Minor Veterinary Surgery: A Handbook for Veterinary Nurses

232 Pages·2006·34.44 MB·English

by  Julian G. Hoad

Jul ian Hoad
Minor
Veterinary
Surgery
A Handbook for
Veterinary Nurses
Julian Hoad
BSc(Hons) BVetMed MRCVS
Veterinary Surgeon, Wingrave Veterinary Hospital, Surrey, UK
Foreword by
Margaret Moore
MA VN CertEd FETC MIScT
Prinri,d Cerberus Training & Consultancy, Henley-an-Thames, Oxon. UK
ELSEVIER
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2006
BUTTERWORfH
HEfNEMANN
ELSEVlER
© 2006, Elsevier Limited. All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical, photocopying,
recording or otherwise, without the prior permission of the Publisher. Permissions
may be sought directly from Elsevier's Health Sciences Rights Department, 1600
John F. Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103-2899, USA: phone:
(+ 1) 215 239 3804; fax: [phone]; or, e-mail: hea/thpermissions@e/sevier.com.
You may also complete your request on-line via the Elsevier homepage
(http://www.elsevier.com). by selecting 'Support and contact' and then 'Copyright
and Permissions'.
First published 2006
ISBN 0 7506 8807 6
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Knowledge and best practice in this field are constantly changing. As new
research and experience broaden our knowledge, changes in practice, treatment
and drug therapy may become necessary or appropriate. Readers are advised
to check the most current information provided (i) on procedures featured or
(ii) by the manufacturer of each product to be administered, to verify the
recommended dose or formula, the method and duration of administration,
and contraindications. It is the responsibility of the practitioner, relying on their
own experience and knowledge of the patient, to make diagnoses, to determine
dosages and the best treatment for each individual patient, and to take all
appropriate safety precautions.
To the fullest extent of the law, neither the publisher nor the author assumes any
liability for any injury and/or damage.
The Publisher
Printed in China
Working together to grow
libraries in developing countries
\vww.elsevier.com I wwv.'.bookaid.org I \vww.sabre.org
ELSEVIER r.~?,~~~,~ Sabre foundation
The
Publisher's
policy is to use
your source for books, paper manufactured
journals and multimedia from sustainable forests
in the health sciences
www.elsevierhealth.com
Contents
Foreword vii Glossary 207
Preface ix (Glossary entries appear in bold throughout
AcknoWledgements xi the text)
Abbreviations xiii Further reading 211
Useful addresses 213
Part 1
General principles Appendix 1
Suggested contents of emergency box 279
The veterinary nurse and minor surgery 3
Appendix 2
2 The minor surgical patient 9 Emergency procedure - cardiopulmonary
arrest 221
3 Premedication and patient preparation 75
Appendix 3
4 General anaesthesia 37 Emergency procedure - status
epilepticus 223
5 Wound dressings and bandages 55
Index 225
Part 2
Minor surgical techniques
6 Wound management 77
7 Principles of soft-tissue surgery 97
8 Common surgical procedures 725
9 Dental and oral surgery 163
10 The postoperative patient 795
v
Foreword
At last - a book on minor surgical techniques gical case, premedication and preparation, and
written for veterinary nurses by a veterinary anaesthesia, through to suitable dressings and
surgeon who clearly views his nurses as valuable bandages for wounds arising from surgery. Each
members of the veterinary team. This book chapter is, in itself, also a useful reference for
should enthuse veterinary nurses and surgeons these individual topics.
alike to embrace the notion of honing the surgical The principles of common surgical and dental
and related nursing skills of listed veterinary procedures are also detailed in full followed by
nurses. This can only contribute to job satisfac advice on care of the postoperative patient.
tion and of course increase the revenue of the The contents are illustrated by colour photo
practice. graphs which support the text where needed,
I can highly recommend this excellent tome to making the information easier to understand and
all listed veterinary nurses interested in expand use.
ing their skills and underpinning knowledge of In conclusion, I consider this book to be an
minor acts of veterinary surgery. essential addition to any veterinary practice or
Taken as a whole, the chapters are sequential college library.
and guide the reader through each stage in a
logical order from assessment of the minor sur- Margaret C Moore
vii
Preface
Veterinary nursing as a profession has changed Preoperative examination and preparation of
much in the last few years, with changes to the patients are discussed in detail, as well as the
Veterinary Surgeons' Act (schedule 3 amend procedure for admitting surgical patients, advice
ments) and an increasing number of diploma to owners and suggestions for organising surgery
holders. The role of the veterinary nurse is moving lis ts.
away from the outdated 'kennel-maid'/anaes Any pitfalls or potential complications of pro
thetic assistant to encompass a wider range of cedures are detailed, together with relevant after
activities, including nursing consultations and care. Handy hints are widespread throughout.
health care clinics, in order to utilise more fully Each procedure is dealt with separately, allowing
the excellent knowledge and training of the this book to be used either as a 'patient-side' ref
veterinary nurse. erence, or as a textbook.
Minor surgery is one such role. Allowing nurses Much discussion is given to wound care and
to perform minor surgical techniques such as advances in dressing compounds, as well as prac
intravenous catheter placement, suturing wounds tical advice on dealing with most types of
and even lumpectomies makes for a much more wound.
efficient use of practice time and increases team Dental medicine and surgery are dealt with in
building and job satisfaction, reducing staff turn some detail, including a review of dental instru
