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Ch10 Inst Equip Supp

Instrument Equipment and Supplies

QuestionsAnswers
Active Drains Use negative pressure; created by removing air from collection device manually or mechanically
Active Drains Electric or Battery operated pump used for mechanical evacuation connected to a collection device
Chest Tube Used for water seal drainage
Hemovac (active drain) Used following orthopedic prcedures when a moderate amount of drainage is expected
Jackson-Pratt (active drain) Used following abdominal procedures when moderate amount of drainage is expected; also in neurosurgery & other general such as a mammoplasty
Stryker (active drain) Used following orthopedic procedures; reduces dead space due to battery-operated evacuation pump
Irrigation & Syringes Used to irrigate wounds, aspirate fluids, or inject medications; calibrated in milliliters/cubic centimeters
Insulin Syringes Calibrated in units
TB Syringes Calculated in tenths or hundredths of a cubic centimeter
Irrigators & Syringes Vary in size: 3-60cc; 10cc syringe is most common; TB syringe contain 1cc of fluid
Irrigationg Syringes Bulb & Barrel syringes Standard most common-Asepto syringe 120cc of fluid
Ear Syringes Does not have a barrel; used to irrigste small incisions & structures from the ear & remove fluids from infants nose & mouth
Catheters Used to remove fluids or other objects; monitor body functions; insert fluids; obtain a urine specimen; used to measure urinary output over extended period; remains low to help with drainage
Robinson (plain) Catheter-Nonretaining, does not require the use of a drainage bag 1 hole; straight-plain tip; AKA red rubber/straight cath
Coude Catheter-Nonretaining, does not require the use of a drainage bag Extended, rigid curved tip;
Whistle Catheter- 2 holes; 1 on top
Multieyed Catheter 3+holes
Drains Used to evacuate air & fluids from a surgical or tramatic wound; functions actively or passively
Penrose Drain (passive drain) Latex tubing placed partially in wound so fluid can move out into dressing by capillary action
Cigarrette Drain (passive drain) Penrose drain with gauze inside so fluid moves out by wicking action
T-Tube (passive drain) Placed in billary system; drains bile via gravity into a bile bag
Gastrostomy Tube (passive drain) Inserted to abdominal wall into stomach; removes gastric acids & adds nourishment; employs sump design (dual lumen) used for evacuation of fluids & allows air to enter for equalizing pressure
Cystostomy Tube (passive drain) Insertd to abdominal wall into bladder; to remove urine
Nephrostomy Tube (passive drain) Inserted percutaneously into kidney; removes fluid
Arterial or Venous/Cannula Needle Introduces a plastic indwelling catheter into a vessel; used to get arterial blood
Angio-Cath Attatched to IV lines for introduction of fluids/medication
Arterial Needles Introduce diagnostic or angioplasty guiding catherters over guiding wires into arterial system
Heparin Needles Attached to syringes used during open cardiovascular procedures to irrigate open arteries with saline-heparin solution
(lg) Biopsy Needles Used for obtaining tissue samples for biopsy; sometimes guided with CT scan or fluoroscopy
Dorsey Cannulated Needle (lg bx needle) Biopsy of cerebral tissue through a burr hole
Chiba Biopsy Biopsy of lung tissue through a chest wall
Franklin-Silverman (w/Trap door) Biopsy of liver & internal organs
Tru-cut Biopsy Needle (Trap-door) Allows for multiple biopsy's to be taken
Biopsy Needles Attached to syringes Used to asperate fluid from a cyst or abcess, breast lesion, lymph node, or other shallow tissue
Types of Stainless Steel Carbon; Chromium; Iron; Alloys
Highly polished Steel High glare
Stained Steel Less Reflective
Ebony Steel Eliminates glare
Beaver Blades Fit all mini handles; most common is #69
Blades 10; 11; 12; & 15 Fit handles 3; 7; & 9
Blades 20-25 Fit #4 handle
Potts-Smith inscions into ducts, veins, or arteries
Jorgenson Hysterectomy
Cushing Scissors Dural incision
Stradismus, Iris, Corneal Eye procedures
aperture an opening
capillay action action by which liquid travels along an established path; often used in reference to suture in which infectious fluid travels along the length of the suture strand placed in a wound; also referred to as wicking
