Veterinary Surgical Nursing

1. Veterinary Surgical Nursing INSTRUMENT MAINTENANCE

2. Sharps ! • Be aware of sharp instruments such as scissors, scalpel blades and needles • Use haemostats or needle holders to remove scalpels • Place into sharps container

3. Allergies ? • Some of the cleaning preparations may cause skin allergies.

4. For Your Protection • Make sure you are wearing suitable protective clothing • rubber gloves • plastic aprons

5. Careful handling • Most instruments are delicate and should be handled carefully • Instrument use should suit the purpose • Try to preserve sharp edges

6. Sort • Remove all opened surgical packs and contaminated equipment for cleaning. • Sort all instruments prior to washing to avoid damaging the finer instruments with the heavier ones.

7. Open • Before cleaning make sure that the ratchets (closing devices) on the instruments which have them are open.

8. Rinse • Rinse instruments and drapes especially if cleaning is to be delayed.

9. Cleaning Methods • Water scrubbing only • Water scrubbing followed by detergent soak • Water scrubbing followed by ultrasound

10. Water Scrubbing • Don’t use hot water – coagulates proteins • Use cool or warm running water • Don’t clean with saline – corrodes

11. Water Scrubbing • Use a toothbrush or scrubbing brush to remove debris • fine grooves and serrations • between the hinges, ratchets and box-joints • Avoid abrasive scrubbers (steel wool)

13. Detergent Soaking • If using a detergent • Use only commercially prepared instrument detergents • Rapidex® can (can also use in Ultrasound cleaning, also disinfectant proprties) • Pyroneg® • Ordinary soaps can precipitate onto instruments as an alkali film – don’t use

14. Ultrasound Cleaning • Used by some practices • Does not sterilise • but very effective in removing debris especially in the difficult to access parts such as the hinges. • The ultrasonic cleaning process is called cavitation • Vibrations + Instrument detergent > bubbles collapse and reform many thousands of times per second on the surface of the instruments causing a scrubbing action by which the debris is removed. • Usually 10 mins enough

15. Ultrasound Basin

16. Ultrasound Detergent

17. Final Rinsing and Drying • After cleaning instruments can be rinsed in hot water and left open on a flat surface to dry. • But, if then using instrument milk do not rinse off this milk

18. Air machines • Orthopaedic drill • Wipe with disinfectant cleaner • Do not immerse • Lubricate as per instrument’s instructions

19. Inspection • Check the alignment and angle of the jaws of instruments. • Scissors become blunt with use and the veterinarian will generally alert you to this so that they can be put aside for sharpening. • Suture needles also become blunt and their tips can become bent over.

20. Inspection (cont’d) • Check the stiffness of hinges • Suture needles also become blunt and their tips can become bent over.

21. Inspection (cont’d) • Check sharp instruments for nicks or burs • Check screws and pins for snugness • Check that needle holders will hold a needle without rotating

22. Inspection (cont’d) • Check that ratchets don’t easily spring open when instrument lightly tapped • Check tips of towel clamps for bending

23. Protection • After cleaning, instruments may be immersed for a short time in a commercially available instrument milk which provides • Lubrication • Corrosion protection

24. Protection • “Instrument milk” • An emulsion of water and oil that does not interfere with sterilisation • 30 seconds enough • Wear gloves • Allow to drain • Don’t rinse off • Anti-rust (sodium nitrite)

25. Lubrication • Don’t use mineral oil or grease ! • An oily film traps and protects bacteria from steam sterilisation

26. Storage • If they are not to be resterilised they should be stored in a dry place • Leave ratchets open or on the first notch. • Storage of instruments with their ratchets fully closed will eventually lead to metal fatigue and loss of function.

27. The End