SURGICAL INSTRUMENTATION

Rhenier S. Ilado RN

Classification of Instruments:A. Cutting and Dissecting cutting instruments have

sharp edges. used to dissect, incise,

separate or excise tissues

1. Scalpels has reusable handle with a

disposable blade a heavy hemostat or Kelly

clamp is used to attach and detach, the blade

Sizes and shapes of Blades:

No. 10 blade used most often

has rounded cutting edge along one side

fits on nos. 3, 7, and 9 handles

No. 11 blade has straight edge that

comes to a sharp point

fits on nos. 3, 7 and 9 handles

No. 12 blade shape like a hook,

with the cutting edge on the inside curvature

it fits on nos. 3, 7 and 9 handles

No. 15 blade has a smaller and

shorter curved cutting edge than a 10 blade

fits on 3, 7 and 9 handles

Nos. 20, 21, & 22 blades are the

same shape but are larger, they

fit on no. 4 handles

No. 23 blade/No. 24 blade

has a curved cutting edge that comes to more of a point than nos. 20, 21 and 22 blades

fits on a no. 4 handle

2. Scissors blades are straight,

angled or curved, as well as either pointed or blunt at the tips

handles may be long or short

used to cut or dissect tissues and also to cut other materials

Classifications:

A. Tissue scissors

has a sharp blades

1. Straight Mayo scissors - Used to cut suture and supplies,

2. Curved Mayo scissors - Used to cut heavy tissue (fascia, muscle, uterus, breast). Available in regular and long sizes.

3. Metzenbaum scissors - Used to cut delicate tissue. Available in regular and long sizes.

2. Suture Scissor has blunt points to prevent structures close to the

suture from being cut used to cut sutures

2. Wire scissors has short, heavy blades used to cut stainless steel sutures

3.Dressings/Bandage scissors used to cut drains and

dressings and to open items such as plastic packets

4. Bone Cutters and Debulking Tools

used for cutting into or through bone and cartilage

a. Chisels

b. Osteotomes,

c. Curette – has a sharp edge at the loop and scoop on the end, used to scrape tissue or bone

B. Grasping and Holding - used to hold tissue, drapes or sponges

1. Tissue Forceps used to pick up or hold soft

tissues and organs

Types:

a. Smooth Forceps also referred to as “pick-ups”

has serrations or grooved at the tip that does not injure delicate structures

b. Toothed/Thumb Forceps referred to as “rat-toothed forceps” has single tooth on one side that fits between two

teeth on the opposing side provides a firm hold no tough tissues, including

skin, fascia

Other Examples:

Russian tissue forceps- used to grasp tissue

DeBakey forceps- used to grasp delicate tissue,

particularly in cardiovascular surgery.

Adson pick-ups either smooth: used to grasp

delicate tissue with teeth: used to grasp the skin other names: Dura forceps

2. Allis Forceps

has scissor action, each jaw curves slightly inward and there is a row of teeth at the end

holds tissue gently but securely

3. Babcock Forceps

the end of each jaw is rounded to fit around a structure or to grasp tissue without injury

used to grasp delicate tissue (intestine, fallopian tube, ovary).

4. Kocher

used to grasp heavy tissue and also used as clamp

jaws either straight or curve other name: “Oschner”

5. Tenaculums a curved or angled points on the ends of the jaws used to penetrate tissue to grasp firmly, such as

when a uterine tenaculum is used to manipulate the uterus

6. Backhaus Towel Clamps used to anchor drapes and towels other name: Towel clip

7. Foerster sponge stick used to grasp sponges. Other names: sponge forcep

C. Clamping or Occluding1. Hemostatic Forceps – clamps

used for occluding blood vessels which has two opposing serrated jaws that are stabilized by a box lock and controlled by ringed handles

Parts of hemostatic forceps includes:

1. Serrated jaws

2. Box lock

3. Shank

4. Ratchets

5. Ring Handle

a. Hemostat used to clamp blood vessels either straight or curved that

taper to a fine point serrations go across the jaws aka. Crile clamp

b. Mosquito clamp

used to clamp small blood vessels or skin jaws may be straight or curved

c. Kelly clamp

used to clamp larger blood vessels and tissue Available in short and long sizes Other names: Rochester Pean

d. Right Angle

used to clamp hard-to-reach vessels and to place sutures behind or around a vessel.  

Other names: Mixter.

D. Exposing and Retracting are used to hold back or retract organs or

tissue to gain exposure to the operative site

1. Handheld Retractors (manual)

most retractors have blade on a handle. These blades are usually dull, but some are sharp used in pairs and they are held by the first or

second assistant

Typesa. Malleable Retractors may be bent to the desired angle and depth

for retraction is used to retract deep wounds - aka. Ribbon retractor

b. Deaver retractor

used to retract deep abdominal or chest incisions

c. Richardson

used to retract deep abdominal or chest incisions

d. Army Navy

used to retract shallow or superficial incisions aka US army

e. Goulet

used to retract shallow or superficial incisions

f. Volkmann Rake used in retracting skin layers

g. Vaginal speculum used for visualization of cervix/vagina during Pap

smear or D&C

2. Self- Retaining Retractors are holding devices with two or more blades that

can be inserted to spread the edges of an incision and hold them apart

have shallow or deep blades have ratchets or spring locks to keep the device

open some are attached to the operating bed for

stability

Types

1. Weitlaner used to retract shallow incisions

2. Gelpi retractor

used to retract shallow incisions

3. Balfour with bladder blade retractor

used to retract wound edges during deep abdominal procedure

used during laparotomy

E. Suturing1. Needle Holders – used to grasp and hold curved

surgical needles most needle holders resemble hemostatic forceps

but the basic difference is the jaws. the size of the needle holder should match the

size of the needle (i.e. heavy jaws for large needles and slim jaws for small needles)

Handling Instruments during Surgical Procedure1. Know the name and appropriate use

2. Handle instrument individually

3. Handle the surgeon or assistant the correct instrument

4.Pass instruments firmly

5. Watch out for loose instruments

6. With a moist sponge, wipe blood and organic debris from instrument after use

7. Placed used instrument into a tray at the end of the surgical procedure

Thank You For Listening!