INSTRUMENTATION
CLASSIFICATION OF INSTRUMENTS
1. Cutting and dissecting
2. Grasping and holding
3. Clamping and occluding
4. Exposing and retracting
5. Suturing
6. Suctioning and Aspirating
7. Probing and dilating
●
Cutting and Dissecting: have sharp
edges
dissect, incise, separate, or excise tissues
Includes: scalpel, knives, scissors, and bone
cutting instruments: osteotomes, curettes, chisels,
rongeurs, saw, drills, biopsy punches &
dermatomes
a. Scalpels: reusable handles w. disposable
blade
-blades vary by size and shape, handles vary by
width and length
Scalpel holder 3 and 7: use blade #10,11,12 and
15
Scalpel holder 4: blades #20,21,22,23,24,and 25
*beaver handle and blade: most used for cardiac
surgery
Putting scalpel blade on knife handle:
-never use fingers alone to attach blade
-hold it down and away from eyes and others
-use strong needle holder (not hemostat), grasp
blade at widest, strongest part and slip into handle
-to prevent damage to blade, needle holder must
not touch cutting edge
b. Knives: usually have a blade at one end
Refer to a non-disposable handle and blade such
as an amputation knife.
c. Scissors: used to cut or dissect tissues
➔ Mayo Scissors: heavy tissue or cutting
sutures,
dressing
and
drains.
(straight/curved)
*fascia, uterus
➔ Metzenbaum: cut and dissect delicate
tissue (curved/straight)
➔ Iris Scissors: fine tissue; cardiac and
plastic surgery.
at the tip’ provide firm hold on tough tissues
including skin.
➔ Bandage Scissors: opening uterus during
C-section
●
Grasping and Holding: tissues should be
grasped and held in position to perform the
desired maneuver such as dissecting or
suturing without injuring surrounding
tissues.
a. Tissue Forceps: used in pairs to pick up or
hold soft tissues and vessels.
➔ Smooth Forceps: thumb forceps or
pickups; tapered with serrations (grooves)
at the tip; will not injure delicate structures.
➔ Toothed Forceps: serrated, single tooth
on one side that fits between two teeth on
the opposing side or row of multiple teeth
➔ Allis Forceps: scissors action, each jaw
curves slightly inward w/ row of teeth at the
end; Teeth hold tissue gently but securely.
➔ Babcock Forceps: end of jaw is rounded
to fit around a structure or to grasp the
tissue w/o injury; rounded section is
fenestrated.
*for delicate tissues: bowel and uterine tubes
➔ Tenaculum: curved or angle points on the
ends of jaws penetrate tissue to grasp
firmly such as when a uterine tenaculum is
used to manipulate the uterus.
●
Clamping and Occluding: clamp and
occlude to apply pressure.
a. Hemostatic Forceps: occlude blood
vessels
1. Hemostat
➔ Mosquito Forceps: smaller than kelly;
small, straight or curved hemostatic
forceps used to hold delicate tissue or
compress a bleeding vessel.
➔ Kelly
C. Noncrushing vascular clamps: occlude
peripheral or major blood vessels temporarily;
minimize tissue trauma.
➔ Right angle clamp
●
Forceps:
smaller
than
pean;
resemble a pair of scissors with the
blade replaced by a blunted grip. They
also feature a locking mechanism to
allow them to act as clamps.
➔ Pean Forceps: “big kelly”
B. Crushing clamps: crash tissues or clamp blood
vessels
➔ Kocher Forceps: tip has tooth
Exposing and Retracting: Soft tissue,
muscles and other structures should be
pulled aside for exposure of the surgical
site.
➔ Malleable Retractors
➔ Hooks
➔ Self retaining Retractors
a. Needle Holder: used to grasp and hold
curved
surgical
needles;
resemble
hemostatic forceps, short, sturdy jaw for
grasping needle w/o damaging it or suture
material.
*choose appropriate size needle holder, vary by
specialty, depend on the depth, can be curved for
deep tissue.
➔ Derf Holder:
➔ Army navy Retractors
➔ Mayo hegar
➔ Richardson Retractors
➔ Olsen-Hegar
➔ Bladder Retractor
➔ Deaver Retractor
●
Suctioning and Aspirating: body fluids,
blood, tissue and irrigating solutions may
be removed by mechanical suction or
manual aspiration, reusable suction tip.
➔ Yankauer Tip
●
Suturing
●
Probing: use of a malleable wire-like
instrument that are used for exploration of
tubular structures.
➔ Fistula probes
●
Dilating: use to gradually dilate a duct or
an orifice to allow an introduction of a larger
instrument or open a stricture, smallest to
largest and may require lubrication, single
or double ended.
➔ Urethral Dilator
➔ Lacrimal duct probes
➔ Hegar Dilator
➔ Biliary duct probes
➔ Bakes Dilator
➔ Rectal probes
HANDLING INSTRUMENTS:
DURING SURGICAL PROCEDURE
1. Know the name and use of each
instruments
2. Handle instruments individually
3. Hand surgeon or assistant the correct
instrument for each particular task.
*Use for intended purpose only
a. Avoid placing fingers in the instruments
rings as the instrument is passed
b. Surgeon are using hand signals to indicate
the type of instruments needed
*An understanding of what is taking place at the
surgical site makes these signals meaningful
c. Select
appropriate
instruments
for
locations of surgical site
*short for superficial work, long ones for deep in a
body cavity.
d. Many instruments are used in pairs or
sequence
*When a surgeon clamps or cuts tissue, he or she
will request suture, then scissors to cut or a
hemostat to hold the end of a strand.
4. Pass the instruments decisively and firmly.
When the surgeon extends hand, the instrument
should be slapped or placed firmly into his lower
palm in the proper position for use.
*Generally when passing a curved instrument, the
curve of the instrument aligns with the direction of
the curve of the surgeon’s hand.
a. If the surgeon is on the opposite side of
table, pass across right to right hand or left
to left hand.
b. If the surgeon or assistant is on the side of
the table and to right, pass with left hand.
(vice versa)
c. Hemostatic forceps are held near the box
lock by the scrub person and passed by
rotating the wrist clockwise to place the
handle directly into surgeons hand
d. Sharp and delicate instruments may be
placed on flat surface for surgeon to pick
up. (prevent injuries by potential contact to
blades and sharps)
5. Watch sterile field for loose instruments;
Remove promptly after use to the MAYO stand or
instrument table
*weight of instruments can injure px and cause
postoperative discomfort
*keep instruments off the field to decrease the
possibility of falling to floor
6. Wipe blood and debris promptly after each use
with moist sponge
7. Flush suction tip and tubing w. Sterile distilled
water periodically to keep lumens patent
8. Remove debris from electrocautery surgical tips
to ensure electrical contact.
9. Place used instruments not needed again into
the tray or basin during or the end of procedure;
keep instruments accessible for final counts.
Cardiac Surgery Retractors
- CABG: vein harvesting instrumentation,
cannulization
for
bypass,
diethrich
scissors, sternal saw, IMA retractors,
surgeon specific instrumentation.
Thoracic Sets
- Used for procedures of thorax
- Includes instruments to shear and remove
ribs
- Thoracoscopy sets differ from thoracotomy
sets