In most veterinary practices each staff member works in a specific department. If you are a member of the surgery department the surgical suite may be your new home. To make sure all surgical procedures and schedules run smoothly it is a good idea to familiarize yourself with everything in it. Increase your value to the practice and take initiative, don’t wait for someone to teach you.
First take a look at all of the anesthesia machines. Are you used to these types of machines, their pop-off valves, oxygen and inhalant levels? If you are not, ask someone in your department or a doctor to show you (don’t be shocked if the doctor has no idea by the way), and have a notebook handy to take notes. Cheat sheets are a great help! The anesthesia machines need to be functioning their best at all times; this will increase the safety level for your patients and you and additionally make the day run smoother with less stress.
Open up every drawer, cabinet, and pass through to find out what is in there. If these areas are not already labeled, either ask the department head if you can label them or do a sketch in your notes (until you are more familiar) with the locations of key instruments: spay/neuter packs, bladder spoons, orthopedic supplies, etc.
Get to know your surgeons! A surgeon guide book that details what each surgeon typically likes during their surgery day can be immensely helpful. A simple start: what is their glove size, typical blade choice, common suture material they use, do they always quarter drape, how do they like their patients shaved, if music is allowed in surgery, what kind of music do they like, is silence golden for one (just the melodic beeping of the pulse oximeter and heart rate), or do they like to rock it out? If such a book is not already available, create one! This is also the best way to learn.
Other handy protocols to create for your surgical guide book include a list of all your surgical packs and the detailed contents of each, in the order in which they are packed; also a list of all the instruments that go into each pack and the order of placement. These are a particularly valuable reference for new hires or those of us who infrequently find ourselves wrapping packs! You can add additional protocols such as instructions for proper instrument care and cleaning, pack/pouch storage times, sterilization protocols, preparation of the surgeon, preparation of the surgical assistant(s), preparation of the surgical patient, scrub technique. These should detailed to the extent that a new employee can follow the procedure even if there is no one to help them (of course that would never happen!)
Figure out the order in which each procedure is to take place and get your surgical packs and supplies ready for each patient before they are sedated. Time is important. The more time your patient is sedated or under anesthesia the greater risk there can be for complications even with the healthiest of patients.
Use all of the monitoring equipment available to you, but do not depend on it. Monitors should only be a back up to your own monitoring. Use a surgical log to document your patient’s vitals. Usually with a young, healthy patient, vital checks every 5 minutes are the normal protocol. With high-risk patients you will have to check more frequently or not leave the patient’s side. In this case you may need to enlist the help of another technician to “run” for instruments, suture material, etc. There are many templates available for the creation of anesthetic/surgical logs; you can even design one of your own by picking and choosing among existing templates and then fine-tune it as you find what works best in your practice.
Keep emergency drugs accessible! They should be both at your knock-down table and in the surgery suite. Know what they do and all the routes they can be given; this will save valuable time during an emergency. You might consider having a posted list of all emergency drugs that includes several weight ranges and the dose in ml to give in that weight range, per species – helpful at times when a true emergency occurs and you need a drug immediately and there is no calculator handy! Additionally, keep extra tubes, catheters, needles, flush, etc within reach just in case.
For each patient consider pre-surgically calculating the dose of each emergency drug. This should be done at least one day prior to the scheduled surgery, and recorded in the patient’s chart or on a template in your veterinary software if you are “paperless”. A numerical assessment of surgical risk can also be recorded on the anesthetic plan. Make sure you are familiar with each patient in regards to their particular health status, such as history of seizures, metabolic issues, cardiac issues, anesthetic drug sensitivities, etc. This makes you an integral factor in each patient’s safety, and an important part of the team ensuring that nothing is overlooked.
Eventually there will come a time when you can’t ever remember not knowing everything about the surgery suite. Then you will be ready for anything…well, almost everything!
