Remedios Trinidad Romualdez Medical Foundation College of Nursing

Submitted to: DEAN SOCORRO SALVACION GASCO

Submitted by: REBOSURA, Kate Angeli J. RIBO, Diana Rose D. RONA, Rheo Beth A. SORRILLA, Patricia Mari S. SULIT, May Arbee L

Surgical Instrumentation
Fabrication of Metal Instruments Stainless Steel An alloy of iron, chromium and carbon. It may contain nickel, manganese, silicon, molybdenum, sulfur and other elements to prevent corrosion or to add tensile strength.

Chromium in the steel makes it resistant to corrosion. Carbon is necessary to give steel its hardness, but it also reduces the corrosion-resistant effects of chromium. Stainless steel instruments are fabricated with one of three types of finishes before passivation: 1. A mirror finish is shiny and reflects light. 2.An anodized finish, sometimes referred to as a satin finish, is dull and nonreflective. 3. An ebony finish is black, which eliminates glare.

Titanium Are excellent for the manufacture of microsurgical instruments. Titanium is nonmagnetic and inert. Titanium alloy is harder, stronger, lighter in weight, and more resistant to corrosion than is stainless steel. A blue anodized finish of titanium oxide reduces glare. Vitallium Vitallium is the trade name for an alloy of cobalt, chromium, and molybdenum. This inert alloy has the strength and corrosion-resistant properties suitable for some orthopedic devices and maxillofacial implants. Instruments made of vitallium must be used when these devices are implanted. Other Metals Some instruments are fabricated from brass, silver or aluminum. Tungsten carbide is an exceptionally hard metal used for laminating some cutting blades or as inserts on the functional tips or jaws of some instruments.

Classification of Instruments A. Cutting and Dissecting 1. Scalpels the type of scalpel most commonly used has a reusable handle with a disposable blade; the blades may be made of carbon steel. Blades with numeric prefix of 1 as in a 10 series fit handle size number 3 or 7. Blades with numeric prefix of 2 as in 20 series fit handle size number 4. The blade is attached to the handle by slipping the slit in the blade into the grooves on the handle. An instrument, never the fingers, is used to attach and detach the blade; this instrument, usually a heavy hemostat or Kelly clamp, should not touch the cutting edge.

The following are descriptions of blade and scalpel combinations: Number 10 blades are rounded toward the tip and are often used to open the skin. Number 11 blades have a linear edge with a sharp tip. Can be used to make the initial skin puncture for tiny deep incisions. Number 12 blades have a curved cutting surface like a hook. Commonly used for tonsillectomy. Number 15 blades have a short rounded edge for shallow short controlled incisions. Number 20 blades are shaped similar to number 10 blades but larger. An assortment of blades with angulations and configurations for specific uses, such as Beaver blade, also are used. These blades insert into a special universal handle that secures by turning a screw-in collar. Knives - knives come in various sizes and configurations. Like a kitchen paring knife, they usually have a blade at one end that may have One or two cutting edges. The knives are designed for specific purposes. Other types of knives have detachable and replaceable blades. Scissors the blades of scissors may be straight, angled, or curved, as well as either pointed or blunt at the tips. The handles may be long or short. To maintain sharpness of the cutting edges and proper alignment of the blades, scissors should be used only for their intended purpose: Tissue/dissecting scissors must have sharp blades. Blades needed to cut tough tissues are heavier than those needed to cut fine, delicates structures. Curved or angled blades are needed to reach under or around structures. Handles to reach deep into body cavities are longer than those needed for superficial tissues. Suture scissors have blunt points to prevent structures close to the suture from being cut. Wire scissors have short, heavy blades. Wire scissors are used instead of suture scissors to cut stainless steel sutures. Heavy wire cutters are used to cut bone fixation wires. o o o Short jaw sharp tipped scissors for deep areas such as the nasal cavity. Sharp-tipped angled scissors with short jaws for vascular surgery. Dressing/bandage scissors are used to cut drains and dressings and to open items such as plastic packets. Small scissors with specially shaped tips such as tenotomy scissors. Bone Cutters and Debulking Tools. Many types of instruments have cutting edges suitable for cutting into or through bone and cartilage. These instruments include chisels, osteotomes, gouges, rasps, and files. Some have moving parts such as rongeurs and rib cutters. Others, such as drills, saws, and reamers, are powered by air or electricity. The purpose of these instruments is to decrease the bulk of firm tissue.

