SAFETY AND PRECAUTIONSHUKGYJFTDRGXFHGJHKJL;KOJL WEEK7.pptx

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1. EXCURSION OF PERIOPERATIVE THEATER SAFETY AND PRECAUTIONS 1

2. WEEK 7 IDENTIFICATION OF OT INSTRUMENTS & HANDLING THEM

3. BASIC SURGICAL TOOLS and SURGICAL MATERIALS

4. BASIC SURGICAL TOOLS

5. BASIC SURGICAL TOOLS PAST PRESENT FUTURE

6. 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 For this reason, most of them are made of high-quality stainless steel; chromium and vanadium alloys ensure the durability of edges, springiness and resistance to corrosion. BASIC SURGICAL TOOLS

7. Classification: Cutting and dissecting instruments Grasping, clamping, occluding instruments Hemostatic instruments Retracting and exposing instruments Wound-closing instruments and materials Special instruments BASIC SURGICAL TOOLS

8. Cutting and dissecting instruments The function of these instruments is to divide tissues, sutures, bandages, etc. BASIC SURGICAL TOOLS

9. Use of scalpels Fiddle-bow-holding Pencil-holding Blades Handle and detachable blade BASIC SURGICAL TOOLS 1.1. Scalpels Conventional scalpel

10. 1.2. Scissors BASIC SURGICAL TOOLS

11. Use of ring-ended instruments with right and left hands 1-4 instrument-holding BASIC SURGICAL TOOLS

12. 1.3. Dissecting hemostatic forceps Three mail functions: - dissecting tool, - grasping tool, - hemostatic tool. Pean Mosquito abdominal Pean BASIC SURGICAL TOOLS

13. 1.4. Electrocoagulating system Monopolar Bipolar BASIC SURGICAL TOOLS

14. 1.5. Ultrasonic cutting system 1.6. CUSA (Cavitron Ultrasonic Surgical Aspirator) 1.7. CO 2 -LASER, neodymium-YAG-LASER BASIC SURGICAL TOOLS

15. 1.8. Dissector 1.10. Saws 1.9. Amputating knives 1.11. Raspatories BASIC SURGICAL TOOLS

16. 2. Grasping, clamping and occluding instruments These istruments are used to grasp, pick up, hold and manipulate tissues, tools and materials. BASIC SURGICAL TOOLS

17. 2.1. Forceps Anatomical forceps Surgical forceps Ophtalmological forceps Ring tip forceps Dental forceps BASIC SURGICAL TOOLS

18. Use of forceps Forceps must never be held in the palm!!!!!! BASIC SURGICAL TOOLS Forceps should be held like a pencil!

19. Bachaus towel clamp Schaedel towel clips 2.2. Towel-holding clamps BASIC SURGICAL TOOLS

20. 2.3. Hemostatic forceps Traumatic Ι Atraumatic hemostatic forceps Kocher Lumnitzer Bulldog Blalock Satinsky BASIC SURGICAL TOOLS

21. 2.4. Needle holders Mathieu needle holder Hegar needle holder BASIC SURGICAL TOOLS

22. 2.5. Organ clamps Allis (lungs) Babcock (gallblader) Ringed gallblader clamp Klammer (intestinal clamp) BASIC SURGICAL TOOLS

23. 2.6. Sponge-holding clamp Sponge-holding clamp BASIC SURGICAL TOOLS Handled sponge

24. 3. Hemostatic instruments These instruments are establishing hemostasis during the operation. BASIC SURGICAL TOOLS

25. 3.1. Deschamp needle and Payr probe Important member of this group are the hemostatic claps (Pean, mosquito, abdominal Pean, Kocher, Lumnitzer, Satinsky, bulldog) and electocoagulatins system. BASIC SURGICAL TOOLS

26. 3.2. Argon beam coagulator (ABC) BASIC SURGICAL TOOLS

27. 4. Retracting and exposing instruments These instruments are used to hold tissues and organs in order to improve the exposure and hence the visibility and accessibility of the surgical field. BASIC SURGICAL TOOLS

28. 4.1. Hook 4.2. Rake retractor 4.3. Roux-retractor BASIC SURGICAL TOOLS

29. 4.4. French retractor 4.5. Visceral retractor 4.6. Abdominal wall retractor BASIC SURGICAL TOOLS

30. 4.7. Weilaner self-retractor 4.8. Gosset self-retractor BASIC SURGICAL TOOLS

31. 5. Wound-closing instruments and materials These instrument and surgical materials are used during tissue closure procedures. BASIC SURGICAL TOOLS

32. 5.1. Staplers BASIC SURGICAL TOOLS Linear Stapler Circular Stapler

33. 5.2. Clips Michel-clips 5.3. Self-adhesive strips 5.4. Surgical adhesives BASIC SURGICAL TOOLS

34. 5.5. Surgical materials BASIC SURGICAL TOOLS

35. 6. Special instruments BASIC SURGICAL TOOLS These instruments are not used routinely during all surgical interventions.

36. 6.1. Volkmann’s curette 6.2. Instruments of bone surgery 6.3. Probe 6.4. Sucker system BASIC SURGICAL TOOLS

37. SURGICAL MATERIALS

38. SURGICAL MATERIALS Surgical needles Medicina is used numerous materials (bone, fishbone, thorn) as surgical needles, and metal needles are widespread from the XIX. Century.

