Basic Instruments - Part 2

-'•

HAPTER 1

Instrument: ELECTROSURGICAL PENCILCategory: AccessoryOther Names: Bovie, cautery, monopolarUse(s): Monopolar cautery uses electricalcurrent to coagulate and cut blood vessels andtissues to provide homeostasis; also used fordissection.Description: This is a disposable instrumentthat usually comes packaged with a bladetip and a holster. The current is activated bya switch or button on the pencil or with afoot pedal. There are several different typesof interchangeable electrode tips that fit intothe hand piece. Some of the common typesof tips are blade, ball, needle, and extendedblade tips.

Instrument Insight: All monopolar electrodesrequire a dispersive pad because the electricityenters the patient's body. Monopolar currenttravels from the generator, to the active electrode,and through the patient's body; the current is thencaptured by the dispersive pad, which channelsit back to the generator, completing the closedcircuit. A scratch pad is used to remove charredblood and tissue from the electrode tip. The tipmay also be Teflon coated for ease in cleaning.

CAUTION: The tip of the pencil becomes hotafter extended use. To prevent burning thedrapes or the patient, when not in use thepencil should be placed in the holster, which isattached to the drapes.

Surgical Instrumentation: An Interactive Approach

Instrument: HARMONIC SCALPELCategory: AccessoryOther Names: Ultrasonic scalpelUse(s): The harmonic scalpel is a graspinginstrument that delivers ultrasonic energybetween the jaws to coagulate and dividetissue by low-temperature cavitation.

Description: This device has a manufacturer-packaged disposable hand piece.A nondisposable cord and wrench are alsoneeded. These two components need to bepackaged and sterilized by the facility.Instrument Insight: Blood and tissue can buildup on the jaws and may need to be removedperiodically with a moistened sponge.

9

a

I

f

9

i

t

9

Instrument: STRAIGHT MAYO SCISSORSCategory: Cutting and dissectingOther Names: Suture scissorsUse(s): Are used to cut suture.Description: Heavy scissors with straight blades

Instrument Insight: When cutting suture,use the tips of the scissors. Slightly rotatethe scissors to visualize the knot or theappropriate length of the suture tail that willremain.

CHAPTER 1 Basic Instruments

Instrument: CURVED MAYO SCISSORSCategory: Cutting and dissectingOther Names: Heavy tissue scissorsUse(s): Dissect or undermine heavy fibrous tissues.Description: Heavy scissors with curved bladesand blunt or sharp tips

Instrument Insight: Tissue scissors are intendedto cut tissue only and should never be used tocut other items. Inappropriate use of thescissors will cause the blades to become dulland not function properly.

Instrument: CURVED METZENBAUMSCISSORSCategory: Cutting and dissectingOther Names: Metz, tissue scissorsUse(s): Dissect and undermine delicate tissues.Description: A longer, thinner scissors with curvedor straight blades that can have blunt or sharp tips

Instrument Insight: Tissue scissors areintended to cut tissue only and shouldnever be used to cut suture or other items.Inappropriate use of the scissors will causethe blades to become dull and not functionproperly.

18 Surgical Instrumentation: An Interactive Approach

titi

Instrument: ALL1S FORCEPSCategory: Grasping and holdingUse(s): Is used for lifting, holding, and retractingslippery dense tissue that is being removed.Commonly used for tonsils; for vaginal, breast,

and thyroid tissues; or for grasping bowelduring a resection.Description: Curved or straight with multiple,interlocking fine teeth at the tip that reduceinjury to the tissues

000cc000

ft«ftftftft

ftft

Instrument: BABCOCK FORCEPSCategory: Grasping and holdingUse(s): Is used for grasping and encirclingdelicate structures such as ureters,

fallopian tubes, bowel, ovaries, andappendix.Description: An atraumatic forceps with a flared,rounded, hollow end with smooth, flattened tips

CHAPTER 1 Basic Instruments 19

Instrument: KOCHER FORCEPSCategory: Grasping and holdingOther Names: Koch, OchsnerUse(s): Is used to grasp tough, fibrous, slipperytissues such as muscle and fascia.

