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chapter 10

instrumentation , equipment and supplies

stainless steal which is the combination of carbon, chromium , iron , and alloys, this combination of metals adds strength to the instrument and resistance to corrosion during repeated sterilization,
knifes and scalpels are often used interchangeably although scalpels typically have a detachable disposable blade and non disposable handles and generally knives have an non disposed handle and blade as a single unit. scalpel handle sizes #3, #4 #7 and #9 . the #3 and #4 standard handles are 5 inches in legnth and the #7 handle is longer . the #3 knife handle is also in a longer handle marked 3l and 4 is too 4l . Blades #10 , #11, #12 , and #15 fit #3, #7, and #9 hand les . blades #20 -25 fit a #4 handle . any beaver blade with fit a beaver blade handle . the most frequently used beaver blade is a #69 blade.
scissors used during a surgical procedure maybe tissue scissors, suture scissors, wire scissors or bandage / dressing scissors, curved mayo scissors , straight mayo scissors , curve metzenbajm and specialized scissors .
grasping / holding instruments are designed to manipulate tissue to facilitate dissection or suturing or to reduce and sterilize fractured bone during internal fixation. these instruments may or may not have a retched locking mechanism. thumb forceps , also refereed to as pickups don't have ratchets and are constructed with a flattened spring handle . thumb forceps are used in the nondomaite hand to grasp and hold tissue when suturing or dissection . adson , Ferris-smith , debakey , brown , Russian, Gerald and cushing bayonet forceps are both with and without teeth and ratcheted instruments are allis , babcok , tenaculum and kosher.
clamping/ occluding instruments are designed to occlude or constrict tissue and are constructed with opposing ring handles for fingers , interlocking ratchets located just blow the ringed handles to lock in place. bone- hold clamping , Backus towel clamp , homeostatic clamps, bulldog vascular clamps
retracting / viewing instruments designed for the exposure of the operative site are called the retracter. retractors may be handheld or self- retaining and are constructed in a variety of sizes.
probing malleable , wirelike instruments for the exploration of a structure. probes are typically found in abdominal , gallbladder , or rectal instrument sets and are often used with guides called grooved directors.
dilating dilators are instruments used to gradually dilate an opening or duct to allow for introdcuton of larger instruments or to open a stricture.
suturing are instruments used to hold a curved needle for suturing called needle holders. needle holders vary in length and maybe fine , regular , or heavy, the choice of needle holder depends on the depth of the wound . type of tissue adn the size of the neddle and suture used . there are jaws , straight needle holder , and curved are called haney needle needle holders. the jaws of a needle holder are designed to prevent the needle from moving during suturing . jaws with tungsten carbide inserts with cross- hatched serrations are usually effective for needle mobilization . like scissors with tungsten carbide inserts with gold handels. most needle holders are constructed as clamps that is designed with ringed handles , ratchets , shanks , box locks and jaws.
suction frazier , baron , yankauer and poole are a few types of suction they can be non disposable or disposable . are instruments that remove blood and body fluids from a body cavity.
torcar is an instrument with a sharp point and cutting edges that allows penetration of a body cavity for the drainage of fluid or the introduction of a endoscope.
mircoinstumentation are instruments that are used to perform microsurgery . when used in conjunction with an operating microscope , allow the manipulation and repair of very small structures and tissue.
instrument care and handling the handing of instruments , like all tasks related to the surgical procedure , has three phases : preoperative, intraoperative , and postoperative tasks. this helps to 1) prevent injury to the patient or surgical team members, 2) extend the life of the instruments and 3) allow the instruments to perform correctly and consistently.
types of instruments sets instruments are typically assembled in sets, sterilized , and stored for later use. the instruments within each type of set are standardized according to the type of procedure for which they will be used and the needs of the facility.
laparotomy set is general used in abdominal procedures typically required for major and minor laparotomy set procedures. laparoscopic sets, used with increasing frequency for abdominal procedures, are equipped with one set of basic laparoscopic instruments & electrosurgical cords that can be stem sterilized and another set that has the camera light cord, insufflator hose, and laparoscopy that must be sterilized via an alternative method.
monopolar cautery Monopolar electrosurgery can be used for several modalities including cut, blend, desiccation, and fulguration. Using a pencil instrument, the active electrode is placed in the entry site and can be used to cut tissue and coagulate bleeding
bipolar electrosurgery uses lower voltages so less energy is required. Electrosurgical current in the patient is restricted to just the tissue between the arms of the forceps electrode.
powered instruments these are instruments used in the OR that are powered by air, nitrogen, electricity, or battery. its very important to pass powered instruments with the safety switch in off position . this prevents the instrument from being accidentally activated and causing injury to the surgical team or the patient.
