Question | Answer |
What are instruments made of? | Stainless steel, high in carbon to harden and less likely to wear, and chromium which is more corrosive resistant |
Three types of instrument finishes? | Polish mirror finish- have more chromium, but alot of glare
Stain or dull finish- more common in OR bc of less glare
Ebonized (black chromium)- no reflective, used in laser cases |
Name the parts of an instrument | shank-Area b
ratchets, finger rings |
Jaws | hold tissue securely, serrated, some have carbide insert that is replaceable, working end of instrument. |
box lock | joins the 2 halves of the instrument and allows the opening and closing. Maybe the a "screw joint" |
Shank | -Area between box lock and finger ring.
-Gives instrument leverage
-Should be balance on both ends
-Length is appropriate to wound depth |
Ratchets | Keep instrument "locked shut: when the instrument is closed on tissue or object that is being grasped. |
What ratchet do instruments need to be on when on the Mayo stand?? | the 1st ratchet |
Finger rings | Provide for ease of holding and manipulating instrument |
What are the 9 categories of instruments? | 1. Cutting and Dissecting
2. Grasping
3. Clamping
4. Retracting
5. Probing
6. Dilating
7. Needle holders
8. Suction
9. Accessories |
Mayo Scissors | Cutting and dissecting,
2 types: curved, used for heavier tissue. Straight, or suture, used for delicate tissue cuts sutures and drapes |
Metz scissors | Cutting and dissecting,
Used to delicate tissue |
Jorgenson | Cutting and dissecting
used for hysterectomies and OBGYN surgeries |
Potts Smith | Cutting and dissecting'used on delicate procedures |
what knife blades can be used on a #3 knife handle? | #10,#11, #12, #15 (used for superficial procedures) |
What is the most common blade for skin? | #10 |
What knife blades will fit a #4 knife handle? | Only a #20, used deeper in the body |
Rongeurs | Cutting and Dissecting, Cut and extract tissue, tips are cupped, very sharp, used for orthopedic and neurosurgery |
Beaver blade | used for ear and eye procedures |
Forceps | Grasping and holding, holds tissue in place,
Ex. Adson and tissue forceps |
Kocher | Biting clamp, Grasping and holding used on hysterectomies |
Tenaculum | Grasping and holding, penetrates tissue like the cervix, holds tissue |
Debakey | Grasping and holding, tissue forceps that are used on delicate tissue inside the body |
Babcock | Clamping and occluding, Atraumatic clamp that is meant to surround or clasp. Used on bowel or Fallopian tube, non crushing |
Hemostat | Clamping and occluding, Occluding clamp that stops blood flow |
Murphy rake | retracting and viewing, 4 or 3 prong, can be sharp or dull(rounded) |
Self retaining retractor | retracting and viewing, better visualization, can be sharp or dull |
Richardson | Retracting and viewing |
Probing | Detects and obstruction or follows a hollow tract. used to enter a lumen that occurs naturally. Urethra or anus is a natural lumen |
Dilating | Widen or stretch the inside of lumen, allows for larger instruments to enter.Used to increase the diameter of a lumen, cervix in gyny surgery,
Ex. Cervix, urethral, esophgeal |
Suturing | Needle-holder fine, regular or heavy.
Grasp needle
Place or remove blade on scalpel |
Suctioning | Removal of blood and fluids from surgical site |
3 types of suctioning | Yankauer-all purpose
Frazier-primarily orthopedic, neurologic surgery
Poole-Primarily abdominal and thoracic surgery |
Suctioning | Removal of blood and fluids from surgical site |
3 types of suctioning | Yankauer-all purpose
Frazier-primarily orthopedic, neurologic surgery
Poole-Primarily abdominal and thoracic surgery |
What are two types of accessories | Towel clips and ring forceps |
How do you handle instruments? | -handle gently
-do Not throw them into basins
-Protect cutting surfaces
-Do NOT soak or rinse in saline
-Keep them wiped off during a case
-Use the correct instrument |
What causes instruments have a reduced life? | -Most damage is caused by improper cleaning and processing, and handling |
Who does the "counts" before and after the procedure? | Scrub or circulator |
What to do when dismantling instruments. | -Check drapes, towels, and table covers
-Collect instruments from Mayo stand
-Separate delicate, small instruments
-Disassemble all instruments
-Open all hinged instruments
-Separate instruments of dissimilar metals |
Dismantling cont.. | -Flush cold distilled water through hollow instruments
-Rinse off blood and debris |
What to remember! | Handle loose instruments seperately to prevent interlocking or crushing
-Keep ring-handled instruments together
-inspect/sort instruments
-leave retractors and other heavy instruments in the tray
-Protect sharp blades, edges and tips |
Richardson Retractor | -Specialty: General
-Usually comes in pairs
-Retracting/Exposing |
Parker Retractor | -Specialty: General
-Retracting/Exposing |
Army-Navy retractor | -Specialty: GEN
-Retracting/Exposing |
Senn Rake Retractor | -can be Sharpe/Dull
-Specialty: General/Plastics
-Retracting/Exposing |
Vein retractor | instrument ending in a rounded flange set transversely for engaging and retracting soft tissues. |
Poole suction | -Specialty: General/Thoracic
-Suctioning
-primarily abdominal region |
Metz scissors (2 types) | -Comes curved or straight.
-Most often curved.
-Also can come as Thyroid Metz (small), Regular Metz, and Extra long Metz.
-Used to dissect delicate tissue.
-Usually called "Metz"
-Specialty: General
-Cutting |
Mayo scissors (2 types) | -Curved are used for dissection.
-Straight for cutting suture.
-All specialties.
