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Introduction to Surgical INSTRUMENTATION

Introduction to Surgical INSTRUMENTATION. ST230 Concorde Career College. Objectives. Discuss the relationship between instrumentation, equipment, and supplies and quality patient care in the OR Identify basic instruments by type, function, classification, and name. Manufacturing.

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Introduction to Surgical INSTRUMENTATION

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  1. Introduction to Surgical INSTRUMENTATION ST230 Concorde Career College

  2. Objectives • Discuss the relationship between instrumentation, equipment, and supplies and quality patient care in the OR • Identify basic instruments by type, function, classification, and name

  3. Manufacturing • Most are stainless steel • Carbon, chromium, iron, alloys • High carbon makes instruments harder and less likely to wear • Chromium increases resistance to corrosion

  4. Manufacturing • Three types of finishing • Highly polished = increased resistance to corrosion, but increases glare from OR lights • Satin (dull) = less reflective, reduces glare • Ebonized = non-reflective, eliminates glare • Used for laser procedures because it prevents reflection of laser beam

  5. CLASSIFICATIONS • CUTTING/DISSECTING • GRASPING/HOLDING • CLAMPING/OCCLUDING • RETRACTING/VIEWING • PROBING • DILATING • SUTURING • SUCTIONING • ACCESSARY INSTRUMENTS

  6. CUTTING/DISSECTING • One or more sharp edges • Used for incision, sharp dissection, or excision of tissue • Include knives, scalpels, scissors, and bone cutting instruments – osteotomes, curettes, chisels, gouges, and rongeurs • May be classified as cutting instruments – saws, drills, biopsy punches, adenotomes, and dermatomes • -tome – refers to a cutting instrument

  7. CUTTING/DISSECTING • The term knife and scalpel are interchangeable although typically scalpels have a detachable disposable blade and non-disposable handle andknives refers to non-disposable handle and blade such as an amputation knife • Scalpels handlessizes include #3, #4, #7, and #9; Beaver blade handle

  8. CUTTING/DISSECTING • Disposable blades are made from carbon steel • Blades should be loaded and removed with an instrument such as a needle holder • #10, #11, #12, #12B, #15, #15C, #20, #21, #22, #23, #25 • Blades fit specific handles - #10, #11, #12, #12B, #15, #15C blades fit #3, #7, #9 handles

  9. CUTTING/DISSECTING • #20, #21, #22, #23, #25 blades fit on a #4 knife handle • Any size Beaver blade will fit on a Beaver blade handle • #10 blades are the most frequently used blades and should be loaded on a #3 knife handle; do not load #10’s on a #7 knife handle • #11, #12, #15 blades are loaded on a #7 knife handle, although a #15 blade is used on a #3 knife handle for small skin incisions

  10. CUTTING/DISSECTING • Blades become dull very quickly. 2 or 3 cuts usually dulls the blade • The blades have to be changed as needed • For safety reasons, if the blade has been changed, the surgeon should be informed that it is a new blade when passing it

  11. CUTTING/DISSECTING • Scissors • Tissue scissors,suture scissors, wire scissors, or bandage scissors • Tissue scissors should only be used to cut tissue because others materials will dull them; an exception would be CV surgeons, they use Metz to cut the small sutures • Wire scissors are used to cut wire • Bandage and straight mayo scissors can be used on dressings

  12. Cutting and Dissecting 14

  13. CUTTING/DISSECTING • In addition to cutting tissue (sharp dissection),scissors are also used to spread and open tissue planes (dull dissection) • Curved mayo scissors are used on heavy tissue • Metz are used on medium to fine tissue • Iris, tenotomy, and Potts-smith scissors are used on delicate tissues

  14. CUTTING/DISSECTING • Examples of specialized scissors • Potts-smith – ducts, veins, or arteries • Cushing - dura • Jorgenson – hysterectomy • Strabismus, Iris, corneal scissors – eyes • Scissors have straight and curved blades and sharp or dull tips

  15. GRASPING/HOLDING • Used to grasp or hold tissue for counter traction or manipulation • Forceps – aka pickups or thumb forceps • Forceps are usually used in the non-dominate hand • Forceps have either teeth, serrations or smooth; Vary in length • Adson – smooth, with teeth, or Brown tips; primarily used for skin closure • Ferris-Smith – used for heavy tissue • Brown, Russian, Gerald, Cushing, bayonet, rat tooth • Allis, Babcock, Kocher - clamps • Bone-holding clamps – ex; Lane, Kern, Lowen, Lewin

  16. Grasping/holding • Designed to manipulate tissue to facilitate dissection or suturing or to reduce and stabilize fractured bone during internal fixation • Lowman – Turkey claw • Lane

