Suction and a Balfour retractor are extremely useful during a laparotomy.Photo courtesy Phil Zeltzman Veterinarians and nurses are notoriously creative when it comes to little hacks that make their lives easier. Here are a few ideas you may or may not have heard of, that you can easily implement in your operating room. Others might represent an upgrade to improve your surgical standards. Electrodes Few things are as frustrating as ECG clamps drying out under a warm air blanket or during a long surgery. A solution is to attach the clamp to an injection needle rather than the skin. Here is the process: Pierce the skin near the points you would normally attach your ECG clamps with a 22 G needle. Use a rubber stopper from a blood tube to protect the end of the needle. Simply attach each ECG clamp directly onto each needle. It may sound strange or painful, but it’s no worse than injecting a vaccine, except your patient is under anesthesia and pain free. Lube Is your eye lube always missing when you need it? Is it out of reach when you are anesthetizing a patient? A simple trick is to use a 6- or 12-ml plastic syringe case that is taped or zip-tied to your anesthesia machine. You can also use this idea to hold your dry syringe (aka “puffer cuffer”) for inflating or deflating your endotracheal tubes. Wires Keeping wires and tubes from getting all tangled is a daily chore. Save yourself the heartache and the time of untangling the mess by attaching plastic or metal hooks to the wall. Have a hook for each wire: ECG, pulse oximeter (SpO2), temperature probe, blood pressure and end tidal CO2. Bonus: Your wires will last longer and work better if they are hung loosely rather than being tightly coiled up. Tongue The SpO2 monitor typically works best when the tongue is moist. Rather than leaving the OR to get a wet gauze square or cotton ball, save yourself time by keeping a squeeze bottle full of water to wet the tongue when it dries out. Clipboard Is your OR tiny? Do you have no space to breathe next to the anesthesia machine? Do you have no flat surface to put your medical record or anesthesia sheet? Here is an easy solution: Hang your clipboard on a screw or a hook in the wall. Suction Surgical suction is extremely helpful for removing blood or fluid from your surgical site or a body cavity. If you’ve ever removed 6 liters of ascites fluid from an abdomen with a syringe, you will understand the benefits of a suction machine. Even if you are not exploring a hemoabdomen or lavaging a surgical site every day, suction is extremely useful for cystotomies and enterotomies. A new portable suction machine starts at around $300. A brand new, sterile suction hose will set you back a couple of dollars! You will save precious time and decrease stress if you can clear your surgical site efficiently. The two main types of suction tips are: The Poole tip, best suited to aspirate large amounts of fluid because of the multiple holes (e.g. hemoabdomen or lavage). The Frazier tip, which is much better to aspirate small amounts of fluid (e.g. joint, localized bleeding). Filters Suction machines sometimes appear to die unexpectedly. After double-checking your connections and the bucket, consider replacing the most unloved part of the machine: the filter. The more you use the machine, the more frequently the filter should be changed. Always have a spare one available. It only costs a few dollars, but can literally be a life saver. Buckets Same concept with suction bottles, aka suction buckets. They can easily crack, so always have a spare. If you don’t have an intact bottle, vacuum will not be established and your suction machine becomes useless. A reusable bucket cost $10 to $15, so it’s worth having an extra one. It is also good to have at least a spare bottle when you have a large volume to aspirate (hemoabdomen, ascites, lavage). You may need to empty the bucket multiple times. If you have more than one bucket, you can replace it with the empty one so that suctioning can continue while the first one is emptied. This is a very inexpensive way to be immensely more efficient. Emergency Have an emergency kit ready with supplies you will need for an emergency surgery (bloat, C-section, blocked patient) so when it happens, you are not running all over the practice to gather supplies and can focus on your patient. Here is a short list: general pack, gown(s), gloves, drape, sterile bowl, and suction hose. You will have more time to gather other supplies, such as suture packs and a stapler. Cautery A cautery machine is another very beneficial piece of equipment that is worth considering. It is a huge time saver as it cuts and cauterizes at the same time so you don’t need to worry about every small vessel you encounter. When you do need to cauterize a vessel, you can do it in a fraction of a second. Larger vessels need to be ligated individually. Unless you have access to gas sterilization (ethylene oxide), make sure your cautery machine accepts cautery handles that can be sterilized in your steam autoclave. Balfour A Balfour abdominal retractor is a huge time saver and allows you to perform a much more thorough laparotomy—hands free. It helps you visualize every abdominal organ. This also allows you to use a nurse for more important things than being a human retractor. Balfours range in size from “baby” to “giant,” and cost approximately $300 to $600 each. Warming Having a warming device and not using it until after surgery is sadly commonly done. Patients begin getting cold as soon as they are given pre-medications or sedatives, and even more when they are anesthetized and possibly have their abdomen open to room air. If you wait until after surgery to use a warming device, you’re playing catchup. This is uncomfortable for the pet and they typically take longer in recovery due to hypothermia. By keeping your patients’ temperature as close to normal as possible you can avoid hypothermia and complications, while ensuring a quicker and smoother recovery. Cuffs Unorganized blood pressure cuffs can quickly become a tangled mess of Velcroed frustration. Yet again, there is a simple solution. Apply a strip of self-adhesive Velcro to a wall near your anesthesia machine. Attach your cuffs to the strip, and voila, you have everything at your fingertips. If you only implement one of these tips, you will increase your efficiency and save yourself some serious surgical hassle. Then you can spend that time and energy on your patient. Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified, is a board-certified veterinary surgeon and serial entrepreneur whose traveling surgery practice takes him all over Eastern Pennsylvania and Western New Jersey. He also is cofounder of Veterinary Financial Summit, an online community and conference dedicated to personal and practice finance (www.VetFinancialSummit.com). Kelly Serfas, a certified veterinary technician in Bethlehem, PA, contributed to this article.