-Cutting |
Bandage or trauma scissors | -Lister Bandage Scissors
-General utility scissors used in
-most specialties.
-Cutting
-Not used on tissue |
Debakey Forceps | -Used on delicate tissue.
-Specialty: General
-Grasping |
Adson forceps w/ teeth | -frequently used
to close the skin when using suture
or for everting skin edges for staple placement.
-Specialty: General/Plastics
-Grasping/Holding
-Always hand to surgeon after suture |
-Toothed Thumb Forcep | -Specialty: General/GYN
-Grasping/Holding
- commonly held between the thumb and two or three fingers of one hand |
Smooth Thumb Forceps | -Specialty: General/GYN
-Grasping/Holding |
Crilewood Needle Holder | -Specialty: Small Gen and Plastics
-Suturing |
Mayo Heager Needle Holder | -All specialties
-Suturing |
Heaney Needle Holder | -Specialty: GYN
-Always load the needle with the curve of the needle holder pointing away from the tip of the needle.
-Suturing |
Forester Sponge Stick
Also known as a ring forcep. | -It doesn't become a sponge stick
until the sponge is put on it.
-Specialty: General/GYN |
Kelly Clamp | -Used in all specialties
-Also known as a pean (pee-on)
-Clamping/Occluding |
Allis Clamp | -Specialty: General
-Grasping/Holding |
Allis-Adair Clamp | -Looks like an Allis but with a wider tip and more teeth.
-Specialty: GYN
-Grasping/Holding |
Babcock | Babcock
Specialty: Gen/GYN
-Autraumatic clamp most often used delicate tissue such as the bowel and fallopian tubes.
-Grasping/Holding |
Kocher clamp | Kocher Clamp
-Multiple specialties
-Grasping/Holding/Clamping |
Bachaus Towel Clip | -Used for holding towel drapes in all specialties.
-Grasping/Holding
-Can be used to grasp bone,myomas or skin when placing the verres needle. |
Russian Forceps | -Specialty: GYN
-Grasping/Holding |
What is the Electrosurgical Unit? | -Application of heat speeds up the natural chemical reaction of blood to stop clotting.
-Electric current can be used to cut or coagulate most tissues. |
Components of the ESU | Generator, Active electrodes, and Inactive dispersive electrode |
Generator | -Machine that produces the power for the "active electrode" to coagulate or cut tissue. |
Active electrode | sterile handpiece that directs the flow of current to the operative site.
-activated by surgeon
-can have hand or foot switch |
Inactive Disperive electrode | -known as the "grounding pad"
-disperses the current released through the active electrode and provides a return from the tissues back to the generator.
-plugged into generator "Bovie machine"
-never place on metal implants |
Two types of ESU | Monopolar and Bipolar Unit |
Monopolar Unit | The current flows from generator to active electrode, through the patient to an inactive dispersive electrode, and then back to the generator.
-HAS "grounding pad" |
Bipolar Unit | Alows current to flow only b/w the tips of the active electrode and returns to the generator.
-Does NOT have a "grounding pad" |
Endoscopic Units | -Used for diagnosis, biopsy, visualization or repair.
-used through an existing body opening (urethra)
-may be rigid(not flexible) or flexible (bendable) |
Flexible Endoscope | -Needs light and air source
-has accessory items such as biopsy forceps, brushes, and polyp snares |
Rigid scopes | -Need "lap tower"
needs light source, light cable, monitor, video recorder,insufflator, and instruments |
Insufflator | taking of a veress needle and putting it in the belly button and attach CO2 to inflates the belly and brings organs down |
Operating microscopes | -Used for microsurgery
-Ex. neurosurgery and eye surgery
-Has objective lens and Ocular lens |
3 types of power surgical saws | Rotary- Used to drill holes or insert screws, wires, or pins
Reciprocating- a cutting action from front to back/back and forth
Oscillating- a cutting action from side to side
All three may be powered by battery, nitrogen, or compressed air |
Pneumatic Tourniquet | -Used on extremities to restrict blood flow
-Everyone in the OR should be aware what time this is turned on
-Used for a maximum of 1-1.5 hours
-If on too long, could cause tissue or nerve damage |
What is the purpose of drapes? | -Isolate and protect the surgical site
-Barrier against contaminates
-Fluid, tear and flame retardant
-Disposable or non-disposable |
Types of drapes | -Fenestrated- has opening, laparotomy
-nonfenestrated- "square drape" split sheet or U-drape -extremities
-Stockinette- rolls up and goes around legs, used for leg surgery, cut already in it,sticky
-Incise- sticky & have antimicrobial, accordion like |
Types of sponges | lap sponges, radiopaque sponges 4x4's Kitners and peanuts, tonsil sponges, and cottnoids |
Laparotomy sponges | -Most absorbant
-5 per package
- If the count in a pack is off, the STSR must open a new pack and the old one must be discarded |
Radiopaque 4x4's | -Smaller, less absorbent
-"Raytec sponges," shows up on x-rays
-10 per pack |
Kitners and Peanuts | -Dissecting sponges
Peanuts
-rolled up sponges used for fluid absorption on the tip of an instrument
-radiopaque
-put into its own container when don using
Kitner- small roll of cotton tape, not sticky |
Tonsil sponges | -Cotton filled with strings
-used for tonsillectomy
-5 per package |
Cottonoids | -10 per package
-neurosurgical patties
-protect delicate neural tissue
-Radiopaque with string
-need to be moistened with saline
-used on brain and spinal procedures
-saline prevents sticking |
What is the purpose of dressings? | -To prevent the wound from trauma/contamination
-Absorb drainage
-Support incision
-Provide pressure
-Conceal wound |
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