Basic or Instruments

7/31/2019 Basic or Instruments

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Parts of the Surgical Instrument

Functions of the Instrument Parts Finger Ringers: place for the user to place his fingers and grip the

instrument securely

Ratchet allows instrument to be locked in place Shank connects box lock to the finger rings Box lock hinge joint; controls the jaws of the instrument Jaws along with the tip is the working part of the instrument

smooth or serrated or cross-hatched for grasping tissue or suture straight or curved

Tips pointed or round; have teeth or no teeth

Important Tips: To identify and differentiate instruments Look at the tip. Does it have teeth? And what do the teeth look like? Is the jaw smooth or serrated? If the jaw is serrated, do the serrations run horizontally or longitudinally? Do

the serrations run the entire length or halfway through the jaw?


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Cutting and Dissecting Instruments

Blades For cutting the skin , tissue , andblood vessels

For small puncture incisions

Scalpel Handle

Knife Handle

Blade Handle

From Right to Left

# 4 Handle (Skin Knife) To cut skin For # 20 and #21 blades

#3 Handle (Inside Knife)

To cut superficial tissues For #s 10, 11, 12, 15 #7 Handle (Deep Knife) To cut deep, delicate tissues #15 for deep cavities, abdomen,

and chest #13 for tonsils Accepts same blades as #3 #s10, 11, 12, 13, 15

#9 Handle Eye, hand, plastic surgery Accepts #3 and #7 Blades #s10,11,12,13,15

Mayo Scissors Thick shank and heavy blades

Straight Mayo (Cutting Scissors) for cutting sutures only

Curved Mayo (Dissecting Scissors) For cutting or dissecting muscle and

tough or heavy tissues.

Metzenbaum Scissors Most common dissecting scissor Thin shank, curved tips, sharper

than mayo

Uses Cut soft and delicate tissues CS ---- to cut fascia


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MAYOMETZ

Bandage or ListerScissors

To cut or remove dressings andbandages

To cut through clothing or gauze CS to cut the uterus

Iris Scissors Cutting and dissecting fine tissue Eye surgery (ex. iridectomy)

Stitch Scissors Used only with non absorbablesutures

Suture ScissorsOne Point SharpScissors

never used in living clients CMS scissor To cut sutures
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Tenotomy Scissors Same use as iris scissors Double blunt points

Wire Scissors Exclusively to cut wire suture

Single Action Ronguer sharp cut snaped jaws To smooth off or chip out bone

Double Action Ronguer same as above but heavier

Single Action BoneCutter

Used to several small bones Amputations


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Double Action BoneCutter

same use as above but onlyheavier

Gooseneck Ronguer Angular double action ronguer

Bethune Rib Cutter 24 long To cut ribs prior removal

Bone Curette numerous sizes and types of handles

Bone Chisel To cut or smooth bone Single bevel tip


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Osteotome Same use as bone chisel Has double bevel point, same as

knife

Gouge Scooped or curved osteome

Smedburg Hand Drill Widely used

manual drill Minor Orthopedic Procedures

Tyding Tonsil Snare Snip the dissected tonsil from thetonsilar fossa

Hurd Dissector andRetractor (Tonsil)

used with a # knife handle and #12blade to


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Adenoid Curette scrape adenoid tissue usually during T & A

Doyen Rib Stripper Scrape periosteum off of ribsbefore removal

AlexanderPeriosteal Elevator

Heavy elevator used on MajorOrthopedic Surgery

One sharp end and one smallhammer like end.

Matson PeriostealElevator

same general use as Alexander,but with one dull end and one rib stripping end

Free PeriostealElevator

Small elevator used for hand,ENT, and plastic surgery

Double dull ends

Lane PeriostealElevators

Lift periosteal coating on boneprior to cutting or smoothing. Theelevator on top is classified assharp due to shape of its tip, thebottom elevator is a dull elevator


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Grasping and Holding Instruments Grasp and hold tissue, drapes, or sponges

Sponge ForcepsOvum Forceps (OB)

For surgical prepping Control small sponges in cavities For DR Control Bleeding Grasp Spongees Pick up Forceps

Uterine Tennaculum Grasp th e cervix of the uterus

Towel Clip Sizes: 3 and 5 Hold drapes and towels in place If extreme care is not taken, can

puncture the skin

Tonsil Seizing Forceps grab tonsils for dissection open finger ring permits snare

placement w/o removing forceps


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Lane Bone HoldingForceps

Used when 2 small bones arefractured and not aligned

Ex. radius and ulna, tibia and fibula

Lowman BoneHolding Clamp

same use as Lane, manipulation,and realignment

Allis Forceps Available in short and long sizes Firm grasp on tissues to be

excised or removed only (cysts,lipomas, etc)

Judd Allis longer; holdsintestinal tissue

Bobcock Forceps Available in short and long sizes Grasp the appendix and prevent

rupturing from removal Grasp delicate tissue (intestine,

fallopian tube, ovary)

Randall Stone Forceps Remove kidney stones


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General Surgical Hemostats

Most commonly used of all instruments after a surgeon has made an incision Usually called, SNAP, STAT, or CLAMP Primary instrument to stop bleeding from severed blood vessels NEEDED IN A HURRY

Mosquito Forceps(5)

Straight or Curved

Smallest of the Hemostats To clamp small blood vessels Pediatric use (delicate Surgery)

Crile (6)

Straight or Curved

Medium size Normal Adult Surgery Curved Crile Fascia,

subcutaneous, and musculararea

Kelly Forceps (7)

