INSTRUMENTATION OPERATING ROOM INSTRUMENTS Classifications of Surgical Instruments ● Cutting and Dissecting (Sharps) ● Clamping and Occluding (Clamps) ● Grasping and Holding (Graspers) ● Exposing and Retracting (Retractors) ● Suturing and Stapling ● Viewing ● Suction and Aspiration ● Dilating and Probing ● Measuring ● Accessory Instruments Cutting and Dissecting (Sharps) Knife / Scalpel ● Handle #4 is the first knife used to cut tough tissues. ● Handle #3 is the second knife used to cut delicate tissues, and is used for minor surgeries. Scissors ● Mayo Scissors (Straight / Curved) ○ used to cut tough tissues. ○ Heavy scissors available in multiple varieties. Straight scissors are used for cutting suture (“suture scissors”), while curved scissors are used for cutting heavy tissue (e.g., fascia). ● Metzenbaum Scissors (Straight / Curved) ○ used to cut delicate tissues. ○ Lighter scissors used for cutting delicate tissue (e.g., heart) and for blunt dissection. ○ Also called “Metz” in practice ● Iris Scissors ○ Used for fine dissection and cutting fine suture. ○ ● Originally for ophthalmic procedures, but now serves multipurpose role Bandage Scissors ○ used to cut the uterus and umbilical cord. Clamping and Occluding (Clamps) Hemostatic Forceps used to temporarily clamp and occlude bleeding vessels. can be straight or curved ● Kelly Forceps ○ longest; used for deep abdominal layers and cavities ● Crile Forceps ○ medium; used for shallow layers ● Mosquito Forceps ○ shortest; used for minor surgery, pediatrics, and superficial layers ● Mixter Forceps ○ used to reach around and ligate blood vessels. ● Ochsner Forceps ○ used to grasp medium to heavy tissue or occlude heavy, dense vessels Grasping and Holding (Graspers) ● Adson Forceps (Toothed) ○ used for handling dense tissue, such as in skin closures ● Adson Forceps (Toothless) ○ used for fine surgical procedures to hold delicate or superficial tissues ○ Forceps toothed at the tip used for handling dense tissue, such as in skin closures. ● Thumb Forceps ○ used for grasping, holding or manipulating body tissue ● Tissue Forceps ○ used in surgical procedures for grasping tissue ○ designed to minimize damage to biological tissue ○ Non Toothed forceps used for fine handling of tissue and traction during dissection. ● Allis Forceps ○ used to hold or grasp heavy tissue like bones, tendons, uterus, and fascia ● Pennington Forceps ○ used for grasping tissue, particularly during rectal operations ● Babcock Forceps ○ used to grasp delicate tissue and hold tubular organs - used with intestinal and laparotomy procedures ● Ovum Forceps ○ used to remove placental fragments inside the uterus ● Towel Clips ○ used to hold drapes in place, to keep only the operating field exposed ● Bonney Forceps ○ Heavy forceps used for holding thick tissue (e.g., fascial closure) Exposing and Retracting (Retractors) Self Retaining Retractors ● Balfour Abdominal Retractor ○ used in laparotomy procedures, and for specific abdominal procedures where the abdomen needs to be held open for examination or evaluation, such as cesarean sections and bowel resection ● Mastoid Retractor ○ used to retract the external canal skin anteriorly for better visualization of the external canal and middle ear. ● Gelpi Retractor ○ used for holding back organs and tissues while accessing areas below an incision during lumbar spine procedures Non-Self Retaining Retractors ● Army Navy Retractor - used for shallow or superficial wounds, and to retract skin or bones ● Richardson Retractor - used to retract, expose or push tissue, muscles, organs or bones during surgery ● Deaver Retractor - used to hold back the abdominal wall during abdominal or thoracic procedures, and to move or hold organs away from the surgical site ● Murphy Rake Retractor - used to gently retract tissue and give better visibility to the surgical field ● Senn Retractor - used to retract fat tissue in minor surgery ● Malleable Retractor - used to retract deep wounds and may be bent to various shapes. Suturing and Stapling ● Needle Holder - used to hold a suturing needle for closing wounds during suturing and surgical procedures ● Skin Stapler - used to close incisions after surgery Viewing ● Speculum - used to see inside a hollow part of the body ● Endoscope - used to look deep into the body and used in procedures called an endoscopy Suction and Aspiration ● Suction - used to remove substances such as blood, saliva, mucus, Dilating and Probing ● Urethral Sounds - used in urological surgery for dilatation of strictures