Key reminders to safeguard surgical procedures

Content sponsored by PRN Pharmacal

At the Directions in Veterinary Medicine (DIVM), dvm360® symposium in Arlington, held April 21 to 22, 2023, Justin Ganjei, DVM, DACVS-SA, and Shadi Ireifej, DVM, DACVS, presented on decreasing the chance of complications during surgical procedures in veterinary medicine. These procedures were broken down into 3 broad categories—diagnostic, prophylactic, and therapeutic—but the advice applied to all of them.

Ensuring Surgical Safety

“The important thing, when you’re doing any kind of surgery, is to be systematic,” said Ganjei. Confirm the record matches the patient in front of you. If you have not worked with the patient prior to this moment, perform your own physical examination to confirm the given diagnosis. Conduct preoperative imaging so the situation and diagnostics of the patient are clear. If something concerning shows up on these tests, consider tissue biopsy. Take symptoms like chronic vomiting or diarrhea as examples. They could be inflammatory bowel disease or something further and it is better to have confirmation. Subsequently, consider any risk to mortality or comorbidities that may impact the success of a surgery. Ensure the client knows what the surgery entails and be clear about any complications, Ganjei explained.¹

A common issue for complications during surgery is cell contamination, said Ganjei. Before even operating on a patient, make sure every instrument is appropriately cleaned and in good working order. “Be aware of your wrist, hands, and fingers,” insisted Ireifej. “Let’s try and use our instruments. Make use of your needle points.” Suturing, for example an abdominal wall, can be done with an instrument and that instrument can be placed on a needle holder. This minimizes the contact between the patient’s skin and the doctor’s gloves.¹

The presenters said posture is sometimes an overlooked part of surgical safety, especially during a long surgery. However, good posture is better for the surgery and the surgeon’s comfort. Having someone alongside the surgeon can minimize physical exhaustion and keep them focused on the task at hand by passing tools, removing bloody gauzes, and assisting with retraction.¹

They also reminded the audience to be in communication the entire duration of surgery. If there are changes on the monitor, like a sudden blood pressure drop, it is important to stay ahead of the problem. It is also good practice to inform them what they are seeing during a procedure and if any physical changes are going to occur.¹

With the vast scope that surgery entails, the parting advice from both Ganjei and Ireifej is to know what you are comfortable with and if you can fully commit to the procedure that is needed for a patient.¹

Reference

1. Ganjei J, Ireifej S. The bloody bloody: surgical Approaches to the hemoabdomen. Presented at: Directions in Veterinary Medicine, dvm360® Symposium; Arlington, Virginia. April 21-22, 2023.