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SURGERY
Classification by type of points
All types of scissors can have blunt or sharp blades (A:
Sharp:Sharp, B: Blunt:Blunt).
All types can have either straight or curved blades.
Mayo and Metzenbaum
Mayo scissors (B) are used forcutting heavy
fascia and sutures.
Metzenbaum scissors (A) are more delicate than
Mayo scissors.
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Forceps: consist of two tines held together at one end with a spring device that
holds the tines open. Forceps can be either tissue or dressing forceps.
Dressing forceps have smooth or smoothly serrated tips.
Tissue forceps have teeth to grip tissue. Many forceps bear the name of the
originator of the design, such as Adson tissue forceps.
Rat Tooth: A Tissue Forceps
Interdigitatingteeth hold tissue
without slipping.
Used to holdskin/dense tissue.
Adson Tissue Forceps
Small serratedteeth on edge of
tips.
The Adsonstissue forceps has
delicate serrated
tips designed for
light, carefulhandling of tissue.
Intestinal Tissue Forceps: Hinged (locking) forceps used for grasping and
holding tissue.
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Allis: An Intestinal Tissue Forceps
Interdigitating
short teeth tograsp and hold
bowel or tissue.
Slightlytraumatic, use to
hold intestine,
fascia and skin.
Babcock: An Intestinal Tissue Forceps
More delicate
that Allis, lessdirectly traumatic.
Broad, flared
ends with smooth
tips.
Used toatraumatically
hold viscera
(bowel andbladder).
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Sponge Forceps
Sponge forcepscan be straight or
curved.
Sponge forcepscan have smooth
or serrated jaws.
Used toatraumatically
hold viscera
(bowel and
bladder).
Hemostatic forceps: Hinged (locking) Forceps. Many hemostaticforceps bear the name of the designer (Kelly, Holstead, Crile). They are used to
clamp and hold blood vessels.
Classification by size and shape and size of tips
Hemostatic forceps and hemostats may be curved or
straight.
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Kelly Hemostatic Forceps and Mosquito Hemostats
Both are transversely serrated.
Mosquito hemostats (A) are more delicate
than Kelly hemostatic forceps (B).
Comparison of Kelly and Mosquito tips
Mosquito hemostats (A) have a smaller, finer tip.
Carmalt
Heavier than Kelly.
Preferred forclamping
of ovarian pedicals during
an ovariohysterectomy
surgery because theserrations run
longitudinally.
Doyen Intestinal Forceps
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Doyen intestinal forceps are non-
crushing intestinal occluding
forceps with longitudinal
serrations.
Used to temporarily occlude lumenof bowel.
Payr Pylorus Clamps
Payr pylorus clamp is a crushing
intestinal instrument.
Used to occlude the end of bowel
to be resected.
Needle holder: Hinged (locking) instrument used to hold the needle while
suturing tissue.
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Good quality is ensured with tungsten carbide inserts at the tip of the needle
holder.
Mayo-Hegar
Heavy, with mildly tapered jaws.
No cutting blades.
Olsen-Hegar
Includes both needle holding jaw and scissorsblades.
The disadvantage to having blades within the
needle holder is the suture material may be
accidentally cut.
Retractors
Senn
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Blades at each
end.
Blades can beblunt (delicate) or
sharp (moretraumatic, usedfor fascia).
Hohman
Levers tissue
away from boneduring orthopedic
procedures.
SELF RETATINING FACTORS
Weitlaner
Ends can be blunt or
sharp.
Has rake tips.
Ratchet to hold
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tissue apart.
Gelpi
Has single point
tips.
Ratchet to hold
tissue apart.
SCALPEL AND BLADES
Handles
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#3 Handle
#4 Handle
Handles and Blades
Blades #10, 11, 12, 15 fit the #3 handle.
Blades #22, #23 fit the #4 handle and are commonly usedfor large animals.
Disposable Scalpel
Towel clamps secure drapes to a patient's skin. They may also be used to hold
tissue.
Backhaus Towel Clamp
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Locking forceps with curved, pointed tips.
PROPER INSTRUMENTS HANDLING
Scissors and Hemostats:
The thumb and ring finger are inserted into the rin
of the scissors while the index and middle finger aused to guide the instrument.
The instrument should remain at the tips of the finfor maximum control.
This is the wrong way to hold thescissors. The ring finger should be
inserted into the ring.
