surgical instrumentation

Surgical InstrumentationSurgical Instrumentation

IMPORTANT TERMSIMPORTANT TERMS• Atraumatic

• without trauma

• Traumatic• Causing Injury by penetration or crushing

• Dilation• Enlarging an opening in a progressive manner

• Dissection• Process of separating tissues through anatomic

planes by using sharp or blunt instrumentation

IMPORTANT TERMSIMPORTANT TERMS

• Grasping• Holding in a traumatic or atraumatic manner

• Retraction• stabilizing a tissue layer in a safe position for

exposure of a part

• Sharp• Instrument with a cutting edge or pointed tip(s) that

is used to cut or dissect tissue

IMPORTANT TERMSIMPORTANT TERMS

• Trocar• A device used for penetration of tissue layers. It is

commonly used for percutaneous endoscopy. It is used as a temporary pathway for gases, other instrumentation, or the removal of an organ or substance.

CLASSIFICATION OF INSTRUMENTS

CLASSIFICATION OF INSTRUMENTS• Cutting and

Dissecting• Grasping and Holding• Clamping and

Occluding• Exposing and

Retracting• Suturing and Stapling• Viewing

• Suctioning and Aspirating

• Dilating and Probing• Measuring• Accessory

Instruments• Microinstrumentation

CUTTING AND DISSECTING


• Scalpels (disposable) Adv. Knives(reusable), Ortho, GS, Amputation

• Handle 4 – Blade 20-24 (SIZES)• Blade 20 – Initial for SKIN knife• Blade 10 – most common• Blade 11 – Vascular, To puncture Aorta, To cut

blood vessel• Blade 12 – EENT, Tonsilectomy• Blade 15 – Plastic, Pedia• Bone Cutters – to Cut RIBS, THORACOTOMY



•Bone Curette• used by Ortho, Neuro Surgeon for Laminectomy•Maybe straight or angulated(spine surgery)

Laminectomy – Lamina removing of intervertebral disk, to remove tissues, debris,



•Mayo Scissors•Tough tissues, curve mayo, ob-gyn(to cut ligaments)

•Metzenbaum Scissors•delicate tissues, Plastic surgeon, Intestine, delicate tissue


CUTTING AND DISSECTING•Suture Scissors

(Blunt /Blunt)

•Nursing Scissor – Blunt/Pointed

GRASPING & HOLDING

GRASPING & HOLDING

•Tissue Forceps

•Smooth Forceps

•Toothed Forceps

•Allis Forceps

•Babcock Forceps

•Stone Forceps

•Tenaculums

•Bone Holders

GRASPING & HOLDING

GRASPING & HOLDING

•Rat-Toothed Tissue Forceps

•General Surgery Skin

GRASPING & HOLDING

GRASPING & HOLDING

•Allis Tissue Forceps•To grasp OB tissues (atraumatic) , AP repair

GRASPING & HOLDING

GRASPING & HOLDING

•Babcock Intestinal Forceps

GRASPING & HOLDING

GRASPING & HOLDING

•Backhaus Towel Clamps

•Towel clips on the edges of drapes, hide the towel clamps

CLAMPING & OCCLUDING


•Hemostatic Forceps

•Hemostats

•Crushing Clamps

•Noncrushing Vascular Clamps

Most commonly used, to clamp blood vessels

Kocher and Oschner forceps




•Hemostats

•Crushing Clamps

•Noncrushing Vascular Clamps- used to occlude peripheral or major blood vessels



•Pean Intestinal forceps

•Intestinal / serrations is horizontal




•Hemostats

•Crushing Clamps

•Noncrushing Vascular Clamps

EXPOSING & RETRACTING


•BALFOUR ABDOMINAL RETRACTOR

•Laparotomy•Retractors assist in the visualization of the operative field while preventing trauma to other tissues



•ARMY NAVY

FARABEUF Retractor



•GELPI Perineal Retractor

•Self retraining

•Biopsy , Skin



•Weitlaner Retractor



•Spay Hook

•Bone hook, skin hook, to retract skin edges during a wide flap dissection, such as a face-lift or mastectomy.

Some have styles of hooks that have ball tips, which causes less trauma to tissues



•Senn Retractors



•Finochietto Retractor•For sternotomy ,



•Ribbon Retractor

•Malleable retractor - neuro

SUTURING & STAPLING

SUTURING & STAPLING

•Needle Holders

•Tungsten Carbide Jaws

•Crosshatched Serrations

•Smooth Jaws

•Staplers

•Clip Appliers

•Terminal End Staplers

•Internal Anastomosis Staplers

•End-to-End Circular Staplers

SUTURING & STAPLING

SUTURING & STAPLING

A needle holder should not be placed on a magnetic pad, because it may become magnetized.

