OPERATING ROOM TECHNIQUE ::: PREPARED BY ::: Ibrahim H. Shamia, RN, MSN, PhD Fellow Ibrahim Shamia Surgical Instrumentation 1

Ibrahim Shamia Surgical Instrumentation HANDLING INSTRUMENT Objectives: After completion this presentation the participant will be able to: Identify the use and function of each type of surgical instrument. Demonstrate the appropriate methods for passing each type of instrument. Understand the rational and methods of documentation of instrumentation. Demonstrate the assembly and passing sharps. Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Introduction Surgical instrumentation is critical to the surgical procedure. The performance of the OR team is enhanced when team members know each instrument by name, how each is safety handled, and how each is used. Preparing the instrument for appropriate processing will be prolong its use in patient care and decrease the costs for repair and replacement. Ibrahim Shamia Surgical Instrumentation

Terms Associated With Surgical Instrumentation Atraumatic: Without injury. Traumatic: Causing injury by penetration or crushing. Dilation: Enlarging an opening in a progressive manner. Dissection: Process of separating tissue through anatomic planes by using sharp or blunt instrumentation. Grasping: Holding in a traumatic or atraumatic manner. Ibrahim Shamia Surgical Instrumentation

Terms Associated With Surgical Instrumentation Cont., Retraction: Stabilizing a tissue layer in a safe position for exposure of a part. A retractor can be manual or self-retaining. Sharp: Instrument with a cutting edge or pointed tip (s) that is used to cut or dissect tissue. These items includes blades, scissors, needles, and other dissection device. Trocar: A device used for penetration tissue layers. It is commonly used for precutaneous endoscopy. It is used as temporary pathway for gases, other instrumentation, or the removal of an organ or substance. Ibrahim Shamia Surgical Instrumentation

Classification of Instruments Various basic maneuver are common to all surgical procedure. The surgeon dissects, resects, or alter tissue and or/ organ to restore or repair bodily functions or body parts. Bleeding must be controlled through the process. The surgical instruments are designed to provide the tools the surgeon needs for each maneuver. Whether they are small or large, short or long, straight or curved, sharp or blunt, all instrument classified by their function. Ibrahim Shamia Surgical Instrumentation

Cutting and Dissecting Cutting instrument have sharp edges. They are used to dissect, incise, separate, or excise tissue. These instrument should be kept separate from other instrument, and sharp edge should be protect during cleaning, sterilizing, and storing. To prevent injury to handler and damage to the sharp edge, proper precaution are necessary to take during the handling or disposing of all sharps, blades. Examples: Scalpels, knives, Scissors, Bone Cutters, Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Grasping and Holding Tissue should be grasped and held in position so the surgeon can perform the desired maneuver, such as dissecting or suturing, without injuring the surrounding tissues. Examples: Tissue Forceps: as Smooth forceps, Toothed forceps, Allis forceps, Babcock forceps. Stone Forceps. Tenaculums. Bone holders Ibrahim Shamia Surgical Instrumentation

Clamping and Occluding Instruments that clamp and occlude are used to apply pressure. Examples: Haemostatic Forceps: as Hemostat, Crushing clamp. Non-crushing Vascular Clamps. Ibrahim Shamia Surgical Instrumentation

Exposing and Retracting Soft tissues, muscles, and other structures should be pulled aside for exposure of the surgical site . Examples: Handled Retractors: Malleable Retractors, Hooks, Self-retaining Retractors Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Suturing and Stapling Needle holders : as Tungsten Carbide Jaws Crosshatched Serrations. Smooth Jaws. Staplers: as Clip Applier. Terminal End Staplers. Internal Anastomosis Staplers. End-to-End Circular Staplers. Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Viewing Surgeons can examine the interior of body cavities, hollow organs, or structures with viewing instruments and can perform many procedures through them. Examples: Speculums. Endoscopes. Ibrahim Shamia Surgical Instrumentation

