OBJECTIVES Identify basic instruments by type, function, and name. Demonstrate proper care, handling techniques, and safety precautions of surgical instruments.

OVERVIEW Categories Parts of clamps Inspecting and testing Specialty instrument sets Handling and passing instruments Hand 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. Finger Rings

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 handed Left 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 Categories Parts of clamps Inspecting and testing Specialty instrument sets Handling and passing instruments Hand Signals