Tuesday 13th Feb, 2018
Ross Allan is an Advanced Practitioner and Small Animal Surgical Certificate Holder. Here he shares his top 8 New Graduate Tips for Surgical Success
Surgery is one of the key aspects of our immensely rewarding job. It is something that can go brilliantly well and quickly transform a patients prognosis. Contrastingly it can quickly terrify us and we can almost always improve on what we do.
As a qualified vet this is a privledgegained through 5 years of hard graft at university and in my opinion is one of the most rewarding or indeed frustrating elements of the veterinary job.
I thought I’d share some of the tips and tricks learnt from 15 years at the University of “hard knocks” on what I think will help you as your start out on this exciting path.
Surgery is not just the procedure itself. By the time you graduate you will be all too aware of this, yet it is still essential to remember this once you start providing the services yourself.
At University many procedures may seem to be almost partitioned off: e.g. that’s a TPLO, that’s an OVH. The clinicians’ will have considered a lot before getting to this point, and it can be a danger to think like this when you start in general practice.
When you first get given the “ops list” it can seem daunting, and could be viewed as a list to “get through”. This is understandable, but be cautious. Remember that you need to consider each patient in full, and from the start. Don’t assume everyone else got it perfect, we are all human. Review the history and check the patient. Examples of things that you may wish you’d noticed include:
Time spent making sure you get this right will make your op days far easier…
When planning your ops list day, consider the order you are going to tackle it. Talk to the nurses and make sure they are aware of this, and let them know what you would like them to do to help you. Nurses are a massive help, and will want your day to go well. They need your input however to make sure they can make up the correct meds in advance, set up the X-ray machine correctly, or call owner’s as you need.
Effective teamwork will make everyone’s day easier.
Do not underestimate the importance of correct positioning of patients in theatre. An example could be removing a mass from the dorsal carpus. This will be far easier if the patient is in dorsal recumbency in a cradle, and the table tilted towards the dogs bottom with the leg extended.
You will try and do it in lateral recumbency once… and then realise that 5 mins getting it perfect will help everyone immeasurably.
Surgical success relies upon effective teamwork, underpinned by a structure of everyone knowing what they should do to help the day go well. Communicating what you need for surgeries, especially as you start to do more complex surgery is important. Havingthis conversation early in the day, or preferably the day before will allow your colleagues to get things ready for you before the last moment. If you don’t have these conversations, and assume that particular kit will be ready it will lead to frustration and a few red faces...
All surgery can go well, but almost always it can go a bit better. You should review what you do, and consider why you did it, and what you may be able to do better another time. This is not meant to be negative, but should be an opportunity for reflective learning. It is wise to ensure that the practice you join encourages you to do this, and has an open attitude to discussing clinical outcomes, and what could be improved.
It is only be considering these that you can learn and develop your clinical skills.
Before cutting, stop. Check with the nurse that you are doing the right thing, with the right patient, and have the right equipment. This is a standard protocol in all human hospitals…
Thinking, and planning any surgical procedure you have not done regularly before is important. Knowledge of the anatomy, optimal position and correct equipment will greatly help your day. But even with planning there needs to be a plan B. This is especially when you get into doing more advanced surgeries.
Making the effort to consider Plan B and setting up “just in case”.... is well worth it.
In many surgery you do for the first few times having either a colleague or nurse scrub up to help you is advisable. Dog neutering for example is much easier if someone is holding the forceps for you as you tie the sutures. This assistance also reassures you that there is someone to help if things go wrong. I would recommend that at interview you ask what help you’ll be given with your first OVHs… this will give you an idea of what the practice is like.