instruments (1).pptx

THE COMMONLY USED INSTRUMENTS ARE EXPLAINED WITH USES AND PARTS

1. I NSTRUMENTS KRISHNA V GANDHI LECTURER GCSN

2. SPONGE HOLDING FORCEP SERRATIONS SHAFT BOX LOCK SHANK RATCHET : 3 C’s CATCH, CLAMP, CRUSH FINGER BOWS

3. Sponge holding forcep is a long, thin, sharp with catches and finger bows that mean it is a long and straight instrument with round fenestrated ends. Braes that have transverse serrations on the inner surface. It is 7 to 9. Inches (18-20cm in length) Also called Rampley’s swab holding forcep

4. The length of an instrument ensure that antiseptics can be applied to the part be prepared for surgery from a distance. So that the sterile gloved hand of the surgeon does not come in contact with the unprepared filled with operation. The fenestrations in the blades accommodate the bulk of the sweep and serrations are designed to give the instrument a good grip.

5. USES Antiseptic dressing or preparation of an operated area before operation. Holds antiseptic cotton swab and gauge before surgery. For swabbing a cavity. To facilitate dissection.

6. CHEATLE FORCEP SHAFT SHANK FINGER BOWS BOX LOCK

7. It is a large, heavy metal forcep with remark curved blade. Inside the blade, there are large serration which help to get while taking instrument vessels or linen. There is no lock. As it is heavy long an good with serration , sterile articles can be safely transported from one tray to another.

8. Cheatle Sterilizer Forceps are used  to remove sterilised instruments from boilers and formalin cabinets . They are used to ensure that as each item is removed, others are not infected. CHEATLE FORCEPS / TRANSFER FORCPS

9. The forceps are placed in a container of methylated spirits when not in use. Usually dipped in antiseptic solution like dettol or carbolic lotion for ready use.

10. ARTERY FORCEP/ HOMEOSTASIS FORCEP BOX LOCK SHANK FINGER GROOVE RATCHET

11. Artery forceps  are also known as hemostats or clamps. They have narrow tapering beaks with transverse serration. SIZE NAME SMALL MOSQUITO / HALSTED MEDIUM SPENCER WELL LARGE BAILEY FORCEPS

12. Usually available as curved. The curve allows easier placement of ligatures around the forceps. Allows easier placement of ligatures around the forcep . Mainly used to hold and cut fascia and peritoneum edges . CURVED ARTERY FORCEP

13. USES To control the bleeding on site. Clamp the bleeding vessels. Helps in suturing in absence of needle holder. To hold free ends or cut ends of suture. To open facial planes in different surgeries. To pass and ligature. To crush base of appendix. NOTE: Care should be taken as they are crushing forceps that can damage delicate structures.

14. NEEDLE HOLDER BOX LOCK SHANK FINGER GROOVE RATCHET GROOVE

15. USES Used for grasping needle at the time of suturing. The inner of the tip is criss-cross serration and a small grove for firm grasp of the curved needle. A needle holder, also called needle driver, is a surgical instrument, similar to a hemostat, used to hold a suturing needle for closing wounds during suturing and surgical procedures. The box joint is placed very close to the tip to give adequate pressure because of the lever effect

16. SR NO HAEMOSTATIC FORCEP NEEDLE HOLDER 1 Lighter instrument Heavier Instrument 2 Blades length 1/3 and shaft length 2/3 Smaller blades 3 Transverse serration on the inner side of blades Serrations – criss cross or transverse and groove in blade 4 Joint screw type or may be box type Joint is box type only

17. K OCHERS FORCEP BOX LOCK SHANK FINGER GROOVE RATCHET

18. Kocher Forceps are a heavy instrument designed to aggressively grasp medium to heavy tissue or occlude heavy, dense vessels. They have horizontal serrations the entire length of the jaw as well as 1 X 2 teeth at the tip. The combination of full serrations plus teeth ensure a firm grip on the tissue or vessel being held.

