SAFETY, ANESTHESIA, POSITIONING Veterinary dental nursing procedures SAFETY, ANESTHESIA,...

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SAFETY, ANESTHESIA, POSITIONING

Veterinary dental nursing procedures

5888H - Veterinary Dental Nursing

Usual GA precautions

• Appropriate monitoring equipment

• IV catheter and fluids as required

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.

Safety Considerations

• Patient safety

• Operator safety

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

Use Cuffed ET tube

• Just enough to occlude air leakage

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)

Good grip on ET tube

Disconnect Tube

• When turning or moving animal

Don’t turn over the back

• Turn under belly– with legs kept underneath– reduces chance of fluid entering trachea

Slight incline for trachea

• Tilt table, or

• Use padding (eg bubble wrap)– More under shoulders, less under neck– Just think of airway position!

Patient Positioning

• Options– Dorsal – Lateral

Dorsal Recumbency

Lateral Recumbency

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

Pharyngeal Packing

Ocular lubricant

• To protect eyes from aerosol– Artificial tears– Lacrilube

• Is used to protect operator and improve visibility– But not too wide!

Care with Mouth Prop

Warmth

• Consider– Heating mat– Bubble wrap– Warm water bottles

• Some methods need care as may have risks of either scalding and/or electrocution

Head on a grill

• To keep body and face drier

Monitor Temperature

• Usually rectal temp measured

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

Operator Safety What operator safety precautions shown here?

Risk of being bitten

• Especially under light GA– Use a mouth prop

Eye protection .

• Risks– Calculus flicked into eyes– Aerosol in eyes (possible

conjunctivitis)

• Protection– Full head visor– Goggles or glasses

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

General contamination

• Build up of debris on the skin or under the fingernails

• Moisture contaminates clothing (hospital hygiene)

Posture

• Often a lengthy procedure in fixed posture – Use adjustable stool

Sharps

• Discard of scalpel blades, needles, old burs into sharps container

• Care with handling sharp instruments

Anaesthetic gases

• Usual scavenging systems– Good fittings required if patient movement

Electrocution

• Electric heating mats

• Faulty electric dental equipment

Other protection

• Gloves

• Cap

• Apron - waterproof

The End

SAFETY, ANESTHESIA, POSITIONING Veterinary dental nursing procedures SAFETY, ANESTHESIA,...

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