Surgical Instrument Lecture Outline

Surgical Instrument Lecture Outline

1)General Information

Cleaning Instructions

Care of Instruments

Color coding packs

2)General Surgery Instruments

Cutting instruments

Needle Holders

Forceps

(1)Thumb

(2)Tissue

(3)Hemostatic

Towel Clamps

Retractors

Staplers

Speculums

Cannulas

Miscellaneous Small Animal Surgery Equipment

Suction Tips

Mayo stand

Surgical table

3)Ophthalmic Instruments

4)Basic Orthopedic Equipment

Note: Anything with a * is something that needs to be included in your Perfect Pack at VTI.

General Information

The best instruments are made of stainless steel

Two different brands: Pakistan or Germany

• Germany is a better product…and more expensive

Cleaning of Instruments

1.Open hinges/ratchets and scrub in cold water immediately after surgery (soak if you cannot get to them immediately)

• Scrub with a tooth brush or other cleaning type brush
• Use either instrument cleaner or soapy water (must rinse well when using soap)

• Touch ALL parts of the instrument

3.Place in ultrasonic cleaning machine

• Ultrasound waves that create tiny bubbles, which break up debris on the instrument; more efficient and detailed than manual cleaning
• High pitched noise ______

STEPS:

• Mix 1 ounce instrument cleaner in 1 gallon of water
• Place instruments OPEN into solution and cover with lid
• Set time for 20 minutes
• Remove instruments and drain solution after EVERY use

4. Inspect for cleanliness, proper alignment, sharpness, ratchet is working

5. Place ______on dry huck towel

6. Spray with instrument milk

• Lubes hinges and prevents rust

7. Leave out to dry completely before putting away

Care of Instruments

Clean properly EVERY time and dry well

Use only for intended purpose

Avoid dropping

Sharpen blades as needed

General Surgical Instruments

Cutting instruments:

1. Scalpel blades–primary cutting tool of surgeon  proven to heal well

• Scalpel blades can come detached from the handles or as disposable, pre-sterilized blades (blade and handle all in one)
• Come in various sizes

#10, #11, #12, #15 (these fit the Bard-Parker no. 3 handle)

#20, #21, #22 (these fit the Bard-Parker no. 4 handle)

USES: Incise tissue (#10), lance abscesses (#12), declaws, feline/rat neuter (#15-small precise), incising vessels (#11), skin scrapes (used and re-sterilized)

1. *Scalpel handles – two common sizes

• Can be plastic or stainless steel

Bard Parker no. 3 – fit blades #10, #11, #12, #15

Bard Parker no. 4 – fit blades #20, #21, #22 (large animal surgeons)

HOLD: Scalpel blade is held with thumb, middle and ring finer; index finger is placed on upper edge and used as a guide

*Should never be used in a stabbing motion – only long, gentle strokes

1. Electrocautery – allows surgeon to cut, simultaneously providing coagulation  minimizes bleeding

• Electrical current passes through a hand piece to the tissue and is grounded through the ground plate under the patient.
• Ground plate - keeps patient from being burned (gel or towel)
• Required for ______cautery
• Not required for BIPOLOR cautery
• Hand piece is controlled by surgeon via foot pedal
• Power level is adjusted by ______

1. Scissors – one of the most common surgical instruments used

• available in MANY widths, lengths, and shapes
• Classified by: shape of tips and character of their points
• Shape = ______
• Character = blunt-blunt, sharp-sharp, or blunt-sharp
• May ONLY be used for intended purpose

PARTS: points, two blades, two handles/shanks, pivot and finger rings

USES: Incising tissue, transecting tissue, separating tissue (ex. Fascia from muscle), cutting suture, drape, and bandages

HOLD: thumb and ______are inserted into the rings; index and middle fingers are used as guides

TYPES:

1. *Standard operating scissors- used to cut drape and suture material

1. *Mayo dissecting scissors – sturdy; cut ligaments and tendons

1. *Metzenbaum dissecting scissors – cutting delicate tissues (fat, muscle, organs)

• Very long shanks; short ______

1. Littauer suture removal scissors - removing suture from patient

• Lower blade has a hook-shaped point
• Wide, round blades
• No wire suture!

1. Spencer suture removal scissors – removing suture from patient

• Lower blade has a hook-shaped point
• Thin blades
• No wire suture!