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This is also the wrong way to hold the
scissors. The tips of the scissors shouldbe pointing upwards.
Thumb Forceps:Thumb forceps are held like a pencil.
Thumb Forceps are not called'tweezers'.
Thumb Forceps are not held like a
knife.
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Scalpels:
The scalpel is held with thumb, middle and
ring finger while the index finger is placedon the upper edge to help guide the scalpel.
Long gentle cutting strokes are less
traumatic to tissue than short choppingmotions.
The scalpel should never be used in a
"stabbing" motion.
SURGICAL HANDWASHING
1) Trimming and Cleaning Nails
Trim fingernails and clean with disposable nail
Down load video of this step.
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2) Initial Wash and Scrubbing Fingers
Wash for 30-60 seconds with surgical scrub.
Scrub fingers with a sterile scrub brush
Make sure to scrub all sides of each finger, includibetween fingers.
Down load video of this step.
3) Scrubbing Hands and Forearms
Scrub hands and arms with a sterile scrub brush
Make sure to scrub each surface of each hand and
An accepted contact time is 10 brush strokes per
Down load video of this step.
4)Rinse
Rinse hands and rescrub as in step 3.
During scrubbing, rinsing and drying, hands are he
This is done so that water will not be dripping fromlower arms and hands.
After both scrubs and rinses, total contact time shoSome surgeons do not rinse off the chlorhexidine i
residual activity.
Down load video of this step.
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HAND DRYING AND GOWNING
A sterile towel is included within the sterile
gown pack. The towel is lifted away from the
table and folded in half lengthwise. One hand
and forearm are dried by one side of the towel.Always dry in the direction of hand to elbow so
that contamination of the upper arm is not spreadby the towel to the surgeon's hand.Down LoadVideo of Drying Hands
The second hand and forearm are then dried by the other side of the towel in
the direction of hand to elbow. The towel is then discarded away from the
surgeon, making sure that the towel doesn't contact the sterile gown.
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All gowns are folded and packaged for sterilization with the inside exposed so
that the surgeon may handle the gown without contaminating the outside of the
gown. Grasp the exposed inside of the gown and lift the gown away from the
table.
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Unfold the gown by placing hands into the white arm holes. Continue placing
hands and arms through the sleeves. If you are planning on closed gloving, do
not thrust hands through the cuffs. Down Load Video of Donning a Gown
An assistant fastens the neck tie and the inside waist tie.Down Load Video
Proceed with closed gloving before the fastening of the final outside tie. Once
the surgeon is gloved, the sterile left tie is grasped by the surgeon and the white
tab is handed to an assistant.
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The assistant pulls the back tie around the surgeon using the white tab. The
surgeon grasps the right tie from the white tab (not touching the now
contaminated white tab) and right and left are tied together. Down Load Video
CLOSE GLOVING
Closed gloving is performed after the surgeon has donned his/her gown,
but BEFORE the surgeon pulls his/her hands through the cuffs of the
gown.
Step 1: An assistant opens the sterile pack of gloves and drops them into the
sterile field.
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Step 2: Left hand (within the gown) lifts the right glove by its cuff.
Step 3: Right glove is laid on the palm of the right hand (cuff to cuff with the
gown sleeve) with fingers of the glove pointing toward the elbow and the
thumb of the glove positioned on top of the surgeon's covered right thumb.
Step 4: The inside of the cuff of the glove is grasped by the right hand (still
within the gown) and the left hand folds the cuff of the glove over the back of
the right hand.
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Step 5: The left had then pulls the cuff of the right glove and sleeve of the right
gown towards the elbow as the right hand slides into the glove. Wait to adjust
the glove until both gloves are on and sterility is ensured (left fingers may slip
out of the gown while trying to adjust the right glove prematurely).
Step 6: With the gloved right hand lift left glove by its cuff and place on palmof left hand (aligned with the cuff of the gown), with glove fingers pointing
toward the elbow and the left thumb of the glove over the covered left thumb of
surgeon.
Step 7: Left fingers (still within the gown) grasp the inside of the glove and the
right hand pulls left glove cuff over the back of the hand.
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Step 8: Pull the glove cuff and gown sleeve toward elbow as left hand slides
into the glove
Step 9: Now that both gloves are on, pull glove cuffs over gown sleeves and
adjust gloves for comfort.