39. Made in best quality and minimal tissue reaction causing stainless steel - Slim and narrow, but strong - Stabil fixation and control in the needle holder - Lead the thread by safely and minimal traumatisation - Sharp to get through the tissues - Rigid, but flexible - Easy sterilisation The criteria of the ideal surgical needles SURGICAL MATERIALS

40. - Double thread (traumatisation) - Lace time - Re-sterilisation - Care of needle-tip - Corrosion Conventional needles Closed eyed French-eyed SURGICAL MATERIALS

41. Atraumatic needles - Simple thread (atraumatic) Manufactured connection of needle and threads - No Lace time - No re-sterilisation - No Care of needle-tip - No Corrosion SURGICAL MATERIALS

42. 3/8 Circle 5/8 Circle ¼ Circle ½ Circle Multiple curved J-shaped Straight Progressive curved Shape of needle SURGICAL MATERIALS

43. Shape of its body Round needle Triangular (Cutting) needle SURGICAL MATERIALS

44. Taperpoint Tapercutting Blunt taper Round needle SURGICAL MATERIALS

45. Cutting needle Conventional Reverz cutting Spatula SURGICAL MATERIALS

46. SURGICAL MATERIALS

47. Criteria of ideal surgical materials • Nonelectrolytic , noncapillary , nonallergenic , noncarcinogenic . • Nonferromagnetic , as is the case with stainless steel sutures. • Easy to handle. • Minimally reactive in tissue and not predisposed to bacterial growth. • Capable of holding tissue layers throughout the wound healing • Resistant to shrinking in tissues. • Absorbed completely with minimal tissue reaction after serving its purpose. • Sterile. SURGICAL MATERIALS

48. Raw material Natural Synthetic Structure Monofil Multifil Absorbability Absorbable Non-absorbable Classification of surgical materials SURGICAL MATERIALS

49. Advantage: Present in the nature - cheap?? Good handling Knotting properties, knot security Disadvantage: Strong tissue reaction by animal and vegetable tissues Enzimatic absorbtion – tissue reactions Uncalculable absorbtion Procurement, screening, monitoring (economies ?) Raw material: Natural SURGICAL MATERIALS

50. Advantage: Minimal tissue reaction Absorbtion by hydrolysis – calculable Strong Disadvantage: Bad handling of Monofil threads Raw material: Synthetic SURGICAL MATERIALS

51. Advantage: Smooth surface Smaller tissue trauma No bakterial culture No capillarity No tumor cell invasion Disadvantage: Bad handling and knotting „Thread memory” Structure: Monofil SURGICAL MATERIALS

52. Advantage: Strong Soft and flexible Good handling Good knotting Disadvantage: Bacterial and tumor cell invasion Capillarity Elongation Rough surface – tissue trauma (sawing and cutting) Structure: Multifil SURGICAL MATERIALS

53. Advantage: The human body break down them Not remain foreign materials (granuloma) Disadvantage: Time of tissue cohesion (important the choose) Absorbability: Absorbable SURGICAL MATERIALS

54. Absorbable 1.Polyglycolic acid (Safil ® , Safil Quick ® , Dexon ® ) 2. Polyglactin (Vicril ® , Vicryl Rapide ® ) 3. Glycomer (Biosyn ® ) 4. Polyglytone (Caprosyn ® ) 5. Glyconate (Monosyn ® ) 6. Polyglyconate (Maxon ® ) 7. Polydioxanone (PDS II ® , MonoPlus ® ) 8. Lactomer (Polysorb ® ) 9. Gut (Cromic Gut ® , Plain Gut ® ) SURGICAL MATERIALS

55. Advantage: Permanent tissue cohesion Disadvantage: Resist foreign materials in the tissues (foreign-body reactions, granuloma, microabscess, fibrosis) Suture rejection Absorbability: Non-absorbable SURGICAL MATERIALS

56. 1. Polyamide ( Dafilon ® , Ethilon ® , Supramid ® , Nurolon ® , Surgilon ® ) 2. Polyester ( Ethibond ® , Ti-Cron ® , Synthofil ® , Dagrofil ® , Mersilene ® ) 3. Polybutester ( Novafil ® , Vascufil ® ) 4. Polypropylene ( Premilene ® , Prolene ® , Surgipro ® ) 5. Silk (Silkam ® , Virgin silk ® , Mersilk ® , Softsilk ® ) 6. Steel ( Steelex ® , Steel wire ® , Steel ® ) Non-absorbable SURGICAL MATERIALS

57. - Synthetic - Absorbable - Coated multifil or flexible monofil No ideal surgical materials! SURGICAL MATERIALS Choice:

58. Metric units / European Pharmacopeia/ from 0,1 metric (0,010-0,019 mm) to 10 metric(1,00-1,09 mm) USP /United States Pharmacopeia/ from 11/0 (0,010-0,019 mm) to 7 (1,00-1,09 mm) 11/0, 10/0, 9/0, 8/0, 7/0, 6/0, 5/0, 4/0, 3/0, 2/0, 0, 1, 2, 3, 4, 5, 6, 7 The size-systems of threads SURGICAL MATERIALS

59. SURGICAL MATERIALS

60. SURGICAL MATERIALS

61. ORTHOPAEDIC SURGERY Joint replacements and other procedures require specialized equipment.

62. ROBOT-ASSISTED SURGERY Increasingly used for procedures in urology, gynecology, endocrine surgery, and other specialties.

63. UROLOGIC SURGERY Minimally invasive cystoscopic equipment is frequently used for both visualization and performing procedures.

64. Powered Instruments 3Types – Battery powered – Air powered – Electric powered

65. Powered Instruments

66. Handling instruments Instruments are placed firmly into the surgeon’s palm in such a manner that it is ready of immediate use.  Ringed instruments are handed with the box locks closed.  Curved instruments are passed with the curve in the direction of intended use.