Transcript Introduction to Surgical INSTRUMENTATION

Introduction to Surgical
INSTRUMENTATION
ST230
Concorde Career College
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Objectives
• Discuss the relationship between
instrumentation, equipment, and supplies and
quality patient care in the OR
• Identify basic instruments by type, function,
classification, and name
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Manufacturing
• Most are stainless steel
– Carbon, chromium, iron, alloys
• High carbon makes instruments harder and less likely to
wear
• Chromium increases resistance to corrosion
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Manufacturing
• Three types of finishing
– Highly polished = increased resistance to
corrosion, but increases glare from OR lights
– Satin (dull) = less reflective, reduces glare
– Ebonized = non-reflective, eliminates glare
• Used for laser procedures because it prevents
reflection of laser beam
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CLASSIFICATIONS
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CUTTING/DISSECTING
GRASPING/HOLDING
CLAMPING/OCCLUDING
RETRACTING/VIEWING
PROBING
DILATING
SUTURING
SUCTIONING
ACCESSARY INSTRUMENTS
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CUTTING/DISSECTING
• One or more sharp edges
– Used for incision, sharp dissection, or excision of
tissue
– Include knives, scalpels, scissors, and bone cutting
instruments – osteotomes, curettes, chisels,
gouges, and rongeurs
– May be classified as cutting instruments – saws,
drills, biopsy punches, adenotomes, and
dermatomes
– -tome – refers to a cutting instrument
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CUTTING/DISSECTING
• The term knife and scalpel are
interchangeable although typically scalpels
have a detachable disposable blade and nondisposable handle and knives refers to nondisposable handle and blade such as an
amputation knife
• Scalpels handles sizes include #3, #4, #7, and
#9; Beaver blade handle
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CUTTING/DISSECTING
• Disposable blades are made from carbon steel
• Blades should be loaded and removed with an
instrument such as a needle holder
• #10, #11, #12, #12B, #15, #15C, #20, #21, #22,
#23, #25
• Blades fit specific handles - #10, #11, #12,
#12B, #15, #15C blades fit #3, #7, #9 handles
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CUTTING/DISSECTING
• #20, #21, #22, #23, #25 blades fit on a #4 knife handle
• Any size Beaver blade will fit on a Beaver blade handle
• #10 blades are the most frequently used blades and
should be loaded on a #3 knife handle; do not load
#10’s on a #7 knife handle
• #11, #12, #15 blades are loaded on a #7 knife handle,
although a #15 blade is used on a #3 knife handle for
small skin incisions
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CUTTING/DISSECTING
• Blades become dull very quickly. 2 or 3 cuts usually
dulls the blade
• The blades have to be changed as needed
• For safety reasons, if the blade has been changed, the
surgeon should be informed that it is a new blade
when passing it
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CUTTING/DISSECTING
• Scissors
– Tissue scissors, suture scissors, wire scissors, or
bandage scissors
– Tissue scissors should only be used to cut tissue
because others materials will dull them; an
exception would be CV surgeons, they use Metz to
cut the small sutures
– Wire scissors are used to cut wire
– Bandage and straight mayo scissors can be used
on dressings
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Cutting and Dissecting
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CUTTING/DISSECTING
• In addition to cutting tissue (sharp dissection),
scissors are also used to spread and open
tissue planes (dull dissection)
• Curved mayo scissors are used on heavy tissue
• Metz are used on medium to fine tissue
• Iris, tenotomy, and Potts-smith scissors are
used on delicate tissues
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CUTTING/DISSECTING
• Examples of specialized scissors
– Potts-smith – ducts, veins, or arteries
– Cushing - dura
– Jorgenson – hysterectomy
– Strabismus, Iris, corneal scissors – eyes
• Scissors have straight and curved blades and
sharp or dull tips
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GRASPING/HOLDING
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Used to grasp or hold tissue for counter traction or manipulation
Forceps – aka pickups or thumb forceps
Forceps are usually used in the non-dominate hand
Forceps have either teeth, serrations or smooth; Vary in length
Adson – smooth, with teeth, or Brown tips; primarily used for skin
closure
Ferris-Smith – used for heavy tissue
Brown, Russian, Gerald, Cushing, bayonet, rat tooth
Allis, Babcock, Kocher - clamps
Bone-holding clamps – ex; Lane, Kern, Lowen, Lewin
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Grasping/holding
• Designed to manipulate tissue to facilitate
dissection or suturing or to reduce and