Description: The jaws have horizontal serrationsand two to one large interlinking teeth at the tip.Instrument Insight: Exercise care when handlingforceps with teeth. The sharp teeth can easilycompromise the integrity of your gloves orthose of the surgeon.

Instrument: ARMY-NAVY RETRACTORCategory: Retracting and exposingOther Names: Army's, Navy's, U.S. retractorUse(s): Is used for retraction of smallsuperficial incisions, to allow betterexposure.

Description: Hand-held, double-endedretractor with an oval fenestration in thehandle and a lateral curve to the blades oneach end. One end is longer than the other sothat it can be placed deeper into the wound.Instrument Insight: Often packaged in pairs


Instrument: GOELET RETRACTORCategory: Retracting and exposingUse(s): Is used for retraction of small superficialincisions, to allow better exposure.Description: Hand-held, double-endedretractor with smooth, cup-shape curved

blades with a crescent-shaped lip. One end islonger than the other so that it can be placedfurther into the wound. The size and shapenever change.Instrument Insight: Usually packaged inpairs

If

Instrument: SENN RETRACTORCategory: Retracting and exposingOther Names: Cat pawUse(s): Is used to retract skin edges and deepertissues of small incisions.Description: Double-ended, hand-held retractor inwhich one end has three sharp or dull claws andthe other end is a small, narrow, lateral-bent blade

Instrument Insight: Usually packaged in pairs.Always hand to the surgeon with the sharpclaws facing downward.

CAUTION: Exercise care when handlingretractors with sharp edges. The sharp edgescan easily compromise the integrity of yourgloves or those of the surgeon.


Instrument: MURPHY RETRACTORCategory: Retracting and exposingOther Names: RakeUse(s): Is used for superficial retraction ofwound edges.Description: Has four claws that may be blunt orsharp. The handle has a teardrop opening withtwo prongs on each side.

Instrument Insight: Usually packaged inpairs. Always hand this retractor to thesurgeon with the sharp claws facingdownward.

CAUTION: Be cognizant of the sharp claws.Sharp edges may puncture gloves and scratchthe skin.

Instrument: VOLKMAN RETRACTORCategory: Retracting and exposingOther Names: RakeUse(s): Is used for superficial retraction ofwound edges.Description: May have two to six claws that may beblunt or sharp. The handle has a teardrop opening.

Instrument Insight: Usually packaged in pairs.Always hand this retractor to the surgeon withthe sharp claws down.

CAUTION: Be aware of the sharp claws. Sharpedges may puncture gloves and scratch theskin.


Instrument: RIBBON RETRACTORCategory: Retracting and exposingOther Names: MalleableUse(s): Is used for retraction of organs andintestines in a wound.

Description: A hand-held, smooth, flat metalstrip with rounded endsInstrument Insight: Can be bent or molded asneeded for use.

Instrument: PARKER RETRACTORCategory: Retracting and exposingOther Names: Park benchUse(s): Is used for retraction and exposure of asmall or shallow wound.

Description: Hand-held, double-ended withsmooth, rounded endsInstrument Insight: Usually packaged inpairs


Instrument: SKIN HOOKCategory: Retracting and exposingOther Names: Joseph, GilliesUse(s): Retracts skin edges.Description: A small hand-held instrument withone or two sharp hooks at one end

CAUTION: The hooks are very sharp. Exercisecare when handling sharp instruments to avoidpuncture to gloves and/or skin. Always handinstrument to the surgeon with the hook(s)down.

Instrument: WEITLANER RETRACTORCategory: Retracting and exposingUse(s): Holds wound edges open.Description: Self-retaining finger-ringed instrumentwith a ratchet/release device on the shanks,which holds them open in the wound. The tip hasthree outward-curved prongs on one side andfour on the other side that may be sharp or dull.

Instrument Insight: Always hand this retractor tothe surgeon with the prongs down.

CAUTION: The prongs may be very sharp.Exercise care when handling sharpinstruments to avoid puncture to glovesand/or skin.


Instrument: GELPI RETRACTORCategory: Retracting and exposingUse(s): Provides wound exposure, ranging fromsuperficial to deep depending on the wounddepth.Description: Self-retaining, ringed instrumentwith a ratchet/release device on the shanks and

two outward-turned sharp prongs, one on eachsideInstrument Insight: Always hand this retractor tothe surgeon with the prongs down.

