OPERATION THEATRE INSTRUMENTS

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OT INSTRUMENTS (perfect tools are essential to validate perfect performance) :

OT INSTRUMENTS ( perfect tools are essential to validate perfect performance) Conducted by: Ms.Monika Clinical instructor Army college of nursing

Introduction :

Introduction The majority of surgical instruments are made up of stainless steel though some instruments are made of titanium or vitallium---a cobalt base alloy. Stainless steel instruments are most commonly used. Stainless steel is an alloy of iron ,chromium & carbon. It also contain nickel or manganese to add tensile strength & also to prevent corrosion .

Cont…..d:

Cont…..d Carbon component of the stainless steel gives the hardness. Chromium makes the stainless steel resistant to corrosion. Instruments must be used for the proposes they are intended for. Also necessary care should be taken before & after the use of the instruments as per the direction of their manufacturer. Instruments are classified according to their functions of use:

a) Cutting & dissecting instruments :

a) Cutting & dissecting instruments These instruments are used for incising or dissecting tissues. They have sharp edges. They are also called sharp instruments because of their sharp edges. Sharp instruments are kept separated from the other instruments. These instruments needs caution handling to prevent accidental cuts or injuries. During use. These instruments never boiled or autoclave for sterilization to protect their sharpness because heat ,especially moist heat destroy their sharpness & make them blunt.

Cont……….d:

Cont……….d These instruments are sterilized by chemical method-------keeping them submerged in chemical solutions for a prescribed period. Bard parker (BP) handle & blade. Knife Scalpel Scissors

Bard parker handle or scalpel blade :

Bard parker handle or scalpel blade It is a handle to hold blades at the distal end . Its proximal end is flat & round. It has a shaft. Part of the shaft is serrated to have a better grip. Its distal end is narrow which has got a slunt dent in which the blade is fixed. B.P handles vary in size.

Bard parker Blades :

Bard parker Blades BP blades also vary in size & shapes. The blades usually have curved cutting edges . Blades are held in dinner knife position or writing position used for incision on skin ,fascia ,muscles ,peritoneum etc. Following are the sizes & shapes of the blades.

Cont…….d:

Cont…….d No: 10 blade fits on B.P handle no. 3 ,7 & 9.it is most commonly used. No: 11 blade has a straight cutting edge ,which ends to a sharp point ,it also fits on B.P handle no. ,& & 9. No:12 blade has a hook like shape with the cutting edges on the inner curvature. it also fits on BP handle no: 3 ,7 & 9. No:15 blade has a smaller & shorter curved cutting edge on the inner curvature. No:20 blade has a shape like no.10 blade ,bit it is bigger in size ,it fits on BP handle no: 4.

Surgical knife :

Surgical knife It is like a kitchen knife with usually a brass handle. Its edge runs along one side till the tip. The tip is pointed or blunt. Knives are used for cutting or dissecting skin or tissues. There is special knife which is called Humby's or Blair’s knife. These knife are specially designed for obtaining a skin graft.

Skin grafting knife:

Skin grafting knife Made of stainless steel. It consists of a handle and stem, on which is mounted and adjustable roller. It is used for taking split skin grafts used for coverage of raw surface composed of healthy vascularized or clean granulations to obtains healing and limit deformity and disability .

Scissors :

Scissors Scissors are used for cutting the tissues in various structures. Scissors are used for cutting sutures ,ligatures ,gauze ,dressing pads ,bandages etc. Pointed tip scissor are also used for removing sutures.

Cont…….d:

Cont…….d Scissors may be straight ,curved or angled with blunt or pointed tips. The handles may be short or long . Different types of scissors are mentioned below: Fine scissors are used to cut delicate tissues. Heavy scissors are used to cut tough tissues. Short shaft scissors are used for cutting superficial structures or tissues.

