Other patient factors, such as the age of the patient, should be considered. Older patients may have osteoarthritis, so they may need extra padding and support for their joints, and there may be comorbidities.
The size of the patient should be taken into account as patients undergoing ex-laps will often lose body temperature quickly, especially smaller patients. A warming device such as a Bair Hugger( 3M) warm air blanket can be used before, during and after surgery.
The surgical kit
A basic surgical kit and some additional instruments will be needed. Figure 3 shows an example of the instruments and kit that may be required, depending on the practice protocol and VS ' s preference.
Haemostasis
Electrocautery is often used to provide haemostasis. This can be either monopolar or bipolar electrocautery. Bipolar electrocautery uses a lower voltage and offers better control to target specific areas of bleeding with minimal damage to other tissues [ 8 ]. However, it is less effective than monopolar electrocautery in providing a larger area of haemostasis. Monopolar electrocautery is also versatile and can be used for several different modalities [ 8 ]. However, when using monopolar electrocautery an earth plate must be positioned under the patient with good contact with the patient; otherwise, burns can occur. Advanced bipolar technology, such as an ENSEAL device( Ethicon), can also be used. This technology allows the tissue to be compressed at high pressure, which works with bipolar electrocautery to seal the blood vessels before a cutting tool separates the tissues.
Retractors
Self-retaining retractors such as Balfour retractors can be used to give a good view of the abdominal cavity by retracting the edges of the incision. Handheld retractors such as Langenbeck and malleable retractors can be used to retract specific tissues to improve the VS ' s view.
Specific instruments for gastrointestinal surgery
Bowel clamps, such as Doyen bowel clamps, can be used when performing an enterotomy or enterectomy to prevent the spillage of GI contents( Figure 4, page 55) [ 9 ]. Doyen clamps have an atraumatic jaw to avoid causing damage to the intestinal tissue while clamping it.
Figure 3. Exploratory laparotomy instrument kit.
54 Veterinary Nursing Journal