High Volume Spay and Neuter: A Safe and Time Efficient Approach

Front Cover
Inside front cover
Front matter
	High volume spay and neuter: A safe and time efficient approach
Copyright
Dedication
Acknowledgments
Table of contents
Section 1 Introduction
	1 Introduction
	2 Principles of high-volume spay/neuter
		Principles of high-volume spay/neuter
			The purpose of high-volume spay/neuter is trifold
			A high-volume problem requires a high-volume solution
			The unique client base associated with high-volume spay/neuter practice must be factored into protocols
			Certain risks are built into high-volume spay/neuter
			Certain benefits are built into high-volume spay/neuter
			The caseload must be balanced
			Workstations should be set up for maximum efficiency
			Doctor and staff must work in concert with each other as a team
			The surgery table should never be empty
			Little things can add up to large amounts of time saved
			The surgeon’s time should be reserved for surgery
			Safety always takes precedence over speed
			Protocol changes must meet safety standards
			Efficiency, not speed, is what makes high-volume spay/neuter possible
			Every effort should be made to make rechecks unnecessary
			High-volume spay/neuter surgeons must be prepared for unforeseen complications
			Nothing trumps experience
	3 Scheduling
		Factors to consider when scheduling surgeries
			Predictable factors
			Unpredictable factors
		Factors that limit the number of surgeries that can be done in a day
			Average surgery time for each sterilization type
			Length of surgery time available per day
			Examination time
			Who does the examinations
			The number of large animals scheduled per day
		Calculations
			Calculating how many surgeries can be done in a day
			Calculating what an average surgery time needs to be to complete a given number of surgeries in a day
		A proposed new way of scheduling
			Why it is needed
			Relative surgery times
			Equivalency number based scheduling protocol
			A simplified scheduling protocol
	4 Setting up the surgical suite
		Supplies needed for surgery set-up
			The surgery table area
			The side of the surgeon (fig. 4.1)
			Behind the surgeon
		Other considerations
			One table vs. two tables
			Two-table configurations (fig. 4.2)
			Where the surgeon stands
		Surgery packs
			Number and type of instruments
			Clamps
			Scissors
			“Extra” instruments
		Ergonomics
			Consider wearing a lifting belt
			Patient placement
			Type of surgery table
			Use a high-quality extreme standing mat
			Take a lunch break
	5 Working as a team
		The team
			Administrative staff
			Licensed technician/anesthetic nurse
			Prep person
			Recovery person
			The doctor/surgeon
		Synergy between doctor and staff
			Support staff
			Doctor/surgeon
		Individual duties
			Morning check-in duties
			Midday/surgery duties
			Afternoon/postop duties
	6 Establishing flow (the order in which patients are done)
		Principles for determining patient order
			Minimize contamination
			Be flexible: Do not leave the surgery table empty
			Do risky patients first
			Match preparation times with sugery times whenever possible
		Factors that increase surgery time
			Ancillary surgeries
			Difficult or unpredictable surgeries
		Factors that prolong preparation time
			Inhalant anesthesia
			Add-on procedures during preparation
			Fractious or feral patients
			Technician skill and availability
		In conclusion
	7 Saving time in surgery
		Techniques that enhance safety and thereby save time
			Safely using the spay hook
			Making the incision more cranially in canines that have given birth
			Carefully breaking the suspensory ligament
			Placing ligatures securely
			Placing ligatures securely in large, obese, in estrus, or pregnant patients
			Closing incisions securely
			Providing thorough aftercare instructions
		Techniques that save time
			Tattooing to prevent unnecessary surgery
			Maintaining sterility between patients without rescrubbing
				■ Do not pre-open gloves
				■ Avoid bare hands between surgeries
				■ The surgeon’s gown should be kept sterile
				■ Rescrub when necessary
			Small incisions
			No skin sutures
Section 2 Surgical Protocols
	8 Small canine spay
		Protocol
			Make the abdominal incisions
			Exteriorize the right uterine horn
			Ready the right ovarian pedicle for ligation
			Loosen or break the suspensory ligament
			Ligate the ovarian pedicle with a miller’s knot
			Transect the pedicle cranial to the ovary
			Detach the mesometrium from the uterus
			Locate and ligate the left ovary/exteriorize the uterus
			Ligate the uterus
			Transect the uterus
			Close the linea alba with a cruciate suture
			Close the skin with a subcuticular mattress suture
			Consider applying a tattoo
			Apply tissue glue to the skin
		Other considerations
			Pregnancy, obesity, or estrus
			Lactation
		Troubleshooting
			The ligature on the ovarian pedicle is too close to the ovary
			The knot of the subcuticular suture will not bury
	9 Large canine spay
		Make the abdominal incisions
		Exteriorize the right uterine horn
		Ready the right ovarian pedicle for ligation
		Loosen or break the suspensory ligament
		Place a second clamp
		Ligate the ovarian pedicle with a Miller’s Knot
		Transect the pedicle cranial to the ovary
		Detach the mesometrium from the uterus
		Locate and ligate the left ovary
		Ligate the two uterine arteries and the uterus
		Transect the uterus
		Close the linea alba with a continuous cruciate pattern
		Close the subcuticular tissue with a continuous subcuticular pattern