19. USES : FOR SECURING HEMOSTASIS To hold securely superior thyroid pedicle vessels Hold retracting cut ends of vessels in tough fibrous tissue Holds ribs during ribs resection To cause artificial rupture of gestational membrane

20. ALLIS TISSUE FORCEP BOX LOCK SHANK FINGER GROOVE RATCHET 4-5 SHARP TEETH

21. Also called as Allis clamp. 4-5 teeth on each tip with curved ends The Allis tissue Forcep is a surgical instrument with sharp teeth, used to hold or grasp heavy tissue. It is also used to grasp fascia and soft tissues such as breast or bowel tissue. Allis tissue Forcep can cause damage, so they are mainly used in tissue about to be removed.

22. USES To hold tough and non bulky tissue To hold the anterior lip of cervix in D &E operation. To hold the apex of the episiotomy wound during repair. To catch hold the margins and angles of the uterine flaps in LSCS after the delivery of the baby. To catch hold the margins of the peritoneum, rectus sheath and vaginal mucosa.

23. SINUS FORCEP BLADE SHANK FINGER BOWS

24. It is a straight, long , delicate and slender metal instrument with about 24 cm long. It has 2 blades, shaft and handles. The distal tip is round, blunt and smooth serrations horizontally inside the tip. Long handles with finger bows but there is no lock or catch for grip.

25. The instrument is long and slander because it may be required to transverse the long and narrow track of sinus. The blades are serrated to get a firm grip on the foreign bodies or granulation tissues to be removed from a sinus to get a grip on a sterile gauze piece or a drain to be introduced in a sinus. A sinus is a blind track line by unhealthy granulation tissue which are end of which opens to exterior.

26. THUMB FORCEP / NON TOOTHED DISSECTING FORCEP FIXED HINGE SHANK JAW TIP

27. Small grooves, but no teeth on the tips Hold tissue by pressure applied to the handles The shaft of the forcep is by thumb and finger so it is known as thumb forcep

28. USES: Grasping Compressing Blunt dissection Pulling tissue Holding delicate structures

29. TOOTHED DISSECTING FORCEP

30. Tips have small teeth Size and number of teeth vary Teeth penetrate tissue to hold it Preferred by most surgeons over thumb forceps because: Less crushing injury More secure hold with less finger pressure

31. USES: To hold tough structures. Used to hold scalp while suturing. to  grasp tiny particles and tissues for biopsy purposes .

32. SCISSORS They are sharp cutting instruments widely used as surgical technique. There are variety of scissors used for specific purpose for cutting, stiching , for cutting bandages and tissues etc. They are small, medium , or large in size Straight or curved end, narrow blade or wide bladed, sharp pointed or blunt.

33. CLASSIFICATION OF SCISSORS 1.According to Curvature and angles. 1-Straight Scissors 2-Curved in edge scissors 3- Angle on edge scissor 2. According to points on tip. 1-Blunt pointed scissor 2-Sharp pointed scissor 3. According To Use 1-Stich scissor 2- Tissue scissor

34. Curve on edge scissor:- They are used at depth where the space to work is very much confluent. Angle on edge scissor:- They are used generally for cutting structure which are directly used. Sharp pointed scissor:- It is used where the surgeon have no risk of injury to important structure. Blunt pointed scissors:- They are used where the surgeon damage to important structure

35. SUTURE CUTTING SCISSOR Used to cut sutures on skin and mucous membranes.

36. CURVED SCISSOR Cutting heavy tissue such as muscle, fascia and uterus.

37. LARYNGOSCOPE

38. A laryngoscope (larynx + scope) is a device that is used to visualize the larynx and adjacent structures mainly for inserting a tube into tracheobronchial tree. History The first laryngoscope was invented by Manuel García in 1854 Alfred Kirstein developed direct vision laryngoscope in1895 It was popularized by Sir Robert Mackintosh and Sir Ivan Magill in early 1940

