Chapter 42: Assisting with Minor Surgery Lesson 2 Surgical Instruments © 2009 Pearson Education

Define and spell the terms to learn for this chapter. Lesson Objectives Upon completion of this lesson, students should be able to … Define and spell the terms to learn for this chapter. List and describe instruments for cutting, dissecting, grasping, clamping, probing, and dilating. Give five examples of suture materials, including gauge ranges, with examples of when they may be used. Explain the guidelines for handling instruments. Page 900 © 2009 Pearson Education

Categories of Instruments Cutting Dissecting Grasping Clamping Dilating Probing Visualizing Suturing Page 910 There are special instruments that are related to individual specialties.

Instruments Used in Minor Surgeries Scalpel Blades Scissors Hemostat Suture materials Insert Figure 42-7 from PCMA 2e Page 910 Minor surgery set up will include a standard group of instruments. They are usually made of steel & treated to be rust & heat resistant, stain proof, & durable. It is very important to be able to identify common instruments used in your facility.

Critical Thinking Question What methods might a medical assistant utilize when trying to remember the names of all the various instruments used in a medical office? Page 910

Questions to Help Identify Instruments What type of handles does it have? What type of tip does it have? What type of closure does it have? What type of edges does it have? How long is it? (may indicate what body part it is used for) Whose name does it bear? Page 910 Categorize instruments by its use. Examine the types of parts of the instrument. Each time you encounter an instrument you are unfamiliar with, use these questions to determine its characteristics & remember the name.

Insert Figure 42-8 from PCMA 2e Cutting Instruments Scalpels or knives are used to make incisions Small curved instruments that are made to fit easily into the surgeon’s hand. A scalpel blade must be inserted into the scalpel handle. Blades come in various sizes depending on the type of incision and tissue. Insert Figure 42-8 from PCMA 2e Page 910-911

Dissecting Instruments Insert Figure 42-9 from PCMA 2e Page 911 The most common tool for dissecting or cutting tissue is scissors.

Scissors Used for debridement Used to cut sutures (thread) Have two blades with sharp edges that come together when the handles are drawn together Tips vary greatly to perform a variety of functions Page 911

Types of Scissors Metzenbaum scissors short, curved, blunt scissors used on and to prevent piercing delicate tissue. Operating scissors or suture scissors used to cut suture material during surgery. have a hook on one edge that fits under the suture for ease in suture removal. Page 911 Operating scissors can be straight or curved with a combination of blades, such as sharp/sharp (s/s), blunt/blunt (b/b), & sharp/blunt (s/b).

Types of Scissors Dissecting scissors Bandage scissors also called straight or Mayo scissors Bandage scissors have a blunt tip and a blunt flat edge to allow it to fit easily under a bandage for cutting Page 911

Insert Figure 42-10 from PCMA 2e Forceps Insert Figure 42-10 from PCMA 2e Page 911 Are grasping & clamping instruments.

Forceps Used to grasp tissue or objects A two-pronged forcep is used to clamp together tightly to prevent slipping. A ratchet clasp allows the forceps to close with differing degrees of tightness. Forceps often have serrations or teeth-like edges that prevent tissue slipping out of the forceps. Page 911

Types of Forceps Tissue forceps have teeth and are used to grasp tissue Thumb forceps are two-pronged with serrated tips to hold tissue Splinter forceps are used to grasp foreign bodies Needle holder forceps are used to grasp needles during suturing Hemostats are applied to blood vessels to hold vessels until they can be sutured. Sponge forceps are used for holding sponges during surgery. Towel clamps are used to hold together the edges of sterile drapes. Page 911

Insert Figure 42-11 from PCMA 2e Hemostats Insert Figure 42-11 from PCMA 2e Page 911 describes hemostats Page 912 shows the picture of a few hemostats

Probing and Dilating Instruments Instruments used to enter body cavities for probing or dilating purposes Insert Figure 42-13 from PCMA 2e Page 912 Specula

Scope Usually lighted Insert Figure 42-12A From PCMA 2e Usually lighted Inserted into a body cavity or vessel to visualize the internal structures. An obturator is placed inside a scope to guide it into a cavity or canal and then removed during visualization of the surgical site. Some obturators have a point used to puncture tissue. Page 912

Speculum Insert Figure 42-13 from PCMA 2e Unlighted instrument with movable parts that when inserted into a cavity, can be spread apart for ease of visualization and tissue sample removal Page 912

Insert Figure 42-14 from PCMA 2e Probe Insert Figure 42-14 from PCMA 2e Used to explore wounds and cavities usually with a curved, blunt point to facilitate insertion. Page 912

Insert Figure 42-15 from PCMA 2e Trocar Used to withdraw fluids from cavities Consists of a cannula (outer tube), and a sharp stylette that is withdrawn after the trocar is inserted. Insert Figure 42-15 from PCMA 2e Page 912

Punch Used to remove tissue for examination and biopsy or microscopic examination of tissue to detect cancerous cells. Page 912

Disciplines That Use Specialized Instruments Insert Figure 42-18 from PCMA 2e Gynecology and obstetrics (OB-GYN) Urology Orthopedics Page 913 Picture shown are orthopedic instruments.

