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Surgery Policy and Guidelines

Definitions

  1. Aseptic technique: Encompasses a number of practices and procedures to reduce microbial contamination to the lowest practical level.
  2. Survival surgery: A surgical procedure from which an animal is expected to recover from anesthesia.
  3. Non-survival (Terminal) surgery: A surgical procedure from which an animal is euthanatized before recovery from anesthesia.
  4. Major survival surgery: A surgical procedure that penetrates and exposes a body cavity or produces substantial impairment of physical or physiologic functions. Examples include: laparotomy, thoracotomy, craniotomy, orthopedic procedures, limb amputation and enucleation.
  5. Minor survival surgery: A surgical procedure that does not expose a body cavity and causes little or no physical impairment. Examples include wound suturing, peripheral vessel cannulation, and placement of subcutaneous implants.

Survival Surgical Procedures

Survival Surgical Procedures for Rodents (Rats, Mice, Gerbils, etc.)

Presurgical Planning

Appropriate planning is important for all successful surgical outcomes. Presurgical planning requires input from all members of the surgical team and includes the investigator, surgeon, anesthetist, technicians, veterinarians, and animal care staff. Investigators are encouraged to contact ULAR veterinarians for assistance in planning surgeries and postsurgical care.

A surgical plan should be developed for each procedure and identify the following:

Personnel Training

Personnel involved with surgery in a research setting often have a wide range of educational backgrounds and may require various levels of training before performing surgery on animals. Personnel trained to perform surgery in humans may require additional training for interspecies variations in anatomy, physiology, and response to anesthetics and analgesics.

Regardless of an individual's responsibility or educational background, all personnel performing surgery must have thorough knowledge and understanding of the approved IACUC protocol procedures and possess knowledge and familiarity with the relevant anatomy of the species and the surgical site.

At a minimum, training of surgical personnel must include:

Surgical Facilities

A dedicated surgical suite is not required for the performance of surgical procedures on rodents. However, the space must be designated for surgery at the time of the procedure and appropriately managed to minimize contamination from other activities in the room during surgery.

Rodent surgical space should be designed and managed to achieve the following:

Aseptic Technique

The goal of aseptic technique is to reduce the possibility of microbial contamination to the lowest practical level. No single technique, practice, germicide, or piece of equipment will achieve this objective. Rather, proper aseptic technique is dependent on numerous practices that require input and cooperation of all personnel within the operating area.

Components of successful aseptic technique include:

Preparation of the animal

Preparation of the surgeon

Sterilization of instruments and supplies

All instruments and supplies that come in contact with the surgical site must be sterile. A number of options are available to sterilize surgical equipment and supplies.

  1. Autoclave- Relies on pressurized steam, is extremely reliable, and cost effective. However, instruments must be durable (e.g., stainless steel) and the process is relatively slow, from 15 to 60 minutes. Instruments are typically wrapped or sealed in packs that are opened as needed on the day of surgery.
  2. Ethylene oxide- A gaseous sterilant that requires specialized containment equipment. This is a good sterilization method for supplies that cannot tolerate high heat such as plastics and catheters. It is more costly than autoclaving and typically is performed overnight.
  3. Cold sterilant solutions (hypochlorite, glutaraldehyde, etc.)- Generally, cold sterilants must have prolonged contact time (15 - 60 minutes) to sterilize surgical equipment. In addition, the instruments must be rinsed completely with a sterile solution like saline to prevent tissue irritation. Note: Alcohol is not a sterilant.
  4. Hot bead sterilizer- This device is a small tabletop unit, approximately 6 x 6 x 8 inches. The appliance heats a small container of Pyrex beads to approximately 250 C and can sterilize the tips of metal surgical instruments in 10-20 seconds. It is very useful for sterilizing instruments between rodents when performing multiple surgeries.
  5. Pre-sterilized items- Many instruments and supplies can be purchased in sterilized packaging. Such items must be used prior to the label expiration date.

Appropriate surgical technique

Anesthesia and intra-operative monitoring

The anesthetic agent, dose, and route of administration must be described in the approved IACUC protocol. Personnel involved with surgical procedures must be competent in administering and monitoring anesthetic depth in the animals. If needed, additional doses of anesthetic may be required during a surgical procedure.

General signs of inadequate surgical anesthesia include:

Antibiotic usage

In general, antibiotics should not be needed for short procedures if proper aseptic technique is followed throughout the surgery and the surgeon is well trained or experienced.