1. Wire cutting scissors – used to cut wire (ex. stainless steel suture OR small diameter IM pins)

1. Bandage cutting scissors – used to remove or fit bandage material

• flat, blunt nodule on the lower tip

• prevents cutting the patient’s skin

TYPES:

1. Utility- heavy duty; angled blades with serrations
2. Large plastic handles

1. Lister bandage scissors – stainless steel; angled blades

1. Knowles bandage scissors – stainless steel; straight blades

1. *Needle Holders – also known as “needle drivers”; may OR may not cut

USE: to grasp needle and pass suture material through tissue; tying knots

PARTS: rounded tips, jaws w/ longitudinal groove in the center, box lock, shank, finger rings and RACHET

TYPES:

1. Olsen-Hegar – jaws are flat and finely serrated

• Has suture scissors below the jaws = efficient
• Downside= ______

1. Mayo-Hegar – no scissors

Grasping/Holding Instruments:

1. Thumb Forceps- form a V-shape; work by ______with a joint at the end of two handles

PARTS: tines/tips, handles, spring hinge

• Are opposed by manually compressing the two handles together

• Come in varied sizes and grasping surfaces
• The more intermeshed teeth = more gentle

USES: manipulation of delicate tissues (usually in non-dominant hand)

HOLD: ______

TYPES:

1. Adson thumb forceps – One tip has two teeth, interlock with the one tooth on the other jaw; bowed handles

1. Adson dressing forceps –flat, smooth jaws

1. *Brown-Adson thumb forceps–each tip has two rows of intermeshed teeth (fit together)

1. Rat-tooth forceps – used for tougher tissues; much narrower shanks; varying amount of teeth

1. DeBakey thumb forceps – the most slender and delicate

• Two long rows of microscopic teeth on each jaw

1. Russian thumb forceps –two broad, spoon shaped tips with serrated edges strong grip

• Great for extracting tissue

1. Bayonet forceps – most used in ear and nose procedures

• Easily grasp objects through the speculum of an otoscope
• Surgeons fingers are not in the line of anatomical site

1. Tissue Forceps- locking instruments

PARTS: jaws, box lock, shank, finger rings and ratcheted locking device

• Come in various tooth patterns and sizes

USES: Grip tissue (with more strength than thumb forceps); can be left in place while surgeon continues elsewhere

TYPES:

1. *Allis tissue forceps – traumatic; applied to tissue being excised
2. Tip has inward facing, interlocking teeth

1. Babcock intestinal forceps – used on bowel, bladder (viscera)
2. Less traumatic; wide grasping surface;tips are rounded and hollow

1. Doyen intestinal tissue forceps – non-crushing; used to temporarily occlude the ______
2. Longitudinal striations along entire jaws
3. Jaws are very long and don’t completely close

• Example: intestinal resection and anastomosis

D. Hemostatic forceps

1. Hemostatic Forceps – also known as hemostats; a type of tissue forceps

USE: to stop bleeding, by crushing tissues and vessels

• Classified by: size, pattern of jaw striations, and shape of tips
• Shape of tips = ______
• Jaw pattern- transverse or longitudinal
• Most have transverse striations along jaws (NOT ALL)

HOLD: thumb and ring finer are inserted into rings; index and middle fingers are used as a guide

• Curve is pointed upwards

TYPES:

1. *Halsted mosquito hemostats – crushing small vessels
2. 3.5 or 5 inches long
3. Transverse striations on entire length of inner jaws

1. *Kelly hemostatic forceps – occluding larger vessels and tissues
2. 5.5 inches long
3. Transverse striations on jaws; go from tip to half way down

1. Crile hemostatic forceps - occluding larger vessels and tissues

• 5.5 inches long

• Transverse striations along ______length of inner jaws

1. Rochester-Pean forceps – grasping larger vessels and hollow organ tissue (pedicles and stumps)

• Transverse striations along the entire inner jaws
• Larger than criles

1. Rochester-Ochsner forceps – grasping larger vessels and tissues very well

• Transverse striations along entire jaw
• ______- one on one tip and two on the other tip

1. *Rochester- Carmalt forceps - grasping larger vessels and hollow organ tissue (pedicles and stumps) Ex. OHE

• Opposing longitudinal grooves
• ______at the tip

1. Ferguson angiotribe – heavy duty; arresting and preventing hemorrhage

• Longitudinal grooves with total cross hatching

1. Alligator forceps – very long shank which sits at a 45° angle to the ring handles

• Serrated jaws at the end for grasping

USES: grasping small objects; removing items from the body; probing fistulas

1. Towel Clamps- used to secure sterile towels/drapes to the patient; a type of forceps

• Must actually penetrate skin when securing item to patient

TYPES:

1. *Backhaus towel clamp – tear drop shaped; ends in sharp points

• Ring handles and a ratchet

1. Jones towel clamp – spring action, yet self-retaining = weird

• has a joint at the end of two handles

1. Roeder towel clamp–Backhaus + ball stops

1. Miscellaneous forceps

1. Forester sponge holding forceps – box lock, shank, ring handles and ratchet

• Jaws are oval loops

USES: holding gauze/lap pad to swab surgical site

• To dry site; soak up fluids

1. Young tongue holding forceps – box lock, shank, ring handles and ratchet

USES: Manipulating the tongue

• Jaws are oval loops
• Rubber insert in jaws

1. Retractors – exposing instruments; may be hand held or ______

USES: to atraumatically improve field of vision; give surgeon more room for viewing wounds/incisions