stabilize fractured bone during internal
fixation
• Lowman – Turkey claw
• Lane
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CLAMPING/OCCLUDING
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Designed to occlude or restrict tissue
Have ringed handles with interlocking ratchets
Straight or curved, long or short, pointed or round
Vascular clamps have atraumatic serrations that are
vertical
• Bulldog clamps are small spring loaded for temporary
occlusion – vascular
• Hemostats are used to occlude bleeders until they can
be ligated
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Clamping and Occluding
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RETRACTING/VIEWING
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Designed for the exposure of the operative site
May be hand-held or self-retaining
Many sizes and designs; sharp or dull tips
Some retractors are malleable
Many hand-held are double-ended with a variation on
each end and usually are mostly used two at a time
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RETRACTING/VIEWING
• Most commonly used hand-held retractors –
– small wounds - Richardson, Army/Navy, Senn, Ragnell,
• A variety of rakes, skin hooks;
– large wounds – Deaver, Ribbon (malleable), Harrington
• Most common self-retaining retractors
– small wounds – Gelpie, Weitlaner
– large wounds – Balfour, Bookwalter, O’Sullivan-O’Conner
• Many have a variety of attachments
• Some large self-retaining retractors are attached to the
OR table for stabilization
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RETRACTING/VIEWING
• Viewing instruments are more specialized
• Ear speculum; nasal speculum; vaginal
weighted speculum
– vaginal retractors
• Endoscopes are also considered viewing
instruments
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PROBING
• Malleable, wire-like instruments that are used
for exploration of tubular structures
– Fistula probes, lacrimal duct probes, biliary probe,
rectal probes
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DILATING
• Used to gradually dilate a duct or an orifice to
allow introduction of a larger instrument or
open a stricture
• Used from the smallest to largest
– May require lubrication
• Can be single or double ended
– CBD, lacrimal duct, tracheal, urethral, cervical
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SUTURING
• Used to hold a curved needle
– needle holders, needle drivers
• Choosing an appropriately-sized needle holder
depends on the size of the needle
– the length depends on the depth
– can be curved for deep tissue
• Vary by specialty
– General, ophthalmic, plastic, GYN, vascular,
microscopic
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Suctioning
Yankauer Suction
Poole Suction
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SUCTIONING
• For the removal of blood and bodily fluids
• Disposable and non-disposable
• Vary by specialty
– Abdominal, ear, neurosurgery, nasal, rectal
• Some suction devices have the ability to coagulate
• Many different lengths for trachea, esophageal, larynx
– these are not typically used in sterile fashion
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MICROINSTRUMENTATION
• Used for working under the microscope
• Small and delicate
• Must be handled with extra care and precision
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Introduction to Surgical
INSTRUMENTATION
ST230
Concorde Career College
30
Objectives
• Describe different types of specialty sets
• Describe types of instruments included in the
sets
• Describe procedures performed using
specialty sets
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Instrument Sets
• Assembled into sets for specific specialties
• Assembled for specific procedures
– Laparotomy
– Craniotomy
– Cardiovascular
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Specialty Sets
• May contain a count sheet
• Names of instruments may vary by
manufacturer, locality, facility, or surgeon
• Many procedures require more than one set
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Laparotomy Sets
• Abdominal procedures
• May need additional sets for certain
procedures (gallbladder, rectal, etc)
• Can be major or minor
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Major Laparotomy Set
OB/Gyn
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D&C
Abdominal hysterectomy
Vaginal hysterectomy
Laparoscopic procedures
C-section
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Abdominal Hysterectomy Set
D&C Set
ENT
• Myringotomy
• Tympanoplasty
• Tonsils
• Tracheotomy
• Sinuses
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ENT Instruments
Plastics
• Lipo
• Minor plastic
• Major plastic
• Breast Augmentation
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Plastic Instrument Tray
GU
• Kidney procedures may need a major set,
basic vascular set, kidney set, long instrument
set and a thoracotomy set
• Prostate procedures may require several sets
as well
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What are these used for?
