbing. Any pup that is still not breathing well at this point is giving a drop of respiratory stimulant on the top of its tongue. Once our nurses feel the pup is breathing on its own they tie its umbilical cord.
Horse Patient preparation Patient should be well oxygenated to assure that the foal has a good oxygen supply and antibiotics should be started before surgery. The entire belly is shaved from the mid-caudal abdomen to the udder. The area should then be soaked in a pre-podine scrub solution and that solution should then be rubbed into the ara that was shaved with your hands (in sterile gloves), a sterile sponge, or a surgical scrub brush.This should be repeated until the entire area is free of dirt or debris. The area should then be washed off with 70% alcohol. The incision is made from the mammary glands all the way down past the umbilicus.
Positioning Typically the mare will be in a lateral recumbency with her hind end pulled up or wenched up off the ground. Tools Scalpel blade, Suture material, Full arm sterile gloves and gowns, 5-6 extra packs of sterile hand towels, Hemostats or an umbilical cord clamp, Umbilical tape or suture material, Naso-Tracheal tube, suction bulbs, ambu bag, Iv catheters, and IV fluids.
Pre-Podine scrub, 70% alcohol. Sterile Fluids for abdominal and uterine lavage and suction to remove it and any other fluids. A gurney and a portable oxygen tank for moving the foal, and obstetrical chains to aid in removing the foal from the mare. Fouls: Post Removal: Umbilical cord is clamped and cut. A naso-tracheal tube can be placed if needed to help make sure the airways are open and the foul is receiving oxygen. Foal is cleaned, dried off, stimulated and fluid/mucus in the mouth and nose are cleared.
Cattle Patient preparation The patient should be shaved with a large surface area on all sides of where the incision will be. This will depend on the positioning of the patient for the surgery. The area should then be drenched with a pre-podine scrub solution and that solution should then be rubbed into the ara that was shaved with your hands (in sterile gloves), a sterile sponge, or a surgical scrub brush.This should be repeated until the entire area is free of dirt or debris.
The area should then be washed off with 70% alcohol. Positioning The patient must have her head secured in a head gate or other device such as a calving or maternity pen if there is one available, to prevent her from moving during the procedure. Other devices such as rope restraints and fencing can be used in a bind as well, but the important part is keeping the patient still. There are eight different approaches for a cesarean section of a cow:
1 -Standing left paralumbar celiotomy – Most commonly used approach, especially in healthy patients. Incision is made on the left side of the patient vertically in the middle of the paralumbar fossa starting by the lumbar vertebrae and going ventrally as far as it is needed to remove the calf. In order for this position to work, the veterinarian needs a decent restraint area and the patient must be able to stand on its own. 2- Standing right paralumbar celiotomy – Same as above but the incision is made on the right side,and used when the patient is thought to have a right horn pregnancy.
3- Recumbent left paralumbar celiotomy – Patient is placed in right lateral recumbency. The incision is made more ventral than the Doctor would in a standing left celiotomy. 4- Recumbent ventral midline celiotomy – Most commonly used in recumbent patients. Patient is positioned in Dorsal recumbency leaning towards the doctor at a 40-45% angle with both front and hind feet tied to a wall or a gate. 5- Recumbent ventral paramedian celiotomy – Similar to the to ventral midline celiotomy except that the incision is placed more parallel to the linea alba like you would in a canine or feline.
6- Ventrolateral celiotomy- Similar again to the other ventral approaches is used more frequently on older patients. The patient is positioned in right lateral recumbency with the hind legs extended straight back and the front legs pulled out and forward. This position uses a curvilinear incision that is placed parallel to the last rib lateral to the umbilicus and goes at an angle backwards towards the patients inguinal area. This is helpful when trying to cut around a patient with large udders. 7/8- Standing or recumbent left oblique celiotomy – Very similar to the left paralumbar celiotomy except that the incision begins in front of and ventrally to the tuber coxae and goes at an angle forward and up at a 45% angle to the last rib.
This technique allows for a larger incision then the others. The patient must be able to stand through the whole procedure or placed in left recumbency with proper restraint procedures. Tools Scalpel blade, absorbable monofilament suture, and tapered needles, Full arm sterile gloves and gowns, 5-6 extra packs of sterile hand towels, enough sterile gauze to lean out the uterus.
