Perioperative Equipment

Ronivin Garcia Pagtakhan, RN MAN

Scissors

• All types of scissors can have blunt or sharp blades

• (A: Sharp:Sharp, B: Blunt:Blunt).

• All types can have either straight or curved blades.

• Mayo and Metzenbaum• Mayo scissors (B) are used

for cutting heavy fascia and sutures.

• Metzenbaum scissors (A) are more delicate than Mayo scissors.

• Metzenbaum scissors are used to cut delicate tissues.

• Metzenbaum scissors have a longer handle to blade ratio.

• Forceps: consist of two tines held together at one end with a spring device that holds the tines open. Forceps can be either tissue or dressing forceps.

• Dressing forceps have smooth or smoothly serrated tips.

• Tissue forceps have teeth to grip tissue. Many forceps bear the name of the originator of the design, such as Adson tissue forceps.

• Rat Tooth: A Tissue Forceps

• Interdigitating teeth hold tissue without slipping.

• Used to hold skin/dense tissue.

• Adson Tissue Forceps• Small serrated teeth on

edge of tips. • The Adsons tissue

forceps has delicate serrated tips designed for light, careful handling of tissue.

• Intestinal Tissue Forceps: Hinged (locking) forceps used for grasping and holding tissue.

• Allis: An Intestinal Tissue Forceps

• Interdigitating short teeth to grasp and hold bowel or tissue.

• Slightly traumatic, use to hold intestine, fascia and skin.

• Babcock: An Intestinal Tissue Forceps

• More delicate that Allis, less directly traumatic.

• Broad, flared ends with smooth tips.

• Used to atraumatically hold viscera (bowel and bladder).

• Sponge Forceps• Sponge forceps can be

straight or curved.• Sponge forceps can

have smooth or serrated jaws.

• Used to atraumatically hold viscera (bowel and bladder).

• Hemostatic forceps: Hinged (locking) Forceps. Many hemostatic forceps bear the name of the designer (Kelly, Holstead, Crile). They are used to clamp and hold blood vessels.

• Classification by size and shape and size of tips

• Hemostatic forceps and hemostats may be curved or straight.

• Kelly Hemostatic Forceps and Mosquito Hemostats

• Both are transversely serrated.

• Mosquito hemostats (A) are more delicate than Kelly hemostatic forceps (B).

• Comparison of Kelly and Mosquito tips

• Mosquito hemostats (A) have a smaller, finer tip.

• Carmalt• Heavier than Kelly. • Preferred for

clamping of ovarian pedicals during an ovariohysterectomy surgery because the serrations run longitudinally.

• Doyen Intestinal Forceps• Doyen intestinal forceps

are non-crushing intestinal occluding forceps with longitudinal serrations.

• Used to temporarily occlude lumen of bowel.

• Payr Pylorus Clamps• Payr pylorus clamp is a

crushing intestinal instrument.

• Used to occlude the end of bowel to be resected.

• Needle holder: Hinged (locking) instrument used to hold the needle while suturing tissue.

• Good quality is ensured with tungsten carbide inserts at the tip of the needle holder.

• Mayo-Hegar• Heavy, with mildly tapered

jaws.• No cutting blades.

• Olsen-Hegar• Includes both needle

holding jaw and scissors blades.

• The disadvantage to having blades within the needle holder is the suture material may be accidentally cut

• Senn• Blades at each end. • Blades can be blunt

(delicate) or sharp (more traumatic, used for fascia).

• Hohman• Levers tissue away from

bone during orthopedic procedures.

• Weitlaner• Ends can be blunt or

sharp.• Has rake tips.• Ratchet to hold tissue

apart.

• Gelpi• Has single point tips.• Ratchet to hold tissue

apart.

• Handles• #3 Handle • #4 Handle

• Handles and Blades• Blades #10, 11, 12, 15

fit the #3 handle. • Blades #22, #23 fit the

#4 handle and are commonly used for large animals.

• Disposable Scalpel

• Towel clamps secure drapes to a patient's skin. They may also be used to hold tissue.

• Backhaus Towel Clamp• Locking forceps with

curved, pointed tips.

TECHNIQUES IN USING SURGICAL EQUIPMENT

• Scissors and Hemostats: • The thumb and ring finger

are inserted into the rings of the scissors while the index and middle finger are used to guide the instrument.

• The instrument should remain at the tips of the fingers for maximum control.

• This is the wrong way to hold the scissors. The ring finger should be inserted into the ring.

• This is also the wrong way to hold the scissors. The tips of the scissors should be pointing upwards.

• Thumb Forceps:• Thumb forceps are held

like a pencil.

• Thumb Forceps are not called 'tweezers'.

• Thumb Forceps are not held like a knife.

• Scalpels:• The scalpel is held with

thumb, middle and ring finger while the index finger is placed on the upper edge to help guide the scalpel.

• Long gentle cutting strokes are less traumatic to tissue than short chopping motions.

Autoclave

• An autoclave is a self locking machine that sterilizes with steam under pressure.

• Sterilization is achieved by the high temperature that steam under pressure can reach.

• The high pressure also ensures saturation of wrapped surgical packs.

Autoclave Settings

Temperature (F)

Pressure (PSI)

Time (min)

General Wrapped

Items250 20 30

Bottled Solutions

250 20 30

'Flashing' 270 30 4-7

Preparation for sterilization

• All instruments must be double wrapped in linen or special paper or placed in a special metal box equipped with a filter before sterilization.

• 'Flashing' is when an instrument is autoclaved unwrapped for a shorter period of time. 'Flashing' is often used when a critical instrument is dropped.

• Color Change Sterilization Indicators

• The white stripes on the tape change to black when the appropriate conditions (temperature) have been met.

• Indicators should be on the inside and outside of equipment pack.

• Expiration dates should be printed on all equipment packs.

Biological sterilization

• indicators contain spores that are supplied in closed containers and are included with the instrument being autoclaved. Inability to culture the spores after autoclaving confirms adequate sterilization. Biological indicators are the most accurate sterilization indicators.

Ethylene Oxide Sterilization: ETO Gas

• EtO Sterilizer• Colorless gas, very toxic and

flammable.• Requires special equipment• Odor similar to ether.• Used for heat sensitive instruments:

plastics, suture material, lenses and finely sharpened instruments.

• Materials must be well aerated after sterilization.

• Materials/instruments must be dry.

Cold (Chemical) Sterilization:• Instruments must be dry

before immersion.• Glutaraldehyde (Cidex) is the

most common disinfectant.• 3 hours exposure time is

needed to destroy spores.• Glutaraldehyde is bactericidal,

fungicidal, viricidal, and sporicidal.

Radiation Sterilization

• High energy ionizing radiation destroys microorganisms and is used to sterilize Pre-packed surgical equipment.

• Used for instruments that can't be sterilized by heat or chemicals.

• Radiation sterilization is being promoted as an alternative to ETO sterilization.

OR GOWNS

Disposable Paper Gown

Linen (cloth) Gowns

Plastic Gowns

Wrap Around Gown

Front Sterile Gown