.com Forum · Real Show Dogs

My dog recently had a dental procedure done by our vet. The procedure was 5 days ago, he had several bad teeth extracted, mostly incisors and a couple molars. He did very well afterwards however yesterday he passed a large wad of gauze. I was very surprised and upset to discover this! At first I wasn't even sure what it was but then realized and was shocked. It was at least a 4x4 piece all wadded up. I don't think this should be considered normal by any means. Am I wrong?

I do plan to call my vet tomorrow am but I'm not exactly sure how to proceed. I was quite upset considering this could have caused major issues or an obstruction! I'm not sure how this could have happened and no one even told me so did they not know? Anyone know how or why this could have happened? Is this common? He is not the type of dog to eat foreign material so did they leave it in his mouth? I'm just glad he didn't choke on it or get it stuck in his throat somehow! Should I consider switching vets? I have always loved my vet but not sure what to do here. I have another dog that will need a dental in the near future and I'm very worried about taking my dogs back. If they made a mistake like this who is to say they won't make another mistake. Just a bit panicked and worried. Any advice? Thanks.

I've had a couple dentals done on dogs and never had anything like that happen.
I would probably call and ask to speak with the doctor who did the procedure and explain what happened. Ask what preventative measures were taken and will be taken in the future to prevent something like this and state you're concerned for the care your dog received and the future care of your other dogs.

My guess is it was a mistake and the doctor will apologize profusely. I'm not a vet or vet tech so I can't comment on at what point it likely happened, but it most definitely needs brought to their attention so they can be more careful in the future. How the doctor reacts will tell a lot about them. If they deny it or shrug it off, I would find a new vet.

Everdale - I'm so sorry this has happened to you and your dog!

I work as a vet nurse - and I have an inkling as to why he ingested the gauze.

SOME vets - not all - use products such as gauze, tampons, or other 'absorbent' material usually tied together by a shoe-lace and they place it at the back of the mouth to prevent excess water, blood, saliva and broken off pieces of tartar and bone/tooth fragments and dust from going down the dogs oesophagus and trachea. This is to prevent them from a) ingesting/inhaling yucky fluid and b) preventing fragments/dust from causing irritation.

The swabs/tampon etc are usually always removed once the vet has finished the procedure and has rinsed and wiped out the mouth. After this is done, the anaesthetic gas is then switched off and the patient is allowed to recover. Once the patient has swallowed several times and is almost 'awake' the ET tube is removed (the tube that has been providing oxygen and anaesthetic gas to the patient that sits in their trachea).

Sometimes patients can wake up VERY fast - to the point where they are chomping their jaws, thrashing around and completely 'out of it' - this happens occasionally in all vet clinics and its never a fun thing to experience. When this happens - the teams biggest responsibility is to get the ET tube out FAST and to restrain the patient so they don't thrash so much that they injure themselves. Sometimes this all happens in seconds!

The worst case scenario in this type of 'wake up' is that the vet or nurse has forgotten to take out the swabs. At this point the patient may spit them out ... or swallow them.

I've never seen a patient at my clinic swallow them - as we only have 1 out of 5 vets use them, but I have experienced a fast 'wake up' and have had to shove my hand in the patients mouth (at risk of getting bitten) and pull out the swab.

If this did indeed happen (which I'm assuming it did as its the most likely answer) - the vet has a duty to tell the owner on discharge. (Which clearly didn't happen )

The only other thing I can think of is that your dog may have ingested them after the procedure - thinking it was something worthwhile eating. (Especially if it had 'dental juices' on it - blood/saliva etc. I know that this may seem unlikely - but I've seen it happen once. A puppy was in for a blood test, and the nurse was holding it on the floor (a G.Shep) and quick-as-a-flash the pup grabbed a used swab (it was 1 individual swab) and ate it. The nurse and vet were mortified! They went straight to the owner and told them - and thankfully the Owner was very understanding. We offered emesis (to make the dog vomit) but the Owners said they would prefer to let it pass naturally. (Which it did 48 hours later). Sometimes freak accidents just happen.

I would definitely call your vet and tell them what has happened and demand an explanation and an apology at the very least. Whichever way the swabs got into your dog's stomach - it shouldn't have happened!

Its' up to you if you want to change to a different vet or not - I don't have any advice on that bit as it's your decision. But I would see how the clinic handles your comments. I would also ask that the Practice Manager/Head Vet finds out which vet and nurse were responsible for your dogs anaesthetic and procedure - and talk to them to find out if they witnessed the ingestion.

Again, I'm very sorry that this has happened to you and your dog as it isn't fair


Edited to fix my typing errors.

-----
Last edited by Chaos and Havoc on 4/3/2016 4:56:11 PM

Thank you both so much for your replies! I really appreciate all of your insight and advice as a vet nurse, Chaos and Havoc. That helps it to make more sense. If that was the case I just don't know why the gauze wasn't removed, how can something like that be forgotten. From what I'm understanding that should all be removed after the mouth is rinsed and before anesthetic gas is switched off and the dog starts waking up. I still am quite confused as to why I wasn't even told that this happened. Do you think it's really possible for them to not even be aware it happened? I am also so surprised that it took so long to pass but I'm just happy it did! I will see what the vet says and how they handle the situation before deciding whether or not to switch vets but I am strongly considering it. What would you do if this were your dog? Not to mention this was an expensive procedure, would you expect to see any type of refund/discount applied? Thank you again.

quote

---

posted by Everdale Goldens
Thank you both so much for your replies! I really appreciate all of your insight and advice as a vet nurse, Chaos and Havoc. That helps it to make more sense. If that was the case I just don't know why the gauze wasn't removed, how can something like that be forgotten. From what I'm understanding that should all be removed after the mouth is rinsed and before anesthetic gas is switched off and the dog starts waking up. I still am quite confused as to why I wasn't even told that this happened. Do you think it's really possible for them to not even be aware it happened? I am also so surprised that it took so long to pass but I'm just happy it did! I will see what the vet says and how they handle the situation before deciding whether or not to switch vets but I am strongly considering it. What would you do if this were your dog? Not to mention this was an expensive procedure, would you expect to see any type of refund/discount applied? Thank you again.