catheter a hollow, cylindrical tube that allows for the removal of fluids or air from the body, injection of fluids, removal of obstruction from ducts, or intravascular monitoring; may be plain tipped or may contain a retention balloon
cottonoid another name for neurosurgical sponge; used to protect delicate neural tissue and to assist with hemostasis
cryo- cold
drain hollow, cylindrical device that is used to evacuate air and or fluids from a surgical wound; may be passive or active
fenestration opening
insufflation forcing powder, gas, or vapor into a body cavity
irrigation washing with a stream of fluid
magnification process of enlarging the size of an object with the use of a device such as a microscope
monopolar cautery monopolar electrocautery in which the electrical circuit completes a path from the generator, to the patient, and then back again to the generator
pneumatic pertaining to air
resistance (1)opposing or counteracting force; (2)A force that delays or impedes action
retract to draw back; to expose
scalpel another name for surgical knife handle on which knife blades are attached
serrations grooves located on the jaws of surgical instruments that are either longitudinal, crosshatched, or horizontal
stainless steel a type of metal that is a combination of carbon, chromium, iron, and other metal; most often used in the manufactures of surgical instruments
teeth small projections from the tip(s) of the jaw of certain surgical instruments; used to aid in grasping tissue or vessels
urethral pertaing to the urethra, which travels from the bladder to the exterior of the body
ureteral pertaining to the ureters that exit the kidney and transport urine from the kidney to the bladder
instrument classification cutting/dissecting; grasping/holding; clamping/occluding; retracting/viewing; probing; dialating; suturing; cutting
grasping/holding designed to manipulate tissue; reduce & stabilize; may or may not have rachets
Ex. of grasping/holding tissue forceps; bone holding clamps; allis; babcock; kocher
clamping/occluding disigned to occlude & constrict tissue
clamping/occluding constrict with opposing ring handles for fingers; interlocking ratchets; two shanks; box lock controls the opposing jaws
probing malleable; wire like; exploration of structure; found in abdominal, rectal, gallbladder instrument sets; with guides called grooved directors; also dialates coronary arteries
dialating used to gradually dialte an orifice or duct; smallest to largeest; found in numbered sets
suturing used to hold with needle holders; vary in length; fine, regular, heavy; jaws with tungsten carbide inserts or crosshatched serratins to hold needle
suturing most are designed as clamps withh ringed handles, ratchets, shanks, box locks & jaws
procedures that use spring action w/single ratchet sutures microsurgical, ophthalmic, vascular procedures
suctioning tips may be disposable or not; tip is connected by plastic tubing to canister; canister attached to vacuum device
Neurosurgeons suctioning preference angled suction tip
Plastic & Ortho suctioning preference Frazier & Baron-small suction tips; use a stylet, numbered according to size
Abdominal Suctioning Yaunkaur & Poole tips-designed for pharyngeal but frequently used abd procedures
ENT during tonsillectomy disposiblle suction tips attached to electode for suction & coagulating
Rosen tip resembles a lg. bent hyppdermic needle, contains adapter for suction tubing attachment; variety of sizes for ear procedures
Trocar has sharp point & cutting edges allowing for body penetration for fluid drainage; used in sinus and gallbladder
instrument cycle preoperative; intraoperative; postoperative
instrument care PREOPERATIVE instruments gathered according to surgeons cards; open container and remove tray; supplies organized and prepared for back table
insrtument care INTRAOPERATIVE anticipate or predict needs of patient & surgeons; a pos care approach is used; STSR must observe the procedure to obtain necessary information
instrument care POSTOPERATIVE prepare instuments for reuse; cleaning & deconamination; inspection & maintenance; reassembly of instrument set; preparation for sterilization; sterilization; storage
Scissors tissue scissors, suture scissors, wire scissors, or bandage/dressing scissors
