Ever wondered why surgery at the vets seems expensive? Well, there’s a LOT that happens behind the scenes that you probably don’t see! Vet Nurse Sophie explains everything that has to happen to allow surgery to take place…
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When it comes to preparing your dog or cat for surgery, there are many things that go on behind the scenes to prepare for this. As well as preparing the animal, we also have a lot of other areas to get ready or “prep”. All these tasks are vital to maintain a sterile environment, prevent infection, safety and to ensure the surgery goes well and your pet recovers safely.
Who is involved in preparing dogs and cats for surgery?
Behind the scenes at the practice there will be a team that is preparing for surgeries. The team behind the scenes consists of vets, nurses and care assistants (e.g. Vet Care Assistants, VCAs, or Animal Nursing Assistants, ANAs). They all play a vital role in the preparation.
The veterinary surgeon helps with the preparation by checking the patients over. They will listen to the pet’s heart and lungs and look for any potential problems that could occur with each patient. Part of their preparation is to also work out the drug dosage that will be needed. While a vet needs to operate, they will always need at least one veterinary nurse to assist them.
The veterinary nurse plays an important role, they maintain the animal under anaesthesia, under the overall control of the vet. They will closely monitor them for the whole procedure and throughout recovery. To assist the veterinary nurse, some practices have a care assistant. Their role is to help prepare the theatre, cleaning and helping prepare the animals for surgery. For any one surgery it will require a minimum of three members of staff all of whom will be trained and qualified.
What is needed for surgery?
Skill
To be able to perform a surgery it requires skill and experience. Only qualified veterinary surgeons can do this. Sometimes a student vet may help but we always need a qualified vet. The skills of a vet may vary, most vets will be able to do simple neuters, elective procedures and feel happy with most emergency surgery procedures, whilst others have studied further and become certificate holders in certain areas. For example, an orthopaedic surgeon, these vets have studied hard to learn about fixing bones.
Often these vets will be found in a referral hospital and their pricing is significantly higher. This is due to the equipment used, the fact that their theatre time is likely to be longer, and because the materials they use to fix bones are pricey. You are also paying for their skill; they work hard to get and to maintain these qualifications so it should be rewarded and appreciated.
The veterinary nurse is another vital part of the team when it comes to surgery, again they need the skill and knowledge to be able to assist with general anaesthesia and potentially in the surgical field itself. A good theatre nurse is essential for a good surgery! Veterinary nurses must be trained and qualified to do this, and will themselves have areas of particular focus. For example, some will have a strong interest in anaesthesia, while others may perform minor surgery and assist the vet as scrub nurses.
Equipment
Having the correct equipment for a veterinary theatre is vital to ensure procedures go well. So what equipment is in the theatres? Well, a pretty average operating theatre would be expected to have:
- Stethoscopes – to listen to heart rates and the lungs. Often, a special oesophageal stethoscope will be used during surgery, to pick up even very subtle changes.
- Thermometers. It is so important to monitor an animal’s temperature during an anaesthetic, as patients can easily start to get cold – in which case, warming systems such as Bair Huggers and heat mats will be needed..
- Procedure table. These are easy cleanable tables, that can be moved up and down to provide a comfortable height.
- IV pumps. These are called intravenous infusion pumps. These are used if your dog or cat is given fluids during a procedure, to allow us to exactly measure the fluid rates to prevent fluid overload or dehydration.
- Anaesthetic machines. These machines allow us to maintain general anaesthesia, and at a minimum will include an oxygen supply, a volatile agent vaporizer, and a flow meter. Most will also have hypoxia alarms, oxygen flush systems, and pressure regulators to keep patients safe and stable under anaesthesia.
- Monitoring machines. While there are a lot of types out there, the most commonly used are multiparameter monitors. These are expensive machines; most practices have one however, as they make such a difference to how early we can pick up any problems and correct them. They typically allow us to monitor the heart rate and rhythm (ECG), respiration rate and exhaled oxygen (capnograph), blood pressure (oscillometric usually, although sometimes Doppler systems are used instead), temperature (thermal probe), and oxygen saturation (pulse oximeter).
- Surgical kits. Surgical kits are used to perform the procedures, and each kit contains all the instruments that would be expected to be needed. Of course, the more procedures planned for a day, the more different kits are likely to be required.
Sterilisation
Sterilisation is so very important to be able to perform surgery. It helps us maintain hygiene and prevent infections. It is important that all surgical equipment is sterilised to kill any microorganisms. Within the practice we use appliances called autoclaves which provide high pressured steam and reach very hot temperatures to kill any microorganisms (even including bacterial spores).
Consumables
A lot of consumables are used daily. Let’s have a look at what we would use for an animal having surgery:
- Needles and syringes. These are used to administer most medication, we also use needles and syringes to administer the anaesthetic.
- Gloves. Gloves are used to prevent contamination, this could be when clipping and cleaning a surgical site, to cleaning a wound. During any surgical procedure, sterile gloves are also worn to again prevent infection.
- Gowns. Sterile gowns are worn in theatre.
- Surgical drapes. These are sterile drapes which are used to keep the surgical area clean.
- Suture material. These are used during surgical procedures to close up, and sometimes we might use surgical staples as well.
- Sterilisation bags – bags or pouches that are used to put surgical kits in. These are special bags which can then go into an autoclave without melting (!) and will keep the kit clean and sterile after removal..
- Injectables/medication.
- Surgical scrub. This is used to clean the surgery site and for the vet to clean their hands with.
- Intravenous fluids.
All these items would be used for every single surgery.
We use a lot of consumables daily, so it is important that the disposals are disposed of appropriately. Some disposables can be recycled, for example sterilisation bags, these can go into recycling as they are very rarely contaminated. Needles and syringes need to be disposed of correctly into pharmaceutical bins to prevent injury and contamination. Any swabs, drapes, gloves and surgical gowns that have been contaminated need to be disposed of in clinical waste. Clinical and Offensive waste is taken away and incinerated, it doesn’t go into landfill sites. Clinical waste and pharmaceuticals are taken away by companies that specialise in the disposal of hazardous and non-hazardous waste.
Conclusion
Veterinary pricing is based on the things we have mentioned. When paying for your dog or cat to have a surgery performed you’re paying for;
- Theatre time.
- Injectables/medication.
- Consumables, which are all of those mentioned.
- Disposal of used items.
- The skill and knowledge of the vet and the nurse.
- The sterilisation of the instruments.
Different procedures cost different amounts based on the consumables needed and the skill and time it takes. When vets are preparing for a surgery, they will ensure all of what we mentioned is available in the practice.
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