theatre instruments -maintain one.pptx

educative

1. MAINTAIN THEATRE INSTRUMENTS AND APPARATUS BY MS.LUCY NGUGI

2. Definition of terms An operating theater is a facility within a hospital where surgical operations are carried out in an aseptic environment. Surgical instruments are hand-held tools or implements used by clinicians for the performance of surgical tasks. Theatre apparatus/equipment -any apparatus, device, machine or appliance used in theater during surgical procedures or to support a surgical procedure. Maintain means to preserve efficiency of instruments or equipment's from failure or decline

3. THEATRE INSTRUMENTS Dissection -process of separating tissues through anatomical planes by using sharp or blunt instruments Dilatation -enlarging an opening in a progressive manner Retraction -stabilizing a tissue layer in a safe position to expose a part Atraumatic -without injury Traumatic -causing injury by penetration or crushing Grasping -holding tissues in a traumatic or atraumatic manner Probing - exploring wounds or cavities that are hard to see by moving or guiding tissue or other objects. Clamping and Occluding - compress blood vessels or hollow organs for hemostasis or to prevent spillage of contents

4. Hemostasis is your body's natural reaction to an injury that stops bleeding and repairs the damage/a process to prevent and stop bleeding. Scope -to view Ligate -to tie a with a ligature(Example ligate blood vessels,tissue pedicle or a duct. Ligation can be done using clips or sutures . Incision –to cut a body tissue. Suture -hold body tissues together after injury or surgery Suction is a useful technique to clear unwanted blood, irrigation fluid, or other fluid from the surgical site to increase exposure of the operative wound

5. Parts of a surgical instrument

6. A B c E E D F

7. The rachet is the step locking device used to lock an instrument into position so as to hold the jaws in place. Jaws - have serrations or course teeth to give a firm hold of a tissue, suture needle etc. Box lock and pin -the hinged area or joint of an instrument that absorbs stress during instrument preparation and use. Shank -can be used a holding area for instruments during procedures Ring handle -to grasp and hold firmly

8. QUESTION Which instruments have ratchets? allis,babcook,lanes tissue forceps, Which instruments lack ratchets? scissors,dissecting forceps

9. THEATRE INSTRUMENTS surgical instruments are classified according to their functional usage into the following categories: Cutting and dissecting surgical instruments Grasping and handling surgical instruments Clamping and occluding surgical instruments Retracting and exposing instruments Instruments for improving visualization -Scopes- endoscope, laparoscopes, bronchoscopes, colonscopes , speculums Suturing and stapling/tissue unifying Suctioning and aspirating

10. Dilating and probing - probes, dilators Hemostatic instruments : This includes instruments utilized for the cessation of bleeding. They include Artery forceps in which bleeding is halted by direct clamping of a vessel .Cautery and related instruments are used in high resource countries Accessory instruments -gallipot, kidney dish, Measuring instruments -vernier calliper,jameson caliper, moiltgen goniometer, Graduated measuring jug Powered instruments- electrical and air powered

11. Cutting and dissecting surgical instruments Many surgical instruments are used for cutting skin, soft tissue, and even bones, or dissecting tissues through their anatomical planes. Some of these instruments are disposable such as scalpels and blades, whereas others are reusable such as knives . Blades of different sizes are used for particular operations. For instance, vascular surgeons commonly use blade 11 to puncture large arteries e.g., aorta ENT surgeons use blade 11 or 12 for tonsillectomy, and plastic surgeons use blade 15 for their operations. Abdominal incision-23

12. Some instruments are designed for dissecting tough tissues such as Mayo scissors commonly utilized by obstetricians and gynecologists for cutting ligaments, while others are designed for dissecting delicate tissues such as Metzenbaum scissors used by plastic surgeons for dissecting intestinal mesentery. Bone curette exemplifies a common instrument in this group that is used by neurosurgeons and orthopedic surgeons for laminectomy Other examples of surgical instruments used for cutting or dissecting are bone cutters, snares, blunt dissectors, biopsy forceps and bunches.

13. CUTTING AND DISSECTING INSTRUMENTS scalpels Scalpel handler/blade holder/bard parker knife handler

14. Sizing of blade holder The #3 knife handles are used to hold blades 10 thru 15 #7 –blades no 10-17 Surgical Knife Handle #4 is an extra fine style that is used to accommodate surgical blades 20-25 to make long incisions in various surgical operations . Other compatible scalpel blades sizes include No. 18, 19, 20, 21, 22, 22A, 24, 25, 25A, 26, 27 and 36.

