Surg tools and equip
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| What are instruments made of? | Stainless steel, high in carbon to harden and less likely to wear, and chromium which is more corrosive resistant
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| 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
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| Name the parts of an instrument |
shank-Area b
ratchets, finger rings
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| Jaws | hold tissue securely, serrated, some have carbide insert that is replaceable, working end of instrument.
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| box lock |
joins the 2 halves of the instrument and allows the opening and closing. Maybe the a "screw joint"
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| Shank | -Area between box lock and finger ring.
-Gives instrument leverage
-Should be balance on both ends
-Length is appropriate to wound depth
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| Ratchets | Keep instrument "locked shut: when the instrument is closed on tissue or object that is being grasped.
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| What ratchet do instruments need to be on when on the Mayo stand?? | the 1st ratchet
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| Finger rings | Provide for ease of holding and manipulating instrument
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| 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
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| Mayo Scissors | Cutting and dissecting,
2 types: curved, used for heavier tissue. Straight, or suture, used for delicate tissue cuts sutures and drapes
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| Metz scissors | Cutting and dissecting,
Used to delicate tissue
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| Jorgenson | Cutting and dissecting
used for hysterectomies and OBGYN surgeries
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| Potts Smith | Cutting and dissecting'used on delicate procedures
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| what knife blades can be used on a #3 knife handle? | #10,#11, #12, #15 (used for superficial procedures)
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| What is the most common blade for skin? | #10
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| What knife blades will fit a #4 knife handle? | Only a #20, used deeper in the body
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| Rongeurs | Cutting and Dissecting, Cut and extract tissue, tips are cupped, very sharp, used for orthopedic and neurosurgery
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| Beaver blade | used for ear and eye procedures
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| Forceps | Grasping and holding, holds tissue in place,
Ex. Adson and tissue forceps
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| Kocher | Biting clamp, Grasping and holding used on hysterectomies
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| Tenaculum | Grasping and holding, penetrates tissue like the cervix, holds tissue
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| Debakey | Grasping and holding, tissue forceps that are used on delicate tissue inside the body
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| Babcock | Clamping and occluding, Atraumatic clamp that is meant to surround or clasp. Used on bowel or Fallopian tube, non crushing
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| Hemostat | Clamping and occluding, Occluding clamp that stops blood flow
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| Murphy rake | retracting and viewing, 4 or 3 prong, can be sharp or dull(rounded)
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| Self retaining retractor | retracting and viewing, better visualization, can be sharp or dull
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| Richardson | Retracting and viewing
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| Probing | Detects and obstruction or follows a hollow tract. used to enter a lumen that occurs naturally. Urethra or anus is a natural lumen
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| 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
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| Suturing | Needle-holder fine, regular or heavy.
Grasp needle
Place or remove blade on scalpel
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| Suctioning | Removal of blood and fluids from surgical site
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| 3 types of suctioning | Yankauer-all purpose
Frazier-primarily orthopedic, neurologic surgery
Poole-Primarily abdominal and thoracic surgery
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| Suctioning | Removal of blood and fluids from surgical site
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| 3 types of suctioning | Yankauer-all purpose
Frazier-primarily orthopedic, neurologic surgery
Poole-Primarily abdominal and thoracic surgery
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| What are two types of accessories | Towel clips and ring forceps
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| 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
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| What causes instruments have a reduced life? | -Most damage is caused by improper cleaning and processing, and handling
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| Who does the "counts" before and after the procedure? | Scrub or circulator
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| 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
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| Dismantling cont.. | -Flush cold distilled water through hollow instruments
-Rinse off blood and debris
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| 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
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| Richardson Retractor |
-Specialty: General
-Usually comes in pairs
-Retracting/Exposing
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| Parker Retractor | -Specialty: General
-Retracting/Exposing
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| Army-Navy retractor | -Specialty: GEN
-Retracting/Exposing
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| Senn Rake Retractor | -can be Sharpe/Dull
-Specialty: General/Plastics
-Retracting/Exposing
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| Vein retractor | instrument ending in a rounded flange set transversely for engaging and retracting soft tissues.
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| Poole suction | -Specialty: General/Thoracic
-Suctioning
-primarily abdominal region
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| 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
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| Mayo scissors (2 types) | -Curved are used for dissection.
-Straight for cutting suture.
-All specialties.
-Cutting
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| Bandage or trauma scissors | -Lister Bandage Scissors
-General utility scissors used in
-most specialties.
-Cutting
-Not used on tissue
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| Debakey Forceps | -Used on delicate tissue.
-Specialty: General
-Grasping
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| 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
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| -Toothed Thumb Forcep | -Specialty: General/GYN
-Grasping/Holding
- commonly held between the thumb and two or three fingers of one hand
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| Smooth Thumb Forceps | -Specialty: General/GYN
-Grasping/Holding
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| Crilewood Needle Holder | -Specialty: Small Gen and Plastics
-Suturing
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| Mayo Heager Needle Holder | -All specialties
-Suturing
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| 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
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| 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
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| Kelly Clamp | -Used in all specialties
-Also known as a pean (pee-on)
-Clamping/Occluding
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| Allis Clamp | -Specialty: General
-Grasping/Holding
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| Allis-Adair Clamp | -Looks like an Allis but with a wider tip and more teeth.
-Specialty: GYN
-Grasping/Holding
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| Babcock | Babcock
Specialty: Gen/GYN
-Autraumatic clamp most often used delicate tissue such as the bowel and fallopian tubes.
-Grasping/Holding
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| Kocher clamp | Kocher Clamp
-Multiple specialties
-Grasping/Holding/Clamping
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| 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.
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| Russian Forceps | -Specialty: GYN
-Grasping/Holding
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| 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.
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| Components of the ESU | Generator, Active electrodes, and Inactive dispersive electrode
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| Generator | -Machine that produces the power for the "active electrode" to coagulate or cut tissue.
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| Active electrode | sterile handpiece that directs the flow of current to the operative site.
-activated by surgeon
-can have hand or foot switch
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| 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
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| Two types of ESU | Monopolar and Bipolar Unit
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| 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"
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| 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"
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| Endoscopic Units | -Used for diagnosis, biopsy, visualization or repair.
-used through an existing body opening (urethra)
-may be rigid(not flexible) or flexible (bendable)
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| Flexible Endoscope | -Needs light and air source
-has accessory items such as biopsy forceps, brushes, and polyp snares
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| Rigid scopes | -Need "lap tower"
needs light source, light cable, monitor, video recorder,insufflator, and instruments
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| Insufflator | taking of a veress needle and putting it in the belly button and attach CO2 to inflates the belly and brings organs down
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| Operating microscopes | -Used for microsurgery
-Ex. neurosurgery and eye surgery
-Has objective lens and Ocular lens
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| 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
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| 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
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| What is the purpose of drapes? | -Isolate and protect the surgical site
-Barrier against contaminates
-Fluid, tear and flame retardant
-Disposable or non-disposable
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| 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
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| Types of sponges | lap sponges, radiopaque sponges 4x4's Kitners and peanuts, tonsil sponges, and cottnoids
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| 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
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| Radiopaque 4x4's | -Smaller, less absorbent
-"Raytec sponges," shows up on x-rays
-10 per pack
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| 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
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| Tonsil sponges | -Cotton filled with strings
-used for tonsillectomy
-5 per package
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| 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
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| 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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