General recommendations for the use of antibiotics:

Postsurgical care

Appropriate postsurgical care will help to ensure timely attention to problems that may arise and provide the animal an uneventful recovery from anesthesia and surgery. Trained personnel and appropriate facilities and equipment must be available for postsurgical care.

Postsurgical care begins with completion of the surgery and recovery from anesthesia. The period may extend for days to weeks depending on postsurgical outcomes and study design. Postsurgical care includes after-hours and weekend care and is the responsibility of the investigator. Postsurgical care includes the following:

Record keeping

Survival Surgical Procedures for Large Animals (Rabbits, Swine, Sheep, Dogs, etc.)

Presurgical Planning

Appropriate planning is important for all successful surgical outcomes. Presurgical planning requires input from all members of the surgical team and includes the investigator, surgeon, anesthetist, technicians, veterinarians, and animal care staff. Investigators are encouraged to contact ULAR veterinarians for assistance in planning surgeries and postsurgical care.

A surgical plan should be developed for each procedure and identify the following:

Personnel Training

Personnel involved with surgery in a research setting often have a wide range of educational backgrounds and may require various levels of training before performing surgery on animals. Personnel trained to perform surgery in humans may require additional training for interspecies variations in anatomy, physiology, and response to anesthetics and analgesics.

Regardless of an individual's responsibility or educational background, all personnel performing surgery must have thorough knowledge and understanding of the approved IACUC protocol procedures and possess knowledge and familiarity with the relevant anatomy of the species and the surgical site.

At a minimum, training of surgical personnel must include:

Surgical Facilities

Animal welfare regulations require that survival surgery in large species be performed in a dedicated surgical facility. The facility must provide separate rooms for patient preparation, surgeon preparation, an operating room and an area for animal recovery. Non-survival surgery, minor surgery can be performed in a dedicated work area. The IACUC reviews and approves all surgical areas at UCI. ULAR maintains several large animal surgical suites in UCI vivaria and investigators are encouraged to contact Veterinary Services for more information.

Large animal surgical space must be designed and managed to achieve the following:

Aseptic Technique

The goal of aseptic technique is to reduce the possibility of microbial contamination to the lowest practical level. No single technique, practice, germicide or piece of equipment will achieve this objective. Rather, proper aseptic technique is dependent on numerous practices that require input and cooperation of all personnel within the operating area.

Components of successful aseptic technique include:

Preparation of the animal

  1. After the animal has been anesthetized, the eyes should be lubricated with a sterile ophthalmic ointment to prevent corneal drying. Alternatively, the lids can be taped closed to prevent the corneas from drying.
  2. Hair should be removed from the surgical site. This should be performed with electric clippers (# 40 blade) or depilatory rather than a razor.
  3. The surgical area to be prepared should be approximately twice that needed for the incision, in the event a larger incision than planned may be required.
  4. The skin should then be cleaned and disinfected with a chlorhexidine or povidone iodine-based disinfectant. The site should be scrubbed by starting at the center of the site and working outward in a circular pattern using sterile gauze and instruments. Typically, three scrubs with a disinfectant, followed by alcohol will suffice.
  5. A final application of disinfectant should be applied to the skin and allow to dry before the start of surgery.
  6. A sterile surgical drape is required to isolate the disinfected area from surrounding tissue and hair. To be effective, a drape should adhere tightly to the skin and be impermeable to moisture. Self-adhesive drapes are available for this purpose.

Preparation of the surgeon

  1. Sterile gloves must be used for all procedures. Prior to donning gloves, the surgeon must scrub the hands and forearms with a disinfectant soap for a minimum of 3 minutes, followed by drying with a sterile towel.
  2. A new pair of sterile gloves must be worn for each patient.
  3. A cap, face mask, shoe covers and sterile gown must be worn for all survival large animal surgeries.

Sterilization of instruments and supplies

All instruments and supplies that will come in contact with the surgical site must be sterile. A number of options are available to sterilize surgical equipment and supplies.

  1. Autoclave- Relies on pressurized steam, is extremely reliable, and cost effective. However, instruments must be durable (e.g., stainless steel) and the process is relatively slow, from 15 to 60 minutes. Instruments are typically wrapped or sealed in packs that are opened as needed on the day of surgery.
  2. Ethylene oxide- A gaseous sterilant that requires specialized containment equipment. This is a good sterilization method for supplies that cannot tolerate high heat such as plastics and catheters. It is more costly than autoclaving and typically is performed overnight.
  3. Cold sterilant solutions (hypochlorite, glutaraldehyde, etc.)- Generally, cold sterilants must have prolonged contact time (15 - 60 minutes) to sterilize surgical equipment. In addition, the instruments must be rinsed completely with a sterile solution like saline to prevent tissue irritation. Note: Alcohol is not a sterilant.
  4. Pre-sterilized items- Many instruments and supplies can be purchased in sterilized packaging. Such items must be used prior to the label expiration date.

