1 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Surgical Supplies and Instruments Chapter 56

2 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Learning Objectives  Define, spell, and pronounce the terms listed in the vocabulary.  Apply critical thinking skills in performing patient assessment and care.  Describe typical solutions and medications used in minor surgical procedures.  Summarize methods for identifying surgical instruments used in minor office surgery.  Outline the general classifications of surgical instruments.

3 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Learning Objectives  Describe the care of surgical instruments.  Identify types of sutures and surgical needles.  Describe the medical assistant's need to be aware of patient concerns regarding patient perception of procedures.

4 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Office Surgery  Restricted to the management of minor problems and injuries  Medical assistant’s duties:  prepare the patient and the sterile field  assist the physician as needed  take care of the patient after the procedure  properly disinfect the area  document as needed

5 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Minor Surgery Room  Near a workroom with a sink and an autoclave  Easy to disinfect and uncluttered  Operating table, a clock with a second sweep, an operating light, sitting stools, and Mayo stands  Cabinets with countertops

6 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Minor Surgery Room

7 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Surgical Solutions and Medications  The solutions used in minor surgery include:  Sterile water  Sterile saline  Antiseptic skin cleansers such as povidone-iodine (Betadine) or chlorhexidine (Hibiclens)  Local anesthetics including ethyl chloride or fluoromethane

8 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Additional Surgical Supplies  Wound drains to drain excess fluid  Sterilized gauze squares or strips saturated with petroleum jelly for packing wounds  Sterilized iodoform gauze strips used to pack abscesses, acting as a wick to draw out the infection and as a local antibacterial agent  Surgical sponges to absorb blood and protect tissues during surgery  Syringes and needles to inject local anesthetics and irrigate wounds

9 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Local Anesthetics  Topical applications  Local anesthetic either sprayed or injected at the site  Local anesthetics may come packaged with or without epinephrine. The physician may use topical silver nitrate to control local bleeding.  Lidocaine, chloroprocaine (Nescaine), or bupivacaine (Sensorcaine) injectables

10 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Critical Thinking Application  Tom is ready to do an inventory of supplies in the minor surgery room. What solutions, medications, and miscellaneous supplies should he make sure are on hand for the busy surgical schedule planned for next week?

11 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Surgical Instruments  Surgical instruments are classified according to their use: cutting, grasping, retracting, probing, or dilating tools.  The components include the type of handle, the closing mechanism, and the jaws. Instrument tips may be either straight or curved, sharp or blunt.  Surgical instruments are expensive and must be cared for properly. Examine instruments when purchased for proper working order and possible faults with mechanisms. Keep stainless steel instruments separate from other metal types.

12 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Cleaning  Each instrument must be cleaned according to the manufacturer’s guidelines, unlocked, and disinfected immediately after use. Some instruments must be washed by hand in a mild, neutral pH solution with a soft brush.  Most instruments can be cleaned with an ultrasonic washer. This prevents possible injury with sharp instruments.

13 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Instrument Types  Instruments used in minor surgical procedures are dependent on the type of procedure and physician preference.  Basic components are the handle, closing mechanism, and part that contacts the patient (jaws).  Have either ring or spring handles; box-lock handles can lock in place with ratchets.

14 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Instrument Types

15 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.  Inner surface of jaws may be serrated.  Instrument tips or jaws may have teeth.  Instrument is typically named for its use or after the person who developed it. Instrument Types

16 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. I Instrument Types

17 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Disposable Scalpels

18 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.

19 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Retractors  Senn retractor

20 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Probes and Dilators  Probes

21 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Critical Thinking Application  Tom is preparing instrument and supply packs for specific procedures performed by Dr. Samanski. One of the packs he is preparing for the autoclave is for removal of a nasal polyp. Based on your understanding of typical and specialty instruments and supplies, what items should Tom include in the instrument pack?

22 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Critical Thinking Application  Tom is responsible for inspecting and caring for all of the surgical instruments in the minor surgical room as well as cleaning and preparing contaminated instruments for autoclaving. He is in the process of writing an addition to the office policies and procedures manual on the management of surgical instruments. Based on what you know about the care and handling of surgical instruments, what should Tom include in the policy?

23 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Sutures  Sutures are either absorbable or nonabsorbable. Absorbable sutures are used internally and are dissolved over time by body enzymes, and nonabsorbable sutures are on the wound surface and left in place until the site is healed.  Catgut and Vicryl are absorbable materials, whereas nonabsorbable sutures can be made of silk, nylon, or staples.  Suture materials range from smaller gauges for finer tissues below 0 (aught) to thicker gauges above 0.  11-0 are thinnest, and 7 are thickest

24 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Sutures

25 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Suture Size  Sutures are sized according to the USP scale.  Sizes and diameters are available on a scale from 6 to 0, which is 0.07 mm in diameter, to 2, which is 0.5 mm:  6-0 = 0.07 mm  5-0 = 0.10 mm  4-0 = 0.15 mm  3-0 = 0.20 mm  2-0 = 0.30 mm  0 = 0.35 mm  1 = 0.40 mm  2 = 0.5 mm

26 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Needles  Surgical needles are either straight or curved: the sharper the curve, the deeper the surgeon can pass the needle.  Most needles are swaged—manufactured with the suture material attached. The medical assistant must ask the physician for his or her preference.

27 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Needles

28 Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved. Patient Education  Patients may have questions concerning the instruments the surgeon is using.  The medical assistant can assist the patient by answering his or her questions to help alleviate any fears.  Explaining patient preparation for the procedure, how it will be conducted, and what to expect afterward helps make the procedure easier to perform and encourages the patient to follow the physician’s advice and orders.