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Edit Comment Close Premium member Presentation Transcript Surgical Instrumentation : Surgical Instrumentation IMPORTANT TERMS : IMPORTANT TERMS Atraumatic without trauma Traumatic Causing Injury by penetration or crushing Dilation Enlarging an opening in a progressive manner Dissection Process of separating tissues through anatomic planes by using sharp or blunt instrumentation IMPORTANT TERMS : IMPORTANT TERMS Grasping Holding in a traumatic or atraumatic manner Retraction stabilizing a tissue layer in a safe position for exposure of a part Sharp Instrument with a cutting edge or pointed tip(s) that is used to cut or dissect tissue IMPORTANT TERMS : IMPORTANT TERMS Trocar A device used for penetration of tissue layers. It is commonly used for percutaneous endoscopy. It is used as a temporary pathway for gases, other instrumentation, or the removal of an organ or substance. CLASSIFICATION OF INSTRUMENTS : CLASSIFICATION OF INSTRUMENTS Cutting and Dissecting Grasping and Holding Clamping and Occluding Exposing and Retracting Suturing and Stapling Viewing Suctioning and Aspirating Dilating and Probing Measuring Accessory Instruments Microinstrumentation CUTTING AND DISSECTING : CUTTING AND DISSECTING SCALPELS Insert Blade using a HEAVY HEMOSTAT of KELLY CLAMP No. 10 BLADE used MOST OFTEN No. 11 Blade No. 12 Blade No. 15 Blade No. 23 Blade KNIVES SCISSORS BONE Cutters and Debulking Tools Biopsy Forceps and Punches Curettes Snares Blunt Dissectors Slide 7: Scalpels (disposable) Adv. Knives(reusable), Ortho, GS, Amputation Handle 4 – Blade 20-24 (SIZES) Blade 20 – Initial for SKIN knife Blade 10 – most common Blade 11 – Vascular, To puncture Aorta, To cut blood vessel Blade 12 – EENT, Tonsilectomy Blade 15 – Plastic, Pedia Bone Cutters – to Cut RIBS, THORACOTOMY CUTTING AND DISSECTING : CUTTING AND DISSECTING Bone Curette used by Ortho, Neuro Surgeon for Laminectomy Maybe straight or angulated(spine surgery) Laminectomy – Lamina removing of intervertebral disk, to remove tissues, debris, CUTTING AND DISSECTING : CUTTING AND DISSECTING Mayo Scissors Tough tissues, curve mayo, ob-gyn(to cut ligaments) Metzenbaum Scissors delicate tissues, Plastic surgeon, Intestine, delicate tissue CUTTING AND DISSECTING : CUTTING AND DISSECTING Suture Scissors (Blunt /Blunt) Nursing Scissor – Blunt/Pointed GRASPING & HOLDING : GRASPING & HOLDING Tissue Forceps Smooth Forceps Toothed Forceps Allis Forceps Babcock Forceps Stone Forceps Tenaculums Bone Holders GRASPING & HOLDING : GRASPING & HOLDING Rat-Toothed Tissue Forceps General Surgery Skin GRASPING & HOLDING : GRASPING & HOLDING Allis Tissue Forceps To grasp OB tissues (atraumatic) , AP repair GRASPING & HOLDING : GRASPING & HOLDING Babcock Intestinal Forceps GRASPING & HOLDING : GRASPING & HOLDING Backhaus Towel Clamps Towel clips on the edges of drapes, hide the towel clamps CLAMPING & OCCLUDING : CLAMPING & OCCLUDING Hemostatic Forceps Hemostats Crushing Clamps Noncrushing Vascular Clamps Most commonly used, to clamp blood vessels Kocher and Oschner forceps CLAMPING & OCCLUDING : CLAMPING & OCCLUDING Hemostatic Forceps Hemostats Crushing Clamps Noncrushing Vascular Clamps- used to occlude peripheral or major blood vessels CLAMPING & OCCLUDING : CLAMPING & OCCLUDING Pean Intestinal forceps Intestinal / serrations is horizontal CLAMPING & OCCLUDING : CLAMPING & OCCLUDING Hemostatic Forceps Hemostats Crushing Clamps Noncrushing Vascular Clamps CLAMPING & OCCLUDING : CLAMPING & OCCLUDING Hemostatic Forceps Hemostats Crushing Clamps Noncrushing Vascular Clamps EXPOSING & RETRACTING : EXPOSING & RETRACTING BALFOUR ABDOMINAL RETRACTOR Laparotomy Retractors assist in the visualization of the operative field while preventing trauma to other tissues EXPOSING & RETRACTING : EXPOSING & RETRACTING ARMY NAVY FARABEUF Retractor EXPOSING & RETRACTING : EXPOSING & RETRACTING GELPI Perineal Retractor Self retraining Biopsy , Skin EXPOSING & RETRACTING : EXPOSING & RETRACTING Weitlaner Retractor EXPOSING & RETRACTING : EXPOSING & RETRACTING Spay Hook Bone hook, skin hook, to retract skin edges during a wide flap dissection, such as a face-lift or mastectomy. Some have styles of hooks that have ball tips, which causes less trauma to tissues EXPOSING & RETRACTING : EXPOSING & RETRACTING Senn Retractors EXPOSING & RETRACTING : EXPOSING & RETRACTING Finochietto Retractor For sternotomy , EXPOSING & RETRACTING : EXPOSING & RETRACTING Ribbon Retractor Malleable retractor - neuro SUTURING & STAPLING : SUTURING & STAPLING Needle Holders Tungsten Carbide Jaws Crosshatched Serrations Smooth Jaws Staplers Clip Appliers Terminal End Staplers Internal Anastomosis Staplers End-to-End Circular Staplers SUTURING & STAPLING : SUTURING & STAPLING A needle holder should not be placed on a