scissors that should never be used to cut anything but tissue because it will dull the blades tissue scissors
only for cutting wire wire scissors
occasionally used for cutting derssings, drapes, drains, and other nonsuture items mayo suture scissors
tips may be pointed or blunt, blades ma be straight or curved tissue scissors
heavy tissue mayo scissors
always used to cut suture straight mayo scissors; straight iris
used for medium to fine tissue, preferred by some cardiovascular surgeons for cutting polypropylene suture curved metzenbaum
delicate tissue is frequently dissected with curved iris, jamieson, westcott, stephen's tenotomy, or potts-smith scissors
do not have ratchets; constructed with a flattened spring handle; usually used in the nondominant hand to grasp and hold tissue tissue forceps; also referred to as pick-ups or thumb forceps
may have teeth, serrations, or may be smooth and vary greatly in leagth tissue forceps
Adson(w/&w/o teeth), Ferris-Smith, DeBakey, Brown, Russian, Gerald(w&w/o teeth), & cushing bayonet forceps Ex. of tissue forceps
Allis, Babcock, and Kocher (Ochsner) Ratcheted grasping/holding instruments
larger bone-holding forceps hae working ends that are designed to either encircle a large or medium bone or firmly grasp and hold it Lane, Kern, Lowman, & Lewin
typically ratcheted and are designed to hold a bone in place for eventual pinning or plating Bone-holding Clamps
tips may be pointed or rounded, jaws may be horizontal, longitudinal, or cross-hatched for better traction on tissue clamping/occulding instruments
atramatic serrations that run along the length of the jaws and permit the partial or total occlusion of vessels w/o damage to the delicate tissue vascular clamps
constructed with long, flexible jaws for increased vessel protection during occlusion. vascular clamps
protect the vessel with disposable, protective plastic inserts that are placed on each jaw Fogarty Hydro-grip
small, spring-loaded devices with atraumatic serrations; does not have finger rings or ratchets Bulldog vascular clamps
typically curved; designed to occlude bleeding vessels until they can be ligated hemostatic clamps
frequently utilized for "tagging" sutures; "tagging" is performed when a suture strand is not immediately cut straight hemostats
Neurosurgical sponges patties/cottonids; protects delicate neural tissue; assist with hemostasis; radiopaque string; assembled 10 per package
Kitner sponges small rolls of cotton tape; dissecting sponges; used in blunt dissection; always loaded on a clamp, Pean; assembled in packages of 5; 1 loaded & 4 in the carrier
Peanut sponges small guaze sponges
Surgical sponges used to absorb blood & tissue fluids; blunt dissection of tissue & protect important structures during procedure; soft & lint free; contains radiopaque strip; counted for most procedures
Tonsil sponges cotton; filled guaze w/string attached; loaded & past on instrument; assembled 5 per package
Radiopaque AKA Ratec sponges 4x4 smaller and less absorbant; for smaller insicions; used for sponge stick; assembled 10 per package; removed from operative field & placed with lap sponges as peritoneum is entered
Laparotomy sponges AKA Laps; Tapes; Packs largest/most absorbant; typically moistened w/saline & used as "pads" to protect retracted viscera; assembled 5 per pack
Reasons for Surgical dressings protect wound from trauma; protect from microbial contamination; absorb drainage & secretion; support incision; provid pressure to reduce/eliminate dead space; reduce or prevent edema
Reasons for Surgical dressings assist in maintaing hemostasis; prevent hematoma formation; conceal wound aesthetically; maintain environment that allows for preservation of new epithileal tissue & destruction of microbes
In OR; dressing application is cosidered final step, it must be done sterily preferably under anesthesia
Dressing sponges do not contain radiopaque they are to remain in their original package; not provided to the sterile field until the final count is complete
Dressing applied is determined by several factors: type, size, & location of wound; amount of drainge expected; surgeon preference; age & size of pt.; underlying medical conditions; condition of surrounding skin; comfort of pt.
