OBJECTIVES

Identify basic instruments by type, function, and name.

Demonstrate proper care, handling techniques, and safety precautions of surgical instruments.

OVERVIEW

CategoriesParts of clampsInspecting and testingSpecialty instrument setsHandling and passing instrumentsHand Signals

Surgical Instruments

Stainless Steel – a combination of:– Carbon– Iron– Chromium– Alloys

Strong Resistant to corrosion High % of Carbon = Stronger

Metal

Surgical Instruments

Instruments may have a special “finish”. Highly Polished

– Increases corrosion resistance– But may reflect surgical lights

Satin (Dull) Finish– Less reflective/reduces glare

Ebonized (Black Chromium) Finish– Non reflective– Used in Laser cases, Why????

Classifications

Instruments are classified into different categories depending on their function:

1.) Cutting/Dissecting

Instruments with sharp edges used for:– Incisions– Sharp Dissection– Excision of tissue

Cutting/Dissecting

Examples:– Knives/Scalpels– Scissors– Osteotomes– Curettes– Ronguers– Saws/Drills– Dermatomes

Cutting/Dissecting

Scalpels or Knives Variety of detachable

blades and Non disposable handles.

– #3, #4, #7 KH– #10, #11, #12, #15, #20

Attached with an instrument by a grooved locking mechanism.

Cutting/Dissecting:

KH – means Knife Handle KB – means Knife Blade #3L, #4L, etc. – the “L” stands for LONG which

means Long Handle. Some blades may be angled to aid the surgeon in

reaching difficult areas. KBs are made of Carbon Steel, and are loaded and

removed with an instrument (such as a Needle Holder).

Cutting/Dissecting

Other types of KH: – Miniature Blade Handle w/ Chuck – used for

procedures that require very small incisions such ash Eye Cases.

– Beaver Handle – specifically designed to hold small Beaver Blades.

#69 – the most commonly used size Beaver Blade. Chuck – device used to tighten the blade onto the handle.

Cutting/Dissecting

Scissors– Sharp cutting edges

varying in lengths and construction.

May be used for sharp or blunt dissection, depending on use.

Specialized scissors are used on specific tissue.

Cutting/Dissecting

Curved Mayo Scissors– Scissor of choice for heavy tissue.

Metzenbaum Scissors– Medium to fine tissue dissection.

Iris, Tenotomy, Potts-Smith Scissors– Delicate tissue.– Eye procedures

– All of the above should never be used to cut sutures!!!

Cutting/Dissecting

Potts-Smith– Used for ducts, Veins, or

Arteries. Jorgenson Scissors

– Hysterectomies. Micro-Scissors

– Microsurgery Cushing

– Dural Incision

Cutting/Dissecting

Metzenbaum Scissors (CRVD)– Preferred by Cardiovascular Surgeons

for cutting Polypropylene Sutures. Strabismus, Iris and Corneal

Scissors – Scissors used for Eye Procedures.

Cutting/Dissecting

Suture Scissors– Scissors used to cut

sutures. Straight Mayos

– Commonly used. Straight Iris

– Used to cut fine sutures during eye or plastic surgery.

– THESE ARE THE ONLY ONES USED TO CUT SUTURES!!!

2.) Grasping/Holding

Instruments designed to manipulate tissue to facilitate dissection, suturing, or stabilize fractures.

May or may not have ratchets.

Grasping/Holding

Tissue Forceps– Look like tweezers– Toothed or Smooth

Examples:– Adson– DeBakey– Russian– Cushing Bayonet

Grasping/Holding

Ratcheted Instruments Examples:

– Allis– Babcock– Kocher

Grasping/Holding

Bone Holding Clamps– Stabilize Fractures

before pinning or plating.

Examples:– Lane– Lowman– Smaller clamps

resemble a Towel Clamp

3.) Clamping/Occluding

Instruments designed to occlude or constrict tissue.

Interlocking ratchets. Examples:

– Vascular clamps– Hemostats

4.) Retracting/Viewing

Instruments used to expose the operative site and allow visualization of structures

May be hand held or self-retaining.

Blunt or Sharp Deep or Superficial

Viewing

5.) Trocars/Cannulas

Instrument with a sharp point that fits into a hollow cannula.