or for obtaining access to the bladder ● Surgical Probes - a blunt-ended surgical instrument used for exploring a wound or part of the body Measuring ● Caliper - used in plastic surgery procedures to ascertain precise measurements ● Ruler - used to obtain precise measurements during orthopedic surgical procedures Accessory Instruments ● Mallet - used with a chisel to split teeth and reshape or remove bones and vomit SUTURES ● a stitch or row of stitches holding together the edges of a wound or surgical incision ● can classified into Absorbable and Non-Absorbable ● Absorbable sutures are broken down by the body via enzymatic reactions or hydrolysis. The time in which this absorption takes place varies between material, location of suture, and patient factors. ● Examples: ○ Vicryl ○ PolyDioxanone Suture (PDS) ○ Monocryl ● Non-Absorbable sutures are used to provide long-term tissue support, remaining walled-off by the body’s inflammatory processes (until removed manually if required). ● Examples: ○ Nylon ○ Prolene Silk Suture Size ● The diameter of the suture will affect its handling properties and tensile strength. ● The larger the size ascribed to the suture, the smaller the diameter is, for example a 7-0 suture is smaller than a 4-0 suture. Surgical Needles ● The surgical needle allows the placement of the suture within the tissue, carrying the material through with minimal residual trauma. ● Characteristics: ○ rigid enough to resist distortion, yet flexible enough to bend before breaking ○ as slim as possible to minimize trauma ○ sharp enough to penetrate tissue with minimal resistance ○ stable within a needle holder to permit accurate placement. Surgical Needles – 3 Parts ○ Swaged end - connects the needle to the suture Surgical Needles – 3 Parts ● Needle Body or Shaft - the region grasped by the needle holder, and can be round, cutting, or reverse cutting. ○ Round bodied needles are used in friable tissue such as the liver and kidney. ○ Cutting needles are triangular in shape, and have 3 cutting edges to penetrate tough tissue such as the skin and sternum, and have a cutting surface on the concave edge. ○ Reverse cutting needles have a cutting surface on the convex edge, and are ideal for tough tissue such as tendon or subcuticular sutures, and have reduced risk of cutting through tissue. Surgical Needles – 3 Parts ● Needle point - acts to pierce the tissue, beginning at the maximal point of the body and running to the end of the needle, and can be either sharp or blunt. ○ Blunt needles are used for abdominal wall closure, and in friable tissue, and can potentially reduce the risk of blood borne virus infection from needlestick injuries. ○ Sharp needles pierce and spread tissues with minimal cutting, and are used in areas where leakage must be prevented. Surgical Needles Shapes ● The needle shapes vary in their curvature and are described as the proportion of a circle completed – the ¼, ⅜, ½, and ⅝ are the most common curvatures used. ● Different curvatures are required depending on the access to the area to suture. PRINCIPLES OF ASEPTIC TECHNIQUE 1. Only sterile items are used within the sterile field. 2. Gowns are considered sterile only from the waist to shoulder level infront and the sleeves. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Tables are sterile at table level. 4 Sterile persons touch only sterile items or areas . Unsterile persons touch only unsterile items or areas. Unsterile avoid reaching over sterile fields. Sterile persons avoid leaning on unsterile areas. Edges of anything that encloses sterile content are considered unsterile. Sterile fields are created as close as possible to time of use. Sterile areas are continuously kept in view. Sterile persons keep well within the sterile area. Sterile persons wear gowns and gloves. Unsterile persons avoid sterile areas. Destruction of integrity of microbial barriers results in contamination. Microorganisms must be kept to an irreducible minimum APPROPRIATE HAND HYGIENE Procedure ● Wet hands with water, and apply soap to cover hand surface ● Rub hands palm to palm ● Right palm over left dorsum with interlaced fingers and vice versa ● Palm to palm with fingers interlaced ● Backs of fingers to opposing palms with fingers interlaced ● Rotational rubbing of left thumb clasped in right palm and vice versa ● Rotational rubbing, backwards and forwards with clasped fingers of the right hand, and vice versa ● Rinse hands with water and dry with a single use towel ● Use the towel to turn off the tap 1.
