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

2. 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.
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© 2009 Pearson Education

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

4. 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.

5. 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?
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6. 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?
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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.

7. 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
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8. Dissecting Instruments
Insert Figure 42-9 from PCMA 2e
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The most common tool for dissecting or cutting tissue is scissors.

9. 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
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10. 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.
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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).

11. 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
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12. Insert Figure 42-10 from PCMA 2e
Forceps
Insert Figure from PCMA 2e
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Are grasping & clamping instruments.

13. 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.
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14. 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.
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15. Insert Figure 42-11 from PCMA 2e
Hemostats
Insert Figure from PCMA 2e
Page 911 describes hemostats
Page 912 shows the picture of a few hemostats

16. Probing and Dilating Instruments
Instruments used to enter body cavities for probing or dilating purposes
Insert Figure from PCMA 2e
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Specula

17. 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.
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18. 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
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19. Insert Figure 42-14 from PCMA 2e
Probe
Insert Figure from PCMA 2e
Used to explore wounds and cavities usually with a curved, blunt point to facilitate insertion.
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20. 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 from PCMA 2e
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21. Punch
Used to remove tissue for examination and biopsy or microscopic examination of tissue to detect cancerous cells.
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22. Disciplines That Use Specialized Instruments
Insert Figure from
PCMA 2e
Gynecology and obstetrics (OB-GYN)
Urology
Orthopedics
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Picture shown are orthopedic instruments.

23. 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.
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24. Types of Suture Material
Absorbable
Nonabsorbable
Insert Figure from
PCMA 2e
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25. 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.
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26. 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.
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27. 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.
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28. 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.
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29. 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.
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30. 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.
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31. Size of Suture Material
Insert Figure 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
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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.

32. 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 from PCMA 2e
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33. 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.
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34. 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.
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35. 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
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36. Insert Figure 42-21 from PCMA 2e
Steri-Strips
Insert Figure 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.
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37. 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.
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38. Staples Made of stainless steel. Applied with a surgical stapler.
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39. 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
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Guidelines 42-2

40. Questions?