39. TYPES OF BLADES 1. MACINTOSH (Curved) Most popular The tongue has gentle curve that extends to the tip In cross section ,the tongue, web and flange form reverse It is positioned in the vallecula anterior to the epiglottis lifting it out of the visual pathway Size ranges from 1-4, Most adults require size 3

40. 2. MILLER (Straight) The tongue is straight with a slight upward curve near the tip The flange, web, and tongue form a C with the top fattened It is positioned posterior to the epiglottis, trapping it while exposing vocal cords and glottis Size ranges 0-4

41. USES Endotracheal Intubation Insertion of nasogastric tube and transesophageal echocardiac probe Foreign body removal Upper airway lesion biopsy Visualizing and assessing the upper airway (vocal cords and larynx)

42. HARTMANN AURAL SPECULUM

43. USES This is a funnel shaped speculum that has no slit on the body. The broader end is thickened for better grip. Examination of the external ear canal and tympanic membrane. Removal of wax, foreign body or ear discharge. In operative procedures like myringotomy, myringoplasty. For transcanal injections.

44. KNIFE HOLDER SCALPEL / BARD PARKER HANDEL DISTAL END SHAFT PROXIMAL END

45. Knife Holder Scalpel It is metal instrument used to attach different types of blade at the distal end. Shaft is 1cm in breath at the middle. Distal end is narrow enough to fix the blades with an adjustment to fix all the handle The proximal end is round Different size of handles are required to fix different size of blades according to their uses.

46. Handle No. Knife No. 3 10,12 4 20,21,22,23 5 24,11,15

47. Where the no. of knife is increasing, it is used in skin and where decreasing, it is used for tissue. Knife no. decreasing , the sharpness is increasing. 12 no. knife is used for tonsil operation. 22 no. knife is used for spinal operation. 11 and 15 no. knife is used for tissue operation. Scalpel consist of a blade and handle. They are of two types. 1-Combine blade and handle scalpel. 2-Interchangable blade and handle scalpel.

48. USES It is the most important instrument in surgery. Some handle are used for repairing the skill to cut the flexia or to open the peritoneum. Round proximal end of handle may be used on muscles of the abdomen after cutting of the flexia over it.

49. Quality of an ideal Scalpel It should be light. Blade should be fairly sharp. The handle should give a good grip. The blade should have straight back. * STERILIZATION IS DONE BY AUTOCLAVING

50. INSTRUCTIONS FOR INSTALLING AND REMOVING SCALPEL BLADES To install the scalpel blade, align the blade with the scalpel handle as shown. WARNING: Scalpel blades are extremely sharp. Always hold the back of the blade. Never force the blade. Use pliers to hold the blade securely if it becomes stuck on the handle. 2. Align the blade into the groove in the handle and gently slide it toward the scalpel handle.

51. 3. Continue to slide the blade onto the scalpel handle until it locks in place. 4. To remove the blade, carefully lift the bottom of the blade until it unlocks from the scalpel handle as shown. 5. Slide the blade off the scalpel handle, moving it away from the handle as shown.

52. MOUTH GAG Mouth gap Tongue blade Chest piece with connecting rod

53. The mouth gag name after designers. Boyler Devis Gag It is self retaining mouth gag consist of following parts -Mouth gap properly -Tongue blade -Chest piece with connecting rod

54. USES : For correct use, hold the instrument with the blade downward and pointed towards the patient. It is introduced into the mouth cavity (Oral care mainly unconscious patient) in such a fashion that the teeth of instrument guarded with rubber tubes. The two blade is used to retract the lower jaw till the mouth cavity opens wide. The instrument consist of tongue blade attached to mouth gag which can be opened by sliding arrangement to retract jaw to open jaw and retract in oral surgery

55. PROCTOSCOPE OBTURATOR HANDEL OBTURATOR OUTER TUBE OUTER TUBE

56. It is used for visualizing anal canal and lower end of rectum. It is made up of steel material. It has two parts :- 1-Outer tube attached with handle 2- Inner is of obturator

57. How To Use Proctoscope ? To examine the rectum and anus, first insert the proctoscope and then remove the obturator and observe that part. Patient placed left lateral position initiating the anus is observed for hemorrhoid fissures and cracks.