Tungsten Carbide jaws – eliminate the twisting and turning of the needle

Crosshatching – provides a smoother surface and prevents damage to the needle

Smooth jaws – used with small needles such as those used for plastic surgery

SUTURING & STAPLING

SUTURING & STAPLING

•Terminal End Staplers

•Internal Anastomosis Staplers

•End-to-End Circular Staplers

VIEWINGVIEWING•Speculums

•Endoscopes

•Hollow Endoscopes

•permits viewing in a forward direction, with a light carrier supplied by a fiberoptic cable provides illumination

•Lensed Endoscopes

•have either rigid or flexible sheaths, used in combination with video assisted technology, can record action videos and still digital photography

SUCTIONING & ASPIRATING


•Suction

•Suction devices remove blood and other fluids from a surgical or dental operative field.

•Used in abdominal laparatomy or within a cavity with copious amounts of fluid. The outer filter shield prevents the adjacent tissues from being suctioned in to the apparatus.

•Poole Abdominal Tip

•Frazier Tip

•Yankeur Tip

•Autotransfusion

•Aspiration

•Trocar

•Cannula



•Suction

•Poole Abdominal Tip

•Frazier Tip - for brain, spinal, plastic, or orthopedic procedures, used when encountering little or no fluid

•Yankeur Tip -Standard tip for suctioning. Has an angle for mouth and throat, also useful for visualization of ruptured aneurysm

•Trocar

•Cannula

DILATING & PROBINGDILATING & PROBING

Probing instruments are used to enter natural openings, such as the common bile duct, or fistulas

Dilating instruments expand the size of an opening, such as the urethra or cervical os

MEASURINGMEASURING

ACCESSORY INSTRUMENTS

ACCESSORY INSTRUMENTS

MICROINSTRUMENTATIONMICROINSTRUMENTATION

Powered Surgical Instruments

Powered Surgical Instruments

DRILLDRILLBURRBURRBLADEBLADEREAMERREAMERABRADERABRADER

AIR-POWEREDAIR-POWEREDELECTRICALLY ELECTRICALLY POWEREDPOWERED

HANDLING INSTRUMENTSHANDLING INSTRUMENTS

•Standardized BASIC sets

•Scrub Person counts ALL instruments, sharp and sponges with the CIRCULATOR

•Handle Loose Instruments SEPARATELY

•Sort by CLASSIFICATION

•PROTECT Sharps

Handling INSTRUMENTS during SURGERY


• Know the NAME and USE

• Handle INDIVIDUALLY

• Use for the INTENDED purpose

• Use of HAND SIGNALS

• Short INSTRUMENTS = Superficial Work

• LONG Instruments = DEEP

• PASS instruments DECISIVELY and FIRMLY

• FREE-HAND TECHNIQUE

• Watch the sterile field for LOOSE instruments

• With a MOIST, SPONGE wipe blood and organic debris from instruments using a DEMINERALIZED STERILE, DISTILLED H20



• Instruments are maintained and sterilized prior to use.

• Surgical instruments must be kept clean during a procedure. This is accomplished by carefully wiping them with a moist sponge and rinsing them frequently in sterile water. Periodic cleaning during the procedure prevents blood and other tissues from hardening and becoming trapped on the surface of an instrument.

ELECTROSURGERYELECTROSURGERY

•INITIAL Incision is made by a SCALPEL

•Doubling the current increases the heat produced fourfold

•ARGON Enhanced ESU Tip is held at 60 degree angle, causing LESS Tissue Damage

•BUZZING – the process of coagulating the VESSELS

•BUZZ should not exceed more than 3 SECONDS

Electrosurgery precautionsElectrosurgery precautions

• ESU should not BE USED in the mouth, trachea, around the HEAD, or in the pleural cavity

• ECG electrodes should be placed as far as possible, BURNS can occur

• Rings and jewelry should be removed• DON’T USE Flammable agents• DO not immerse an active electrode in liquid• DRY Sponges can IGNITE• Investigate a repeated request for more current

LASER SURGERYLASER SURGERY

• Light amplification by stimulated emission of radiation (LASER)

• Types of LASERS = ARGON, CARBON DIOXIDE, HOLMIUM, KRYPTON, NEODYMIUM, PHOSPHATE, RUBY/XENON

PATIENT SAFETY in LASERSPATIENT SAFETY in LASERS Eyes and Eyelids

should be adequately protected (aluminum foil, moist pads)

Antiseptics must be NONFlammable

Rectum should be packed with a MOISTENED sponge to prevent escape of METHANE gas

Anesthetic Agents should be NONCombustible

Flexible metallic or insulated silicone endotracheal tubes

Wear high filtration MASKS for CO2 laser ablation such as condylomata (Venereal warts)

Advantages of LASERSAdvantages of LASERSPrecise CONTROL =

ACCURATE incisionAccess to HARD to

REACH areas (endoscopes, rhodium reflector mirrors)

Unobstructed view of the surgical site

Minimal TRAUMA to tissues

DRY, Bloodless SURGICAL Field

Minimal THERMAL effect

Reduced RISK for INFECTION

Prompt HealingReduced

OPERATING Time

surgical instrumentation

Documents

oschner forceps

retracting suturing

adjacent tissues

ob tissues atraumatic

skin hook

skin knife blade

tissue important terms

blood vessel blade