Powered Surgical Instruments CHESAPEAKE BAY PERIOPERATIVE CONSORTIUM Property of Chesapeake Bay Perioperative Consortium, © 2017

Objectives The learner will be able to: Identify current applications of powered surgical instruments Describe basic components of powered surgical instruments Identify the mechanisms of action of powered surgical instruments Discuss care and handling of powered surgical instruments

Power Equipment Power equipment ranges in type from electrosurgical units to high-technology laser units. Which includes : Power drills Saws Specialized light sources

Uses of Powered Instruments Precision Drilling - Insert screws, wires, pins Precision Cutting -side to side, front to back -obtaining bone graft -Amputation Sculpting -Reamers -Burrs

Uses of Powered Instruments Shaving -smoothing joint surfaces -skin grafts Ultrasonic Cell Disruption -Cataract- (Phacoemulsification) -Brain Tissue (CUSA-cavitron ultrasonic surgical aspiration -Lithotripsy (Kidney stone)

Specialty Uses Orthopedics -Reciprocating Saws - Oscillating Saws - Saggital Saw - Rotary attachments -Reamers, Drills - Screwdriver - Wire Drivers - Rasps - Osteotomes - Power rongeurs

Specialty Uses cont. Thoracic •Neurosurgery - Sternal Saw - Craniotome •Plastic Reconstructive - Perforator - Dermabraders - Drill - Dermatomes - Midas Rex •Oral/Dental - High speed drill/burrs - Drills - Saw

Power Source Compressed air/Nitrogen - centrally supplied - tank with gauge Electrical Battery Sonic Energy (generator)

Advantages Enables surgeon to work with greater efficiency. Causes less trauma to tissues and surrounding structures. Reduces blood loss from bone. Decreases surgical time. Reduces fatigue for the surgeon. Patient under anesthesia for a shorter period of time.

Disadvantages/Dangers Heat Generated from drill can damage bone cells High speed disperses fine mist of bone and blood Normal tissue and operators fingers may be caught in drill or saw. Air Hoses may whip out of control if defective or not attached properly.

Handling and Safety All powered equipment must be checked by Bio-medical engineering. Examine air hoses for integrity. DO NOT use if s/s of wear and tear. Inspect batteries for corrosion or other damage/defects. Inspect accessories for intactness & sharpness of cutting edges.

Handling and Safety Cont.. All power equipment should be inspected by the user before and after each use. Power cords should never be crimped or bent; any tears or breaks in the cord should negate the use of the cord until it is repaired cords should lie flat on the floor Extension cords should be avoided and power

Handling and Safety Inspect accessories after use for intactness Inspect straightness of accessories Wear PPE during use Use tissue protectors/burr guards Never leave the trigger out of the safety mode when not in use

Handling and safety Cont.. Inspect accessories after use for intactness. Inspect straightness of accessories. Wear PPE during use. Use tissue protectors/burr guards. Never leave the trigger out of the safety mode when not in us.

Handling and Safety cont. Place powered equipment on a separate table when not in use. Operate equipment only at manufacturer’s recommended setting. “Bleed” attachments before detaching from compressed air source.

ALWAYS TEST THE INSTRUMENTS WITH THE ACCESSORIES ATTACHED TO IT BEFORE HANDING IT TO THE SURGEON

Troubleshooting Power source Hose, cord, or battery Hand piece Check components in the following order: Power source Hose, cord, or battery Hand piece Accessory attachment Controls and/or safety switch

Care and Cleaning Concurrent cleaning during case. DO NOT IMMERSE HAND PIECES IN WATER Concurrent cleaning during case. Use water, not saline for wiping. After case, clean immediately. Dried-on organic material will hamper action of disinfectants and sterilization processes.

Care and Cleaning Leave air hoses attached during cleaning to prevent entry of moisture into motor Remove accessories prior to cleaning Wipe surfaces of hand pieces, cords, hoses with mild detergent/disinfectant recommended by manufacturer

Care and Cleaning Pay special attention to cannulated areas. Rinse carefully w/ water to avoid moisture to motor, holding instrument nose-down Dry with soft cloth If using ethylene oxide sterilant, dry thoroughly to prevent ethylene glycol formation

Lubrication Follow manufacturers recommendations. Use recommended products. Some instruments need to be run during or after lubrication.

IMPORTANT! All instruments and devices used in surgery should be cleared by the US Food and Drug Administration (FDA) for use in surgery and have written, manufacturer-validated cleaning and decontamination instructions for use (IFU).

References Rothrock, J, C. Alexander’s Care of the Patient in Surgery.14th ed. St. Louis,MO: Mosby;2011. Guideline for Cleaning and Care of Surgical Instruments.In: Aorn Guidelines for Perioperative Practice. AORN, Inc, 2017.