58. USES: To find out piles To find out ulcer or any growth is in rectum. To examine rectum and anus .

59. NASAL SPECULUM / THUDICHUM

60. It is light weight metal instrument which has two thin blades connected with “V” shaped ring The blades are like two wings and attached. Right angle to a flat metal joined middle part act as a handle.

61. USES: The blades are broughtly together before introducing in the nasal cavity and expended after introduction to the nose. Used to clear the area in nasal surgery. Used for both diagnostic and therapeutic purpose.

62. INTRODUCTION TO THE NOSE The speculum should be inserted as the skin with blades are close. The pressure on the rim of speculum gradually released, the blades more apart allowing sufficiently inspection on the interior part of the nasal cavity.

63. PINNARD FETOSCOPE AURAL END ABDOMINAL END  A device used to obtain information about a fetus within the uterus. 

64. TUNNING FORK STEM FOOT PIECE PRONGS BASE SHOULDER

65. A tuning fork is a two-pronged metal fork that can be used as an acoustic resonator. It is usually made up of steel, magnesium or aluminum that is used to tune , it vibrates sinusoidally to generate a pure tone Longer forks vibrates at slower frequency It is activated by striking against examiners elbow, heel of hand

66. MAYO’S TOWEL CLIP SHARP POINTS BOX LOCK SHANK FINGER GROOVE RATCHET

67. USES HOLDS drapes so that only operative field is exposed Fix suction tube with drapes Holds ribs Retract cord during hernial repair

68. DOYENS RETRACTOR BLADE HANDLE

69. Doyens Retractor are Non self retaining Blades are Blunt Broad Curved Long handle

70. USES Used to retract bladder and bowel during laparotomy Obstetric uses: Retract the bladder during LSCS. Retract the abdominal wall.

71. MORRIS RETRACTOR BLADE FENESTRATED HANDLE

72. USES: Used while making and closing abdominal incision for ease of working in the deeper layer. to retract pectoralis major during surgery. To hold back the abdominal wall during abdominal or thoracic procedures. It is a long retractor with a broad operating end.

73. SINGLE HOOK RETRACTOR HOOK SHAFT

74. USES To retract skin edges To retract tough fascia

75. DOUBL E HOOK RETRACTOR SHAFT HOOK HOOK

76. USES To retract skin edges To retract tough fascia

77. PINNARD FETOSCOPE AURAL END ABDOMINAL END  A device used to obtain information about a fetus within the uterus. 

78. BLAKE’S UTERINE CURETTE SHARP, SMALLER END BLUNT, LARGE END

79. Commonly used in D + C for incomplete abortion . In D +E operation, the curettage is done by blunt end as the uterine wall is soft It can also be used in D+C operation one week following evacuation of hydantiform mole

80. SIMS SPECULUM

81. Non self retaining posterior vaginal speculum . Two blades of unequal breath. Handle in between Groove in the handle USES To inspect cervix and vagina OPD - PAP SMEAR IUCD INSPECTION ENDOMETRAL BIOPSY

82. OBSTETRIC USES: Confirm / identify PROM identify local cause of traumatic bleeding GYNECLOGICAL USES: Hysteroscopy / hysterectomy Vaginal surgeries

83. ADVANTAGES Groove in the centre drains secretion and keeps area clean More expose of the vaginal wall than cuscos speculum Difference in the blade size facilitate introduction into vagina depending upon space available.

84. URETHRAL DILATOR

85. USES Double end Curved on both sides Graduated set of dilators of different sizes To dilate cervix before pregnancy While performing gynecological surgeries Diagnosis of cervical incompetence in non pregnant women To dilate cervix before procedures like D&E, D&C

86. THANKS