Dry sterile dressings are most often applied to closed surgical wounds. Antiseptic/Anitbiotic ointment may be applied, prior.
choledochoscope for exploration of the billiary bladder
mediastinoscope for visualization and biopsy of the structures of the mediastinum
angioscope for visualization of the heart and mahor vessels, or vascular endoscopes for the interior of smaller vessels
ventriculoscope for exploraion of the brain's ventricular system
fetoscope for visualization of a fetus in utero
stockinette used prior to splint or cast application
tube guaze used on a digit
montgomery straps used in situations that may require frequent wound inspections or dressing changes
pressure dressing type of three layer dressing to which additionsl material is added to the intermediate layer or one that is tightly secured to cause compression of the surgical wound
tissue compression; a type of pressure dressing influences wound healing dynamics and may promote wound healing ; however too tightly may cause neurovascular compromise
pressure dressing may serve as one or more of the following immobilization of an area; support; absorbtion of excessive dainage; even pressure distribution; elimination of dead space; reduced edema; reduced hematoma formation
Bulky dressing is a type of three layer dressing added to the intermidiate layer; used to immobilize an area; provide additional support to the wound; or absorb excessive drainage
rigid dressings cast & splints applied following a closed tramatic injury or surgery to provide support &/or to prevent movement; made of plaster or a lightwight synthetic such as fiberglass
splints (rigid dressing) may be molded plastic or a metal
splints (rigid dressing) applied to one side of a structure to provide support & prevent unidirectional movement
cast (rigid dressing) encircles (encases) a body part to provide support or prevent any type of movement
cast (rigid dressing) incorproates the joint(s) proximal &/or distal to the affected area; most widely used type of cast is the cylindrical cast, applied to extremities
body jacket (rigid dressing) extends from the axillae to the hips to immobilize the lower thoracic and lumbar vertebrae
Walking cast (rigid dressing) lower extremity that has a polyurethane sole or rubber heel added to allow for ambulation
Spica cast (rigid dressing) secured to the torso to support the hip or shoulder in the desired position
Minerva Jacket (rigid dressig) extends from the head (incorporating the mandible while exposing the face) to the hips to immobilize the cervical and upper thoracic vertebrae
specialty dressings designed for specific applications or uses, Ex. bolster dressing; wet-to-dry; wet-to-wet; thyroid collar; ostomy bag; drain dressing; tracheotomy; eye pads; eye sheilds; & perineal pads
Bolster dressing (specialty dressing) sutured into position AKA stent dressing or tie-over dressing; often placed over a skin graft recipient site to apply even pressure & prevent fluid from accumulating under the graft.
wet-to-dry (specialty dressing) wet gauze (normal saline, antibiotic solution), applied to wound and allowed to dry, then removed along with adhered tissues, often performed on burned wounds
wet-to-wet (specialty dressing) wet gauze is applied to the wound & is changed before its dried; provides minimum wound debridement & less pain
thryroid collar (specialty dressing) Queen Ann's collar; circumferential neck wrap applied to secure dressing over a thyroid incision
ostomy bag (specialty dressing) applied over an intestinal stoma to contain excretions; bag is attached to patients skin with in an adhesive that is incorporated around the edges of the bag
drain dressing (specailty dressing) gauze sponge (sof-wick drain sponge) manufactured fashioned with scissors to accomodate aa wound that contains a drain
tracheotomy dressing (specialty dressing) drain dressing placed around a trach tube, tube is secured with wide umbilical tape or velcro fastners that is tied around the patients neck
eye pad (specialty dressing) oval shaped gauze applied over the eye lid to retain medication & keep lid closed
eye sheild (specialty dressing) rigid oval sheild applied over the eye pad to protect the eye from pressure/trauma
perineal (peri) pad (specialty dressing) used to absorb vaginal or perineal drainage (sanitary napkin)
packing material material used to assist with hemostasis, provide pressure, support a wound &/or eliminate dead space; may be placed in the nose, rectum, vagina, or in an open wound
packing material typically a long strip of gauze (1yd, 5ft, 8ft)variety of widths (1/4, 1/2, 1in.) plain (NuGauze packing strip) impregnated with antiseptic (NuGauze packing strip w/iodoform 5%) or contain a radiopaque marker
