Approaching high-volume spay and neuter as a separate discipline, this comprehensive reference addresses the unique challenges of this branch of shelter medicine. You will learn how to become faster at performing these procedures in a variety of settings, while still maintaining the safety of the patient. Safety is emphasized throughout with guidance on how to best treat patients with unknown medical histories and financial constraints that restrict the ability to do pre-anesthetic blood work. Special attention is given to considerations about surgical technique, as well as topics such as suture selection and size, suture pattern, patient order, medications, and aftercare. Coverage of mobile veterinary services examines how to provide low-cost spay and neuter to underserved communities with this emerging trend in the industry.
- Comprehensive coverage examines the "hows" and "whys" of the mechanics of high-volume spay/neuter, as well as how to manage complications that can occur.
- Written by Victoria Valdez, an experienced veterinarian who has performed more than 40,000 spays and neuters.
- Information on how to set up both a mobile and a stationary suite offers guidance for providing low-cost spay and neuter services in a variety of settings.
- Easy-to-read reference manual format ensures each chapter includes all pertinent information on a topic, eliminating the need to cross-reference throughout the book.
- Enhanced eBook on Expert Consult offers a fully searchable version of the text.
Author(s): Victoria Valdez
Publisher: Elsevier
Year: 2021
Language: English
Pages: 153
City: Philadelphia
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
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