Appropriate surgical technique

  1. Maintenance of the sterile field- If an instrument, gloved hand, or sterile gown touches something outside the sterile field (area of the surgical drape and inside of the opened instrument pack), the item must be replaced immediately.
  2. Gentle tissue handling- Minimize the use of toothed or crushing instruments. Hold the cut edge rather than grasping the middle of a tissue layer. When tying off vessels, include a minimum of surrounding tissues. Use electrocautery and electroscalpels sparingly as they cause tissue necrosis. Keep tissue moist during surgery.
  3. Ablate all "dead space" during closure- Any pockets or spaces remaining between tissue layers will fill with extracellular fluid or blood and increase the risk of developing abscesses.
  4. Minimize the duration of surgery - Prolonged surgery times expose tissues to contaminants and dry out tissues and lead to increased risk of necrosis and postoperative infection.
  5. Supplemental fluids- Prolonged surgeries require placement of an IV catheter and intraoperative fluid supplementation. Fluid administration may also be continued into the postoperative recovery period. Please contact Veterinary Services for assistance in developing a fluid therapy plan.
  6. Supplemental heat- Animals lose their ability to regulate body temperature while under general anesthesia and they should be provided a heat source during surgery such as a heat lamp or heating blanket. Regular body temperature must be maintained throughout the procedure and recovery period.

Anesthesia and intra-operative monitoring

The anesthetic agent, dose, and route of administration must be described in the approved IACUC protocol. Personnel involved with surgical procedures must be competent in administering and monitoring anesthetic depth in the animals. If needed, additional doses of anesthetic may be required during a surgical procedure.

General signs of inadequate surgical anesthesia include:

Antibiotic usage

In general, antibiotics should not be needed for short procedures if proper aseptic technique is followed throughout the surgery and the surgeon is well trained or experienced.

General recommendations for the use of antibiotics:

Postsurgical care

Appropriate postsurgical care will help to ensure timely attention to problems that may arise and provide the animal an uneventful recovery from anesthesia and surgery. Trained personnel and appropriate facilities and equipment must be available for postsurgical care.

Postsurgical care begins with completion of the surgery and recovery from anesthesia. The period may extend for days to weeks depending on postsurgical outcomes and study design. Postsurgical care includes after-hours and weekend care and is the responsibility of the investigator. Postsurgical care includes the following:

Record keeping

Survival surgical procedures for non-mammalian species (fish, amphibia, reptiles, avian)

Presurgical Planning

Appropriate planning is important for all successful surgical outcomes. Presurgical planning requires input from all members of the surgical team and includes the investigator, surgeon, anesthetist, technicians, veterinarians and animal care staff. Investigators are encouraged to contact ULAR veterinarians for assistance in planning surgeries and postsurgical care.

A surgical plan should be developed for each procedure and identify the following:

Personnel Training

Personnel involved with surgery in a research setting often have a wide range of educational backgrounds and may require various levels of training before performing surgery on animals. Personnel trained to perform surgery in humans may require additional training for interspecies variations in anatomy, physiology, and response to anesthetics and analgesics.

Regardless of an individual's responsibility or educational background, all personnel performing surgery must have thorough knowledge and understanding of the approved IACUC protocol procedures and possess knowledge and familiarity with the relevant anatomy of the species and the surgical site.

At a minimum, training of surgical personnel must include:

Surgical Facilities

A dedicated surgical suite is not required for the performance of surgical procedures on non-mammalian species. However, the space must be designated for surgery at the time of the procedure and appropriately managed to minimize contamination from other activities in the room during surgery.

Non-mammalian surgical space should be designed and managed to achieve the following:

Aseptic Technique

The goal of aseptic technique is to reduce the possibility of microbial contamination to the lowest practical level. No single technique, practice, germicide, or piece of equipment will achieve this objective. Rather, proper aseptic technique is dependent on numerous practices that require input and cooperation of all personnel within the operating area.