Ortho
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Internal fixation sets
External fixation sets
Minor ortho
Major ortho
Total joints
IM rods
Hands
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Synthes ORIF Instruments
Cardiac sets
• CABG- vein harvesting instrumentation,
cannulization for bypass, diethrich scissors,
sternal saw, IMA retractors, surgeon specific
instrumentation
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Thoracic sets
• Used for procedures of the thorax
• Includes instruments to shear and remove ribs
• Thoracoscopy sets differ from thoracotomy
sets
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Peripheral vascular
• Instruments for exposure and repair of vessels
• Aneurysms, Fem-pops, A-V fistulas
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Neuro
• Exposure and repair of the brain, spinal cord,
and peripheral nerves
• Crani sets, lami sets, thrasphenoidal
hypophysectomy sets
• Cloward retractors
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Craniotomy Instruments
Introduction to Surgical
INSTRUMENTATION
ST230
Concorde Career College
52
Objectives
• Discuss the various uses for basic surgical
instrumentation
• Identify some commonly-used instruments
Farris Smith
• VERY traumatic
• Uses- closure of fascia
• Nickname- Big Ugly,
Mother-in-Law
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DEBAKEY
• Atraumatic
• Uses- DELICATE TISSUE
such as BOWEL
• MOST COMMONLY
USED FORCEP IN
GENERAL SURGERY
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HARRINGTON RET
• Blunt edges
• Uses- retracting the
liver
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GREEN RET
• Uses – thyroid ret
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LAHEY RET
• Uses – thyroid ret
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SENN RAKE RET
• Mostly used x 2
• Sharp and dull
• Uses- small incisions
such as hands
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POTTS-SMITH SCISSORS
• Vascular
• Billary tract
explorations
• Extending incisions
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FREER ELEVATOR
• Uses – removing
periosteum from bone
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METZENBAUM SCISSORS
• Uses – for fine or
delicate dissection
• The most commonly
used scissors
• DO NOT USE OR PASS
FOR CUTTING SUTURE
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FRAZIER SUCTION TIP
• Uses – suctioning in
small places
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POOLE SUCTION
• Uses – suctioning
irrigation
• Changed on and off for
laparotomies
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DEAVER RETRACTOR
• DEEP ABDONMINAL
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RICHARDSON
• OPENING AND
CLOSING INCISIONS
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STRIAGHT MAYO SCISSORS
• Uses- cutting suture
• Called “Suture
scissors”
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CURVED MAYO SCISSORS
• Uses- cutting heavy
tissue such as muscle,
fascia, uterus
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OSHNER/KOCHER
• Traumatic
• Uses- heavy tissue
such as fascia or uterus
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Hemostats
• Crile - Big bites of
tissue such as
mesentery
• Kelly – Clamping of
superficial vessels
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BABCOCK
• Atraumatic
• Uses – clamping
delicate tissue such as
bowel, uterine tubes
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ALLIS
• Uses – medium tough
tissue such as skin,
mucusmembranous
tissue
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Adson Tissue Forceps
• Uses – skin, specialty
surgery
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BODY-WALL RET
• Uses – retracting the
abdominal wall
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LAHEY CLAMP
• Very traumatic
• UTERUS
• THYROID
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Passing Instruments
Passing the scalpel
Passing Instruments
Passing the scissors
Passing Instruments
Passing the tissue
forceps
Passing Instruments
Passing the hemostat
Passing Instruments
Hand signal for suture
Passing Instruments
Passing the suture
Instrument Care
• Handled with great care during all phases
– Prevents injury
– Extends the life of the instrument
– Allows instrument to perform correctly
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Instrument Sets
• Assembled into sets for specific specialties
• Assembled into sets for physician
preference (ie: Dr. Smith tubal set)
• Assembled for specific procedures
– Laparotomy
– Craniotomy
– Cardiovascular
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Instrument Sets
• Names vary from one facility to another
– Major tray versus laparotomy tray
– Laparoscopy tray versus Pelviscopy tray
– Ortho tray versus Bone tray
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Instrumentation
Instrument List/Count
Sheet
Instrumentation
Preference Card
Instrumentation
Instrument Care and
Handling
• The Instrument Cycle
– Preoperative Phase
– Intraoperative Phase
– Postoperative Phase