over and improving practice profits. mentation and techniques for cleaning and
This book is aimed at those veterinary nurses polishing dog and cat teeth; rabbit dental care is
who want to learn more about surgical techniques also covered.
and those who are already performing minor Postoperative care and pain management form
surgery but who want to improve. Other than the bulk of the last chapter, with a section on
providing information regarding the reasoning dealing with client concerns and complaints,
behind minor surgical techniques, there are easy giving practical advice for improving client
to-follow instructions for performing many minor communication.
surgical techniques. It is hoped that veterinary I hope this book will encourage veterinary
students and recent graduates may also find the nurses to develop their surgical skills and knowl
book a useful source of reference. edge; I also hope that it will encourage practices
Wherever possible, I have included colour to appreciate more fully the abilities of their vet
photographs to help clarify certain procedures erinary nurses, and to provide support and help
and to provide examples of different techniques. for them to become proficient in various minor
Wherever relevant, dosages are given for stan surgical techniques.
dard or useful drug combinations for average
sized dogs and cats. Julian Hoad
ix
Acknowledgements
There are many people who have encouraged and supported me in the course of writing this book,
and my heartfelt thanks go to all my friends and co-workers. In particular, I must thank my uncle,
Robert Hutchinson, for encouraging me to start writing, and my employer, Nic Dodds, for allowing
me continually to disrupt the working day to gather photographs, and in granting me a generous
amount of time off for writing. My computer would like to thank Adrian Ward for debugging it several
times.
My family have been very patient with me and I would like to thank my mother, Alicia, my brother,
Marcel, and my sister, Giselle, for tolerating my ratty moods whilst I was writing.
The many hands and faces that appear in the book holding patients or instruments belong to Giselle
Hoad, Josey Killner, Kerry Mead, Nicky Cole and Sandy Griffith. Special thanks also to Minky Broad
for consenting to be photographed in dozens of bandages!
This book would not have been written without the love and encouragement of Syivia, my fiancee, to
whom this book is dedicated.
xi
Abbreviations
ACh acetylcholine IV intravenous
ACP acepromazine IVFT intravenous fluid therapy
AIPMMA antibiotic-impregnated LDS ligating and dividing system stapler
polymethylmethacrylate MAC minimum alveolar concentration
BID (of dosing) twice daily MCT mast-cell tumour
CBA cat-bite abscess MRSA methicillin-resistant Staphylococcus aureus
CO2 carbon dioxide N20 nitrous oxide
CoSHH Control of Substances Hazardous to Health NaCI sodium chloride
Act 1988 NSAID non-steroidal anti-inflammatory drug
CPD continuing professional development 0, oxygen
CRT capillary refill time (less than 2-3 s OCRLlOCL odontoclastic resorption lesions/odonto-
normally) clastic lesions
CVP central venous pressure OD outside diameter
ECG electrocardiogram PDS" polydioxanone sulphate (suture material,
E-collar Elizabethan collar Ethicon)
ET endotracheal PO orally
FeLV/FIV feline leukaemia virus/feline immuno- PVC polyvinyl chloride
deficiency virus RCVS Royal College of Veterinary Surgeons
FNAB fine-needle aspiration biopsy RTA road traffic accident
G gauge (thickness) of needle SC subcutaneous
GIAIILA gastrointestinal anastomosis SID (of dosing) once daily
HMSO Her Majesty's Stationery Office (publishers SpO, arterial haemoglobin saturation
of government documents) TA thoracoabdominal
IC intracardiac TID (of dosing) three times daily
IM intramuscular VDS Veterinary Defence Society
IPPV intermittent positive-pressure ventilation VN (listed) veterinary nurse
IT intratracheal
xiii
Part 1:
General principles
1 The veterinary nurse and minor surgery
2 The minor surgical patient
3 Premedication and patient preparation
4 General anaesthesia
5 Wound dressings and bandages
1
The veterinary nurse
and minor surgery
• Is covered by the Royal College of Veterinary
In this chapter Surgeons (RCVS) Veterinary Surgeons' Act
(1966) with schedule 3 amendments (see
Definition and scope of minor veterinary surgery
later)
Role of the veterinary nurse
The ReVS schedule 3 and its application to minor
Thus, suturing a skin laceration on the tarsus of
surgery within the practice
a healthy 6-year-old cat would be considered
Ensuring professional support
minor surgery, whereas placement of a chest
Personal learning, development and
drain and closing the thoracic cavity clearly
self-assessment
would not be. Similarly, a small skin tear on an
eyelid margin may require precise repair utilising
magnification - certainly not minor surgery.
However, closing the subcutaneous tissue and
skin after laparotomy or thoracic surgery would
be considered to be within the scope of minor
surgery.
Lumpecromies are usually considered minor
DEFINITION AND SCOPE OF MINOR
surgery. However, there is considerable differ
VETERINARY SURGERY
ence between a grape-sized flank lipoma and a
Minor veterinary surgery includes procedures football-sized lipoma in the axilla - the size of
ranging from removing skin masses and suturing lump for which a dog needs to be treated for
minor wounds to certain dental procedures. separation anxiety after its removal!
Specifically, minor veterinary surgery: For example, a mast-cell tumour with high
• Does not involve any procedure considered to metastatic potential will need to be removed
be life-threatening or risky with a large margin and may require complex
• Does not involve any complex procedure skin reconstruction techniques to close the
• Is carried out on a patient that is otherwise wound. None of this procedure would be con
healthy sidered to be minor surgery. However, removal
• Does not involve entry into a body cavity of a 1-2-cm cutaneous mass, which has been
3