Surgical Instruments Surgical Instruments Prepared by Dr. Asmaa boushra Outline 1-Introduction. 2-Basic terminology 3-Definition of surgical instruments. 4- Classification of surgical instruments . Retracting instruments . Grasping and Clamping. Cutting and Dissecting. Grasping and Holding Instruments. 5- Role of scrub nurse for surgical instruments These tools are used for Holding Pulling Clamping Cutting Crushing Closing a wound . Specific objective Demonstrate the surgical instruments . Discuss the names , types & function of various surgical instruments. Apply the scrub nurse role related surgical instruments. Introduction In surgical field , the variety and increasing complexity of techniques used, together with the high number of materials and instruments employed, demands that professionals who join these field have a specific professional development related to instruments and techniques. Basic Terminology Excision : Removal of tissues by surgical cuts Incision : Surgical cut made into a tissue of organ Cannula :A tube that is inserted into a body cavity for drainage of fluid. Forceps: for compressing or grasping tissue. Thumb forceps & hemostats are typical forceps. Hemostats aid in compressing tissue, especially blood vessels, to stop bleeding (hemostasis). Needle holders: hemostat-like devices that hold needles used to suture wounds closed. Needles: permanently attached suture material = swaged-on. Tip needles may be blunt, tapered, sharp, cutting, or some other configuration. Scalpel handle and blades: size 10 blade most popular, size 11 has a straight edge and a sharp point. Size 15 has a very small cutting edge, used for fine, delicate surgery(e.g. eye). Size 20 is similar to 10 but larger. Definition of surgical instrument Surgical Instrument: Is a specially designed tool or device for performing specific actions of carrying out desired effects during operation, such as modifying biological tissue. Some surgical instruments are designed for general or specific procedure or surgery. Classification There are several types of surgical instruments Retracting Grasping and Clamping. Cutting and Dissecting. Grasping and Holding Instruments. Surgical Instruments • Retracting • Grasping and Clamping • Cutting and Dissecting • Grasping and Holding Retracting Retracting and Exposing Instruments used to hold back or retract organs or tissue to gain exposure to the operative site A Deaver retractor (manual) is used to retract deep abdominal or chest incisions. Available in various widths. A Richardson retractor (manual) is used to retract deep abdominal or chest incisions An Army-Navy retractor (manual) is used to retract shallow or superficial incisions. Other names: USA, US Army. Doyen retractor used in pelvic surgery A cecil-joll retractor is a specialized surgical instrument commonly used for difficult incision sites A malleable or ribbon retractor is used to retract deep wounds. May be bent to various shapes. Senn Miller Retractor is commonly used to hold open the tissue or muscle in small surgical sites Volkmann Retractor is a popular hand-held instrument that used to retract skin Langenbeck Retractor used to retract skin and muscles during operation A Weitlaner retractor (self-retaining) is used to retract shallow incisions. A Gelpi retractor (self-retaining) is used to retract shallow incisions. A self retaining abdominal (self-retaining) is used to retract wound edges during deep abdominal procedures. self retaining round abdominal retractor Finochetto Rib retractor is used in thoracic surgery lung retractor used to retract the lung tissue during thoracic surgery. Rib raspatory is a specialized cardiothoracic instrument that surgeons commonly use to scrape bone and other hard tissues from the ribs Bailey Rib Contractor Standard Alexander Farabeuf Periosteotome Bronchus Clamp Crile Wood Needle Holder Tungsten Carbide Jaws Serrated Yankauer Suction Tube Richardson Retractor Loop Handle Harrington Retractor Martin Tissue Forceps Davidson scapula retractor Bailey Rib Approximator Nasal Speculum Used to spread nostrils during examination Cutting and Dissecting Instruments Cutting and Dissecting Instruments Scalpels Very sharp knife Handle and blade are packaged separately Used to make surgical incisions Teno tome - dissecting scalpel used for fine dissection and cutting or dividing tendons Different sizes and styles Knife Handle, Scalpel Holder Holds scalpel blade Acts as a handle 7 handle with 15 blade (deep knife) - Used to cut deep, delicate tissue. 3 handle with 10 blade (inside knife) – Used to cut superficial tissue. 