Components of successful aseptic technique include:

Preparation of the animal

Aquatic species

  1. After the animal has been anesthetized, it should be transferred to the surgical station and placed on a moist substrate (shallow water, moist towel, etc.)
  2. Surgical preparation of the incision site should minimize disruption of skin and mucus layer.
  3. The skin at the incision site should be gently wiped with sterile gauze or cotton-tipped applicator to reduce gross contamination. If greater antimicrobial activity is wanted, the skin can be wiped with a dilute solution of povidone iodine (1:20) or chlorhexidine (1:40). Application of harsher chemical disinfectants and alcohol may irritate the skin and increase the risk of tissue damage and postoperative morbidity and mortality.
  4. For larger fish species, removing large scales by extracting them caudally can facilitate a smooth incision.
  5. A sterile clear plastic drape can be positioned over the animal to help isolate the incision site, create a sterile field and help retain moisture. A rim of petroleum jelly can be used to adhere the drape to the animal, if desired.
  6. The animal's skin should be kept moist throughout the surgery, with care taken to prevent irrigating the incision site with contaminated anesthetic or tank water.

Avian

  1. After the animal has been anesthetized, the animal should be positioned to allow easy access to the surgical site.
  2. The feathers at the surgical site should either be parted for small incisions or plucked to expose the intended incision site. The skin should be exposed to create a space approximately twice the size of the intended incision. Tape can be applied to surrounding feathers to prevent them from entering the sterile field during surgery.
  3. The skin should then be cleaned and disinfected with a chlorhexidine or povidone iodine-based disinfectant. The site should be scrubbed by starting at the center of the site and working outward in a circular pattern. Typically, one scrub with a disinfectant, followed by alcohol will suffice.
  4. If possible, the use of a sterile surgical drape is recommended to help isolate the sterile field and reduce the risk of postoperative infection.

Reptiles

  1. The animal should be anesthetized and restrained in a position that allows easy access to the surgical site.
  2. The skin should then be cleaned and disinfected with a chlorhexidine or povidone iodine-based disinfectant. The site should be scrubbed by starting at the center of the site and working outward in a circular pattern. Reptiles harbor significant pathogens on the skin, such as Salmonella, and a prolonged vigorous scrub with multiple applications of disinfectant followed by an alcohol wipe is recommended.
  3. A sterile surgical drape should be used whenever possible to isolate the disinfected area from surrounding skin. To be effective, a drape should adhere tightly to the skin and be impermeable to moisture. Self-adhesive drapes are available for this purpose.

Preparation of the surgeon

Sterilization of instruments and supplies

All instruments and supplies that will come in contact with the surgical site must be sterile. A number of options are available to sterilize surgical equipment and supplies.

  1. Autoclave- Relies on pressurized steam, is extremely reliable, and cost effective. However, instruments must be durable (e.g., stainless steel) and the process is relatively slow, from 15 to 60 minutes. Instruments are typically wrapped or sealed in packs that are opened as needed on the day of surgery.
  2. Ethylene oxide- A gaseous sterilant that requires specialized containment equipment. This is a good sterilization method for supplies that cannot tolerate high heat such as plastics and catheters. It is more costly than autoclaving and typically is performed overnight.
  3. Cold sterilant solutions (hypochlorite, glutaraldehyde, etc.)- Generally, cold sterilants must have prolonged contact time (15 - 60 minutes) to sterilize surgical equipment. In addition, the instruments must be rinsed completely with a sterile solution like saline to prevent tissue irritation. Note: Alcohol is not a sterilant.
  4. Hot bead sterilizer- This device is a small tabletop unit, approximately 6 x 6 x 8 inches. The appliance heats a small container of Pyrex beads to approximately 250 C and can sterilize the tips of metal surgical instruments in 10-20 seconds. It is very useful for sterilizing instruments between animals when performing multiple surgeries.
  5. Pre-sterilized items- Many instruments and supplies can be purchased in sterilized packaging. Such items must be used prior to the label expiration date.

Appropriate surgical technique

  1. Maintenance of the sterile field- If an instrument or gloved hand touches something outside the sterile field (area of the surgical drape and inside of the opened instrument pack), the instrument or glove must be replaced or re-sterilized immediately.
  2. Gentle tissue handling- Minimize the use of toothed or crushing instruments. Hold the cut edge rather than the grasping the middle of a tissue layer. When tying off vessels, include a minimum of surrounding tissues. Use electrocautery and electroscalpels sparingly as they cause tissue necrosis. Keep tissue moist during surgery.
  3. Minimize the duration of surgery. Prolonged surgery times expose tissues to contaminants and dry out tissues and lead to increased risk of necrosis and postoperative infection.
  4. Supplemental heat- Animals lose their ability to regulate body temperature while under general anesthesia and they should be provided a heat source during surgery such as a heat lamp (remembering that you can dry tissues and cause further damage if surgery is prolonged over 15 minutes) or heating blanket.