Pre-Podine scrub, 70% alcohol. Hemostats or an umbilical cord clamp, Umbilical tape or suture material, suction bulbs, IV catheters, and IV fluids. obstetrical chains to aid in removing the calf. Sterile Fluids for abdominal and uterine lavage and suction to remove it and any other fluids. Calves: Post Removal: Umbilical cord is clamped and cut. Calf is cleaned, dried off, stimulated, and fluid/mucus in the mouth and nose are cleared. Water can be placed in the calves ears to make it shake its head.
Goat/Sheep Patient preparation The patient should be shaved with a large surface area on all sides of where the incision will be. This normally will be the entire left side of the patient from the last rib all the way to the pelvic bone and from the vertebrae to the ventral midline. The area should then be drenched with a non-foaming betadine scrub and that solution should then be rubbed into the ara that was shaved with your hands (in sterile gloves), a sterile sponge, or a surgical scrub brush.This should be repeated until the entire area is free of dirt or debris.
The area should then be washed off with 70% alcohol. Positioning Standing left paralumbar is the most commonly used position, especially in healthy patients. Incision is made on the left side of the patient vertically in the middle of the paralumbar fossa starting by the lumbar vertebrae and going ventrally as far as it is needed to remove the kid. Careful placement is made so that it is possible to keep the rumen in place. In order for this position to work, the veterinarian needs a decent restraint table that the patient can stand on and be lifted to an appropriate height for surgery, and the patient must be able to stand on its own.
This technique can also be done in lateral recumbency if needed. Tools Scalpel blade, absorbable monofilament suture, and tapered needles, Full arm sterile gloves and gowns, 5-6 extra packs of sterile hand towels. Non-Foaming betadine scrub, 70% alcohol. Hemostats or an umbilical cord clamp, Umbilical tape or suture material, suction bulbs. Kids:Post Removal: Umbilical cord is clamped and cut. Calf is cleaned, dried off, stimulated, and fluid/mucus in the mouth and nose are cleared.
Pig – Although not common. Only 1% of Sows will need help with farrowing. Patient preparation The area should then be drenched with a non-foaming betadine scrub and that solution should then be rubbed into the ara that was shaved with your hands (in sterile gloves), a sterile sponge, or a surgical scrub brush.This should be repeated until the entire area is free of dirt or debris. The area should then be washed off with 70% alcohol. Positioning Patient is placed in right or left recumbency and an incision is made through the ventral flank or a vertical sub-lumbar incision as close to the uterine body as possible.
Tools Scalpel blade, absorbable monofilament suture, and tapered needles, Full arm sterile gloves and gowns, 5-6 extra packs of sterile hand towels. Non-Foaming betadine scrub, 70% alcohol. Hemostats or an umbilical cord clamp, Umbilical tape or suture material, suction bulbs, sterile lube. Piglets:Post Removal: Will probably require hand raising, although a flank incision allows for the piglets to nurse away from the incision. Piglets are cleaned, dried off, stimulated, and fluid/mucus in the mouth and nose are cleared. Hold the piglets by their rear legs with their head downwards and gently but forcefully pump their legs up towards the abdomen to force air into the lungs.
Orchiectomy (Neuter)
Dog Patient preparation Ventral abdomen near the penis and scrotal sac should be shaved and scrubbed with either betadine or chlorhexidine scrub and alcohol. Positioning The patient is placed in dorsal recumbency with the legs securely fastened to the surgical table to prevent rotation during surgery. Tools Neuter pack, Scalpel blade, Suture Material, Surgical glue,
Cat Patient preparation Scrotal sac are plucked (shaving can cause too much irritation) and scrubbed with betadine only. Cat’s skin tend to react more to chlorhex scrub. Positioning The patient is placed in dorsal recumbency with the legs securely fastened to the surgical table to prevent rotation during surgery. Tools Neuter pack, Scalpel blade, Suture Material, Surgical glue, Betadine scrub.
Horse – Called Gelding Patient preparation Scrotal sac is shaved and scrubbed with betadine until all the dirt and debris is removed. It is then rinsed off with alcohol. Positioning Castrations on a horse can be done in either standing, lateral, or dorsal recumbency. If the horse is to be standing during the castration, the horse has to be in good health with both testicles descended, and the patient must be big enough for the doctor to be able to lean under the horses abdomen to remove the testicles. So this can not be done on miniature horses.
The patient also has to be well enough trained to be able to be restrained properly with a twitch without fighting the technician and the doctor to ensure that he does not hurt himself or anyone involved, but this allows the patient to forego full anesthesia and can be done in the field instead of in a clinic. If the horse needs to be sedated or the doctor feels like it is safer to do so, the patient is placed in lateral recumbency with the hind legs tied straight down so they are out of the way. Tools Twitch, Scrub, Alcohol, Scalpel blade, Scapel holder, Emasculators, Sterile gauze.