drapes maybe woven, nonwoven, or plastic used to isolate & protect the operative site from contaminates; when properly used they serve as a barrier that eliminates the migratin of miccroorganisms from nonsterile areas to the sterile field
effective drape materials should be lint free; fluid resistant: to prevent strike-through contaminate; antistatic: prevents sparking that could ignite; tear & puncture resistant; free of toxic residue; flame retardant; nonreflective color
One Layer Dressing: used to cover sm. incision w/min. drainage; frequently used to cover the site of intravenous access; consists of polyurthane film w/adhesive backing op-site & bioclusive (brand names); liquid collodion (bandage) flammable; aerosol adhesive sprays, foams, gels, hydrocolloids & skin closure tapes, skin closure tapes maintain approximation of wound edges (can be used alone or combined)
Three Layer Dressing: used to cover any size incision w/expected drainage consist of inner (contact) layer, AKA primary layer; intermeidate (absorbant) layer, AKA secondary layer; outer (securing) layer, AKA tertiary layer
3 layer dressing: inner, contact, primary layer covers wound completely & remains in direct contact wicking action of contact layer allows pasage of drainage or secetions away from healing wound into the absorbant (intermediate, secondary) layer
3 layer dressing: intermediate, absorbant, secondary layer placed over contact layer, absorbs any drainage or secretion; thickness varies. ex include 2x2 & 4x4 gauze sponges (topper, sof-wick) fluffed gauze sponges (kerlix) abdominal pad (aka ABD pad)
3 layer dressing: outer, securing, tertiary layer used to secure the contact and absorbant layer in place
options for securing a dressing tape (paper, silk, adhesive) most frequently used; wrap: (elastic bandage) Ace: adhesive crinkled gauze, Coban: rolled gauze, Kling: fluffed rolled gauze, Kerlix-used to secure a dressing or a splint to an extremity, provides pressure & support
options for securing a dressing Kerlix-conforms to body contours, or secure a thoracic dressing while allowing for movement of the chest wall during respiration
options for securing a dressing the wrap (rolled cotton sheeting, Webril) may contain a self-adhesive (velcro) or may be secured with tape, may be supplied as padding under a cast. Neurovascular damage may result if a wrap is too tight.
bone marrow trocar introduced through cortical bone may be used to obtain bone marrow
syringe tip may be plain (leur-slip) needles simply slpip over syringe tip or locking (leur-lok), locks needle onto syringe with a twisting motion
air way tubes maintain patency of the upper respiratory tract: ET tube; Oral airway; Nasal airway; Tracheotomy tube
Endotracheal tube adult/pediatric, cuffed/uncuffed styles, passed through the nose or mouth, between the vocal cords into the trachea
Oral airway separate the jaws and depress the tongue
Nasal airway inserted through the nose to prevent obstruction of the airway due to relaxation of the soft palate; reffered to as nasal trumpet because of its shape
Tracheotomy tube placed directly into the trachea via an incision in the neck, has 3 components (1) outer cannula (2) inner cannula, & (3) obturator
Poole suction allows for rapid aspiration usually irrigation fluid w/o interference from viscera
microinstrumentation typically made of titaneum due to weight and strength; arachnoid knife, delicate with an angeled tip frequently used for neurosurgery
retractors-instruments designed for the exposure of the operating site hand held or self retaining; variety of sizes; double ended; used in pairs on opposite sides
self retaining, interchangable blades: retractors for brain or abd procedures may attach to OR table for better stabilization Bookwalter; O'Conner-O'Sullivan; Balfour
wide & dull retractors for abd & thoracic organs
sharp rake like retractors for nonvital structures (skin, fat)
single/double hook-retractors retracts skin during plastic proccedures
flat malleable made of low carbon stainless steel or silastic can be bent for various retraction duties Brain spoon is hand-held or self retaining
(1) nonpermeable (occlusive) fine mesh guaze impregnated w/emulsion (vaseline gauze, xeroform gauze); used to create air/water tight seal; nonadherent & allows passage of drainage; may be placed around an exit wound for a schest tybe to prevent air from reentering the pleural space
(2) semipermeable (semi-occulsive) hyrocolloid(exu-derm, Tegasorb); hydrogel(Nu-gel, Aqua-gel); used to create mechanical surface & allow passage for air & fluids; used to debride a wound; may be on a chronic wound such as a burn or becubitis ulcer
Created by: Ernestine Ochoa-Menjivar Ernestine Ochoa-Menjivar on 2012-05-14



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