Anesthesia and intra-operative monitoring

The anesthetic agent, dose and route of administration must be described in the approved IACUC protocol. Personnel involved with surgical procedures must be competent in administering and monitoring anesthetic depth in the animals. If needed, additional doses of anesthetic may be required during a surgical procedure.

General signs of inadequate surgical anesthesia include:

Antibiotic usage

In general, antibiotics should not be needed for short procedures if proper aseptic technique is followed throughout the surgery and the surgeon is well trained or experienced.

General recommendations for the use of antibiotics:

Postsurgical care

Appropriate postsurgical care will help to ensure timely attention to problems that may arise and provide the animal an uneventful recovery from anesthesia and surgery. Trained personnel and appropriate facilities and equipment must be available for postsurgical care.

Postsurgical care begins with completion of the surgery and recovery from anesthesia. The period may extend for days to weeks depending on postsurgical outcomes and study design.

Postsurgical care includes after-hours and weekend care and is the responsibility of the investigator. Postsurgical care includes the following:

Terminal Surgical Procedures

Terminal surgical procedures are defined as those procedures that the animal is not intended to recover from anesthesia after completion of the surgery. Although postoperative recovery and care is not an issue in terminal surgeries, many issues common to the performance of any surgery must be addressed for a successful outcome. Investigators are encouraged to contact ULAR veterinarians for assistance in planning surgeries.

Presurgical Planning

Appropriate planning is important for all successful surgical outcomes. Presurgical planning requires input from all members of the surgical team and includes the investigator, surgeon, anesthetist, technician, and veterinarian.

A surgical plan should be developed for each procedure and identify the following:

Personnel Training

Personnel involved with surgery in a research setting often have a wide range of educational backgrounds and may require various levels of training before performing surgery on animals. Personnel trained to perform surgery in humans may require additional training for interspecies variations in anatomy, physiology, and response to anesthetics.

Regardless of an individual's responsibility or educational background, all personnel performing surgery must have thorough knowledge and understanding of the approved IACUC protocol procedures and possess knowledge and familiarity with the relevant anatomy of the species and the surgical site.

At a minimum, training of surgical personnel must include:

Surgical Facilities

A dedicated surgical suite is not required for the performance of terminal surgical procedures. However, the surgery space must be designated for surgery at the time of procedure and appropriately managed to minimize contamination from other activities in the room during surgery.

The surgical space should be designed and managed to achieve the following:

Aseptic Technique

Aseptic technique is generally not required for the performance of terminal surgery. However, for studies in which local bacterial contamination of tissues, or sepsis, could influence study outcomes, standard aseptic technique is recommended. Such studies include long term (>8 hours) terminal surgeries and collection of samples for tissue or microbial culture.

If aseptic technique is required for a study, guidelines are provided in the in survival surgical guidelines of this webpage.

Anesthesia and intra-operative monitoring

The anesthetic agent, dose, and route of administration must be described in the approved IACUC protocol. Personnel involved with surgical procedures must be competent in administering and monitoring anesthetic depth in the animals. If needed, additional doses of anesthetic may be required during a surgical procedure.

General signs of inadequate surgical anesthesia include:

Personal Protective Equipment

It is recommended that laboratory personnel wear:

Record keeping

Record Keeping Requirements

Surgical records are both helpful and required by animal welfare regulations. Accurate records allow one to monitor trends and they can be helpful in refining and improving research projects. Complete records also assure compliance with accepted care standards and agreed-upon procedures approved by the IACUC. Records can also be helpful in interpreting research data.

Records are required for all animals undergoing terminal or survival surgery. The format for the records is generally up to the investigator. For rodents and other smaller species, surgical and postsurgical records can be maintained in a laboratory notebook. For larger species, such as rabbits, cats, swine, etc., surgical and postoperative records may be maintained in laboratory notebooks. However, postsurgical records must accompany the animal in the vivarium to allow veterinary oversight and involvement in the care of the animal. Consequently, the IACUC requires that postoperative records for larger species be maintained separate from a general laboratory notebook and be kept with the animal in the vivarium during the entire postoperative period before they are stored with laboratory notebooks.

Surgical Records

Surgical records must include:

Postsurgical Records

Postoperative care records must include:

Terminal Procedures

The following records are required for terminal surgical procedures:

Sample Post-Procedural Care and Monitoring Record Forms (ULAR site)

For more information and sample Post-Procedural Care and Monitoring Record forms, please visit the ULAR website.