SAFETY, ANESTHESIA, POSITIONING Veterinary dental nursing procedures SAFETY, ANESTHESIA,...
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Transcript of SAFETY, ANESTHESIA, POSITIONING Veterinary dental nursing procedures SAFETY, ANESTHESIA,...
SAFETY, ANESTHESIA, POSITIONING
Veterinary dental nursing procedures
SAFETY, ANESTHESIA, POSITIONING
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Usual GA precautions
• Appropriate monitoring equipment
• IV catheter and fluids as required
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Contaminated Surgery
• Veterinarians should in general avoid performing “dirty” dentals on an individual animal at the same time as major sterile surgery– Bacteria entering the blood stream during
dental work can lodge in the blood clots of the major surgery site.
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Safety Considerations
• Patient safety
• Operator safety
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Patient Safety
• Head movement > endotracheal tube induced tracheal trauma; if tracheal trauma:– subcutaneous emphysema – if tracheal air escapes – tracheal stricture – can appear days or weeks later.
• Head movement > tube twisting and kinking• Head tilted up > fluids, blood, blood clots,
calculus easily enter trachea.• Cuffed tube > distal cuff still permits fluid to
enter proximal trachea.• Wet face, cold table/grill > greater heat loss
and hypothermia• Wet ET tube tie > loosens and falls out easily
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Use Cuffed ET tube
• Just enough to occlude air leakage
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Good grip on ET tube
• Ensure good grip on tube tie; might use– Rubber elastic band (not too tight on face)– Drip tubing (not too tight on face or tube)
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Good grip on ET tube
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Disconnect Tube
• When turning or moving animal
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Don’t turn over the back
• Turn under belly– with legs kept underneath– reduces chance of fluid entering trachea
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Slight incline for trachea
• Tilt table, or
• Use padding (eg bubble wrap)– More under shoulders, less under neck– Just think of airway position!
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Patient Positioning
• Options– Dorsal – Lateral
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Dorsal Recumbency
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Lateral Recumbency
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Place absorbent wad in pharynx
• eg swabs, throat pads– Past hump of tongue– REMEMBER TO REMOVE when finished
• have a reminder check system – eg a marker on the ET tube when swab placed
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Pharyngeal Packing
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Ocular lubricant
• To protect eyes from aerosol– Artificial tears– Lacrilube
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
• Is used to protect operator and improve visibility– But not too wide!
Care with Mouth Prop
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Warmth
• Consider– Heating mat– Bubble wrap– Warm water bottles
• Some methods need care as may have risks of either scalding and/or electrocution
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Head on a grill
• To keep body and face drier
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Monitor Temperature
• Usually rectal temp measured
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Recovery
• Place in lateral or sternal recumbency with the head and neck extended, preferably head below thorax– Monitor temp, pulse, respiration, consciousness
until able to maintain sternal recumbency– Keep orifices clear, clean and dry– Remove pharyngeal swabs– Remove endotracheal tube at appropriate time– Analgesics as indicated– Report recovery problems– Final grooming before discharge
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Operator Safety What operator safety precautions shown here?
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Risk of being bitten
• Especially under light GA– Use a mouth prop
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Eye protection .
• Risks– Calculus flicked into eyes– Aerosol in eyes (possible
conjunctivitis)
• Protection– Full head visor– Goggles or glasses
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Pneumonia
• Large numbers of bacteria in aerosolised water droplets– These small droplets float deep into lungs
• Possible bacterial pneumonia
• Use face mask– Quality type, well fitted– But discard after use
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
General contamination
• Build up of debris on the skin or under the fingernails
• Moisture contaminates clothing (hospital hygiene)
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Posture
• Often a lengthy procedure in fixed posture – Use adjustable stool
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Sharps
• Discard of scalpel blades, needles, old burs into sharps container
• Care with handling sharp instruments
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Anaesthetic gases
• Usual scavenging systems– Good fittings required if patient movement
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Electrocution
• Electric heating mats
• Faulty electric dental equipment
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
Other protection
• Gloves
• Cap
• Apron - waterproof
5888H - Veterinary Dental Nursing
SAFETY, ANESTHESIA, POSITIONING
The End