Chapter 
14 Surgical Room Skills 257
(a)
(b)
FIGURE 14.10 Non‐rebreathing system and rebreathing bags and hoses: (a) non‐rebreathing system; (b) 1, 2, and 3 L rebreathing bags; (c) “F”
rebreathing hoses; (d) “Y” rebreathing hoses.
FIGURE 14.11 Brush cleaning a surgical instrument.
used to get all the debris off the instrument (Figure 14.11).
It is rinsed thoroughly and if available put into an ultra-
sonic cleaner (Figure 14.12). This is a machine that pro-
duces bubbles that implode on the surface of the
instrument knocking the microscopic debris off. This
cleaner requires non‐suds‐producing detergent. The
instruments are put into a wire basket with the jaws open,
the basket is lowered into the water and detergent. A
setting of 5 minutes is set on the dial that also turns the
cleaner on. After the cycle, the instruments are rinsed
thoroughly once more. The hinges on the instruments
should be lubricated and allowed to dry before being
(c) (d)
repacked or stored. A specially made lubricant for sur-
gical instruments must be used to keep them in good
working order. Don’t pile the basket too full and don’t
mix instruments made of different metals because the
instruments do not get as clean and the different metals
may react with each other causing discoloration or cor-
rosion. Change the water and detergent for each load by
unclamping the hose located on the back of the cleaner.
Make sure the hose is in the sink before unclamping it!
Learning Exercise
Develop a protocol for taking care of the surgical
instruments properly in order to extend their
lifespans.
Assembling Surgical Packs
Assembling surgical packs is often delegated to the
veterinary assistant. It is important to pay attention to
details when assembling these packs as the instruments
and materials contained therein are vital to the success
of a surgery. In order to select the appropriate instru-
ments, it is important to be able to identify the surgical
instruments listed in Table 14.1. Take note of their size
and the serrations on the jaws to distinguish one from
another.
258 Tasks for the Veterinary Assistant

FIGURE 14.12 Instrument cleanser and ultrasonic cleaner.

Instrument Packs Step 3 Make sure all the instruments are unlatched.
Assemble the instruments as shown in Figure 14.14c,
Instrument packs are those that contain the hemostats, with the sterilization strip positioned as shown. Place
needle holders, and other instruments used during a the assembled instruments in the center of the wrap.
surgical procedure. Every clinic will have their own Step 4 Place the counted gauze sponges on top of the assem-
“recipe” for how many of each is placed in the pack. The bled instruments (Figure  14.15a). It is important to
following list is just an example of what should be count the sponges so that none are left inside the patient
included, which you will have to adjust as per the wishes when they are counted at the end of surgery. Gauze
of the veterinarian (Figure 14.13): sponges come in a sleeve and if you look closely you will
see that every tenth one is hanging out a bit from the
A. 2–3 Rochester–Carmalt forceps
stack (Figure 14.16). So you could conceivably just take
B. 2 Crile or Kelly forceps
the gauze in groups of 10. However, you should always
C. 4 Halstad Mosquito forceps
count because the sleeve could have been dropped or
D. #3 Scalpel handle
some taken out for use elsewhere! This would mess up
E. Groove director
your count and potentially cause the patient to be
F. Snook hook
reopened to look for the missing gauze sponges.
G. Dressing thumb forceps
Step 5 First fold – starting with the closest point of the top
H. Adson or Adson‐Brown or rat‐tooth thumb
wrap take it over the instruments then fold it back as
forceps
shown in Figure 14.15b. The first folded edge must be
I. Metzenbaum or Mayo scissors
even with the instruments and the point ends up
J. Operating scissors
pointing toward the outside edge or toward you again.
K. Mayo Hegar or Olsen Hegar needle holder
Step 6 Second fold – fold the wrap point on the left so the
L. 4 Backhaus towel clamps.
fold is even with the instruments gathered beneath
The following are the instructions for packing an and point the point toward the outside edge as shown
instrument pack (Figures  14.14, 14.15, 14.16, 14.17, in Figure 14.15c.
and 14.18): Step 7 Third fold  –  same as step 6 only with the right‐
hand point – not shown.
Step 1 Gather supplies – all of the instruments required Step 8 The fourth corner is brought over the width of the
for the pack, two cloth wraps, gauze sponges, steriliza- package toward you and the folding point is deter-
tion indicator, and autoclave tape (Figure 14.14a). mined. This would be the edge of the gathered instru-
Step 2 Layout wraps – position the wraps, one on top of ments in the wrap (Figure 14.17a). Grasp the wrap at
the other as shown in Figure 14.14b, with the corners this point and Figure 14.17b shows how the top of the
pointing at you. wrap is folded with the point folded under.
 Chapter 14 Surgical Room Skills 259

TABLE 14.1

Surgical Instrument Names and Uses

A. Allis tissue forceps Atraumatic tissue holder
   
   
B. Sponge holding Grasp inanimate objects like
forceps sponges and dead tissue

A. Small Backhaus towel These are both used to keep

clamp drapes and towels in place on the
  patient. The sharp points pierce
  the material and skin leaving very
B. Large Backhaus towel small holes
clamp

A. Hartman mosquito All of these forceps are used to

forceps clamp off vessels or tissues that
  will be removed. They crush
  tissue which cuts off blood supply.
B. Halstad mosquito The serrations on the jaws are
forceps horizontal along the entire length
 
