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Abdominal Surgery Patient Prep

Views: 15896 - Comments: 15

Surgery assistant at DoveLewis, Sue Marcoe, demonstrates how to clip and prepare a patient for abdominal surgery.

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Suzanne Marcoe's picture
Suzanne Marcoe

Enrolled: 09/2011

Megan Brashear's picture
Megan Brashear

CVT VTS(ECC)

Enrolled: 07/2011

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Comments

Sarah Crisp's picture

I always use gloves and a small stack of dry gauze for the prepuce flush, which makes the process a lot cleaner. You never know what's going to flush out of there... seriously. It's also good to keep the patient as dry as possible to help retain body heat!

Sidenote: I hope everyone notices how cool our baby socks with bubble wrap are. Cute AND effective.

Megan Barclay's picture

Great video, I wasn't aware of the prepuce flush before seeing this, so I will be including this into all of my abdominal preps now. Also, leaving the sterile swabs over the surgical site while transferring is a good tip.
Love the socks. :)

Jennifer Boston's picture

I have a question about the betadine/alcohol combination. I was taught in school that the alcohol inactivates the betadine. A better combination is chlorhexadine scrub with alcohol?

Katrina Bowers's picture

I was always taught never to go back and forth even over the incision site. When watching the video, the gauze essentially comes in contact with the prepuce area and then back over the incision area. I was taught this is a big no-no. Just curious.

Megan Brashear's picture

Katrina, good points! As far as scrubbing back and forth, in human studies regarding skin prep they scrubbed back and forth over the incision site for 30 seconds before targeting outwards (it was a solution study - chlorhex vs iodine but in their procedures they scrubbed back and forth). The most important aspects of a scrub are to not cause damage to the skin (soft touch with your scrubs!) and CONTACT TIME. In this video, this is our rough prep, and some prepuce contact. The goal here is to get the hair clipped and start the cleaning solution contact time. In the surgery suite we perform another scrub wearing sterile gloves and using sterile gauze where the prepuce gets it's own separate scrub. Shoot me a message if you'd like to read any of those human scrubbing papers!

Megan Brashear's picture

Jennifer, there isn't any inactivation that happens, but there are various solution combinations. Our surgeons prefer the betadine and alcohol combo. More importantly, we have an extremely low surgical site infection rate here. As important as scrub choice is contact time with the incision site, operating room cleanliness, hospital cleanliness, and post-op care.

Israel Figueroa's picture

Never have heard of doing the prepuce flush!! But makes total sense will definitely include that in our pre surgical procedure thank you so much.

Christy  Laney's picture

I'm assuming this video has changed since the surgery in the video was a feline spay with no prepuce so the quiz should be updated to reflect the new video. :)

Megan Brashear's picture

Christy, thank you for bringing this to our attention! We are switching the video back to the appropriate dog video, not exactly sure how and when the swap happened but it is fixed and the quiz matches the video again.

Tracie Stol's picture

Hi Megan It looks like the video has gone back to the feline spay. Thank you so much for these wonderful videos and great quizzes.

Heather Darbo-McClellan's picture

I was under the impression that the most nosocomial studies suggest that you scrub 3 times before wiping with alcohol/saline. From what I have read it is for dwell/contact time to allow the scrub to stay in contact with the skin longer to kill organism. What are your thoughts and finding?

Chris Green's picture

Thanks for the great question! There is not a simple answer to your question, but here are a few tips. First of all, you should follow the directions provided by the manufacturer for the exact product you use. When we talk about dwell/contact time, you are absolutely correct that the longer the product is in contact with the skin the better. Here at DoveLewis, we tend to place a few gauze squares with betadine on the incision site to help get more contact time while we move the patient into the surgery suite for the surgical prep, as shown in the video. If you are using chlorhexidine, all of the long lasting effects are wiped away by alcohol, and therefore you should use alternating chlorhexidine scrub and solution instead. If you are using the traditional betadine and alcohol solutions for prep, you should follow a scrub-alcohol-scrub-alcohol-scrub-alcohol process. Just remember that the patient should be clean before starting your scrub, so you don’t need to aggressively scrub, but rather apply the solutions and allow the contact time to do its work. I hope this answers your question, let me know if you have any other questions!

Rachel Medo's picture

Hi Meghan,

Great question. We use bubble wrap and socks to keep patients extremities warm during surgery. You can think of it like mittens or extra thick socks for people!