First and foremost, the one universal truth about everyone at Animal Hospital of North Asheville is that we love animals. Next, you might think that we Surgery Technicians also love blood and the gore, but it isn’t like that at all. A surgical suite is one of the most organized, most precise and cleanest environments possible. We thrive on meticulous attention to detail. Everything has a place; everything has a purpose; everything must work perfectly!
Surgery Technicians require advanced skills as well as meticulous attention to detail. We are both NC licensed Registered Veterinary Technicians with degrees and between us, we have over 20 years of experience in surgery and anesthesia at Animal Hospital of North Asheville. When you leave your pet with us for surgery, we know you are entrusting us with a beloved family member. We honor your trust by going to great lengths to care for your pet before, during, and after surgery. While we are very careful, very technical people, whose minds are always concentrating on our strict procedures and protocols, our hearts see your pet as a loving and beloved family member in need of reassurance and gentle care.
Each surgery day, the one veterinarian who is the surgeon of the day, reviews each pet’s medical record and fills out a surgical admittal record with pre-medications, dosages and protocols designed for the specific needs of that individual patient. Each patient arrives with family members and is examined by the surgeon, vitals are taken and entered into the medical record, and then the pet is admitted. One of the objectives is to have the stay be physically comfortable (lots of bedding and walks in our fenced outdoor walking area) and emotionally comfortable. Each patient receives gentle attention, petting and constant reassuring praise. Cats are placed in condominiums with perches, thermostatically warmed floors and a translucent hiding area that they can enter if desired. The canine and the feline ward nurses follow the doctor’s instructions and meet the needs of each individual patient.
The technicians make note of what kind of surgeries are scheduled and all equipment and instruments needed for a procedure are organized. The instruments have previously been ultrasonically cleaned, packed, wrapped and sterilized. The type of sterilization used on the pack differs according to the type of instrument. Our automatic steam sterilizer is used for most surgical packs, but Animal Hospital of North Asheville is one of two hospitals in Western North Carolina with a gas sterilizer as well. We do specialized procedures and these procedures require instruments that are too delicate for steam sterilization and require us to use our ethylene oxide sterilization unit. This type of sterilization takes longer and is much more costly.
The next step is to get the Surgery Suite ready.
- Turn on the Gaymar circulating warm water blankets. It is important to maintain the patient’s body heat which will drop due to anesthesia and the exposure of tissues to room temperature unless special steps are taken to keep the patient warm.
- Turn on gas evacuation system and leak check machines. This is to be sure that anesthetic gas is not escaping into the rest of the hospital, and also to ensure the patient’s safety. We maintain our anesthesia machines according to AAHA (American Animal Hospital Association) standards. We are proud that our anesthetic machines are sent out on a rotating basis to be calibrated. Company reps tell us that most hospitals, even AAHA hospitals, do not send their anesthesia machines out for regular maintenance.
- Prepare anesthetic machine with calcium carbonate and the liquid anesthetic that will vaporize and become gas as the patient needs it.
- Oxygen is piped throughout the hospital and is available at all times in surgery.
- Warm the IV fluid bags and the IV line warmers .
- Stock the room with linen service blankets and towels.
- Set up and check the 6 parameter monitor for each patient.
- Set up for specific surgery.
- Fill out paperwork and draw up induction agent and pain medication.
The Surgery Technician now gets the Patient Preparation Area ready.
- Set up the 6 parameter patient prep monitors and all prep supplies.
Now that the Preparation Area is ready, the Pack Prep Area must be made ready as well:
- Prepare the water bath for soaking endotracheal tubes and surgical instruments after they are used.
- Prepare the ultrasonic cleaner.
At this point, the Surgery Technician is ready for the patient. The technician checks the doctor's paperwork to be sure the drugs in stock match the patient undergoing surgery, both in dose and appropriateness for the particular patient. The technician also looks over the patient’s history for diseases/conditions, may discuss these with the doctor, and also check to make sure that lab work has been completed and reviewed by the doctor. Finally, the technician goes over the plan of action for the patient.
- Patients are gently pre-medicated 30 to 45 minutes prior to induction of anesthesia. The drugs relax the patient and relieve any anxiety as well as reduce the amount of anesthesia needed by about one third. Our careful use of pre-anesthetic drugs based on the individual needs of the patient heighten the safety of anesthesia.
- The patient is gently placed on the prep table and the technician soothingly talks to the pet explaining what is happening. Vitals are carefully taken and recorded.
- An IV catheter is placed in every patient for two main reasons (and some others): to maintain the volume of fluids (blood) circulating in the body so that none of the organs are damaged by low blood pressure and so that an immediate route for IV drugs is available during the procedure for quick action. Due to the pre-anesthetic medications, most patients do not even realize that an IV catheter is being inserted. Once the catheter is in place and carefully secured, the catheter is flushed, the induction agent is given through the catheter, and the patient falls asleep while being petted and reassured.
- Once the patient is asleep, within seconds an endotracheal tube sized for the patient (breathing tube) is placed through the mouth into the trachea, secured, and a special cuff on the tube is inflated to just the right size so that no fluid or air can leak between the tracheal wall and the tube.
- The tube is immediately hooked up to the anesthesia machine so that the patient begins breathing oxygen. The patient’s eyes are lubricated so that they won't dry out and develop ulcers during the surgery. Patients can't blink to moisten their eyes when they're anesthetized.
