addition to the instrumentation previously mentioned for a standard abdominal approach, including a routine soft tissue instrument set and an appropriately sized Balfour retractor (Figure 2.1) to improve exposure, the use of the balfour retractor blade allows for upward retraction of the xyphoid process following a ventral midline diaphragmatic incision. If a balfour blade is not available, Parker Kerr retractors may aide as a handheld retractor substitute (Figure 2.23). If the pacemaker is placed through a lateral thoracotomy approach, appropriate instrumentation is listed in Box 2.12. Prior to anesthetic induction, the surgeon should consult with a cardiologist to determine the pacemaker best suited for a particular patient.
Figure 2.12 Patient positioning for dorsal perineal urethrostomy approach.
Box 2.6 Instrumentation for Perineal Urethrostomy
Routine soft tissue instrument set
Senn retractors
Iris forceps
Tenotomy scissors
#11 blade
Small needle holder
Small Gelpi retractor
Bipolar cautery
Tom cat catheter (Covidien)
Figure 2.13 Perineal urethrostomy instrumentation, including small Gelpi (bottom left), tomcat catheter, iris forceps, tenotomy scissors (top right), small needle drivers (immediately below tenotomy scissors), bipolar cautery (middle right), and Senn retractors (bottom right).
Figure 2.14 Intraoperative perineal urethrostomy surgery of a cat in dorsal recumbency showing the use of the tomcat catheter as a guide for the urethral incision with a #11 scalpel blade. Advancement of the catheter also aids in controlling hemorrhage during the procedure.
Box 2.7 Instruments for Retrograde Hydropulsion
Covidien feeding tube and urethral catheter (Kendall); red rubber catheter
Large syringe (60 cc)
Sterile saline (NaCl)
Lubricant
Box 2.8 Instruments for Urethrostomy and Urethrotomy in Dogs
Routine soft tissue instrument set
Iris forceps
Tenotomy scissors
#11 blade
Small needle holders
Senn retractors
Bipolar cautery
Weck‐Cel® eye spears
Fine suture material
Red rubber catheter (Kendall; size will be determined by patient size)
Lubricant
± Surgical loupes
Pericardiocentesis for Pericardial Effusion
The ideal position for performing a pericardiocentesis is with the patient in sternal recumbency. The procedure can also be performed with a patient in lateral recumbency or in a standing position, depending on their disposition. Proper restraint is vital to prevent pulmonary laceration or cardiac perforation. The patient should be attached to an electrocardiogram during the procedure to monitor for ventricular premature contractions due to possible unintended cardiac contact. The pericardiocentesis site should be clipped and aseptically prepared with a chlorhexidine‐based antiseptic solution. The instruments needed are listed in Box 2.14 (see also Chapter 34, Figure 34.3 and Chapter 45).
Figure 2.15 Contrast study in a male dog identifying the location of a urethral obstruction.
Figure 2.16 Contrast extravasation from a tear in the urinary bladder in a patient diagnosed with a uroabdomen.
Figure 2.17 (a) Temporary tracheostomy set. (b) Additional equipment to perform a temporary tracheostomy including a tracheal hook retractor (far left), tracheal dilator (middle), reusable metal tracheostomy tubes, stay suture labels, and a tracheostomy tube holder (far right).
Box 2.9 Instruments for Contrast Studies
C‐arm fluoroscopy or intraoperative radiography
Small basin for iohexol
Sterile saline (NaCl) for diluting iohexol to varying concentrations
Red rubber catheter (Kendall)
Tomcat catheter (Covidien)
For pyelography, 22 g needle and syringe
Box 2.10 Instruments for Temporary Tracheostomy Tube Placement
Routine instrument set