		Consider applying a tattoo
		Apply tissue glue to the skin
		Other considerations
			Pregnancy or pyometra
			Lactation
		Troubleshooting
			Bleeding from the abdominal incision
	10 Standard feline spay
		Make the abdominal incisions
		Exteriorize the right uterine horn and right ovary
		Ready the right ovarian pedicle for ligation
		Loosen or break the suspensory ligament
		Ligate the ovarian pedicle with a Miller’s Knot
		Transect the ovarian pedicle
		Detach the mesometrium from the uterus
		Locate and ligate the left ovary
		Ligate the uterus with a Miller’s Knot
		Transect the uterus
		Close the linea alba with a cruciate suture
		Close the skin with a subcuticular mattress suture
		Consider applying a tattoo
		Apply tissue glue to the skin
		Other considerations
			Maintaining statistics
			Determining gestational age of feline fetuses in utero (table 10.1)
			Determining estrus status in a feline
		Troubleshooting
			Postpartum patients
			Lactation
			Cannot expose the uterine bifurcation
	11 Auto-ligation feline spay
		Protocol
			Make the abdominal incisions
			Exteriorize the right uterine horn
			Perform an auto-ligation
			Ligate the uterus with a Miller’s Knot
			Close the linea alba with a cruciate suture
			Close the skin with a subcuticular mattress suture
			Consider applying a tattoo
			Apply tissue glue to the skin
		Other considerations
			Maintaining statistics
			Determining gestational age of feline fetuses in utero (table 11.1)
			Determining estrus status in a feline
		Troubleshooting
			Delicate ovarian vessels in very small kittens
			Abdominal closure is not flat
	12 Canine scrotal neuter
		Protocol
			Make an incision along the scrotal midline
			Exteriorize the testicle
			Strip fat from the spermatic cord if needed
			Exteriorize both testicles before applying ligatures
			Ligate the spermatic cords with Miller’s Knots
			Repeat for the other spermatic cord and transect the cords
			Close the incision
			Consider a tattoo
		Troubleshooting
			Abdominal fluid (ascites) is present in the scrotum
	13 Canine prescrotal neuter
		Canine prescrotal neuter protocol
			Position the first testicle
			Make the midline incision
			Incise over the testicles
			Exteriorize the testicles
			Transect the ligaments if needed
			Remove fat from the spermatic cord if needed
			Exteriorize both testicles before applying ligatures
			Ligate the spermatic cords using Miller’s Knots
			Transect the spermatic cords
			Close the peri-testicular incisions
			Close the skin
			Consider applying a tattoo
			Apply tissue glue to the skin
		Troubleshooting
			Scrotal bleeding
			Cannot exteriorize the testicle enough to sever ligamentous attachments
	14 Feline neuter
		Protocol
			Position the patient
			Anesthesia
			Incise the scrotum
			Instill epinephrine
			Incise over the testicles
			Exteriorize the testicle
			Remove fat
		Perform auto-ligations
			Repeat for the other testicle
			Elevate the scrotum
			Allow to heal by second intention
			Consider a tattoo in kittens less than 4 months old
		Troubleshooting
			Fluid in the scrotum
	15 Inguinal cryptorchid neuter
		Protocol
			Locate the cryptorchid testicle by palpation
			Remove the nonretained testicle
			If needed, make a prescrotal midline incision
			Manually relocate the testicle
			Expose the retained testicle
			Exteriorize the retained testicle
			Ligate the spermatic cord using a miller’s knot
			Close the incisions
			Consider applying a tattoo
			Apply tissue glue to the skin
		Troubleshooting
			Unable to move retained testicle sufficiently close to midline
	16 Abdominal cryptorchid neuter
		Protocol
			Express the bladder
			Position the patient
			Retract the penis
			Make the ventral skin incision
			Make the abdominal incision
			Exteriorize the bladder
			Locate the bifurcation of the ductus deferens
			Trace the ductus deferens to the retained testicle
			Exteriorize the retained testicle and remove the vaginal tunic
			Ligate the spermatic cord and ductus deferens
			Transect the spermatic cord and the ductus deferens
			Return cord and ductus to abdomen
			Close the abdominal incision
			Close the skin
			Consider applying a tattoo
			Apply tissue glue
			Remove the other testicle
		Troubleshooting
			The cryptorchid testicle cannot be located in the abdomen
	17 Ancillary surgeries (umbilical hernia, dewclaw removal, feral cat ear tipping)
		Umbilical hernia repair protocol
			Incise the skin
			Dissect the hernial sac
			Remove or replace the falciform fat
			Close the hernial ring
			Close the skin
		Nonattached dewclaw removal protocol
			Clamp the base of the dewclaw
			Excise the dewclaw
			Apply epinephrine
			Apply surgical glue to skin edges
			Glue the skin plantar-medial to the clamp
			Fold the skin over the glue
			Remove the clamp and hold in place while the glue dries
			Clean the clamp
			Skin sutures or bandages are not needed
		Ear tipping of feral cats protocol
			Induce anesthesia
			Clamp the ear
			Excise the ear tip
			Apply epinephrine
			Apply styptic powder
			Remove the clamp
		Other considerations regarding ear tipping
			The size of the ear tip
			The locaiton of the ear tip
			Ways to avoid ear tipping the wrong cat
Section 3 Complications
	18 Complications
		Splenic repair protocol
		Abdominal bleeding protocol
		Scrotal ablation protocol
		Preparation for major complications
	19 Cardiac arrest
		CPR protocol
			Positions
		Assignments
		Crash cart
			Crash cart maintenance
		Training
Index
	A
	C
	D
	E
	F
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