International Spay Neuter Field Clinic Guidelines

A. IntroductionB. Planning

a. Community organizationi. Local veterinary community

ii. Community outreachiii. Cultural sensitivityiv. Language skills available throughout clinic

b. Permit acquisitionc. Clinic locationd. Caseload

i. How caseload is acquired/decidedii. Identification and records

iii. Transport iv. Clinic housing

e. Volunteersi. Adequate numbers and expertise to ensure standard of care and safety

ii. Veterinariansiii. Veterinary Technicians and/or assistantsiv. Others

f. Medical suppliesi. Budget constraints

ii. Manifestiii. What needs to be importediv. What can be acquired locallyv. Methods of sterilizing

1. Prior to clinica. drapes, instruments, etc

2. Throughout clinica. Sterilizing machines

i. autoclave or pressure cooker1. Kills all viable organisms including spores using

pressure2. Instruments must be open for adequate

sterilization3. Pressure cooker is relatively cheap and easy to

maintain4. Autoclave

a. Expensive pressure cookerb. Expensive to operate and maintain

c. Ease of use if available and working correctly

ii. Dry oven1. Requires the use of steribags for appropriate

sterilization2. Cloth wrapped instruments and drapes will

burn if sterilized at the appropriate temperature for the appropriate amount of time

3. Requires specific indicator strips for dry ovens to assure adequate sterilization

b. Sterilizing solutionsi. Kills most microorganisms except spores when done

correctlyii. Requires minimal time in solution for adequate

sterilization. Minimum of 15 minutes. Instruments must be open for adequate surface contact.

iii. Instruments need to be clean prior to immersion in sterilizing liquid

iv. Examples Benz-all, Dermacritg. Miscellaneous supplies

i. Laundry, biohazard materials, cleaning supplies, trash collection and disposal, cages

C. Preoperative considerationsa. Disease awareness

i. Rabies1. Local incidence2. How to address bite cases that may occur during clinic

ii. Infectious diseases 1. Incidence of tick borne diseases such as Erlichia and Babesia2. Common pathogens, distemper, parvo etc.

iii. Available vaccinesb. Clinic detail checklist

i. Equipment listii. Medical supply list

iii. Clinic flowD. Clinical details

a. Recordsi. Minimal data

1. Owner name, address, contact information, surgical releasea. Owner communication to assure understanding of procedures

to be performed

2. Patient informationa. Name, species, breed, age, weight, physical exam

3. Medications administered4. Anesthesia record5. Surgical record6. Recovery notes7. Post operative instructions

b. Physical exami. Temperature, pulse rate and quality, respiration rate and lung sounds

ii. CRT and mucous membrane color and textureiii. Exam of all other systems for clinically relevant findingsiv. Reproductive tract

1. Verify sex 2. Males – Cryptorchid3. Females – vaginal swelling or discharge, pregnant, in heat.4. Presence of transmissible venereal tumors

c. Analgesiai. Anesthetic protocols include analgesics. Every surgical case should receive

analgesics. ii. Recognition of ability to acquire

1. Cost2. Availablity

iii. Premeptive analgesiaiv. Mulitmodal analgesiav. Common analgesics

d. Anesthesiai. Minimally acceptable standards will vary based on the use of gas or injectable

anesthesia and what analgesics and anesthetics are available.ii. Needs to be adequate and humane. A surgical plane of anesthesia must be

maintained throughout procedure.iii. Primary reason analgesia and anesthesia are inadequate are:

1. Drugs useda. Insufficient, inadequate, inappropriateb. Surgical skill

i. Affects surgical timeii. Affects tissue handling. Rough tissue handling induces

more post-operative pain. iv. What analgesics and anesthetics are availablev. Monitoring equipment and personnel

1. Anesthesia should be monitored to anticipate if/when more or less anesthesia may be required and to assist in identifying intra-op complications.

2. Must be prepared and have the ability to address rapid changes in the depth of anesthesia. “Top off” does and method of delivery should be determined prior to inducing anesthesia.

vi. Adjuncts 1. Intubation 2. Ambu bag for injectable anesthesia3. Catheters4. Fluid therapy5. Thermoregulation6. Protocols

a. Adequate analgesia and anesthesia do not require the latest or most expensive analgesics, sedatives or anesthetics.

b. Protocols will vary based on what is available and affordable.i. Cost

ii. Ease of acquisitioniii. Knowledge of drugsiv. Injectable vs. gas anesthesia

vii. Must be able to address complications that may arise 1. Emergency drugs and procedures2. Catheters3. Fluid therapy4. Additional analgesia and anesthesia5. Thermoregulation6. Emergence delirium7. Consequences of non-sterile technique

viii. Specific protocolse. Surgery

i. Location of surgery area1. Location will vary depending on the logistics of the clinic site. Ideally it is

a room or an area dedicated to surgery, covered and protected.ii. Asepsis

1. Fundamental to safe surgery and decreased post-op complications.2. Always established and maintained throughout surgical procedure

a. The cost of establishing and maintaining are far cheaper and more humane than the lack of sterile technique and the consequences.