---

I doubt that the vet/nurse was unaware that it had happened - as they should have realized.

Where I work we have 5 vets - only one of them uses swabs - and they get 2-5 swabs (depending on the patients size) and they fold them in half and then tie a brightly coloured shoe lace around them and then they push them into the back of the dogs mouth for the above-mentioned purpose. They leave the rest of the shoe lace hanging out of the mouth. They try to choose a bright colour that will stand out from the dogs hair etc. It's the vets responsibility to remember to take the swabs out - as they are the one who puts them in there. Using swabs or other absorbent material has its specific purpose and benefits - but it doesn't come without risk.

The other 4 vets I work with opt to not use any form of absorbent material - and usually it's because of the fact that it can be risky if its 'forgotten' about. Instead they use a positioning technique to keep fluid away from the trachea/oesophagus. They place a large rolled-up towel under the dogs shoulders to raise the body up, and then the patients head is sitting much lower than the rest of the body - to allow gravity to work - thus allowing the fluid to drain downwards.

This usually works well - however it's often when you need to turn the dog over (to access the other side of the mouth) that is the biggest risk of allowing fluid to be inhaled/ingested.

For smaller patients its easy enough to lift and rotate them with their head remaining lower by tilting the head down - but in larger breeds it can be a real effort. (as you need 3 people to turn them safely - and most of the time there is only 2 people there to help).

If there are only two people helping - then the risk of them inhaling/ingesting water is greater as the vet and nurse have only got 2 hands to move a sometimes 30kg + animal.

Like I said before - I have had one experience where the swabs were almost forgotten about.

To give you an idea of what 'can' happen - here's a scenario that's often seen in vet clinics:

Vet has finished procedure - has wiped out mouth, but wants to 'keep swab in until patient is almost awake'. Vet hasn't told nurse that they have placed swab.
Vet is in a hurry - wants to move on to the next procedure. Asks nurse to go and get injectable meds before patient is awake.
Nurse has to quickly grab the meds (often in another room) and then draw them up and administer them. Vet walks off to type up history for patient - leaving nurse to clean the patient up (remove blood/saliva/water from hair around face) and recover them on her own.
During the procedure the anaesthetic gas is run at a percentage adequate for the level of anaesthesia required. Towards the end of the procedure the percentage of gas is lowered gradually to allow a 'faster recovery' - some patients can still take 3-15 minutes to wake up once turned off the gas completely.

However there are SOME patients who may have either:
a) been agitated/stressed before the anaesthetic
b) had a 'rocky' induction - their level of anxiety causes a physiological response to 'fight the induction agent'
c) they've had a 'up & down' anaesthetic

Any of those 3 things can cause a patient to be at risk of a 'bad recovery' - it can cause them to wake up within seconds of turning the gas off, and these are the patients where things can go bad (thrashing, vocalizing, chomping, biting, chewing the ET tube out, or potentially swallowing a swab that hasn't been removed yet)

If the patient wakes up thrashing they then have to:

- restrain the patient so they don't fall/jump off the table
- pull the ET tube out without getting bitten
- call for help
- deal with being pee'd/poo'd/anal glanded on (happens all the time in thrashing patients)

And all of this can literally happen in seconds with patients who have had either one or all 3 of those things I mentioned just before.

These sorts of 'bad recoveries' don't happen very often as 99% of the time the vets have used appropriate sedatives and induction agents to prevent it - but like all things - it can still happen. Some breeds are prone to 'bad wake ups' than others. Little white 'fluffies' and English Staffies are the 2 that pop into my head that I've seen countless bad recoveries from.

I honestly think that the vet has probably 'forgotten' to take the swabs out in this case - and I think they have chosen not to tell you. Both very bad decisions.

I don't know what their policies are re: partial refunds for 'stuffing up' ... but I know that had this situation turned ugly and your dog had indeed developed an obstruction requiring surgery and it turned out to be the swabs that caused it - then in that case the treatment costs associated with the foreign-body surgery should be paid for by the vet clinic.

Oops - it timed me out.


Chaos and Havoc

Thank you again for sharing all of your knowledge and insight. This is very helpful for me and I appreciate it a lot. He is a small breed so I was shocked to see this large wad of gauze passed and I couldn't believe he could have easily swallowed that. Everything you shared helps it to make a bit more sense. Thanks for taking the time to put it all into writing. I always thought we had a great vet who has been taking care of my dogs for many, many years and has become very familiar with them. I'm just not sure how I can ever feel comfortable taking them there again which is a shame. I agree that choosing not to tell me is a VERY bad decision. That's why I'm wondering if there is any way they didn't know. Not sure if it is the nurse and/or vet to 'blame'. And I too can't help but think how this could have turned ugly if an obstruction developed.