Other Sharp Dissectors Biopsy forceps and punches. A small piece of tissue for pathologic examination may be removed with a biopsy forceps or punch.

Curettes. Tissue or bone is removed by scraping with the sharp edge of the loop, ring, or scoop on the end of a curette. Snares. A loop of wire may be put around a pedicle to dissect tissue such as a tonsil. The wire cuts the pedicle as it retracts into the instrument. The wire is replaced after use. Blunt Dissectors. Friable tissues or tissue planes can be separated by blunt dissection.

Grasping and Holding Delicate Forceps. Fine tissues such as eye tissue are held with delicate forceps. Adson Forceps. Forceps are used to pick up or hold soft tissues during closure. Bayonet Forceps. Forceps are angled like a bayonet to prevent the users hand from occluding vision in a small space. Smooth Forceps. Also referred to as thumb forceps or pick-ups, smooth forceps resemble tweezers. They are tapered and have serrations at the tip. They may be straight or bayonet, short or long, and delicate or heavy. Toothed Forceps. Toothed forceps differ from smooth forceps at the tip. They have a single tooth on one side that fits between two teeth on the opposing side or they have a row of multiple teeth at the tip. Toothed forceps provide a firm hold on tough tissues, including skin. Finer versions have delicate teeth for holding more delicate tissue. Allis Forceps. An allis forceps has a scissors action. Each jaw curves slightly inward, and there is a row of teeth at the end. Babcock Forceps. The end of each jaw of a Babcock forceps is rounded to fit around a structure or to grasp tissue without injury. Lahey Forceps. The tips of the Lahey forceps are sharp points for grasping tough organs or tumors during excision. Stone Forceps. Either curved or straight forceps are used to grasp calculi such as kidney stones or gallstones. These forceps have blunt loops or cups at the end of the jaws. Tenaculums. The curved or angled points on the ends of the jaws of tenaculums penetrate tissueto grasp firmly, such as when a uterine tenaculum is used to manipulate the uterus. Bone Holders. Grasping forceps, Vise-Grip pliers, and other types of heavy holding forceps stabilize bone.

Clamping and Occluding Hemostatic Forceps. Most clamps used for occluding blood vessels have two opposing

serrated jaws that are stabilized by a box lock and controlled by ringed handles. When the box locks are closed, the handles remain locked on ratchets. Hemostats. Most commonly used surgical instruments and are used primarily to clamp blood vessels. They have a crushing action. Hemostats have either straight or curved slender jaws that taper to a fine point. Crushing Clamps. Many variations of hemostatic forceps are used to crush or clamp blood vessels. The jaws may be straight, curved, or angled, and the serrations may be horizontal, diagonal, or longitudinal. The tip may be pointed or rounded or have a tooth along the jaw such as on Heany or hysterectomy clamps. Fine tips are needed for small vessels and structures. Longer and sturdier jaws are needed for larger vessels, dense structures, and thick tissue. Longer handles are needed to reach structures deep in body cavities.

Noncrushing Vascular Clamps. Used to occlude peripheral or major blood vessels temporarily, which minimizes tissue trauma. The jaws of these types of clamps have opposing rows finely serrated teeth. The jaws maybe straight, curved, angled or S-shaped.