 
C. Crile forceps

(Continued)
260 Tasks for the Veterinary Assistant

TABLE 14.1

(Continued)
A. Kelly forceps Both are used to clamp larger
  tissues for blood control or
  tissues for removal. The Kelly
B. Rochester Carmalt has horizontal serrations on half
forceps the jaw and the Rochester has a
combination of vertical on half
the jaw and vertical/horizontal
serrations at the tips

A. Olsen Hegar Both are used to grasp and

needle holder scissor manipulate the suture needle
combination while suturing. The Olsen Hegar
  has a scissor built into the jaws
 
B. Mayo Hegar needle
holder

A. Metzenbaum scissors These are used to cut tissue and

  nothing else! They are extremely
  sharp, and the blunt ends are
B. Mayo scissors used for “blunt” dissection
 Chapter 14 Surgical Room Skills 261

TABLE 14.1

(Continued)
Operating scissors All three of these scissors are
A. Blunt/blunt used to cut inanimate objects like
  sutures
   
B. Sharp/sharp The differences are in the tips
  as designated. The sharp/blunt
  scissors are the most common
C. Sharp/blunt

Thumb forceps The first three thumb forceps are

A. Adson tissue used to manipulate tissue either
  for inspection or for suturing. D
B. Adson–Brown tissue is used for manipulating dressing
  materials and grasping inanimate
C. Rat‐toothed tissue objects
 
D. Dressing

Scalpel blades and handles Scalpel handles are packed in

A. Small animal with with the surgical instruments, but
corresponding blades the blades are packaged by the
  manufacture to open as needed
B. Large animal with
corresponding blades

(Continued)
262 Tasks for the Veterinary Assistant

TABLE 14.1

(Continued)
Suture needles Suture needles are either
A. Cutting edge – inset 2 included with the surgical pack or
close‐up kept in “cold” sterilization trays.
  The cutting edge needle is used
B. Taper – inset 1 close‐ for skin and the taper needle is
up used for tissues
 
C. Postmortem

A. Groove director These are auxiliary instruments

  and may not be utilized in your
B. Snook’s ovariectomy clinic. The groove director helps
hook to make a straight incision line
and the snook hook is used to find
the uterine horn during a spay

FIGURE 14.13 Instruments to include in an instrument pack. See text for identi cation.
 Chapter 14 Surgical Room Skills 263

(a) (b) (c)

FIGURE 14.14 Steps 1–3 of putting an instrument pack together: (a) Step 1, gather supplies; (b) Step 2, lay out the cloth wraps; (c) Step 3,
assemble instruments.

(a) (b) (c)

FIGURE 14.15 Steps 4–6 of putting an instrument pack together: (a) Step 4, lay gauze sponges on instruments; (b) Step 5, rst fold of wrap;
(c) Step 6, second fold with left‐hand point.

FIGURE 14.16 Sleeve of gauze sponges.

(a) (b)

FIGURE 14.17 Step 8 of putting an instrument pack together: (a) nding the folding point; and (b) folding the last point over.
264 Tasks for the Veterinary Assistant
(a) (b)
FIGURE 14.18 Step 9 of putting an instrument pack together: (a,b) repeat steps 5–7 to fold the second or bottom wrap; (c) create a tab with the
last fold.
FIGURE 14.19 Autoclave tape. Inset: exposed to autoclave and not
exposed to autoclave.
Step 9 Repeat Steps 5–7 with the second wrap, positioning
all of the points so they are pointing to the outside
edge (Figure 14.18a,b). This will be important when
we open the pack which will be covered later in this
chapter. To finish the last point bring it across the
entire wrapped package only instead of folding it like
in Step 8 the excess material is neatly tucked into folds
of this wrap (Figure  14.18c). This holds the pack
secure and leaves a tag sticking out which is grasped to
start the opening process.
Autoclave tape (Figure  14.19) is then applied to the
outer wrap. Autoclave tape is designed to develop black
streaks to indicate if a pack has been through the autoclave
(Figure 14.19 inset). It is not an indication of sterility. The
stripes on the tape turn black when exposed to heat. Tear
off 2, 4–5” pieces of tape and bend one end over making a
small tab. Then using an ink pen write the date and your
initials on one piece and the contents of the pack on the
second piece. Apply the tape so the tabs are on top of the
last fold. This keeps the fold in place when you are tearing
the tape off during the opening process. Figure  14.20
shows an autoclaved pack with the tape in the appropriate
(c)
FIGURE 14.20 Autoclaved package showing the autoclave tape turned
black.
location, note that it has been exposed to the autoclave as
the tape has black streaks. It is tempting to use a long piece
of tape to make sure the pack stays secure, but if folded as
instructed this is unnecessary and wasteful.
Folding a Grown and Wrapping it
for Autoclaving
Just like with the instruments, every clinic differs in how
they fold their cloth gowns. The following is one way to
accomplish this task. To start to fold a gown put it on,
making sure you have the right side out. Bring your
hands out of the sleeves about 8 inches from the arm pit
seam, grasp part of the sleeve, and pull the sleeves inside
out (Figure 14.21a). Bring the sleeves together, straighten
the arms so they form a circle and straighten the length
of the gown, so it is folded in half lengthwise. Make sure
the material is smoothed and wrinkle free as going
through the autoclave process will make the wrinkles
stiff thus making the gown hard to put on.
Step B is folding the gown in half lengthwise one
more time (Figure 14.21b). Step C is making the sleeve
openings obvious on top of the gown (Figure 14.21c).