Cont……….d:

Cont……….d Long shaft scissors are used to reach & cut inner or under structures. Sutures scissors have blunt tips to prevent cut or injury on the body structures near suture. These are used to cut suture or ligament after stitching or ligating. Dressing or bandage scissor are used to cut gauze pieces ,dressing ,drains or plastic packets.

Straight pointed tip scissor Angled tip scissor :

Straight pointed tip scissor Angled tip scissor Straight or curved pointed tip scissors are used for removing the sutures from the surgical wound after its healing. angled tip scissors, with a blunt tip on the bottom blade, which helps in cutting bandages. The bottom blade of the scissor is longer and goes easily under the bandages. The blunt tip design of the scissor prevents accidental injury

Curved tip scissor Broad tip scissor :

Curved tip scissor Broad tip scissor These are the surgical scissors used to cut the ends of catgut during scissors They are small in size .

Mayo straight or curved tip scissor :

Mayo straight or curved tip scissor Mayo’s straight or curved scissors are smooth at the tips & are used for cutting tissues & internal organs.

Metzenbaum scissor :

Metzenbaum scissor Metzenbaum scissors are surgical scissors designed for cutting delicate tissue. The scissors come in variable lengths and have a relatively long They are constructed of tungsten carbide blades can be curved or straight. The blade tips are blunt.

Lister scissor :

Lister scissor scissors designed for the cutting of bandages that are in place on the patient. The blades take a 45° angle at the pivot so that they can be inserted under the bandage and leave the knuckles of the cutting hand clear of the patient. The lower blade has a rounded, blunt end to facilitate entry under the bandage without catching the blade.

Nelson scissor :

Nelson scissor blunt-pointed, curved or straight-bladed, long-handled scissors designed for thoracic surgery.

Mc indoe scissor :

Mc indoe scissor The McIndoes Scissor Straight are used in Tissue Dissection

b) Forceps :

b) Forceps

a) rampley’s sponge holding forceps :

a) rampley’s sponge holding forceps It is known as a sponge holder. It is a heavy instrument which is approximately 24-72 cm long. Its shaft are long blades & are fenestrated at the tips. The inner sides blades are serrated so as to provide a firm grip on an object & prevent from slipping. It has a catch lock.

Cont……..d:

Cont……..d It is used for holding sponge & cleaning the site of the operation or for deep mopping to clean or swab blood in the cavity. It is also used for packing body cavities such as vagina. It is used for separating tissues also. It is again used to catch soft organs like ovary ,cervix etc.

3) Dissecting forceps :

3) Dissecting forceps This type of forceps has two flat shafts or wings of approximately 5 inches long. The wings or shafts are joined at the proximal end. The outer surface of the shaft are serrated to allow a firm grip. The distal end tips are pointed & are slightly curved inward. Dissecting forceps are of following types.

1) Plain or non 2) Plain blunt tip dissecting forcep toothed pointed tip dissecting forceps :

1) Plain or non 2) Plain blunt tip dissecting forcep toothed pointed tip dissecting forceps This is plain but pointed at the tip. it is used for holding soft structures like skin ,intestine etc while suturing the incision or wound site. This forcep has plain but blunt tips used for holding of smooth soft & broad site while suturing,.

3) Toothed dissecting 4) Mc indoes dissecting forcep forcep:

3) Toothed dissecting 4) Mc indoes dissecting forcep forcep This forcep has pointed teeth on the inner surface of the tips. this forcep is used to hold tough tissues such as skin ,fascia ,rectal sheath etc while suturing. This is a plain dissecting forceps without any teeth at the tips. the tips are pointed & curved inwards.

Gillies dissecting forceps :

Gillies dissecting forceps This is a plain dissecting forceps which has two pointed buttons on the inner surface of one wing. It is used for major operations.

c) Artery forceps :

c) Artery forceps Forceps are hinged instruments used to hold an object that’s difficult to grasp in place. There are hundreds of types of forceps used in medicine, from surgery to obstetrics to dentistry These forceps are used for various purpose. It has a catch lock to bring the blade together which when locked prevents the blades from slipping on objects. The inner surface of the blade are serrated. It is of various size & shape. It can be straight & curved & used for holding or clamping purpose. Its tips is round or blunt.