Exposing and Retracting Handheld Retractors. Retractors are not intended for cutting or dissecting. The blades vary in width and length to correspond to the size and depth of the incision. The curved or angled blade may be solid or prolonged like a rake. These blades are usually dull, but some are sharp. Some retractors have blades at both ends rather than a handle on one end. Malleable Retractors. A flat length of low-carbon stainless steel, silver, or silver-plated copper that may be bent to the desired angle and depth for retractions. Hooks. Single, double, or multiple very fine hooks with sharp points are used to retract delicate structures. Hooks are commonly used to retract skin edges during a wide-flap dissection such as a face-lift or mastectomy. Self-Retaining Retractors. Holding devices with two or more blades can be inserted to spread the edges of an incision and hold them apart. A self-retaining retractor may have shallow or deep blades. Some retractors have ratchets or spring locks to keep the device open; others have wing nuts to secure the blades. Suturing or Stapling Needle Holders. Used to grasp and hold curved surgical needles. A needle holder has short, sturdy jaws for grasping a needle without damaging it or the suture material. The jaws are usually straight, but they may be curved or angled; the inside surfaces of the jaws also may differ. The size of the needle holder should match the size of the needle. A needle holder should not be placed on a magnetic pad because it may become magnetized. Tungsten Carbide Jaws. Tungsten carbide is a hard metal. Jaws with an insert of solid tungsten carbide with diamond cut precision teeth are designed specifically to eliminate the twisting and turning of the needle in the needle holder. Crosshatched Serrations. The serrations on the inside surface of the jaws are crosshatched rather than grooved, as in a hemostat. Cross- hatching provides a smoother surface and prevents damage to the needle. Smooth Jaws. Some surgeons prefer needle holders that have jaws without serrations. These needle holders are used with small needles, such as those used for plastic surgery. Staplers. Whether reusable or disposable, all surgical staplers are bulky, heavy instruments. Reusable staplers have many moving parts and are disassembled for cleaning and assembled at the sterile field before use. Clip Appliers. Used to mark tissue and to occlude vessels or small lumens of tubes. Terminal End Staplers. Designed for closing the end of a hollow organ with a double staggered line of staples. Internal Anastomosis Staplers. Designed to connect hollow organ segments to fashion a larger pouch. End-to-End Circular Staplers. Designed to staple two hollow, tubular organs end to end to create a continuous circuit.

Viewing Speculums. The hinged, blunt blades of a speculum enlarged and hold open a canal or a cavity. Endoscopes. Designed for viewing in a specific anatomic location, inserted into a body orifice or through a small skin incision. Hollow Endoscopes. The rigid hollow sheath permits viewing in a forward direction through the endoscope.

Lensed Endoscopes. Used in combination with video-assisted technology, computerization permits recording action videos and still digital photography.

Suctioning, Irrigating and Aspirating Suction. Involves the application of pressure to withdraw blood or fluids, usually for visibility at the surgical site. Poole Abdominal Tip. Used during abdominal laparotomy or within any cavity in which copious amounts of fluid or pus are encountered. Frazier Tip. Used when encountering little or no fluid except capillary bleeding and irrigating fluid. Yankauer Tip. Large quantities of blood and fluid can be suctioned quickly with a Yankauer tip, which is useful for visualization during raptured aneurysms. Autotransfusion. Double-lumen suction tip is used to remove blood for auto transfusion. Aspiration. Used to obtain a specimen for laboratory examination or to obtain bone marrow for transplantation. Trocar. Needed to cut through tissue for access to fluid or body cavity. Cannula. Used to aspirate fluid without cutting the tissue, also used to open blocked vessels or ducts for drainage or to shunt blood flow from the surgical site.

Dilating and Probing A dilator is used to enlarge orifices and ducts and a probe is used to explore a structure or to locate an obstruction. Probes are used to explore the depth of the wound or to trace the path of a fistula. Measuring Rulers, depth gauges, and trial sizers are used to measure parts of the patients body. Some of these devices are used to determine the exact size needed for an implant, such as a joint or breast prosthesis. Microinstrumentation Material and Surface Microinstruments are made of stainless steel or titanium. Shape and Tips Microinstruments are shorter than standard instruments and often are angulated for convenience approach and avoidance of obstruction of the surgical field. Handles Designed for a secure and comfortable grasp, with a diameter comparable to that of a pen or pencil.

