Basic surgical instrumentation

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

1. Basic Surgical instrumentation Jamilah saad Alqahtani CNS,MSN,NS,RGN,BSN, OR Specialist

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3. Outlines Surgical instruments history & background Comparison between past, present and the future of surgical instruments definition of Surgical instruments Fabrication of Metal Instruments Classifications of surgical instruments principles of using surgical instruments Passing the surgical instruments powered instruments Handling, cleaning and sterilizing key points in Handling instruments before, during and at the end of procedure 5/26/2018 jamilah saad Alqahtani 3

4. Introduction Surgical instrumentation is critical to surgical procedure. The performance of OR team is enhance when team members know each instrument by name, know how each is safely handled and know how each is used. Preparing the instrument for appropriate processing will prolong its use in patient care and decrease the costs for repair and replacement. 5/26/2018 jamilah saad Alqahtani 4

5. Introduction Communication is key to extending instrument life and promoting patient safety Of all the different kinds of medical instruments found in a hospital setting, surgical instruments are among the most sensitive and delicate. Patient safety depends on sterile, functional instrumentation. To prevent damage to the instruments and promote patient safety, it is critical that OR nurses and technicians should be trained the best care and precaution when handling, cleaning and sterilizing surgical instruments. 5/26/2018 jamilah saad Alqahtani 5

6. Historical Background Surgical instruments have been manufactured since the dawn of pre-history. Rough trephines for performing round craniotomies were discovered in neolithic sites in many places. It is believed that they were used by shamans to release evil spirits and alleviate headaches and head traumas caused by war-inflicted wounds. https://www.gettyimages.co.uk/detail/news-photo/trephine-is-a-crown-saw-used-for-perforating-the-skull-and-news-photo/90766805 https://www.surgicalholdings.co.uk/surgical/surgical_instruments.php?content=history 5/26/2018 jamilah saad Alqahtani 6

7. Historical Background In the Antiquity, surgeons and physicians in Greece and Rome developed many ingenious instruments manufactured from bronze, iron and silver, such as scalpels, lancets, curettes, tweezers, specula, trephines, forceps, probes, dilators, tubes, surgical knifes, etc. They are still very well preserved in several medical museums around the world. Most of these instruments continued to be used in Medieval times, albeit with a better manufacturing technique. https://www.researchgate.net/publication/16158509_The_history_and_evolution_of_surgical_instruments_II_Origins_Function_Carriage_Manufacture 5/26/2018 jamilah saad Alqahtani 7

8. Historical Background In the Renaissance and post-Renaissance era, new instruments were again invented and designed, in order to accompany the increased audacity of surgeons. Amputation sets originated in this period, due to the increased severity of war-inflicted wounds by shot, grapnel and cannon. https://hipertextual.com/2017/05/hombre-herido-diagramas 5/26/2018 jamilah saad Alqahtani 8

9. BASIC SURGICAL TOOLS PAST PRESENT FUTURE 5/26/2018 jamilah saad Alqahtani 9

10. Definition Surgical instruments are precisely designed and manufactured tools. for single (disposable) or multiple use (non-disposable), must be resisted physical and chemical effects, body fluids, secretions, cleaning agents and sterilization 5/26/2018 jamilah saad Alqahtani 10

11. Fabrication of Metal Instruments Stainless steel Titanium Vitallium Other metals Plated instruments 5/26/2018 jamilah saad Alqahtani 11

12. Classification Of surgical Instruments Cutting and dissecting Grasping and holding Clamping and occluding Exposing and retracting Suturing stapling Viewing Suction and aspirating Dilating and probing Measuring Accessory instruments Microinstrumentation 5/26/2018 jamilah saad Alqahtani 12

13. Classification Of Surgical Instruments Cutting and dissecting Scalpels knives Scissors 5/26/2018 jamilah saad Alqahtani 13

14. Classification Of Surgical Instruments 4- Bone cutters and debulking tools 5- Other sharp dissectors 6- Blunt dissectors 5/26/2018 jamilah saad Alqahtani 14