4 handle with 20 blade (skin knife) - Used to cut skin. #7, #3, #4 Scissors Types- According To Curvature Straight, Curved or Angled “ Uses of scissor Dressing, Stitch removal, Tissue “ “ the Tip - Sharp or blunt . Utility Cut material that may dull the blade. Type of utility Operating Surgical ,Cut soft tissue Straight Mayo scissors - Used to cut suture and supplies. Also known as: Suture scissors. EX: Straight Mayo scissors being used to cut suture. Curved Mayo scissors - Used to cut heavy tissue (fascia, muscle, uterus, breast). Available in regular and long sizes. Metzenbaum scissors - Used to cut delicate tissue. Available in regular and long sizes. Iris Suture Scissors Used to remove sutures Blade has beak or hook to slide under sutures Sharp/Sharp Scissors Used to cut and dissect tissue Both blade tips are sharp Sharp/Blunt Scissors Used to cut and dissect fascia and muscle One blunt tip and one sharp tip Curved Blunt/Blunt Scissors Both blade tips are blunt Can be curved or straight Lister Bandage Scissors Used to remove bandages and dressings Probe tip is blunt; inserted under bandages with relative safety Pott's Scissors Microvascular scissors Greenberg retractor Neurosurgery suctions Stevene scissors Clamping and Occluding Instruments Clamping and Occluding Instruments Are used to compress blood vessels or hollow organs for hemostasis or to prevent spillage of contents. A mosquito is used to clamp small blood vessels. Its jaws may be straight or curved. hemostat, mosquito (left to right) Curved Mosquito Hemostat Used to hold delicate tissue Used to compress bleeding vessels Jaws are fully serrated Clamping and Occluding Instruments A Kelly is used to clamp larger vessels and tissue. Available in short and long sizes. Kelly, hemostat, mosquito A burlisher is used to clamp deep blood vessels. Burlishers have two closed finger rings. Burlishers with an open finger ring are called tonsil hemostats. A right angle is used to clamp hard-to-reach vessels and to place sutures behind or around a vessel. A right angle with a suture attached is called a "tie on a passer." Grasping and Holding Instruments A hemoclip applier with hemoclips applies metal clips into blood vessels and ducts which will remain occluded. Are used to hold tissue, drapes or sponges. An Allis is used to grasp tissue. Available in short and long sizes. A "Judd-Allis" holds intestinal tissue; a "heavy allis" holds breast tissue. A Babcock is used to grasp delicate tissue (intestine, fallopian tube, ovary). Available in short and long sizes. A Kocher is used to grasp heavy tissue. May also be used as a clamp. The jaws may be straight or curved. Other names: Ochsner. Grasping and Holding Instruments A dissector is used to hold a peanut. dissector EX: Dissector holding a peanut. A towel clip is used to hold towels and drapes in place. Other name: towel clip. Backhaus towel clip Large & small towel clips Bulldog clamp to prevent bleeding vena caval clamp Duval’s lung forceps Pick ups, thumb forceps and tissue forceps are available in various lengths, with or without teeth, and smooth or serrated jaws. Russian tissue forceps are used to grasp tissue. Adson Forceps are used for holding and manipulating delicate tissues etc. DeBakey forceps are used to grasp delicate tissue, particularly in cardiovascular surgery. Grasping and Holding Instruments Mayo-Hegar needle holders are used to hold needles when suturing. They may also be placed in the sewing category. short, medium & long (top to bottom) EX: Needle holder with suture. Sponge Forceps Used to hold gauze squares or sponge to “mop up” the surgical site Jaws are serrated Splinter Forceps Fine tip for foreign object retrieval Toothed Tissue Forceps Used for grasping and holding tissue, muscle or skin surrounding a wound Plain Thumb Forceps Used to hold tissue in place when applying sutures Used to gently move tissues out of the way during exploratory surgery Used to insert packing into or remove objects from deep cavities Needle Holder Used to hold and pass a suturing needle through tissue Has groove to hold needle within jaws Towel Clamp Adds weight to drapes and towels to ensure they stay in place Allow exposure of the operative site Grasping forceps Amputation saw Osteotome Bone lever Bone cutting A bone cutter is a surgical instrument used to cut or remove bones Mallet Surgical mallets are used in several surgical procedures that involve either scraping, slicing, or cutting of the bone in orthopedic procedures. The mallet is used to give controlled tap or pressure on a chisel or osteotomy. Bone nibbler They are used in neurosurgery, podiatric surgery, maxillofacial surgery, and orthopedic surgery to expose areas for operation Role of scrub nurse During surgery: Handle instruments gently. Don’t throw them into basins. Keep the sharp surfaces of cutting instruments away from other metal surfaces that could dull them. Don’t soak them in saline solution. Use the correct instrument for the job at hand, e.g., •Heavy needles will damage delicate needle holders. ••Use towel clips and not hemostats for securing drapes. After surgery Decontaminate/clean instruments as soon as possible. Don't allow blood to dry on them. Use accepted techniques when sterilizing instruments. Separate sharp or delicate instruments from others when processing.