Primary uses includes cutting (knives, scissors, saws), exposure (spatulas, retractors), gross and fine fixation (forceps and clamps), and suture and needle manipulation (needle holders). Knives Edges of razor, diamond and dissecting knives have different degrees of sharpness and thickness of blades that are appropriate to the cutting function of each. Scissors Designed to make a specific type of incision related both to the plane and to thickness. Powered Instruments Spatulas and Retractors Used to draw tissue back for better exposure or protection. Forceps Toothed forceps are used for grasping tissue but never for grasping needles or sutures. Smooth forceps are used for tying delicate ligatures and sutures. Bipolar forceps are used for electrocoagulation. Clamps Used for vascular occlusion and for approximation of edges of tissues. Needle Holders Used for suturing.

Powered Surgical Instruments Power Sources Air-powered instruments small, lightweight, free of vibration and easy to handle for pinpoint accuracy at high speed. Electrically powered instruments saws, drills, dermatomes and nerve stimulators are potential explosion hazards in the OR. Battery Power Alternating Current power switches should be off before cords are plugged into electrical outlets. Sonic Energy moves cutting edges in a linear direction.

Handling Powered Instruments Set the instrument and attachment alone on a small sterile table when they are not in use. Handle and store the air hose or electrical power cord with care. To prevent inadvertent activation, assemble the appropriate hand piece, attachments and power source with the safety mechanism in position. Test whether the instrument is in working condition.

Cleaning and Sterilizing Powered Instruments Clean and decontaminate the instrument immediately after use to maintain optimal function. Lubricate the instrument as recommended by the manufacturer. Handling Instruments Handle loose instruments separately to prevent interlocking or crushing. Inspect instruments for alignment, imperfections, cleanliness and working condition. Remove any malfunctioning instrument from the set. Sort instrument neatly by classification. Keep ring-handled instruments together with the curvatures and angles pointed in the same direction. Leave retractors and other heavy instrument in a tray or container, or lay them out on a flat surface of the table. Protect sharp blades, edges ad tips.

Handling Instruments during the Surgical Procedure Know the name and appropriate use of each instrument. Handle instruments individually. Hand the surgeon or assistant the correct instrument for each particular task. Pass instruments decisively and firmly. Watch sterile filed for loose instruments.

With a moist sponge, wipe blood and organic debris from instruments promptly after use. Flush the suction tip and tubing with sterile distilled water periodically to keep the lumen patent. Remove debris from electrosurgical tips to ensure electrical contact. Place used instruments that will not be needed again into a tray or basin during or at the end of the surgical procedure.

Key points in handling instruments when dismantling the instrument table includes the following: Check drapes, towels and table covers to be sure that instruments do not go to the laundry or in to the trash. Collect instruments from the Mayo table and any other small tables, and collect those that may have been dropped or passed off the sterile field. Separate delicate, small instruments and those with sharp or semisharp edges for special handling. Disassemble all instruments with removable parts to expose all surfaces for cleaning. Open all hinged instruments to expose box locks and serrations. Separate instruments of dissimilar metals. Flush cold distilled water through hollow instruments or channels. Rinse off blood and debris with demineralized distilled water or an enzymatic detergent solution. Follow the procedures for preparing each instrument for decontamination or terminal sterilization. Wrap the instrument for sterilization. Sterilize the instrument in steam unless contraindicated by the manufacturer.

SCALPE

TISSUE SCISSORS

SUTURE SCISSORS

WIRE SUTURE SCISSOR

JOSEPH NASAL SCISSOR

POTTS ANGLED SCOSSORS

TENOTOMY SCISSORS

BANDAGE SCISSORS

CURETTES

SNARES

DELICATE FORCEPS

SMOOTH FORCEP

TOOTHED FORCEPS

BAYONET FORCEPS

HEMOSTAT

CRUSHING CLAMP

RETRACTORS

NEEDLE HOLDER

STAPL

CLIP APPLIERS

SPECULUM

ENDOSCOPE

SUCTION CATHETER

TROCAR