blade or Beaver 6400 mini‐blade (#64)
Patient drape
Table drape
3‐ml syringe
4‐0 to 6‐0 braided absorbable suture
Sterile bowl and 0.9% saline for lavage
Box 2.32 Instruments and Supplies for Nictitating Membrane Laceration
Eyelid set
Eye utility pack
Sterile blue towels (4 pack)
#15 Bard–Parker blade or Beaver 6400 mini‐blade (#64)
Patient drape
Table drape
3‐ml syringe
Sterile bowl and 0.9% saline for lavage
5‐0 to 7‐0 absorbable suture
Enucleation
An enucleation procedure is performed in sternal recumbency. Instruments and supplies for enucleation surgery are listed in Box 2.33.
Oral Emergencies
Nursing Responsibilities
Refer to the American Veterinary Medical Association individual state guidelines to review the practices that veterinary technicians are authorized to perform during dental procedures to ensure compliance in the workplace. Nursing responsibilities include:
Anesthesia (includes preparation, preoxygenation, induction, monitoring, intubation/extubation, ± recovery)
Charting/medical records
Pre‐/post‐oral examination under doctor supervision
Moldings and impressions
Nerve blocks
Surgical suite set‐up (have requested instrumentation and equipment available)
Diagnostic imaging
Surgical assistance (provided if more than one nurse is assigned to the case)
Clean/disinfect surgical suite
Prepare patient for discharge (pharmaceuticals, discharge instructions, etc.)
Instrument reprocessing.
Box 2.33 Instruments and Supplies for Enucleation Procedure
Enucleation set
Eye utility pack
Retrobulbar block0.5% Bupivicaine2% Lidocaine22‐gauge × 1.5‐in needles (2)3‐ml syringe
#15 Bard–Parker blade
Patient drape
Sterile blue towels (4 pack)
Sterile bowl and 0.9% sterile saline for lavage
Dental cotton rolls (10 pack)
3‐0 or 4‐0 suture
Formalin container for globe
± Battery‐operated cautery
Safety Requirements
Surgical Environment
It is vital for clinics offering dental services to establish a safe, well‐developed working environment to facilitate dentistry and oral procedures. Oral procedures requiring the use of powered instrumentation (drills, burrs, scalers) that will aerosolize the room with bacterial contaminants should be confined to a designated, well‐ventilated space, and isolated from sterile surgery suites. Laminar air flow (LAF) ventilation systems accompanied with high‐efficiency particulate air (HEPA) filters are recommended for use in surgical settings, especially a dental operatory. The combination of LAF and HEPA filters is designed to significantly reduce personnel exposure to aerosols and improve the overall air quality. Filters should be replaced roughly every 6–12 months.
Personal Protective Equipment
The impact of aerosolized exposure can significantly impact the systemic health of clinical staff. As a result, due diligence must be exercised to ensure that proper personal protective attire is worn when necessary. Standard operating room attire consists of a clean pair of scrubs, bouffant cap, dedicated surgery footwear (closed toed) or shoe covers, and a surgical mask that will provide the appropriate level of protection the procedure requires. Full radiation safety protection must be worn at all times when obtaining dental radiographs while limiting exposure to radiation as much as possible. Exam gloves must be worn at all times when contact with mucous membranes, excretions, secretions, blood, and bodily fluids is likely to occur. Gloves should be discarded when heavily soiled and immediately following each use. Gloves should also be disposed of during the intraoperative phase when transitioning from dirty to clean areas/procedures on the same patient. Hand hygiene should be practiced before and after donning gloves. Protective eyewear (goggles/full face shield) should be worn during oral procedures involving irrigation. Disposable gowns should be worn when handling patients with infectious diseases. It may be necessary to wear a level‐4 gown to prevent strike‐through from occurring in certain procedures containing infectious fluids. Surgical masks vary in terms of level of protection and filtration. The purpose of N95 masks is to aid in protection against airborne zoonotic infectious diseases. Although the surgical caseload in veterinary medicine in which N95 masks would be required for use is relatively low, it is suggested that individuals involved in dentistry and oral surgery procedures are fit‐tested to secure an appropriately sized N95 mask to wear when needed. The reader is referred to the American Society of Testing Materials guidelines regarding performance criteria for grading masks.
Standard Oral Surgical Preparation Protocol
The oral cavity should be irrigated with 0.12% chlorhexidine gluconate antiseptic rinse to reduce the number of microbial bacteria inside the patient's mouth, which also effectively reduces the aerosol contamination in room air. The reader should follow the facility's specific guidelines for standard aseptic skin preparation for oral procedures that require a skin incision.
Patient Positioning
Patients are placed in lateral or dorsal recumbency for oral emergency procedures. It is the nurse's responsibility to ensure that the patient is kept warm and dry throughout surgery. Use of veterinary warming devices is encouraged to reduce the patient's risk of developing hypothermia, which could lead to a prolonged anesthetic recovery. Warming devices to consider include circulating water blanket, forced‐air warming blanket, IV fluid warmer, reservoir warmer for dental water, and ample blankets/towels. It is advisable to intubate the patient using a cuffed endotracheal tube. In addition, the pharynx should be packed with gauze (pharyngeal packing) prior to the start of the procedure to decrease the risk of fluid aspiration.
Surgical Supplies
Oral surgery sets can be created based on grouping instrumentation required to perform specific types of procedures. Examples include small and large dental surgical instrument sets, periodontal extraction cassettes, orthodontic supplies including glass ionomer cement and light cure composites,