3. If sterile technique is broken, needs to be addressed, not ignored.a. Consequences of non-sterile technique may not be visible, such

as slow rate of healing or is in more pain.b. Serious consequences of non-sterile technique may not be

visible for a few days. Therefore post-op complications may go unaddressed unless post-op care is very good.

iii. Surgical prep1. Adequate surface for patient and equipment2. Equipment necessary

a. Sterile gloves, drape, suture, blade, instruments, gauzei. Cap and mask preferred but not always available

b. Method of sterilizing instrumentsi. Autoclave

ii. Cold sterilec. Drape material

i. Adequate size to maintain asepsisii. Should be resist ant to fluids in normal surgical

conditionsd. Suture material

i. Approved for medical use3. Pre-operative preparation

a. Clipping hair and hair removalb. Patient prep

i. Solution and scrub techniquec. Surgeon prep

iv. Recommended techniques1. Adult dog or cat

a. Ventral midline or flank approachb. Complete ovariohysterectomyc. Closure

i. Body wall must include rectus fascia1. simple interrupted, cruciate or continuous

ii. Subcutaneousiii. Subcuticular

2. Adult male dog a. Prescrotal approachb. Complete removal of both testesc. Closure

i. Subcuticular +/- subcutaneousd. Cryptorchid

i. Must remove both testesii. Approach and closure determined by location of testes.

3. Adult male cata. Scrotal approachb. Complete removal of both testesc. Incision left open to heal by second intention

4. Pediatric female dog or cata. As described above for adult dog and cat

5. Pediatric male dog or cata. Scrotal approachb. Closure glued (dog) left open (cat)

v. Pediatric surgeryvi. Hemostasis

1. Must be addressed throughout procedure2. The common occurrence of tick borne diseases and their effects can

contribute to pre, intra or post-op complications3. Must be familiar with the diseases and how to address possible

complications.vii. Thermoregulation

1. Produces significant and often avoidable complications, delays recovery2. Temperatures should be monitored intro op if procedure is long,

prolonged, complicated or one is operating in extreme environmental conditions.

3. Warm ambient temperatures are not conveyed to a table surface. Heat loss form an animal to the table surface can be significant. Always have something between anima and table surface such as a dry towel, bubble wrap, newspaper.

4. Keep patients dry and warm. Fluid soaked animals are much more prone to hypothermia as they lose heat on a surface colder than they are.

5. Keep heat sources such as socks filled with rice, warm water bottles, etc. available. Never put a heat source directly against an animal’s skin.

6. Minimize the use of water/cold prep solutions. Excess prep liquid should not be squeezed onto the surgical surface of the animal. Alcohol greatly and rapidly lowers body temperature.

7. If working in extremely hot environment with minimal to no ventilation, employ methods to keep body temperatures within normal parameters

a. Fans, cool floors, IV fluids, cool water bottlesf. Recovery

i. Needs to be monitored. Important to have experienced people so as to be able to identify normal vs. abnormal recovery and parameters.

1. Experienced personnel increase the ability to recognize and address possible complications as soon as possible.

ii. Reference of normal recovery parameters available to assist volunteersiii. Any questions on parameters should be addressed by a veterinarian or

experienced veterinary technician.iv. Most common area of the clinic where volunteers are bittenv. Thermoregulation is the most common post-op complication.

1. Keep patients dry and warm. Fluid soaked animals are much more prone to hypothermia as they lose heat on a surface colder than they are.

2. Keep heat sources such as socks filled with rice, warm water bottles, etc. available. Never put a heat source directly against an animal’s skin.

3. Pediatrics a. Are prone to hypothermia and hypoglycemia. Have heat sources

as well as a concentrated glucose source such as honey, karo syrup available.

g. Post –op care and instructionsi. Must be provided and explained in a language the owner understands.

ii. Must provide contact information for possible post-op issues or questions.