Page 521 - WSAVA2018
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Instrument Lubrication
Following cleaning and rinsing, all instruments
with moving parts should be lubricated. Instrument manufacturers recommend the use of water-soluble lubricants such as instrument milk, an oil-in-water emulsion that has anti-microbial properties.
As a general rule the instruments should be submerged in the lubricant bath for thirty seconds and then left
to drain without rinsing or drying. However, if the instruments are to be sterilised in a hot air oven then all traces of the lubricant should be removed as the intense heat causes the milk to form a “gum” which is difficult to remove.
Machine or mineral oils are not suitable as lubricants as they leave a sheen on the instrument surface and will inhibit steam penetration during the sterilisation process. Some instruments, such as orthopaedic drills, have
their own silicone gel. This should always be used in accordance with manufacturer instructions.
Once the cleaning process has taken place, surgical instruments must be left to dry. Instruments must be laid out flat with any ratchets and hinges open to ensure adequate drying and reduce the risk of rust damage. Instruments are always air dried in a clean, low traffic area to avoid contamination. Alternatively a drying cabinet may be used. Use of a cloth or towel to dry surgical instruments will lead to accumulation of debris, which could harbour bacteria.
Sterilisation
Surgical instruments and equipment are sterilised before each and every subsequent use. The sterilisation process takes place after the instruments have been cleaned and are dry.
Heat Sterilisation
Autoclaves
This is the most widely used and efficient method of sterilisation and is also the most economical. Most items used within the veterinary practice can be autoclaved and include:
-Instruments
-Cloth drapes and gowns
-Swabs
-Most rubber articles – need to check with manufacturer/ instructions
-Some plastic goods – need to check with manufacturer/ instructions
References
The Animal Industries Resource Centre Course materials – Certificate IV in Veterinary Nursing
Your Singapore, the Tropical Garden City
WSV18-0305
SVA SOFT TISSUE SURGERY
THE 4-LIGATURE SPLENECTOMY
H.B. Seim1
1Colorado State University
INTRODUCTION
Splenectomy can be a life-saving procedure and is often necessary on an emergency basis. Unfortunately, most dogs that present with a spontaneous hemoabdomen associated with a splenic bleed have neoplasia as
the underlying etiology; although benign lesions such
as hematomas may also be seen. Stable dogs with non-ruptured splenic masses are also candidates
for splenectomy. Spontaneous hemoabdomen is a challenging condition that requires rapid diagnosis with timely therapeutic intervention to maximize the chance of a successful outcome. Unfortunately, malignant neoplasia is the most common etiology and despite a successful short-term outcome, a guarded long-term prognosis is common. The peritoneal cavity can be considered a large potential space in which the majority of a dog’s blood volume can reside. Consequently, with rupture of a highly vascular intra-abdominal organ, vascular collapse and end-organ ischemia can result rapidly. The major objectives of the veterinarian who is treating a patient with spontaneous hemoabdomen include; rapid and effective resuscitation, timed surgical intervention, rapid identification of the point of hemorrhage and efficient elimination of the source of hemorrage.
INDICATIONS
Splenectomy is indicated for removal of splenic neoplasm, rupture, torsion, infarct, abscess and hypersplenism.
PATIENT POSITIONING
The patient is placed in dorsal recumbency for routine celiotomy.
RECOMMENDED INSTRUMENTS
A Balfour self-retaining abdominal retractor is essential to maintain adequate exposure allowing complete exploration of the abdominal cavity as well as visualization of the splenic blood supply. When large amounts of blood or fluid are present in the abdominal cavity suction, using a Poole suction tube, is helpful. It
is best to have a variety of sizes of hemostats available. The author recommends a minimum of 6 medium to large hemostatic forceps (Crile, Kelly or Carmalt) and 4 – 5 small hemostatic forceps (mosquito).
Ligation of individual blood vessels or clusters of vessels is performed using 3-0 or 4-0 synthetic absorbable
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