1)Mosquito 2) Dunhill artery artery forceps forcep :

1)Mosquito 2) Dunhill artery artery forceps forcep This is small fine artery forceps used for holding or clamping or for biting or grasping tissues. It has serration at the tip. It may have straight or curved tip. It has straight but short blades.

3) Curved tip 4) Robert artery artery forcep forcep :

3) Curved tip 4) Robert artery artery forcep forcep It is bent tip forceps to reach blood vessels blocked by other tissues. Artery forceps are commonly made of stainless steel, making them easy to wash and sterilize. It is designed like moynigham artery forcep but shorter.

4) Curved tip right 5)Spencer well’s angle artery forceps artery forceps :

4) Curved tip right 5)Spencer well’s angle artery forceps artery forceps Artery forceps are surgical instruments used to close ruptured blood vessels The instrument — also called a hemostat and, more simply, a clamp — is one of modern medicine’s most common tools. Artery forceps are commonly used by medics and civilian paramedics to save patients who are in immediate danger of dying from massive blood loss This small fine artery forcep is used to clamp small bleeding point. It has straight & long blades.

6) Spencer well’s 7)kelly’s haemostat haemostat forceps forceps :

6) Spencer well’s 7) kelly’s haemostat haemostat forceps forceps hemostatic forceps may be an effective as well as safe alternative approach for active GI bleeding of various origins. Kelly forceps are a type of usually made of stainless steel. They resemble a pair of scissors with the blade replaced by a blunted grip. They also feature a locking mechanism to allow them to act as clamps. Kelly forceps is used for surgery. They may be either curved or straight. In surgery, they may be used for occluding blood vessels

8)Kocher’s artery 9)Lehey artery forcep forcep :

8)Kocher’s artery 9) Lehey artery forcep forcep This artery forcep has toothed tip to catch hard parts like rectal sheath or bone. It has long blades & long tips too .

10) Oschner artery forceps :

10) Oschner artery forceps a two-bladed instrument with a handle for compressing or grasping tissues in surgical operations

11) Right angle artery forceps :

11) Right angle artery forceps This artery forceps has a tip which is bent at the right angle of the shaft. It is used for separating or typing blood vessels.

d) Tissue forceps :

d) Tissue forceps Tissue forceps are used to hold tissues. They are again classified as : Lane ‘s tissue forcep Allis tissue forcep Babcock’s tissue forcep Sinus forcep

1)Lane’s tissue 2) Aillis tissue forcep forcep:

1)Lane’s tissue 2) Aillis tissue forcep forcep It is like artery forceps but have single pointed teeth on either side of the inner surface of serrated tip. This allow to hold the small mass tissue or to hold the edge of incision It has broad teeth & is used for holding large mass tissue. The teeth interlock on closing the catch lock.

3) Babcock tissue forcep:

3) Babcock tissue forcep This forceps is used for grasping of smooth delicate tissue. It has fenestrated jaws to hold bowels or fallopian tube.

E) sinus forceps:

E) sinus forceps It looks like a long artery forceps. It does not have the catch lock It is about 24 cm long with rounded tip. There is serration on the inner surface of the blade. It is used to plug cavities such as nose ,ear or abscess cavity.

f) Cheatle forceps:

f) Cheatle forceps It is large & heavy forceps with curved blades. The inner surface of the blades are serrated which allows a firm grip while holding items. It has no catch lock.

g) Dieing forceps :

g) Dieing forceps This forceps is used for removing gall bladder stone. There is no lock system The tip is like sponge holding forceps.