microscopes the compound operating microscope is a binocular apparatus that uses bent light wave for variable magnification of tissue during microsurgery.
magnification the optical lens system provides the magnification and resolving of the microscopic power necessary to do the surgical work. focal length of the objective lens ranges from 100 to 400 mm.
resolving power of the microscope the resolving power of an objective lens is measured by its ability to differentiate two lines or points in an object. The greater the resolving power, the smaller the minimum distance between two lines or points that can still be distinguished.
coaxial illuminators use fiber optics to transmit light waves through the microscope's optic system.
paraxial illuminators contains tungsten or halogen bulbs and focusing lenses mounted to the body of the microscope.
video monitors , recorders and cameras these are used so the procedure can be viewed on a video monitor and recorded for doctomantion . the stills from the camera can be used for later study.
fiber-optic headlamps and other light sources this is to illuminate the interior of the body during endoscopic procedures .
pulse lavage irrigator is utilized to thoroughly irrigate a traumatic , infected or surgical wound. also is used to clean and debride surgical wounds.
phacoemulsifier and irrigation / aspiration units. a machine that uses ultrasonic energy to fragment the lens and I/A or irrigator / aspirator to remove the fragments.
cryotherapy is a unit that uses liquid nitrogen , freon, or carbon dioxide gas to devliever extreme cold through an insulated prove to disease tissue , creating necrosis without damaging the adjacent tissue.
insufflator is the machine that infuses the co2 gas into the abdominal cavity.
insufflation is the expansion of the abdominal cavity with co2 gas
nerve stimulators produce very small electrical currents that, when applied to tissue , help to identify and preserve essential nerver for cranial , facial , neck or hand reconstructive producers.
sunction systems suction apparatus utilizes a vacuum to remove fluids from the surgical site and patient's airway. vacuum source: may be portable or centralized. vacuum source tubing : connects the vacuum source with the collection unit , collection unit : maybe reusable or a disposable liner, tubing : connects the collection unit to the suction tip and the suction tip : removes the fluid from the source .
pneumatic tourniquets is necessary during some procedures on the extremities to restrict blood flow to the surgical site. the two main purposes of this tourniquet is 1) the amount of blood lost by the patient is minimized . 2) violation of the surgical site for the sterile site for the sterile team members is improved.
penatic tourniquets consist of cuff , tubing and a power source
tourniquet application 1) all equipment is checked for accuracy , function , integrity and cleanliness. 2) preset the pressure according to the physician's orders, 3) padding , such as stockinette or rolled cotton sheeting , is applied circumferentially to the patient's skin, 4) the appropriate cuff is snugly applied and secured over the padding , 5) the tubing is connected securely to the cuff, 6) if necessary a protective covering is applied to the cuff. 7) the patient is prepped and draped , 8) the extremely is exsanguinated with the use of gravity and or, an esmarch bandage, 9) the tourniquet inflated to the correct pressure and the timmer started. 10) the tourniquet is deflated and the tine is noted and 11) everything is documented.
SCD or sequential compression devices consists of a compressor that is electrically operated , connecting tubing, and one or more sleeves that enclose that patients limbs.
drapes are used by the surgical team to serve as a barrier to isolate and protect the operative site from contaminants and microbes that can cause SSI .
fenestration drapes Drape sheet that has an opening that is placed to expose the anatomic area where the incision will be made.
incise drapes have a adhesive backing that maybe impregnated with an antimicrobial iodine agent that is slowly released after application to destroy bacira from patient's skin during the procedure.
aperture drapes are smaller , clear plastic drapes with openings that our surrounding by an adhesive backing . normally used in eye and ear procedures.
transverse fenestrated drapes is a drape that is used to expose the transverse incisions of the surgical site.
non fenestrated sheets are for minor surgical or therapeutic procedures, create a sterile field around the wound site with sterile towel drapes. Multi-layered and poly-lined for added strength.
stockinettes are stretchable gauze tubes to cover limbs .
cottonoids are neurological sponges also referred to as patties.
composite skin graft is a small graft containing skin and underlying cartilage or other tissue. Donor sites include, for example, ear skin and cartilage to reconstruct nasal alar rim defects.
the three layer dressing is used to cover any size incision from which drainage ,is expected. the contact layer will be on of the three types with these preporses occlusive nonocclusive and semi occlusive.
catheters tubes , and drains are available to serve any patient care functions. there are different types there are foley, pesser and malecot .
suprapubic catheter is placed into the bladder through a surgical opening in the abdominal wall..
cutting / dissecting are instruments with one or more sharp edges that are used for incision, sharp dissection , or excision of tissue are classified as cutting / dissection instruments. include knives, scalpels , scissors, and bone-cutting instruments , saws drills biopsy punches, adenotmes, and dermatomes . note that tome means cutting so anything with the suffix is a instrument that cuts bone and tissue.
Created by: mlester451



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