15. Classification Of Surgical Instruments Grasping and holding Tissue forceps 5/26/2018 jamilah saad Alqahtani 15

16. Classification Of Surgical Instruments 2- Stone forceps 3- Tenaculums 4- Bone holders 5/26/2018 jamilah saad Alqahtani 16

17. Classification Of Surgical Instruments Clamping and occluding Hemostatic forceps Non crushing vascular clamps 5/26/2018 jamilah saad Alqahtani 17

18. Classification Of Surgical Instruments Exposing and retracting Handheld retractors Self retaining retractors 5/26/2018 jamilah saad Alqahtani 18

19. Classification Of Surgical Instruments Suturing or stapling Needle holder 5/26/2018 jamilah saad Alqahtani 19

20. Classification Of Surgical Instruments 2- Staplers 5/26/2018 jamilah saad Alqahtani 20

21. Classification Of Surgical Instruments Viewing Speculums 5/26/2018 jamilah saad Alqahtani 21

22. Classification Of Surgical Instruments Viewing 2.endoscopes 5/26/2018 jamilah saad Alqahtani 22

23. Classification Of Surgical Instruments Suctioning and aspiration Suction 5/26/2018 jamilah saad Alqahtani 23

24. Classification Of Surgical Instruments Dilating and probing 5/26/2018 jamilah saad Alqahtani 24

25. Classification Of Surgical Instruments Measuring Accessory instruments Microinstrumentation 5/26/2018 jamilah saad Alqahtani 25

26. Basic Principles Of Handling Surgical Instruments Safety Economy movement Relax handling Avoid awkward movement 5/26/2018 jamilah saad Alqahtani 26

27. Passing Surgical Instrument Tip is visible Hand is free Handle is placed directly into waiting hand Avoid placing fingers in the rings as the instruments is passed 5/26/2018 jamilah saad Alqahtani 27

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29. Power Sources Surgical Instruments Air-powered instruments 5/26/2018 jamilah saad Alqahtani 29

30. Power Sources Surgical Instruments Electrical powered instruments 5/26/2018 jamilah saad Alqahtani 30

31. Handling Powered Surgical Instruments Keys points in handling powered instruments including the following: Set the instruments and attachments on small sterile table Handle and store the air hose or electric cord with care To prevent inadvertent activation assemble the appropriate handpiece attachments (e.g. blades, drills, reamers) and power source with safety mechanism in position. Always be certain that attachments completely seated and locked in the handpiece . Test the functionality of the instrument before surgeon use. 5/26/2018 jamilah saad Alqahtani 31

32. Cleaning and sterilizing power instruments 5/26/2018 jamilah saad Alqahtani 32

33. General guidelines apply to the cleaning of all power instruments Clean and decontaminate the instruments immediately after use to maintain optimal function Lubricate the instrument as recommended by the manufacturer 5/26/2018 jamilah saad Alqahtani 33

34. Care Cycle For Surgical Instruments 5/26/2018 jamilah saad Alqahtani 34

35. Handling Surgical Instruments Setting up the instruments table Handling Instruments during surgical procedure passing surgical instrument Dismantling the Instruments Table at the of procedure

36. Setting up the instruments table Key points in handling instruments before the surgical procedure include : Handle loose instruments separately to prevent inter-lacking or crushing. Inspect instruments such as scissors and forceps for alignment, imperfections, cleanliness and working condition Sort instruments nearly by classifications Keep ring handled instruments together with curvatures and angles pointed in the same direction Leave retractors and heavy instruments in a tray or container or lay them out on a flat surface of the table 5/26/2018 jamilah saad Alqahtani 36

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38. Handling Instruments during surgical procedure What are the most important things needed for effective and efficient role of the scrub nurse in this time ? 5/26/2018 jamilah saad Alqahtani 38

39. Handling Instruments during surgical procedure Know the name and appropriate use of each instruments. Using the fine instruments for heavy tissue damages the instrument Handle instruments individually. Tangled instruments are hard to separate in an emergency Hand the surgeon or assistant the correct instrument for each particular task Pass instruments decisively and firmly when surgeon extends her/his hand the instrument should be slapped or placed firmly into his/her palm in the proper position for use.in general when passing curved instrument, the curve of the instrument aligns with the direction of the curve of the surgeon’s hand. 5/26/2018 jamilah saad Alqahtani 39