CAUTION: The prongs are sharp and canpuncture gloves and skin.

Instrument: FRAZIER SUCTION TIPCategory: Suctioning and aspiratingUse(s): Is used to suction in confined spacessuch as the nasal cavity, or in lumbar andcervical procedures, or in craniotomies.Description: An angled cylindrical tube witha relief opening/hole on the handgrip. The

diameter of the suction tube is measured onthe French (F) scale and ranges from 3F to 15F.Instrument Insight: The Frazier suction tip ispackaged with a thin wire stylet. This stylet fitsinside the suction tip to push out any tissue, blood,or debris that gets trapped while suctioning. Thesuction is increased by the relief/opening.

CHIPTE11 Basic Instruments 25

Instrument: POOLE SUCTION TIPCategory: Suctioning and aspiratingOther Names: Abdominal suckerUse(s): Suctioning large amounts of bloodand/or fluids from a body cavity. The innercannula of this suction tip can be used tosuction down the shaft of the femur during atotal hip replacement procedure.

Description: Can be disposable or reusable.Has two components: an outer sheath and aninner cannula.Instrument Insight: Multiple fenestrations (holes)on the outer sheath allow for more suction.If less suction power is desired, the surgeonmay use the inner cannula only.

Instrument: YANKAUER SUCTION TIPCategory: Suctioning and aspiratingOther Names: Tonsil suction tip, oralUse(s): Is used for suctioning in all types ofwounds. Allows effective suction withoutaspiration damage to the surrounding tissue.

Description: A hollow plastic tube with a griphandle and a slightly bent shaft thatterminates with a bulbous tip and largeopeningInstrument Insight: The disposable Yankauer isthe most widely used suction tip.


Instrument: CRILE-WOOD NEEDLE HOLDERCategory: Suturing and staplingOther Names: Fine needle holderUse(s): Is used for holding delicate tointermediate size needles when suturing.

Description: Has a narrow rounded tip withcrisscross gripping pattern in the inner jaws.

59

«P

89

Instrument: MAYO-HEGAR NEEDLE HOLDERCategory: Suturing and staplingUse(s): Is used for holding heavy needles whensuturing.

Description: Has a broader jaw that is roundedat the tip with crisscross pattern on the innerjaws.


Instrument: RYDER NEEDLE HOLDERCategory: Suturing and staplingUse(s): Is used for holding delicate tointermediate size needles when suturing.Commonly used in vascular procedures.

Instrument Insight: Never used to grasp large,heavy needles.

Instrument: SKIN STAPLERCategory: Suturing and staplingUse(s): Is used during wound closure for skinapproximation.Description: A sterile, individual patient-useinstrument; it is preloaded with stainless-steel rectangular staples that are used forapproximation of the skin. There are manydifferent manufacturers and models ofstaplers. It has a handle and a trigger that issqueezed to fire the staples; at the tip is analignment arrow.

Instrument Insight: The arrow at the tip ofthe device is to align the stapler with theapproximated skin edges for proper stapleplacement. Two persons often perform skinstapling. The surgeon or assistant uses two tissueforceps to grasp the skin edges and bring themtogether. The assistant or a surgical technologistpositions the stapler over the wound, carefullyaligning the arrow with the incision and squeezingthe trigger until resistance is met. Once the stapleis placed, remove the stapler and align it for thenext firing until the wound is closed.


***

Instrument: HEMOCLIP APPLIERCategory: Suturing and staplingOther Names: Clip applierUse(s): Is used for occluding vessels or othertubular structures.Description: Has angled tips with fine groovesin the inner jaws that slide over the clip to pick

it up. Manufactured in various clip sizes andlengths in a color-coded cartridge for easyidentification of clip size.Instrument Insight: The size and type ofclip have to match the appropriate clipapplier.

Instrument: SURGICLIP APPLIERCategory: Suturing and staplingOther Names: Hemoclip, ligaclipUse(s): Is used for occluding vessels or othertubular structures.

Description: A sterile, individual patient-useinstrument, preloaded with clips. Manufacturedin various clip sizes and lengths.

Documents

Basic Instruments - Part 2