SUR 111 LAB #8

Skill Assessments 10-1 Assembly of the Instrument Set 10-2 Hand Signals 10-3 Loading, Passing, and Unloading the Knife Handle 10-4 Instrument Handling/Passing

10-1 Assembly of the Instrument Set Instruments to be assembled in trays have been through the decontamination, washer-decontaminator cycle and are therefore safe for handling Instruments are assembled in groups according to the specific instrument tray they belong to For example: instruments for a “Minor Tray” or “Trach Tray” only go in those trays Differentiation is achieved with colored tape that is placed on individual instruments that mark them as part of one tray verses another Instruments are assembled according to the order of the instrument count sheet Count sheets are initialed by the assembler who is verifying that all components of the tray are present and in working order

10-1 Assembly of the Instrument Set Preparation: OR attire and PPE (in CPD you have on surgical scrubs and all PPE except the mask) CPD is considered a semi-restricted area Wash your hands Clean work area Have instrument count sheet for specific tray of instruments to be assembled Internal chemical indicators External chemical indicators/locking mechanism Filters Labeling device Wrappers or peel packs Container system

10-1 Assembly of the Instrument Set Inspect instruments individually for cleanliness, working order, and all parts present Unlock ratcheted instruments Disassemble instruments that are put together Protect tips of instruments that are sharp or pointed with tip protectors Organize specialty items together (forceps/knife handles, skin hook) and wrap or peel pack Leave peel pack open if used String instruments according to count sheet order

10-1 Assembly of the Instrument Set Place count sheet and internal chemical indicator inside the instrument tray Verify that container system is clean and dry Place basket of instruments in container system Place number of filters required by the container system and secure them Place lid on container system and secure with locks and external chemical indicators Place tray in storage area for container systems to be autoclaved Clean are and continue with further tray assemby

10-2 Instrument Handling/Passing Student will read textbook pages Regarding instrument passing, handling and maintaining order within the sterile field Knife loading, passing and unloading as well as Instrument passing will be demonstrated and practiced in lab All Instrument recognition and proper instrument passing will be demonstrated and checked off during lab or on Lab Practical #2

10-3 Loading, Passing, and Unloading the Knife Handle Sterile field established STSR is making final surgical case preparation after initial count has been done Blades are counted items Read section in Textbook page regarding knife handles and their blades Must be able to match blade with appropriate handle Typically for creating a surgical wound, the #10 blade on a #3 handle is preferred For smaller incisions the #15 on a #3 handle may be used If unsure, load both if you have them available on your field

10-3 Loading, Passing, and Unloading the Knife Handle

10-3 Loading the Knife Handle Remove the blade from the package and secure it firmly with a needle holder grasping the blade at the non-sharp edge with your dominant hand Notice edges of knife handle and knife blade prior to proceeding Needle holder will be pointed up at an angle above the hole but the jaws will not cover the hole in the blade Knife handle is held in non-dominant hand with grooved edges facing you Slip the knife blade gently over the tip of the knife handle and pull down onto the raised upper section The blade will snap into place and sit flush with the handle tip DO NOT force the blade on and DO NOT bend it!

10-3 Passing the Knife Handle Two Methods of Passing the knife handle: 1. Safe zone (recommended by JCAH and OSHA) 2. Passing STSR’s hand to surgeon’s hand

10-3 Passing the Knife Handle Why not use safe zone all of the time? Because it may not be conducive to the case For example: if a surgeon is using a microscope or wearing magnifying glasses called loupes then it is not feasible for the surgeon to have to look away from what he is doing to retrieve the blade or syringe only to have to re-focus on the procedure The surgeon is reliant on the STSR to pass the sharp item correctly and be paying attention to retrieve it when he or she is finished with the sharp item Policy dictates this and supports it FYI: There are still surgeons who will not use the safe zone as old habits die hard Following safety precautions in passing sharps will help you to avoid personal injury, patient injury or surgeon injury

10-3 Passing the Knife Handle Utilizing the safe zone –Place one sharp item at a time in the safe zone pan –When passing hold the tray underneath to avoid personal injury –Pay attention to the surgeon and procedure any time a sharp is one the field to be ready to retrieve the item back in the pan –Place the pan away from the field when the surgeon is finished using it

10-3 Passing the Knife Handle Passing the Knife or Scapel STSR hold the knife opposite the sharp side of the knife on top of the handle with wrist raised Pass to surgeon pencil style with handle in the web between the surgeon’s thumb and index finger Pay attention to the surgeon and procedure any time a sharp is one the field to be ready to retrieve the item Surgeon may want to place the sharp on your mayo or say to you “knife back” Retrieve it and place it on your back table

10-3 Unloading the Knife Handle Blades are changed intra-operatively –should a blade become dull –after skin incisions are made if that handle is needed for something else Blades are removed at the end of a case for proper sharps disposal

10-3 Unloading the Knife Handle Knife handle is held in non-dominant hand with grooved edges facing you and blade tip pointing down Remove the blade by securing it firmly with a needle holder in your dominant hand grasping the blade at the at the right side of the base Slip the knife blade gently off the tip of the knife handle Take care not to bend the blade as it will break with little force exerted on it! Place the blade in your sharps container or needle board

10-3 Instrument Handling/Passing Students recognize instruments from minor instrument tray Students can classify all instruments on minor instrument tray Students can name instrument classifications not represented on the minor instrument tray Students can pass all instrumentation properly to the surgeon

Skill Assessment Review 10-1 Assembly of the Instrument Set 10-2 Instrument Handling/Passing 10-3 Loading, Passing, and Unloading the Knife Handle