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Surgical Instruments and Aseptic Technique

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1 Surgical Instruments and Aseptic Technique
Chapter 28 Surgical Instruments and Aseptic Technique 1

2 Learning Objectives Name and describe the commonly used surgical instruments State advantages of surgical stapling and list common surgical stapling devices List commonly used instruments and equipment for ophthalmic, orthopedic, and arthroscopic procedures 2

3 Learning Objectives List surgical instruments and supplies routinely included in general and emergency surgical packs for small and large animals Describe procedures for cleaning, packing, and sterilizing instruments Differentiate between sterilization and disinfection 3

4 Learning Objectives List and describe physical and chemical methods of sterilization and methods of quality control of sterilization methods State safe storage times for sterile packs List and describe common antiseptic and disinfectant agents 4

5 Learning Objectives Describe preparation requirements for patients, including skin preparation, patient positioning, and draping Describe preparation requirements for the surgical team and explain the procedures that may be used for hand scrubbing before surgery Describe the procedure for donning surgical attire Describe procedures for opening sterile items 5

6 Technician’s Role During Surgery
Maintain aseptic technique Assist in surgery Immobilization of body part Tissue retraction Hemostasis control Anticipate instruments needed Discuss role of technician in surgery assistance—hold a body part, hold an instrument, hold off a bleeding tissue, etc. 6

7 General Surgery Instruments
Thousands of different instruments Increase efficiency Ease performance Specific purpose for each instrument 7

8 The most commonly used materail is stainless steel, which is an alloy of iron, chromium, silicon, manganese, nickel, molybdenum, sulfur, phosphorus, and titanium. There are 2 basic compound types: Martensitic- high carbon and low chromium content, rendering it very strong, highly magnetic, and susceptible to corrosion. i.e. thumb forceps, hemostats, retractors,etc. Austenitic- stainless steel is compounded mainly of chromium and nickel. Superior in that is has high tensile strength and is very resistant to corrosion i.e. implants, pans, bowls, handles, and trays

9 Scalpels Figure shows scalpel handles and attachable surgical blades.
Bard-Parker No. 3 handle uses blades 10, 11, 12, and 15. No. 3 handle and No. 10 blade are commonly used in small animal surgery. Bard-Parker No. 4 handle uses blades No. 4 handle and No. 20 blade are commonly used in large animal surgery. 9

10 Biomedical Lasers Most common types Advantages Disadvantages
Carbon dioxide Neodymium:yttrium-aluminum-garnet Advantages Disadvantages CO2 and the ND:YAG are the lasers most common to veterinary medicine. Advantages: hemostasis, less postoperative swelling and pain Disadvantages: delayed wound healing, safety issues 10

11 Electrosurgery Electric current passes through tissue
Cut tissue Coagulate tissue Monopolar electrosurgery Bipolar electrosurgery 11

12 Monopolar Electrosurgery
In monopolar electrosurgery, current passes from handpiece through patient, to a metal plate that is placed under the patient. Figure on left shows monopolar electrosurgery handpiece; if handpiece has cutting-coagulation button, foot switch is not needed. Surgeon passes end of cord to nonsterile assistant who plugs it into electrosurgical unit. Figure on right shows ground plate on surgery table with gel to improve skin contact when animal lies on it. 12

13 Bipolar Electrosurgery
In bipolar electrosurgery, current passes between two tips on the handpiece that grasp the tissue; no ground plate is needed. Figure shows bipolar handpiece, which is sterilized for use. Nonsterile foot switch is needed for activation. 13


15 Scissors Scissors are specifically designed for many purposes, including tissue dissection and cutting suture or bandage materials. (left to right) Sharp-sharp operating scissors, Mayo dissecting scissors, and Metzenbaum dissecting scissors (at right, from top to bottom) Lister bandage scissors, wire-suture-cutting scissors, and Littauer suture removal scissors Operating scissors: straight vs. curved; blunt-blunt, blunt-sharp, or sharp-sharp Mayo-dissecting scissors cut tough tissue. Metzenbaum dissecting scissors for soft tissue dissection. Lister bandage scissors cut bandages without cutting skin. 15




19 Needle Holders Designed for holding curved suture needles during suturing and for performing instrument suture ties. Mayo-Hegar needle holder on the left On the right, Olsen-Hegar needle holder has built-in suture scissors, which negates the need for an assistant to cut suture. 19

20 Basic Components of a Needle Holder



23 Thumb Forceps Thumb forceps hold tissue while dissecting or suturing.
(left to right) Brown-Adson thumb forceps, Adson thumb forceps, rat-tooth thumb forceps, DeBakey vascular thumb forceps, Russian thumb forceps, dressing thumb forceps 23

24 Close-up of Tips of Thumb Forceps
(left to right) Brown-Adson thumb forceps, Adson thumb forceps, rat-tooth thumb forceps Brown-Adson used during suturing and wound closure. Rat-tooth used on skin or fascia. 24

25 Close-up of Tips of Thumb Forceps
(left to right) DeBakey vascular thumb forceps, Russian thumb forceps, dressing thumb forceps DeBakey used for vascular surgery. Russian used for needle handling. Dressing forceps have no teeth; used for applying and removing dressings. 25





30 Tissue Forceps Tissue forceps clamp and hold tissue with self-locking mechanism. (left to right) Allis tissue forceps, Babcock tissue forceps, Doyen intestinal tissue forceps, Backhaus towel clamps (two sizes) Doyen intestinal tissue forceps (third from left) is used to occlude and hold intestines. Backhaus towel clamps (on far right) hold drapes and towels to the patient. Roederer towel clamp (not pictured) has a metal ball attached to the jaws that prevents deep tissue penetration and prevents the towel from slipping toward the box lock of the forceps. 30

31 Close-up of Tips of Tissue Forceps
(left to right) Allis tissue forceps and Babcock tissue forceps Allis forceps grasp and crush tissue. Babcock forceps grasp, but do not crush. 31






37 Hemostatic Forceps These are tissue forceps that crush blood vessels to stop bleeding. (left to right) Halsted mosquito hemostatic forceps, Kelly forceps, Crile forceps Halsted forceps are used on small vessels. Kelly and Crile forceps are used on larger vessels. 37

38 Close-up of Jaws of Hemostatic Forceps
(left to right) Kelly and Crile forceps Curved jaws of Kelly forceps is only half-grooved. Crile forceps has straight jaws. 38

39 More Hemostatic Forceps
(left to right) Rochester-Carmalt forceps, Rochester-Pean forceps, Rochester-Ochsner forceps Rochester-Carmalt forceps are large crushing forceps, commonly used in spaying. Rochester-Pean forceps are used on large vessels and tissue bundles. Rochester-Ochsner forceps are used most often in large animal surgery. 39

40 Close-up of Jaws of Hemostatic Forceps
(left to right) Rochester-Carmalt forceps, Rochester-Pean forceps, Rochester-Ochsner forceps Rochester-Carmalt forceps (on left) have longitudinal grooves and cross-grooves at the tip to provide more traction. Rochester-Ochsner forceps (on right) have interdigitating teeth at the tips that aid in grasping the tissue. 40









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