Remedios Trinidad Romualdez Medical Foundation

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    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

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    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 non-

    magnetic 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 MetalsSome 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 Dissecting1. Scalpelsthe 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 heavyhemostat or Kelly clamp, should not touch the cutting edge.

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    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, theyusually 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 orblunt 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 heavierthan 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 Short jaw sharp tipped scissors for deep areas such as the nasal cavity.o Sharp-tipped angled scissors with short jaws for vascular surgery.o Dressing/bandage scissors are used to cut drains and dressings and to open items such as plastic

    packets.

    o 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 oftissue for pathologic examination may be removed with a biopsy forceps or punch.

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    Curettes. Tissue or bone is removed by scraping with the sharp edge of the loop, ring, or scoop onthe end of a curette.

    Snares. A loop of wire may be put around a pedicle to dissect tissue such as a tonsil. The wirecuts 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 resembletweezers. They are tapered and have serrationsat the tip. They may be straight or bayonet, shortor long, and delicate or heavy.

    Toothed Forceps. Toothed forceps differ from smooth forceps at the tip. They have a single toothon 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 isa row of teeth at the end.

    Babcock Forceps. The end of each jaw of a Babcock forceps is rounded to fit around a structureor to grasp tissue without injury.

    Lahey Forceps. The tips of the Lahey forceps are sharp points for grasping tough organs ortumors during excision.

    Stone Forceps. Either curved or straight forceps are used to grasp calculi such as kidney stones orgallstones. 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 penetratetissueto 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 forcepsstabilize bone.

    Clamping and Occluding

    Hemostatic Forceps. Most clamps used for occluding blood vessels have two opposingserrated 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 bloodvessels. 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 bloodvessels. 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 ason 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.

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    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 inwidth 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 copperthat may be bent to the desired angle and depth for retractions.