ACVC 2018: Did I Do That? Averting Preventable Complications
Don’t let carelessness or lack of knowledge put your patients in danger.
Veterinary teams must act quickly when complications arise in their patients, and complications that result from staff carelessness or lack of knowledge “can weigh heavy on the nursing staff,” Danielle Browning, LVMT, VTS (Surgery), said during her session at the 2018 Atlantic Coast Veterinary Conference®. Ms. Browning described several complications that occur in clinics and how to avoid them.
Heat loss occurs in the first 20 minutes of anesthesia, Ms. Browning said, which means it’s crucial to keep a patient warm. Her suggestion: Cover the patient’s paws and extremities with cellophane or baby socks, use warm air units under and over the patient, and make sure to keep the animal as dry as possible when preparing the skin for surgery.
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“When you guys prep patients, think. Is the water dripping off them?” Ms. Browning asked the audience. “They shouldn’t have to be soaking wet. Also avoid excessive alcohol use, as studies in rats have shown they can become hypothermic.”
This complication results when isopropyl alcohol pools on a patient’s scrotum, causing a chemical burn in a very uncomfortable area. To prevent this, Ms. Browning said, always be cognizant when squirting alcohol on a patient’s abdomen before a cystocentesis.
To avoid corneal ulcers in patients under anesthesia or sedation, she explained, the anesthetist must lubricate the patient’s eyes adequately. Also avoid rubbing objects, like facemasks or towels, against the cornea and use scrubs sparingly when prepping sites located near the patient’s eyes. Ms. Browning also noted that cats and brachycephalic dogs are at higher risk of this complication, and longer lasting procedures can also increase risk.
Surgical Sponge Left in Body
Leaving a sponge in a body after surgery can cause a host of complications. “Perform a count immediately before the skin incision is made and before body cavity closure,” Ms. Browning urged. Some surgical sponges have radiographic markers that can be purchased for easy location and retrieval.
Arthritic dogs on the operating room table require additional padding to help support their hips and shoulders. “It’s all about properly positioning the patient while under anesthesia and sedation,” she explained. In her experience, she has found that vacuum bags that allow the patient to be positioned in various positions have been very helpful.
Most commonly affecting toy breed dogs, atlantoaxial luxation occurs with excessive flexion of the neck, causing spinal cord compression. Ms. Browning recommended that these patients should never wear neck leads and should always be restrained properly when in the veterinary hospital to avoid worsening of their clinical signs. She cautioned about avoiding dorsal flexion of the neck.
Adhesive Stripping of the Skin
Skin and hair can both be peeled away when pulling off medical tape used to secure either IV catheters or island bandages. Before removing the tape, Ms. Browning recommended, saturate it with a medical-grade adhesive remover or isopropyl alcohol. These will help lift the adhesive off the skin.
Bandage Induced Pressure Sores
Ms. Browning told those in attendance at the session that the key to these type of sores is to “distribute the pressure around the area that’s getting the sore.” For example, soft padded bandages can cause pressure sores, often at the point of the elbow and hock. Instead of excessively padding the pressure point, Ms. Browning said, focus on building up padding layers around the pressure point with “donut” or “ring” pads.
On the topic of thermal burns, Ms. Browning noted that “animals don’t have that superficial plexus that humans do, so they are even more prone to burns.” She cautioned those in the audience that burn severity is dependent upon the temperature and the duration of the heat source.
“You don’t ever want to put bottles or glove directly on the patient. People have said ‘put some towels on there [as a spacer between a heat source and the animal] but even there, you’ll see quite a bit of heat,” she said. “We want to refrain from taking any type of homemade warming device and putting it directly on the patient.”
Fluids Faux Pas
Administering Nonsterile Solutions Intravenously
When a patient is receiving both enteral nutrition through a feeding tube and intravenous fluid therapy, it is all too easy to mistake one for the other and hook up the wrong line to the patient. “Prevent this complication by clearly labeling the end of all administration lines with their contents,” Ms. Browning suggested. She also said food coloring can be added to all parenteral nutrition solutions to help staff never make this costly mistake.
Fluid Overload in Surgery
A common concern when administering fluid therapy, fluid overload usually occurs when the circulating veterinary nurse becomes distracted and forgets about the patient’s fluids. This complication is easily avoided with the use of a fluid administration pump, syringe pump, or burette to bolus specific amounts of fluid, Ms. Browning said.
Giving Wrong Injectable Medication
Giving the wrong injectable medications can be detrimental. This is why it’s highly important to “label and read all syringes before administration,” Ms. Browning stressed. She said veterinary nurses should follow these simple rights: the right medication at the right dose at the right time by the right route to the right patient. “Then double check and document,” she concluded.
Owners Giving Medications Improperly
When a patient leaves your practice, its care is out of your hands and in the owner’s. Make
sure you fully prepare the owner when it comes to administering medications to their pet. Ms. Browning said it can be helpful to keep a checklist of what to do before the patient leaves the hospital:
- Provide written discharge instructions for the pet owner.
- Triple check the administration instructions on the bottle for errors
- Make sure there are clear instructions on the bottle for how long to treat the pet.
Fecal and Urine Scald
A patient with incontinence or a patient that is too weak to move can experience fecal or urine scald. To prevent this complication. Ms. Browning recommended barrier film solutions, which allow the skin to breathe while repelling fluids and protecting the skin from fluid irritation. “I love barrier film products,” she told the audience, showing before and after pictures that showed clear benefit in just one day of using these products in these situations.