magnetic pad, because it may become magnetized. Tungsten Carbide jaws – eliminate the twisting and turning of the needle Crosshatching – provides a smoother surface and prevents damage to the needle Smooth jaws – used with small needles such as those used for plastic surgery SUTURING & STAPLING : SUTURING & STAPLING Terminal End Staplers Internal Anastomosis Staplers End-to-End Circular Staplers VIEWING : VIEWING Speculums Endoscopes Hollow Endoscopes permits viewing in a forward direction, with a light carrier supplied by a fiberoptic cable provides illumination Lensed Endoscopes have either rigid or flexible sheaths, used in combination with video assisted technology, can record action videos and still digital photography SUCTIONING & ASPIRATING : SUCTIONING & ASPIRATING Suction Suction devices remove blood and other fluids from a surgical or dental operative field. Used in abdominal laparatomy or within a cavity with copious amounts of fluid. The outer filter shield prevents the adjacent tissues from being suctioned in to the apparatus. Poole Abdominal Tip Frazier Tip Yankeur Tip Autotransfusion Aspiration Trocar Cannula SUCTIONING & ASPIRATING : SUCTIONING & ASPIRATING Suction Poole Abdominal Tip Frazier Tip - for brain, spinal, plastic, or orthopedic procedures, used when encountering little or no fluid Yankeur Tip -Standard tip for suctioning. Has an angle for mouth and throat, also useful for visualization of ruptured aneurysm Trocar Cannula DILATING & PROBING : DILATING & PROBING Probing instruments are used to enter natural openings, such as the common bile duct, or fistulas Dilating instruments expand the size of an opening, such as the urethra or cervical os MEASURING : MEASURING ACCESSORY INSTRUMENTS : ACCESSORY INSTRUMENTS MICROINSTRUMENTATION : MICROINSTRUMENTATION Powered Surgical Instruments : Powered Surgical Instruments DRILL BURR BLADE REAMER ABRADER AIR-POWERED ELECTRICALLY POWERED HANDLING INSTRUMENTS : HANDLING INSTRUMENTS Standardized BASIC sets Scrub Person counts ALL instruments, sharp and sponges with the CIRCULATOR Handle Loose Instruments SEPARATELY Sort by CLASSIFICATION PROTECT Sharps Handling INSTRUMENTS during SURGERY : Handling INSTRUMENTS during SURGERY Know the NAME and USE Handle INDIVIDUALLY Use for the INTENDED purpose Use of HAND SIGNALS Short INSTRUMENTS = Superficial Work LONG Instruments = DEEP PASS instruments DECISIVELY and FIRMLY FREE-HAND TECHNIQUE Watch the sterile field for LOOSE instruments With a MOIST, SPONGE wipe blood and organic debris from instruments using a DEMINERALIZED STERILE, DISTILLED H20 Handling INSTRUMENTS during SURGERY : Handling INSTRUMENTS during SURGERY Instruments are maintained and sterilized prior to use. Surgical instruments must be kept clean during a procedure. This is accomplished by carefully wiping them with a moist sponge and rinsing them frequently in sterile water. Periodic cleaning during the procedure prevents blood and other tissues from hardening and becoming trapped on the surface of an instrument. ELECTROSURGERY : ELECTROSURGERY INITIAL Incision is made by a SCALPEL Doubling the current increases the heat produced fourfold ARGON Enhanced ESU Tip is held at 60 degree angle, causing LESS Tissue Damage BUZZING – the process of coagulating the VESSELS BUZZ should not exceed more than 3 SECONDS Electrosurgery precautions : Electrosurgery precautions ESU should not BE USED in the mouth, trachea, around the HEAD, or in the pleural cavity ECG electrodes should be placed as far as possible, BURNS can occur Rings and jewelry should be removed DON’T USE Flammable agents DO not immerse an active electrode in liquid DRY Sponges can IGNITE Investigate a repeated request for more current LASER SURGERY : LASER SURGERY Light amplification by stimulated emission of radiation (LASER) Types of LASERS = ARGON, CARBON DIOXIDE, HOLMIUM, KRYPTON, NEODYMIUM, PHOSPHATE, RUBY/XENON PATIENT SAFETY in LASERS : PATIENT SAFETY in LASERS Eyes and Eyelids should be adequately protected (aluminum foil, moist pads) Antiseptics must be NONFlammable Rectum should be packed with a MOISTENED sponge to prevent escape of METHANE gas Anesthetic Agents should be NONCombustible Flexible metallic or insulated silicone endotracheal tubes Wear high filtration MASKS for CO2 laser ablation such as condylomata (Venereal warts) Advantages of LASERS : Advantages of LASERS Precise CONTROL = ACCURATE incision Access to HARD to REACH areas (endoscopes, rhodium reflector mirrors) Unobstructed view of the surgical site Minimal TRAUMA to tissues DRY, Bloodless SURGICAL Field Minimal THERMAL effect Reduced RISK for INFECTION Prompt Healing Reduced OPERATING Time THANK YOU : THANK YOU ALL RIGHTS RESERVED 2007© You do not have the permission to view this presentation. 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