Used to introduce endoscopic instruments or to drain fluid.

Disposable cannulas are more frequently used and they come in different sizes.

6.) Probing

Malleable, Wire-like instruments used to explore fistulas or ducts.

Found in rectal or gallbladder instrument sets.

7.) Dilating

Instruments used to gradually dilate an orifice or duct to allow introduction of larger instruments.

Tapered instruments found in numbered sets.

Examples:– Cervical– Urethral– Esophageal

8.) Suturing

Instruments used to hold suture needles during suturing.

Needle Holders– Varies in size

depending on the needle size.

Jaws typically have tungsten carbide inserts to immobilize the needle.

9.) Suctioning

Hollow instruments connected to suction tubing to provide better visualization or irrigation of the operative site.

Suction Tips– Frazier– Yankauer– Poole

Disposable Vs. Non-Disposable

Suctioning…

Is the removal of blood & body fluids from the operative site for better visualization.

Utilizes a canister connected to a vacuum device.

Some disposable suctioning device have an attached active electrode that allows for simultaneous suctioning and coagulation.

Micro Instruments

Small delicate instruments used in conjunction with an operating microscope.

Stainless Steel or Titanium

Spring loaded and designed to be held by thumb and forefinger.

PARTS OF CLAMP

• Very end of jaws• Should approximate

tightly when closed• Exceptions:

• Vascular• Intestinal

TIPS

PARTS OF CLAMP

• Working end of the instrument.

• Serrations• Horizontal• Vertical• Crossed designs• Can be all or part of the

jaw.

JAWS

PARTS OF CLAMP

• Hinge part of instrument.

• Screw joint in Scissors• Controls the opposition

of the jaws.

Box Locks

PARTS OF CLAMP

Area between box lock and finger ring.

Provides instrument with balance.

Has a lever action on jaws Length determines force

on jaws

Shank

PARTS OF CLAMP

Interlocks to keep instrument locked shut when closed.

Should mesh together smoothly when closed.

Ratchets

PARTS OF CLAMP

• For finger placement when using instrument.

FingerRings

INSPECTING/TESTING

• General functioning ability.• Ensure instrument is free from:

• Rust, Corrosion, and pitting• No loose parts

• Clean and free of bioburden

INSPECTING/TESTING

Inspection points:

Jaws - tips close tight?Box locks -move freely?

Shanks - straight?Ratchet - stay closed?Cutting edges - sharp?

- Efficient instrument handling through the surgical procedure is the hallmark

of an efficient scrub.

INSPECTING/TESTING

Instrument Sets

Standardized according to specialty/procedure.

Set names may vary from facility to facility.– Ex: Minor Set Vs. Basic

Instrument Set Count sheets ensure all

necessary instruments are present.

Instrument Sets

Laparotomy OB/GYN

Ophthalmic Otorhinolaryngology

Plastic Genitourinary Orthopedics

Cardiac Thoracic

Peripheral Vascular Neurosurgical Endoscopes

HANDLING INSTRUMENTS

Passing instrument– Know name and use– Appropriate instrument – Pass firmly in position of use– Handle individually– Avoid hand to hand transfer of sharps

HANDLING INSTRUMENTS

Scalpel:– “Pencil grip”– Blade down, handle towards surgeon.– Secure.– No Hand Technique.

Neutral Zone

HANDLING INSTRUMENTS

Forceps:– Place between thumb and finger. (Pencil grip)– Tips in working position

HANDLING INSTRUMENTS

Clamps:– Ratchet closed– Place ring end firmly in surgeons palm using

wrist motion.– Position of function.

HANDLING INSTRUMENTS

Retractors:– Closed Position (if indicated)– Pass over field in position of function.– Note Double Ended Retractors.

HANDLING INSTRUMENTS

Needle Holders:– Closed Position– Needle loaded in proper position.

Right handedLeft handed

– Do not let the suture strand drop while passing.

– No Hand Technique.

HANDLING INSTRUMENTS

Recognize hand signals:– Scalpel– Hemostat “tags”– Forceps ”pick ups”– Scissors– Suture– Free ties

Review and Summary

CategoriesParts of clampsInspecting and testingSpecialty instrument setsHandling and passing instrumentsHand Signals