Straight or Curved Looks like PEAN but jaws are

only serrated half way Tip has half serrations Largest size To clamp larger blood vessels or

tissues Curved Kelly for peritoneum

Pean Rochester

Straight or Curved

Looks like Kelly but jaws arefully serrated

Use to clamp large blood vesselsor tissues

For Gastrectomy


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HysterectomyForceps

Hysterectomy (removal of uterus) Other major abdominal surgeries

Kocher Ochsner

Straight or Curved

Grasp heavy tissue Very strong, very traumatic

tissue forcep

Pennington Rectal Surgery Lung Surgery

Right Angle orMixter Forceps

Strong for Hemostasis or graspingin awkward places

Clamping Deeper tissues Grasping a ligature around a curve

blood vessel Hold a peanut

Ex. TAHBSO


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VaginalHysterectomy

Heaney Forcep

Intervaginal Work Short, stout, jaws with one or two

teeth

Carmalt Forcep Large Forcep Allows tissue to be pulled laterally

Buie HemmorhoidClamp

Tooth runs entire length of jaw Gives instant Hemostasis

Doyen IntestinalForcep

Very gentle clamp with a very greatdeal of spring in the jaws Clamped on bowel tissue with

minimal trauma

Lahey Right AngleForcep

lighter version of Carmalt type jawpattern


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Schindt TonsilHemostat

basically just a 7 crile longer used deep in the throat

Kidney PedicleClamp

Kidney Surgery

Forceps To cut or suture tissues

Tissue Forcep(Pick-up w/ teeth)

Grasp tough tissue securely forcontrol during suturing or dissecting

Thumb ForcepDressing Forcep

(Pick up w/o teeth)

To Pick up dressings (4 x 8,etcs) For delicate tissue

Russian TissueForcep

Commonly used in GYN(Hysterectomy)

They have serration up to the tips ,allowing better grasp of tissue withminimum trauma.


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Brown TissueForcep

Fine tissue work Many small teeth

Adson TissueForcep

Has Small teeth close the skin Smooth grasp delicate tissue

Adson BrownTissue Forcep

Combination of Adson ForcepsWITH BROWN TEETH

Fine needle work with many smallteeth

Debakey Forcep Cardiovascular forcep

Often used because of its firm nontraumatic grip

Cushing DressingForcep

7 long good intermediate forcep


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RETRACTING and EXPOSING INSTRUMENTS

Hold back or retract organs or tissue to gain exposure to the operative site

Come in pairs They are either "self-retaining" (stay open on their own) or "manual" (held by hand). When identifying retractors, look at the blade, not the handle

Deaver Major Inter Abdominal Retractor Retract deep abdominal or chest

incisions

Big abdominal procedures

RichardsonRetractor

Single Ended

Double Ended

Small shallow use

Large abdominal cavity; deepabdominal or chest incisions.

Army Navyretractor

(US, US Army)

Retract shallow or superficialincisions

Pediatric clients

Goulet Retract shallow or superficial

incisions .

Malleable orRibbon

retractor

Retract deep wounds. May be bent to various shapes.


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Weitlanerretractor

Self retaining Small for shallow and small

incisions Pediatric Hernias Used to open neck muscles Thyroidectomy

Balfour withBladder Blade

Self retaining 4 Feet, 1 screw, 1 blade Most popular major abdominal

retractor used in all major cases Retract wound edges during deep

abdominal procedures

Senn

Retractor

Manual Double Ended Dull or Sharp Retract superficial tissue For minor surgery like arterio

venous Wrist or antecubital area

Cushing VeinRetractor Vein stripping (varicose veins)

VolkmannRake Retract Skin layers

Green Goiter Thyroidectomy

Langenbeck

Visualization of anal or vaginalarea

Skin Hooks Retract thin skin such as eyelids Eye surgeries

VaginalSpeculum

Pap smear D & C Visualization of Cervix


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Tracheal orHupp

Retractor

Very small version of rakeretractor

For hand and plastic surgery

SauerbruchRetractor

General purpose retractor withlonger blade than Army Navy fordeeper use

BenettRetractor and

Elevator

Works more as a lever than aretractor

For the lower leg between tibiaand fibula

MastoidRetractor

small retractor Retract the skin by the ear for

mastoid procedures

JenningsMouth Gag

For tonsils under generalanesthesia

Pratt Rectal

Speculum Rectal Surgery

HirchsmanAnoscope

clinical instrument for dx or rectalexam


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GravesVaginal

Speculum

Allow surgeon to do vaginal examprior surgery

AuvardWeightedVaginal

Speculum

Primary form of retractor forIntervaginal Procedures

Sims Retractor

Used with the above speculum foreven greater retraction

Vienna NasalSpeculum

various lengths of nose piece, usedon most all nose cases

Single Prong Retractors (Hooks)

Bone Hook largest used in Orthopedic

Skin Hook Hand surgery Plastic surgery


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Dura Hook Neuro Hand Surgery

Suction Tips (Hooks) used with sterile tubing to suction excess fluids from the wounds

PooleAbdominalSuction Tip

Holes in cannula prevent bowelbeing drawin into the tip

Tonsil or

YankhauerTip

Originally designed for tonsils but

now used by all services Removable tip allows fast cleaning

Frazier BrainSuction

popular in neuro, plastic ENT, andany other area where a very smalltip is needed


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Miscellaneous

UterineCurette

Sims Curette (Sharp) scrapeendocervical & endometrium lining

Thomas Curette (Dull) scrape

endocervical & endomentrium lining Scrape inner wall of uterus in case of incomplete abortion or for dx of theuterine wall condition

Hysterometeror Uterine

Sound

Used with Vaginal Speculum Measures depth of Uterus prior any

surgery (Normal: 5 6)

NEEDLES

Needles For suturing May be cutting or curved

Needle Holder

Jaw may have a groove Use: For holding needle


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Mayo Table

OR Table

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