  17. CLAMPING/OCCLUDING • Designed to occlude or restrict tissue • Have ringed handles with interlocking ratchets • Straight or curved, long or short, pointed or round • Vascular clamps have atraumatic serrations that are vertical • Bulldog clamps are small spring loaded for temporary occlusion – vascular • Hemostats are used to occlude bleeders until they can be ligated

  18. Clamping and Occluding 20

  19. RETRACTING/VIEWING • Designed for the exposure of the operative site • May be hand-held or self-retaining • Many sizes and designs; sharp or dull tips • Some retractors are malleable • Many hand-held are double-ended with a variation on each end and usually are mostly used two at a time

  20. RETRACTING/VIEWING • Most commonly used hand-held retractors – • small wounds - Richardson, Army/Navy, Senn, Ragnell, • A variety of rakes, skin hooks; • large wounds – Deaver, Ribbon (malleable), Harrington • Most common self-retaining retractors • small wounds – Gelpie, Weitlaner • large wounds – Balfour,Bookwalter, O’Sullivan-O’Conner • Many have a variety of attachments • Some large self-retaining retractorsare attached to the OR table for stabilization

  21. RETRACTING/VIEWING • Viewing instruments are more specialized • Ear speculum; nasal speculum; vaginal weighted speculum • vaginal retractors • Endoscopes are also considered viewing instruments

  22. PROBING • Malleable, wire-like instruments that are used for exploration of tubular structures • Fistula probes, lacrimal duct probes, biliary probe, rectal probes

  23. DILATING • Used to gradually dilate a duct or an orifice to allow introduction of a larger instrument or open a stricture • Used from the smallest to largest • May require lubrication • Can be single or double ended • CBD, lacrimal duct, tracheal, urethral, cervical

  24. SUTURING • Used to hold a curved needle – needle holders, needle drivers • Choosing an appropriately-sized needle holder depends on the size of the needle • the length depends on the depth • can be curved for deep tissue • Vary by specialty • General, ophthalmic, plastic, GYN, vascular, microscopic

  25. Suctioning Yankauer Suction Poole Suction 27

  26. SUCTIONING • For the removal of blood and bodily fluids • Disposable and non-disposable • Vary by specialty • Abdominal, ear, neurosurgery, nasal, rectal • Some suction devices have the ability to coagulate • Many different lengths for trachea, esophageal, larynx – these are not typically used in sterile fashion

  27. MICROINSTRUMENTATION • Used for working under the microscope • Small and delicate • Must be handled with extra care and precision

  28. Introduction to Surgical INSTRUMENTATION ST230 Concorde Career College

  29. Objectives • Describe different types of specialty sets • Describe types of instruments included in the sets • Describe procedures performed using specialty sets

  30. Instrument Sets Assembled into sets for specific specialties Assembled for specific procedures Laparotomy Craniotomy Cardiovascular 32

  31. Specialty Sets • May contain a count sheet • Names of instruments may vary by manufacturer, locality, facility, or surgeon • Many procedures require more than one set

  32. Laparotomy Sets • Abdominal procedures • May need additional sets for certain procedures (gallbladder, rectal, etc) • Can be major or minor

  33. Major Laparotomy Set

  34. OB/Gyn • D&C • Abdominal hysterectomy • Vaginal hysterectomy • Laparoscopic procedures • C-section

  35. Abdominal Hysterectomy Set

  36. D&C Set

  37. ENT • Myringotomy • Tympanoplasty • Tonsils • Tracheotomy • Sinuses

  38. ENT Instruments

  39. Plastics • Lipo • Minor plastic • Major plastic • Breast Augmentation

  40. Plastic Instrument Tray

  41. GU • Kidney procedures may need a major set, basic vascular set, kidney set, long instrument set and a thoracotomy set • Prostate procedures may require several sets as well

  42. What are these used for?

  43. Ortho • Internal fixation sets • External fixation sets • Minor ortho • Major ortho • Total joints • IM rods • Hands

  44. Synthes ORIF Instruments

  45. Cardiac sets • CABG- vein harvesting instrumentation, cannulization for bypass, diethrich scissors, sternal saw, IMA retractors, surgeon specific instrumentation

  46. Thoracic sets • Used for procedures of the thorax • Includes instruments to shear and remove ribs • Thoracoscopy sets differ from thoracotomy sets

  47. Peripheral vascular • Instruments for exposure and repair of vessels • Aneurysms, Fem-pops, A-V fistulas

  48. Neuro • Exposure and repair of the brain, spinal cord, and peripheral nerves • Crani sets, lami sets, thrasphenoidal hypophysectomy sets • Cloward retractors

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