Suture Materials and Needles Suture (thread) materials used to bring together or approximate a surgical incision or wound until healing takes place. are added to the surgical tray setup when they are needed for a procedure. Sutures come either with or without an attached needle. The package label will indicate type, size, and length of the suture material. Page 913

Types of Suture Material Absorbable Nonabsorbable Insert Figure 42-19 from PCMA 2e Page 913

Absorbable Sutures Digested by tissue enzymes and absorbed by the body tissues. Do not have to be removed. Absorption usually occurs 5 to 20 days after insertion. Used for internal organs such as the bladder and intestines, subcutaneous tissue, and ligating or tying off blood vessels. Page 913

Types of Absorbable Sutures Plain catgut: used in areas where rapid healing takes place such as highly vascular areas of the lips and tongue. Surgical catgut: used on tissues that are fast healing such as the vaginal area. Chromic catgut: has a slower absorption rate and can be used to hold tissue together longer, such as for muscle repair. Page 913-914

Nonabsorbable Sutures Used on skin surfaces where they can easily be removed after incisional healing takes place. Types include nylon, cotton, silk, Dacron, and stainless steel Black silk is the most commonly used nonabsorbable suture. Page 914

Suture Materials Silk suture: Nylon suture: Most expensive, also considered the most dependable. An all-purpose suture, widely used and easy to tie. Nylon suture: Has elasticity and strength that makes it ideal for use in joints and for skin closure. Disadvantage is the difficulty in forming a tight knot. Page 914

Suture Materials Polyester suture: Steel suture: Second strongest of all the standard suture material. Used in ophthalmic, cardiovascular, and facial surgery Steel suture: Used in staples, as well as nonabsorbable suture wire that is composed of 316L stainless steel. Most widely used suture material in major surgery. Strongest of all suture material. Page 914

Suture Materials Cotton suture: Linen suture: With less strength than other suture materials, is no longer widely used. Linen suture: Created from natural flax fiber. Page 914

Size of Suture Material Insert Figure 29-17 from Frazier/Malone MA, p. 584 Measured by the gauge or diameter Stated in terms of zeroes, decreasing in size with the number of zeros Page 914 0 is the thickets & 6-0 is the smallest. The fine sutures leave less scarring. The physician determines the type & gauge of sutures to be used.

Insert Figure 42-20 from PCMA 2e Suture Needles Available in differing shapes depending on where they are used. Have either a sharp cutting point used for tissues that provide some resistance, or a round noncutting point used for more flexible tissue such as peritoneum. Insert Figure 42-20 from PCMA 2e Page 914-915

Straight Needle Used when the needle is pushed and pulled through the tissue without the use of a needle holder. Has an eye that is threaded with the suture material. The suture material thickness will be double when threaded through the needle since it will enter the eye from one side and come out the other. Page 915

Curved Needle Allow the surgeon to go in and out of a tissue when there is not enough room to maneuver a straight needle. Requires a needle holder. Page 915

Swaged Needle A swaged needle and suture materials are combined in one length. Offers the advantage of the suture material not slipping off the needle since it is attached. Will contain a label indicating the gauge, type of needle point (cutting or noncutting), and type and length of the suture material Page 915

Insert Figure 42-21 from PCMA 2e Steri-Strips Insert Figure 42-21 from PCMA 2e Nonallergenic and available in a variety of widths. Used instead of sutures when not much tension is to be applied to a wound such as on a small facial cut. Page 915

Skin Adhesives Composed of Cyanoacrylate adhesives that react with water to create an instant, strong, flexible bond. Composition of skin adhesives is similar to Superglue. Used to close lacerations or small surgical incisions. Page 915

Staples Made of stainless steel. Applied with a surgical stapler. Page 915

Guidelines for Handling Instruments Instruments should be cleaned after use Handle carefully Avoid allowing instruments to become tangled Sharp instruments should remain separated from others Instruments with ratchets should be stored open Check all instruments for defects before sterilizing them Page 915-916 Guidelines 42-2

Questions?