Читать книгу Gastrointestinal Surgical Techniques in Small Animals - Группа авторов - Страница 99

It is paramount to keep any of those drains well protected from the environment to prevent ascending infection. Sticky drapes can be used to cover the exit site of the closed suction drain. It should also be well covered to prevent any accidental removal by the patient. An E collar should be placed on the patient.

Cytology of the abdominal fluid should be performed daily basis to follow the progression of the disease process in the abdominal cavity. Fluid can be collected from the reservoir if a closed suction drain has been used, or at each bandage change if the abdomen has been left open. Measurement of lactate and glucose from the abdominal fluid can help determine if septic peritonitis is still present. If septic peritonitis is present, the difference between the concentration of glucose in the fluid and blood is more than 20 units or the difference between the concentration of lactate in the fluid and blood is more than 2 units. Those results are 100% sensitive and specific in dogs and 86 and 100% respectively in cats (Bonczynski et al. 2003). However, if the fluid is collected from the closed suction drain and the reservoir and not the abdomen, those differences are not accurate (Szabo et al. 2011).

Figure 5.4

With an open abdomen, it is paramount that the bandage change and the lavage of the peritoneal space are performed under anesthesia in an operating room (Staatz et al. 2002). The surgical site is inspected at each bandage change. If needed, the additional sutures can be added to an enterotomy, or a resection anastomosis. Also it is important to perform enteral feeding for dogs and cats with open abdomen. A gastrostomy feeding tube is used to aspirate stomach content to prevent reflux, vomiting, and aspiration pneumonia. A jejunostomy feeding tube is used to feed the patient while under heavy sedation with an open abdomen. Enteral feeding is an efficient technique to maintain protein and albumin levels. Open abdomen drainage is usually used for 24 or 48 hours. The abdomen is then closed on a closed suction drain. Negative pressure therapy might be superior to passive abdominal drainage because the abdominal fluid is better contained (Spillebeen et al. 2017).