Introduction to Surgical INSTRUMENTATION Concorde Career College

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

Manufacturing Most are stainless steel Carbon, chromium, iron, alloys High carbon makes instruments harder and less likely to wear Chromium increases resistance to corrosion

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

CLASSIFICATIONS CUTTING/DISSECTING GRASPING/HOLDING CLAMPING/OCCLUDING RETRACTING/VIEWING PROBING DILATING SUTURING SUCTIONING ACCESSARY INSTRUMENTS

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

CUTTING/DISSECTING The term knife and scalpel are interchangeable although typically scalpels have a detachable disposable blade and non-disposable handle and knives refers to non-disposable handle and blade such as an amputation knife Scalpels handles sizes include #3, #4, #7, and #9; Beaver blade handle

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

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

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

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

Cutting and Dissecting 14 14

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

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

GRASPING/HOLDING 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

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

CLAMPING/OCCLUDING 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

Clamping and Occluding 20 20

RETRACTING/VIEWING 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

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

RETRACTING/VIEWING Viewing instruments are more specialized Ear speculum; nasal speculum; vaginal weighted speculum vaginal retractors Endoscopes are also considered viewing instruments

PROBING Malleable, wire-like instruments that are used for exploration of tubular structures Fistula probes, lacrimal duct probes, biliary probe, rectal probes

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

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

Suctioning Yankauer Suction Poole Suction 27 27

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

MICROINSTRUMENTATION Used for working under the microscope Small and delicate Must be handled with extra care and precision

Introduction to Surgical INSTRUMENTATION Concorde Career College

Objectives Describe different types of specialty sets Describe types of instruments included in the sets Describe procedures performed using specialty sets

Instrument Sets Assembled into sets for specific specialties Assembled for specific procedures Laparotomy Craniotomy Cardiovascular 32

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

Laparotomy Sets Abdominal procedures May need additional sets for certain procedures (gallbladder, rectal, etc) Can be major or minor

Major Laparotomy Set

OB/Gyn D&C Abdominal hysterectomy Vaginal hysterectomy Laparoscopic procedures C-section

Abdominal Hysterectomy Set

D&C Set

ENT Myringotomy Tympanoplasty Tonsils Tracheotomy Sinuses

ENT Instruments

Plastics Lipo Minor plastic Major plastic Breast Augmentation

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

What are these used for?

Ortho Internal fixation sets External fixation sets Minor ortho Major ortho Total joints IM rods Hands

Synthes ORIF Instruments

Cardiac sets CABG- vein harvesting instrumentation, cannulization for bypass, diethrich scissors, sternal saw, IMA retractors, surgeon specific instrumentation

Thoracic sets Used for procedures of the thorax Includes instruments to shear and remove ribs Thoracoscopy sets differ from thoracotomy sets

Peripheral vascular Instruments for exposure and repair of vessels Aneurysms, Fem-pops, A-V fistulas

Neuro Exposure and repair of the brain, spinal cord, and peripheral nerves Crani sets, lami sets, thrasphenoidal hypophysectomy sets Cloward retractors

Craniotomy Instruments

Introduction to Surgical INSTRUMENTATION Concorde Career College

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

DEBAKEY Atraumatic Uses- DELICATE TISSUE such as BOWEL MOST COMMONLY USED FORCEP IN GENERAL SURGERY

HARRINGTON RET Blunt edges Uses- retracting the liver

GREEN RET Uses – thyroid ret

LAHEY RET Uses – thyroid ret

SENN RAKE RET Mostly used x 2 Sharp and dull Uses- small incisions such as hands

POTTS-SMITH SCISSORS Vascular Billary tract explorations Extending incisions

FREER ELEVATOR Uses – removing periosteum from bone

METZENBAUM SCISSORS Uses – for fine or delicate dissection The most commonly used scissors DO NOT USE OR PASS FOR CUTTING SUTURE

FRAZIER SUCTION TIP Uses – suctioning in small places

POOLE SUCTION Uses – suctioning irrigation Changed on and off for laparotomies

DEAVER RETRACTOR DEEP ABDONMINAL

RICHARDSON OPENING AND CLOSING INCISIONS

STRIAGHT MAYO SCISSORS Uses- cutting suture Called “Suture scissors”

CURVED MAYO SCISSORS Uses- cutting heavy tissue such as muscle, fascia, uterus

OSHNER/KOCHER Traumatic Uses- heavy tissue such as fascia or uterus

Hemostats Crile - Big bites of tissue such as mesentery Kelly – Clamping of superficial vessels

BABCOCK Atraumatic Uses – clamping delicate tissue such as bowel, uterine tubes

ALLIS Uses – medium tough tissue such as skin, mucusmembranous tissue

Adson Tissue Forceps Uses – skin, specialty surgery

BODY-WALL RET Uses – retracting the abdominal wall

LAHEY CLAMP Very traumatic UTERUS THYROID

Passing Instruments Passing the scalpel

Passing Instruments Passing the scissors

Passing the tissue forceps 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 82

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 83

Instrument Sets Names vary from one facility to another Major tray versus laparotomy tray Laparoscopy tray versus Pelviscopy tray Ortho tray versus Bone tray 84

Instrument List/Count Sheet Instrumentation Instrument List/Count Sheet

Instrumentation Preference Card

Instrument Care and Handling Instrumentation Instrument Care and Handling The Instrument Cycle Preoperative Phase Intraoperative Phase Postoperative Phase