TYPES:

Hand held:

1. *Snook OHE hook (spay hook)

• Specifically for grabbing uterine horns during OHE

1. Volkmann Retractor – looks like a curved fork
2. Army-Navy retractor – flat, blunt blade that is bent on each end

• One end is longer than the other
• Hole in the center of blade

1. Senn retractor – curved 3-prong claw at one end; bent, flat blade on the other end
2. Point opposite diections

1. Malleable retractor – thin metal that is bent to desired shape

Self-retaining:

1. Balfour abdominal retractor – 3 adjustable curved loops, mounted on a bar

• Middle portion rests on xiphoid; lateral loops open incision

USE: Retract abdominal wall for access to peritoneal cavity

1. Finochietto rib spreader – two broad, outward facing blades mounted on a ratcheted bar = 6-12” spread

• Handle to adjust distance by turning

USE: gaining access to thoracic cavity during thoracotomy holds ribs apart

1. Gelpi retractor – points, blades, finger rings, ratcheted hinge

• Very sharp points that separate as the hinge is closed
• Wide shaft
• Points face away from each other
• Can buy stops to put on the points

USE: opening deep wounds

1. Weitlaner – claws, blades, finger rings, ratcheted hinge

• Claws open as hinge is closed
• Prongs point away from each other
• 3 x 4 interdigitating teeth

1. Stapling Devices – fast and easy application compared to suturing

USES: wound closure; vessel ligation

TYPES:

1. Skin stapler – primarily closing skin incisions; staples are stainless steel
2. Faster than suturing
3. Few allergic reactions
4. Also used for securing catheters, nasal cannulas, feeding tubes

1. Ligaclip stapler – closing visceral wounds/incisions (internal)

• Example: liver biopsies

1. Stapler remover- required to remove staples

Dilating Instruments:

1. Speculums- may be plastic or steel

USES: to open up a narrow passageway

TYPES:

1. Nasal
2. Vaginal
3. Oral

1. Cannulas- hollow tubes

USES: for delivery of fluids, or removing blockages

TYPES:

1. Lacrimal cannula – to flush the lacrimal duct
2. Aluminium hub; small as 30 gauge
3. Curved or straight
4. Can also be used for anal sac duct flushing

Miscellaneous Surgical Equipment:

1. Suction Tips- tip attached to a long, sterile polyethylene tube, attached to a vacuum and plugged in

USES: clearing blood/fluid from surgical site, lavaging wounds, dentals

• Ex. GI surgery w/ gastric lavage

TYPES:

1. Poole suction tip – plastic; made of two tubes within each other; taken apart for cleaning
2. Outer tube is like a sleeve with holes through out it  avoids clogging of tip
3. Distributes suctioning power

USES: suctioning large volumes of fluids from surgical field

• Commonly in abdominal or thoracic cavities

1. Yankauer suction tip – stainless steel or plastic; hollow tube with a curve and a bulbous head

USES: removing secretions during oral surgery, suctioning fluid

1. Fraizer suction tip – small and slender; various diameters ______

• Small hole on the handle to regulate degree of suction

USES: remove very small amount of fluid (in place of gauze)

1. Mayo Instrument Stand – metal device with two wheels

USES: to hold instruments during surgery

• Covered with a sterile huck towel or a drape before instruments are placed; adjustable height

1. Surgical Table – used for holding the patient during surgery
2. Can usually move up and down and form a “V” shape
3. May or may not be heated
4. Groove directors – used to guide scalpel blade

• most surgeons just use thumb forceps

1. Thoracic positioner – “V-trough”; used to stabilize patient

1. Instrument tip protectors – to protect tips

Ophthalmic Instruments: - used for procedures involving the eye

1. Iris scissors – small, delicate scissors

1. Ophthalmic needle holders

TYPES:

1. Castroviejo needle holders – delicate needle holders
2. Long handles, spring action, delicate jaws
3. Catch and release in the middle

USE: corneal surgeries

1. Derf needle holders – smaller version of Mayo-hegar needle holders

USE: suturing eyelid lacerations, tarsorrhaphy, entropion, extropion, enucleations, etc

1. Ophthalmic retractors – retracting the eye lid open

TYPES:

1. Cook eye speculum – two curved, outward facing blades attached to a bar
2. Screw for adjusting the size self-retaining

1. Barraquer speculum (eye lid speculum) – wire; no screw adjustment