Suctioning and Aspirating Blood, body fluids, tissues, and irrigation solution may be removed by mechanical suction or manual aspiration. Examples: Suction: Poole Abdominal Tip, Frazier Tip, Yankauer Tip, Aspirating Tube. Aspiration: Trocar, Cannula. Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Dilating and Probing A dilator: Is used to enlarge orifices and ducts, such as dilation of the uterine cervix. A probe: Is used to explore a structure or to locate an obstruction. Probes can be used to explore the depth of a wound or trace the path of a fistula. Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Handling Instruments Surgical instruments are expensive and represents a major investment. Surgical procedures have become more complicated and intricate. As a result: Instrument become more complex, more precise in designs, and more delicate in structure. Abuse, misuse, inadequate cleaning or processing, or rough handling can damage and reduce the life expectancy. Proper care an instrument should have a life of 10 years or more. Ibrahim Shamia Surgical Instrumentation

Setting Up the Instrument Table Standardized basic sets of sterile instruments are selected for each specific surgical procedure. A set is a group of instruments that may include all appropriate classifications of instruments or the instruments needed for a specific part of the procedure e.g., gallbladder set. The surgeon may prefer some specific instruments that are wrapped separately or added to the instrument set. Ibrahim Shamia Surgical Instrumentation

Setting Up the Instrument Table Cont., Instrument are usually prepared, wrapped and sterilized several hours before the surgical procedure so they are dry and cool for safe handling. The scrub nurse count all instruments, sponges, and sharps with the circulator before setting up the Mayo stand and instrument table. Ibrahim Shamia Surgical Instrumentation

Key Points In Handling Instruments Handle loose instruments separately to prevent interlocking or crushing. Inspect instruments such as scissors and forceps for alignments, imperfections, cleanliness, and working conditions. Sort instrument neatly by classifications. Keep ring-handled instruments together with the curvature and angles pointed in the same directions. Ibrahim Shamia Surgical Instrumentation

Key Points In Handling Instruments Cont., 5. Leave retractors and other heavy instruments in a tray or container or lay them out on a flat surface of the table. 6. Protect sharp blades, edges, and tips. They should not touch anything. Ibrahim Shamia Surgical Instrumentation

Handling Instruments During the Surgical Procedures Efficient instrument handling throughout the surgical procedure is the hallmark of an efficient scrub nurse. Key points in handling instruments during the surgical procedures includes the following: know the name and appropriate use of an instrument. Handle instruments individually. Handle the surgeon or assistant the correct instrument for each particular task. Pass instrument decisively and firmly. When the surgeon extends his hands, the instrument should be proper position for use. Ibrahim Shamia Surgical Instrumentation

Key Points In Handling Instruments During The surgical 5. Watch the sterile field for loose instruments. After use remove them promptly to the Mayo stand . 6. With the a moist sponge, wipe blood and organic debris from instruments. 7. Flush the suction tip and tubing with sterile distilled water periodically to keep the lumen patent. 8. Remove the debris from electrosurgical tips to ensure electrical contact. 9. Place used instruments that will not be needed gain (except sharp, cutting, delicate, or powered instruments) into a tray or basin during or at the end of the surgical procedures. Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Hand signs & instruments handling Scissor Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Hand signs & instruments handling Artery Forceps Clamp Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Hand signs & instruments handling Knife Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Hand signs & instruments handling Forceps Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Hand signs & instruments handling Suture Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Hand signs & instruments handling Free Tie Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Hand signs & instruments handling Handling The Knife Ibrahim Shamia Surgical Instrumentation

Handling the clamp forceps Hand signs & instruments handling Handling the clamp forceps Ibrahim Shamia Surgical Instrumentation

Handling The Needle Holder Hand signs & instruments handling Handling The Needle Holder Ibrahim Shamia Surgical Instrumentation

Apply The Tie With Clamp Forceps Hand signs & instruments handling Apply The Tie With Clamp Forceps Ibrahim Shamia Surgical Instrumentation

Apply & Remove The Blade From Scalpel Hand signs & instruments handling Apply & Remove The Blade From Scalpel Ibrahim Shamia Surgical Instrumentation

Ibrahim Shamia Surgical Instrumentation Thank You Ibrahim Shamia Surgical Instrumentation