At this point, the patient has already been hooked up to lots of monitors. The Surgery Technician is constantly monitoring the patient’s vitals – EKG, blood pressure, oxygen saturation, heart rate, breathing and quality of breath, CO2 levels, pulse waves, temperature. In addition to using AHNA’s state-of-the-art monitors, a trained registered veterinary technician is also constantly evaluating the patient directly. The same technician stays with the patient from before induction to recovery as it is important that there is no break or “hand-off” of duties. Once the patient is breathing oxygen, the anesthetic gas (either sevoflourane or isoflourane depending on the patient) is turned on and the patient begins to get the effect of the gas anesthetic as the injectable induction agent “wears off”.
- The surgical site is carefully shaved with special electric clippers, always being careful not to damage the skin. Coolant is sprayed on the blades to keep them cool as the clipping is done and the hair is sucked into the vacuum.
- If requested by the owner, the technician will trim nails, inject a microchip, and express anal glands while the pet is under anesthesia.
- During this preparation stage, which occurs outside of the surgical suite, the technician is constantly monitoring vitals and watching the trends that the vitals are setting. The level of gas that the patient receives is adjusted as needed to maintain the safest depth of anesthesia. All actions are recorded in the medical record.
- Local nerve blocks are injected around the surgical area so the patient will be more comfortable and as an added bonus the nerve blocks reduce the level of gas anesthesia needed, which results in a safer procedure. Additionally, our skilled surgery technicians also administer an epidural when appropriate so that the patient is as pain free as possible upon recovery. As this is a very advanced skill, we are proud to offer this high level of care at Animal Hospital of North Asheville especially as it is so very valuable to the patient’s comfort.
- The last step before going into surgery is to take a photo of the surgical site.
Once the patient’s surgical site is prepped, he or she is gently moved into the Surgical Suite (AHNA has rolling hydraulic beds for lifting and moving the patient) and is carefully hooked to all the machines, monitors, and fluids located in the surgery suite and the patient is positioned for surgery. The patient’s skin in the area of the incision has already been clipped and scrubbed before moving the patient to surgery, but once in surgery, the area is again carefully scrubbed and a final prep is done. Both our surgery technicians take special care when positioning patients so that when they wake up there is no soreness.
To maintain a steady body temperature during surgery:
- Water circulating heating pad
- Pillows and blankets
- The Bair Hugger Temperature Management Unit, which is a blanket of warm air. Mission Hospital uses the same technology to maintain temperature during and after surgery.
- Patients lose heat through their footpads, so we use bags that we heat and wrap around the patient’s feet to keep them warm.
The technicians must know each doctor’s personality and how they work since each doctor has his or her own “style” during surgery. The doctors are very open to suggestions from the Surgery Technicians and they meet with us before each surgery to be sure everything is discussed and anticipated. In surgery, it truly is all about the details!
The surgeon is scrubbed and wearing a cap, gown and mask (just as the surgery technicians are) when he or she enters the surgery suite. Using sterile technique, the technician hands the surgeon the surgical pack and opens any additional sterile equipment that they need. The doctor performs surgery while the technician continues to monitor the patient and attend to the surgeon’s needs - adjusting lights or getting more equipment, suture material, etc. Again, the technician is constantly monitoring the patient and making whatever adjustments are needed. For some surgeries, such as laparopscopic surgeries, two veterinarians operate together or an additional technician acts as a surgery assistant. The technician must always be two steps ahead of the surgeon; anticipating the surgeon’s every need. During each anesthetic procedure, the surgery technician constantly checks and records vitals and is responsible for recording the duration of anesthesia and surgery.
After surgery, the technician:
- Cleans up the surgical site
- Takes a post-op photo of the incision
- Administers post-op drugs to prevent pain
- Turns off the gas anesthesia and administers pure oxygen
- Deflates the cuff on the endotracheal tube
- Gently moves the patient out to recovery where the Surgery Technician gives the Recovery Nurse a full accounting of the procedure and the patient’s needs. The Surgery Technician remains available to the recovery nurse for any questions or clarification. The Recovery Nurse holds or stays right beside the pet, petting them and reassuring the pet as they awake from the anesthetic. The Recovery Nurse continues to monitor and record vitals until the pet is fully recovered.
Typically, while Sharon is in surgery with a patient, Gretchen is working out in the prep area with the next patient, and they alternate all day long until all surgery is complete. Timing is key to everything they do.
At the end of the day, they clean everything, sort and wrap the surgery packs and send them back to the autoclave and gas sterilization unit to be re-sterilized, clean the surgery suite from top to bottom, and reset for the next day of surgery.
Gretchen has worked at AHNA for 4 years and loves the challenge of surgery almost as much as she loves the pets themselves.
Sharon has worked as a Surgery Technician at AHNA for 16 years and she loves her job.
“My job is so fulfilling,” said Sharon. “I also have a wonderful partner in Gretchen, I couldn't ask for a better one, not to mention all the doctors are such a pleasure to work with. It really is a team effort. It’s so rewarding to all of us to keep the patients safe, comfortable, and pain-free. And the best reward of all is seeing the tail wags when an owner comes to pick up their pet. Every day I give 110% to each patient to make sure that they are safe and comfortable. I treat every patient like my own pet. Every dog or cat is a beloved family member to somebody.”