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Ch10 Inst Equip Supp
Instrument Equipment and Supplies
| Questions | Answers |
|---|---|
| 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:
E.Ochoa
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