Table 1 . Basic instrument list for colic surgery . [ 12 ]
Instruments
Thorough and repeated lavage of the abdominal incision with sterile 0.9 % saline or lactated Ringer ' s solution , during and after each layer of closure , can protect against incisional complications [ 13 ] . Wound stents that can be sutured in place to protect the wound for 24 – 48 hours post-surgery may help to reduce the likelihood of incisional infections [ 15 ] .
Adhesion prevention
Quantity Backhaus towel clamps 8 – 10 # 3 scalpel handles and blades 1 # 4 scalpel handles and blades 1 Brown-Adson thumb forceps 1 Rat tooth ( 2 ) thumb forceps 1 DeBakey or smooth thumb forceps 1 Mayo scissors ( straight ) 1 Mayo scissors ( curved ) 1 Metzenbaum scissors ( straight ) 1 Metzenbaum scissors ( curved ) 1 Suture scissors 1 Mayo-Hegar needle holders 2 – 3 Mosquito haemostats 4 Sponge forceps 2 Kelly haemostats 10 Sterile bowl or kidney dish 1 – 2 Dosing syringe 1
Decompression tubing and needles ( 1 tube , 5 – 10 × 21 – 14 G needles )
Poole Suction Tip 1 Gauze swabs ( 10 cm × 10 cm ) 4 Laparotomy sponges 4 Allis tissue forceps 2 Carmalt forceps 2 Doyen or Fogarty intestinal clamps 4
See left column
Postoperative intra-abdominal adhesions may be clinically insignificant but may also cause serious complications [ 16 ] . Prevention of adhesion formation is difficult in horses , but every effort should be made intraoperatively to reduce the risk of formation [ 16 ] . The primary measures in the prevention of adhesion formation are meticulous haemostasis , minimising trauma and contamination of the intestines , and a short duration of surgery [ 16 ] . Sterile polyionic solution , such as 5 litre bags of 0.9 % sodium chloride or lactated Ringer ' s , should be used continuously during surgery , via an intravenous administration set , to moisten the intestines and minimise friction that could promote adhesion formation [ 16 ] ( Figure 4 ).
Figure 4 . The risk of adhesion formation can be minimised by keeping the intestines continuously moistened with sterile isotonic fluids , administered via an intravenous giving set .
Bags of sterile lavage solution can be hung from a ceiling-mounted rope or drip stand for ease of access . In cold climates , fluids may need to be heated to body temperature to reduce the risk of cold shock on introduction to the abdomen . High-volume lavage of the abdominal cavity can be performed during surgery to reduce the risk of adhesions by flooding the abdominal cavity with a warm , sterile solution , such as lactated Ringer ' s [ 7 ] . Generally , the circulating theatre VN will pour open bottles or bags of warm lavage solution into the open abdomen , taking care not to contaminate the VS or the surgical field .
An added measure in the prevention of adhesions is the intraoperative use of 1 % carboxymethylcellulose ( CMC ) coating solution , to minimise serosal friction , particularly in cases with extensive small intestinal manipulation [ 16 ] . CMC is believed to have the potential to reduce adhesion formation post-surgery , particularly in cases susceptible to post-surgical ileus [ 16 ] . CMC solutions can be poured into a second sterile kidney dish or bowl on the surgery table . The solution can be applied by the surgical assistant using a syringe or by pouring it directly on to the intestines .
To further reduce the risk of adhesions , an omentectomy may also be performed to remove omentum from the abdomen [ 17 ] . The blood vessels of the omentum can be ligated using an absorbable
28 Veterinary Nursing Journal