Surgery Protocol for bone exposure of the Humerus and Radius in Dog

Clean Nurse
Sterilization/Autoclaving of the Surgical Instruments

PACK PREPARATION FOR STERILIZATION

Packaging Aim
Before sterilization: packaging protects the clean instruments from the risk of
contamination.
Packaging must allow the packages to be opened easily and aseptically.
Packaging must be permeable to steam, water repellent, resistant to tears and
impermeable to microorganisms.

Steps in folding a surgical gown for wrapping and sterilizing:

(a) front of gown for which sterility must be maintained
(b) folding neck down to expose the sleeve entry points
(c) folding right side inward to cover the right sleeve
(d) folding left side inward to cover the left sleeve and folding the gown in half
lengthwise to result in a rectangular shape
(e) folding the rectangular gown in an accordion pleat
(f) finishing the accordion pleat with the sleeve hole in an upward corner (area of left
hand)

Steps in folding a surgical drape for wrapping and sterilization:

(a) drape folded in half and one side accordion pleated
(b) both sides accordion pleated and the pleats folded toward each other to create a long
rectangle
(c) accordion pleating of the rectangle
(d) finished accordion fold
(e) demonstration of how the drape would be unfolded, preserving one-fold, and held for
application to the surgical field.

Square method of wrapping surgical packs:

(a) instruments in an instrument tray placed on two wrappers with edges of the tray
parallel to edges of the wrappers
(b) left edge accordion pleated with flap for grasping during pack opening, and right edge
pleated in like fashion and lapped over the left flap (bottom drawing),
Angled method of wrapping surgical packs:
(a) drapes placed on two wrappers with edges of drapes in line with the corners of the
wrappers
(b) first edge folded so that the pleat creates a triangular tab for grasping during pack
opening
(c) one side pleated to cover the triangular tab
 (d) next side pleated to overlap the opposite side, and final side advanced to cover
previous sides and tucked under the previous folds leaving a tab for pulling to open
(e) beginning of outer wrap identical to inner wrap
(f) folding of sides of wrap prior to tucking, and
(g) completed outer wrap secured with autoclave tape.

Autoclaving
 The instrument ready to be sterilized by steam sterilization in an autoclave are
registered.
 The appropriate heating source 121oC for the autoclave is defined with the technical
resource person or the assign person to do the sterilizations.
 The choice between electricity/gas/kerosene will defend on the type of autoclave.
 It is important to ensure that there is enough space on all sides of the autoclave for safe
use and maintenance.
 Check the autoclave several times during its run to ensure it is maintaining pressure and
temperature for the entire run. The red pointer should be returned to zero after each run.
 A steam exit has to be provided in line with the specifications, the pressure returns to
zero, open the autoclave and set the machine for the heat cycle.
 Do not touch the packs while they are wet to avoid scalding.
 Do not place wet packs on tables and to avoid any contamination prior to the sterile
materials.

Ensuring sterility
 Sterile good are stored in clean, dry areas
 Sterile items are handled with clean, dry hands
 Sterile packages are laid on dry surfaces
 If a sterile package becomes damp or wet, it is considered nonsterile and therefore,
cannot be used.

Preparation of the surgical room

a. The nurses should check the operating room schedule the day before surgery for any
changes that may have been made.
b. The clean nurse should wash his/her hands thoroughly and wear surgical cap. The
surgical cap must cover the hair completely to prevent possible contamination of the
sterile area by falling hair or dandruff. After that, he/ she should change into a fresh,
cotton scrub suit before going inside the surgical suite's semi-restricted sections.
c. Set up the equipment and check each item for proper functioning. This includes
such things as:
 Switch on the overhead light to ensure proper functioning.

 Check the operating table for proper working order.

  Line the kick buckets with plastic bags.

 Check the supply cabinets for stock. Restock, if necessary.

d. Check with the scrub for any special equipment he/she may need for the case.

d. Check that all equipment needed to position the patient is in the room. If not, the unsterile
nurse will get the necessary equipment.

Arranging of surgical instruments

a. The instruments that are placed on the tray are those that will be used for
making and opening the initial incision. These are the instruments that the
surgeon will use at the beginning of the procedure.
b. For each basic procedure, a definite class of instruments of suitable size, shape,
strength, and function is required. For example: knives and scissors are for
cutting or dissecting; tissue forceps are for grasping and holding; hemostatic
forceps and clamps are for clamping and occluding (closure); retractors are for
exposing; needle holders are for suturing; and sponges are for absorbing fluid
and blood.

Gowning
1. Assist the surgeon, assistant surgeon and anesthetist in donning his gown.
2. After the assistant surgeon inserted the arms into the sleeves of the gown, it will be
fastened by positioning it over the shoulders seam. The hands will only over be in contact
with the inside surface of the gown.
3. The gown will be secured at the neck, upper back and tying the waist tie.

Assisted gloving technique

1. A gowned and gloved assistant has the cuff of the glove stretched wide by fingers placed
on the outer surface of the glove. Then, the surgeon introduces the hand into the glove.
2. When there is a sterile glove on one (right) hand, that hand can help introduce the other
(left) hand into a glove.

Opening small items

a. Open items such as the lap tapes, the scalpel blades, surgical sutures,
b. Hand it over to the surgeon.
Post operative
Post- operative management and care for 1 week

1. After the surgery, the doctor gives the prescription or the intended drugs for the recovery
process of the surgical patient.
2. Then after the patient regain consciousness the assign nurse will check the vital signs for
the overall assessments of the patient.
3. During the time, the dog should be allowed to rest quietly in a warm (not too hot) place.
4. The thermoneutral zone for dogs will vary. The recommended ambient temperature range
for housing dogs is between 18 and 28 degrees Celsius (64- and 84-degrees Fahrenheit)
with a temperature setting in the low to mid 70s being typical.
5. Efforts to maintain normal body temperature should be made from the time of patient
admission until discharge

For the safety and well-being of dog, we recommend to follow these post-operative
instructions:

1. The nurse must keep the animal in a confined area for a day.
2. Restrict pet activity for 7 to 14 days after surgery.