40. Handling Instruments during surgical procedure 5. Watch the sterile field for loose instruments. After use remove them to the mayo stand or instrument table 6. With moist sponge wipe the blood and organic debris from instruments a promptly after each use 7. Flush the suction tip and tubing with sterile distal water periodically to keep the lumen patent 8. Remove debris from electrosurgical tips to ensure electrical contact. 9. Place used instruments that will not be needed again in to a tray or basin during or at the end of surgery 5/26/2018 jamilah saad Alqahtani 40

41. Passing An Instrument To The Surgeon 5/26/2018 jamilah saad Alqahtani 41

42. Points to remember when passing an instrument to the surgeon If the surgeon is on the opposite side of the operating bed, pass across right hand to right hand and for lifted handed surgeon by left hand If the surgeon in the same side of the operating bed and to the right pass with your left hand Hemostatic forceps are held near the box lock by the scrub person and passed by rotating the clockwise to place the handle directly into the surgeon’s waiting hand 5/26/2018 jamilah saad Alqahtani 42

43. Points to remember when passing an instrument to the surgeon clip appliers are held between the fingers by the hinged joint during loading and passing. Placing fingers in the ring may cause the clip to be dischange unintentionally. The loaded applier is passed so the rings automatically pass over the surgeon’s fingers in position of function for rapid use. Sharp delicate instruments may be placed on a flat surface for the surgeon to pick up 5/26/2018 jamilah saad Alqahtani 43

44. Dismantling the Instrument Table Check the drapes, towels, and table covers to be sure that instruments do not go to the laundry or into the trash . A final quick count is a safeguard. Collect instruments from the mayo stand and any other small table separate delicate , small instruments with those that may have sharp or semi sharp edges for special handling Disassemble all instruments with removable parts to expose all surfaces for cleaning Open all hinged instruments to expose box lacks and serrations 5/26/2018 jamilah saad Alqahtani 44

45. Dismantling the Instrument Table 6. Separate instruments of dissimilar metals. Instruments of each type of metal should be cleaned separately to prevent electrolytic deposition of other metals. 7. Flush cold, distilled water through hollow instruments or channels such as suction tips or endoscopes, to prevent organic debris from drying. 8. Rinse off blood and debris with demineralized distilled water or an enzymatic detergent solution. 9. Follow the procedures for preparing each instrument for decontamination or terminal sterilization. 10. Wrap the instrument for sterilization 11. Sterilize the instrument in steam unless contraindicated by manufacturer. 5/26/2018 jamilah saad Alqahtani 45

46. Summary Surgical instruments background Compare the different between past, present and the future of surgical instruments definition of Surgical instruments, Fabrication of Metal Instruments , Classifications of the surgical instruments Basic principles of using surgical instruments, principles of Passing surgical instruments powered instruments and proper Handling of powered instruments and cleaning and sterilizing of them key points in Handling instruments before during operation and dismantling of instruments at the end of procedure 5/26/2018 jamilah saad Alqahtani 46

47. References Fairchild SS. Perioperative nursing: Principles and practice: Little, Brown; 1996. Berry K, Kohn M. Operating room technique. New York: Mosby. 2004:345-62. http://medical.tpub.com/14275/css/Handpiece-And-Bur-Exchange-118.htm http://catalog.hospitime.com/hospitime-surgicalinstruments-care-cycle/ file:///C:/Users/jamilah/Downloads/handlingofsurgicalinstruments-141127210405-conversion-gate01.pdf https://www.slideshare.net/ahmadfsulong/handling-of-surgical-instruments/17 https://www.surgicalholdings.co.uk/surgical/surgical_instruments.php?content=history 5/26/2018 jamilah saad Alqahtani 47

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49. Have a nice day 5/26/2018 jamilah saad Alqahtani 49