3) Needle holder :

3) Needle holder This instrument is used to hold the needle while suturing. Its of two types: Mayo’s needle holder Gillies needle holder

1) Mayo’s needle 2) Gillies needle holder holder :

1) Mayo’s needle 2) Gillies needle holder holder It has got long handles & short blades. The inner surface of the blades have cross serration to provide a firm grip over the needle. The serrated surface has a groove to grasp the needle firmly. The has a catch lock. It has 1 long blade & another short blade.

4) Retractors :

4) Retractors These instruments re used to retract the wound edges & expose the cavity. These are again of various types: Manual retractor Self retaining retractors

a) Manual Retractors :

a) Manual Retractors These retractors are to be held by hands & are of different types: 1) Lagenback retractors : it has got a handle &a long flat shaft which has a blade bent at right angle at the tip of the shaft.

2) Hook 3) Morris double retractors ended retractor:

2) Hook 3) Morris double retractors ended retractor It has got a handle & a shaft. The shaft has hook at the tip . It can be single or double hook retractor It has got a shaft angle. The both ends of the shaft have blades at the right angle. This is used to hold back edges of the wound or cavity to facility exposure or retract strong structures like abdominal walls.

5) Deaver’s deep retractor :

5) Deaver’s deep retractor It has broad & curved blade at one end of the shaft . It used for deep retraction.

6) Czerny's 7) Abdominal retractor retractor :

6) Czerny's 7) Abdominal retractor retractor It has fenestrated shaft. There is a blade at right angle at one tip. The other tip has double hook bent at right angle on the opposite side. Abdominal  retractor is a surgical instrument by which a surgeon can either actively separate the edges of a surgical incision or wound, or can hold back underlying organs and tissues, so that body parts under the incision may be accessed

b) Self Retaining retractors :

b) Self Retaining retractors Balfour’s self retaining retractor This is known as balfour’s self retaining retractor. It has special fittings for self retaining. It is used for retracting abdominal cavity during laparotomy. Two small retracting blades are attached to the ends of both the metal clips. The rods are curved at the tip to give space. It can be locked & adjustable.

5) Suture Needle :

5) Suture Needle Suture needle are used to stitch the edges of the wound. A small, slender implement used for sewing or surgical suturing, made usually of polished steel and having an eye at one end through which a length of thread is passed and held .

a) Straight b) Curved needle needle:

a) Straight b) Curved needle needle c) Swaged needle

Cont…….d:

Cont…….d Straight round body: Curved round body : these are used for suturing soft & delicate structures. Straight cutting body : these are used for suturing tough structures like skin ,fascia etc. Curved cutting body : these needles are pointed at the one end & the other end has an eye. Swaged needle : a needle with no eye, having suture attached to a hollow end.

6) Towel clip :

6) Towel clip The towel clip is used to hold & fix the drapes in place to make a sterile surface. Moynihan’s towel clips Mayo’s towel Clips Backhaus small towel clips

Three types of towel clips.:

Three types of towel clips. 1) Moyniham’s tetra clips 2) Mayo’s towel clips towel clips are Used to fix drapes to tissue with minimal trauma.

Cont………d:

Cont………d 3) Doyen’s towel clip 4) Backhaus small towel clip

7) Aneurysm needle :

7) Aneurysm needle It has a handle & a hook at the tip. The tip of the hook is blunt & has a eye. The eye hold is used to carry the ligatures to separate a blood vessels & ligate.

8) Probe :

8) Probe It is a long instrument. There is an eye hold at the proximal end. The distal end is smooth & round. It is used to introduce into the depth of a cavity.

9) Trocars & canula :

9) Trocars & canula Canula is a hollow instruments with a sharp trocars which fits into the lumen of the canula. It is used for abdominal paracentasis The trocar & canula is introduced together. The sharp pointed tip of a trocar punctures the site. Then the tocar is removed. The canula is retained through which the fluid is drained out.

10) Suction nozzle :

10) Suction nozzle It is a metal suction tip attached to the suction apparatus through a long rubber tube. It is used for suction of the blood etc at the operation site during surgery.

Thank you for your kind attention :

Thank you for your kind attention

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