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Schedule 3
WK 20
| Question | Answer |
|---|---|
| What is schedule 3, under schedule 3 of the Veterinary Surgeons Act (1966), | only Registered Veterinary Nurses (RVN) and Student Veterinary Nurses (SVN) have the privilege to perform certain procedures in veterinary practice, as delegated to them by Veterinary Surgeon colleagues employed in the same practice |
| what is schedule 3 | 1. the animal is under the care of the VS 2. the VS is the employer/acting on behalf of the employer 3. the VS is satisfied the RVN/SVN is qualified to carry out the procedure it must also be under direction of the VS |
| Direction = | the VS instructs the RVN/SVN as to the task to be performed but is not necessarily present (good practice to have contactable VS at all times) |
| Supervision - | the VS is present on the premises and able to respond to a request for assistance if required |
| Direct, personal and continuous supervision = | the VS or RVN is present and giving the SVN their undivided personal attention |
| how is it different for SVNs | Any treatment or surgery should be supervised by a VS or RVN. Surgical procedures should be direct, continuous and personal. |
| Minor surgery | a grey area no definitive list of surgical procedures practice dependant many complex considerations and limitations SUPERB checklist created in 2019 to be used as a guide |
| considerations for delegation | Is the animal under their care? How difficult/complex is the procedure? Does the RVN/SVN understand the risks and how to deal with them if they occur? How experienced is the RVN/SVN? Is the VS available to assist if required? |
| considerations for delegation | Is the RVN/SVN happy to carry out the procedure? Is the RVNs name on the RCVS register? Is the SVN listed as a SVN with the RCVS? Does the procedure involve entrance into a body cavity? |
| additional considerations | are there any patient considerations how difficult/complex is the procedure are there any risks associated with the surgery |
| examples of minor surgical procedures | Suturing of minor skin wounds. Skin mass removal. Biopsies* Treatment of an aural haematoma. Lancing of abscesses* Digit and dew claw removal. Ear tip amputation. Tail tip amputation. Dental scaling and polishing |
| *Biopsies and lancing of abscesses – as long as | the surgical procedure does not enter a body cavity. |
| surgical biopsy technique | a medical procedure that removes a small sample of tissue, cells, or fluid from the body to be examined under a microscope abscesses haematoma seroma benign & malignant neoplasia Inflammatory/degenerative lesions eg skin lesions |
| surgical biopsy techniques = | punch biopsy needle core biopsy incisional biopsy impression smear excisional biopsy pinch/grab biopsy fine needle aspirate (FNA) |
| needle core biopsy | used for soft tissue core biopsy outer & inner part of the instrument cutaneous, subcutaneous, intra abdominal and intra thoracic masses easy quick and safe small sample obtained multiple may be required needle to facilitate collection of sample |
| needle core biopsy | disposable equipment various lengths and gauges (14-18G) contraindicated in coagulopathy |
| Needle Core Biopsy step by step | Sedation, local anaesthesia or GA Clip and surgically prepare the surgical site. Surgical attire and gloves required. +/- incise the skin depending on the depth of the mass. Closure of skin may be required after biopsy (suture or staple). |
| Pinch Biopsy / Grab Biopsy | pinch/grab tissue and pull used to obtain samples from mucosal surfaces (oral cavity, respiratory tract) areas visualised directly or via endoscopy if falls under schedule 3, we see them directly sedation or GA grab forceps used various types |
| Incisional Biopsy | usually require GA also known as wedge biopsy take a sample of the mass and a sample of ‘normal’ tissue (margin) Biopsy site should be positioned in probable surgical /radiation site. tissue) |
| Incisional Biopsy | In a large mass, take multiple samples from different locations (including one with healthy tissue) surgically prepare the area make two incisions to form a v close the wound with simple interrupted suture |
| excisional Biopsy also known as a lumpectomy x2 surgical approaches = | 1. Elliptical incision 2. single incision |
| indications for an excisional biopsy | size (where an incisional biopsy may be irrelevant for example a very small mass diagnostics aesthetics due to inference with normal function even if benign eg pain affecting normal movement life threatening/potential to metastasise (malignant) |
| what masses may RVNs remove | masses involving the subcutaneous tissue or skin ideally identified as benign those thatll allow closure by routine measures (no skin grafts ect) remember schedule 3 check with owner during admit if multiple masses are present |
| surgical margins = | areas of tissue free of neoplastic cells margins of excision depend on the type of mass (typically 1-3cm) mast cell tumours require larger margins sterile marker pen always send for histopathology if neoplastic cells are left tumour will continue |
| tension lines | the direction of tension on the skin should be considered. They change around the patient in terms of direction. On the body theyre in opposite direction on what they are on the limbs |
| Excisional Biopsy Equipment | dull surgical kit (needle holders, tissue forceps, scalpel blade, scalpel blade holder, haemostats, drape ect) second, clean stitch up kit and gloves equipment for full skin prep biopsy container/sample pot |
| why is a second kit needed = | a second clean stitch up kit is often used due to the risk of cross contamination of neoplastic cells into healthy/non neoplastic tissue |
| excisional biopsy | x2 full thickness incisions make and elliptical shape this is easier to close in contrast to a circle hold the skin with forceps and blunt dissect under the mass using scissors (non cutting technique) blunt dissection stretches skin, rather than cuts |
| blunt dissection | take the scissors out of the area whilst they are open, not closed. If closed, there is a risk of cutting something eg a blood vessel |
| Excisional Biopsy Haemostasis methods (digital, swab, ligature, cautery). | +/- stay suture to help orientation closed dead space with absorbable suture pattern routine skin closure if dead space under sc tissue is not closed seroma may form |
| skin incision | not used for excisional biopsy used for encapsulated masses (eg benign lipoma) dont always get clear margins one single incision over the top of the mass under the skin blunt dissection around the mass to free it from surrounding tissue |
| single incision haemostasis methods (digital, swab, ligature, cautery) | +/- stay suture to help orientation. Closed dead space with absorbable suture pattern. Routine skin closure |
| other surgical techniques | Aural haematoma management. Abscess management. Wound closure. Dew claw removal. Digit removal. Tail tip amputation. Pinnectomy. Nasolacrimal duct flush. |
Created by:
lucy.fox