Cattle There are four ways a cow can be castrated. 1 – Banding: Closes off all circulation to the testicles and scrotal sac and allows for the entire area to fall off in about 10-15 days. This technique uses an elastrator which places a rubber band like ring around the lower end of the scrotum. 2- Cutting: Just like in a cat or dog, the testicles are surgically removed. 3- Chemically: This is done by an injection of a Chem-Cast solution that targets and destroys the hormones that are responsible for sperm production and sexual behavior in cows. This solution is injected directly into the testicles.
4- Burdizzo: This is a tool that is placed on the outside of the testicles and clamped down so that it crushes the cords to the penis. Patient preparation Shave and clean the cows scrotal area with warm soapy water until it is free of all dirt and debris. Then scrub one to two times with chlorhexidine scrub. If banding soak the castration bands in alcohol for a minimum of 5 minutes prior to placement.
Positioning Banding – Standing or lateral recumbency Cutting – Standing recumbency Chemically – Standing recumbency Burdizzo – Standing recumbency Tools Calf table or Bovine chute with a head gate. A halter tied to a fence may work as well. A tail jack, which immobilizes the hind legs of the patient so it can not kick and hurt you or itself. Scalpel or newberry knife, emasculator, Bucket of warm water/Chlorhexidine solution, elastrator, castration bands, needle, syringe, a Chem-Cast solution (if chemically neutering).
Goat Patient preparation Soak the castration bands in alcohol for a minimum of 5 minutes prior to placement. Positioning Position the goat in dorsal recumbency with their legs straight up in the air and together. Tools Elastrator, Castration bands, Alcohol
Pig Patient preparation Clean the area with Iodine until all dirt and debris is removed. Positioning Patient is held by it’s hind legs with its head down, or can be placed in dorsal recumbency with the legs straight up. Tools Iodine, scalpel blade.
laparotomies
Dogs and Cats Patient preparation The mid- to caudal abdomen should be shaved and scrubbed. Depending on the reason for the surgery, the area that needs to be prepped may be larger than with a normal surgery, going all the way from the rib cage to the pelvic area. Positioning The patient is placed in dorsal recumbency with the legs securely fastened to the surgical table to prevent rotation during surgery. Tools Large pack, Scalpel blade, Suction, Lap sponges, Extra towel clamps, and Extra gauze packs, Towels, Sterile/warm Saline, Retractors.
Horse Patient preparation Patient ventral abdomen is shaved from above the second to last rib cage all the way back to the pelvis area. The area should then be scrubbed with chlorhexidine scrub or povidone-iodine scrub. Positioning Patient is placed in dorsal recumbency with the legs secured out to the sides and out of the way. Tools Rope Halter, Large pack, Scalpel blade, Clamps, Surgical Stapler, Suction, Suture, Lap sponges, Extra towel clamps, and Extra gauze packs, Towels, Sterile/warm Saline, Retractors, Self retaining ring drapes, shoulder length rectal gloves, rubber boots.
Cattle Patient preparation Most common approach is a left flank laparotomy. The area is first prepped by rinsing the area with water and scrubbing with chlorhexidine scrub or povidone-iodine scrub and then rinsed with a 70% alcohol solution. A regional epidural may also be used. Positioning The patient should be placed in a stanchion in standing recumbency with their right side against the wall. Tools Stanchion, Large pack, Scalpel blade, Clamps, Surgical Stapler, Suction, Suture, Lap sponges, Extra towel clamps, and Extra gauze packs, Towels, Sterile/warm Saline, Retractors, Self retaining ring drapes, shoulder length rectal gloves, rubber boots.
Goat Patient preparation The area is first prepped by rinsing the area with water and scrubbing with chlorhexidine scrub and then rinsed with a 70% alcohol solution. A regional epidural may also be used. Positioning There are two common approaches, flank (left or right) and midventral, although flank is the most common. Flank is done with the patient is standing recumbency, midventral is done with the patient in lateral recumbency. Tools Large pack, Scalpel blade, Clamps, Surgical Stapler, Suction, Suture, Lap sponges, Extra towel clamps, and Extra gauze packs, Towels, Sterile/warm Saline, Catgut and Nylon suture, Retractors, Self retaining ring drapes, shoulder length rectal gloves, rubber boots.