15. BLADE SIZE AND SPECIFIC PROCEDURES

16. Parts of a blade holder Pattern number

17. Loading blade Grip blade with forceps, or similar, avoiding contact with cutting edge. Hold handle in left hand with bayonet fitting uppermost. Place blade partway over handle fitting and engage slots. Slide blade until it clicks into position.

18. Straight-mayo scissors Curved mayo scissor- -To cut heavy tissues(muscle and fascia) To cut tough tissues like ligaments. mainly obstertrics Suture scissor/Straight blunt scissor- to cut sutures(nursing scissor)

19. Metzenbaum-to cut soft delicate tissues(its long and thinner) Stitch removal scissor Stitch cutting scissor Suture wire cutting

20. Knight nasal scissor Nasal Sinus scissor-short jaws Iris scissor

21. Goldman fox scissors -cutting of the gums, sutures or bandages. With smooth or toothed/serrated blades

22. Bone cutter

23. EPISIOTOMY SCISSOR UMBILICAL CORD SCISSOR

24. Grasping and holding surgical instruments Surgeons use certain instruments to grasp or hold tissues to help to have a closer view of their surgical field. The most common surgical instruments used for this purpose are forceps Tissue forceps-smoothed dissecting (non toothed) forceps also called deabekey, toothed dissecting forceps(lanes forceps) and narrow tothed called gillies ADSON forceps- a specialized surgical instrument commonly used for grasping delicate tissues during complex surgeries of the eye, nose and throat. The instrument is commonly used in ophthalmic procedures, ENT surgeries as well as general and vascular surgeries. Babcock forceps- is used for grasping soft tissues intestine and towels stone forceps- grasp gall stones Tenaculum- stabilization and traction of the cervix and to decrease the flexion of the uterus to ease passage of instruments into the endometrial cavity Bone holders/forceps- holding bones in orthopedic procedures

25. Babcock forceps is used for grasping intestine and towels , Allis forceps - used to hold or grasp heavy tissue. It is also used to grasp fascia and soft tissues such as breast or bowel tissue.(curved and straight ) Little wood- used to grasp tissues, the rectus sheath and retract it during gynecological procedures Green Armitage- used to grasp and clamp tissues of the uterus Cheatle forceps(transfer forceps) - used to remove sterilized instruments from boilers and formalin cabinets Towel clips- used for grasping dense thick tissue or holding towels and drapes during various surgical operations

26. GRASPING AND HOLDING INSTRUMENTS Allis tissue forceps -sharp teeth, used to hold or grasp heavy tissue. It is also used to grasp fascia and soft tissues such as breast ... Babcook tissue forceps-hold soft tissues like hold appendix or cecum Stone forceps Bone holding forceps

27. Dissecting forceps types Debakey forceps are non-toothed forceps used in a wide variety of procedures, importantly can be used to grasp soft tissues (such as bowel) without damaging them. Lanes forceps are toothed instruments, useful for grasping tissues and are widely used within all surgical specialties (however not to be used to grasp bowel) Gillies forceps are narrow toothed forceps, often used to grasp skin ADSON(rat toothed) –narrow tips for grasping delicate tissues during complex surgeries of the eye, nose and throat. The instrument is commonly used in ophthalmic procedures, ENT surgeries as well as general and vascular surgeries. Russian forceps -atraumatic tissue grasping during dissection Gerald Tissue Forceps are a light to intermediate weight instrument with very narrow tips specifically used to handle delicate tissue. They are often used in cardiothoracic procedures. Ear forceps Corneal forceps Nelson forceps- fine NON-tearing teeth for holding delicate tissue

28. Toothed dissecting forceps(lanes forceps

29. Corneal forceps

30. Gerald Tissue Forceps Ear forceps

31. Nelson forceps

32. Backhaus towel clamp used for grasping dense thick tissue or holding towels and drapes during various surgical operations Jones towel clamp Sponge holding forceps-used for holding swabs or sponges in medical procedures. Hold hydatid cyst removal and gall bladder in cholecystectomy used to remove sterilized instruments from boilers and formalin cabinets. They are used to ensure that as each item is removed, others are not infected. The forceps are placed in a container of methylated spirits when not in use. Has no lock. Kept in salvon . .

33. Green- Armytage -used to grasp and clamp tissues of the uterus Lane tissue holding forceps -tough and bulky tissues –more tissues can be held with it.

34. Little wood

35. Kocher tissue forceps : Traumatic used to hold tough ,fibrous ,slippery tissue like muscles and fascia that will be removed

36. Clamping and occluding surgical instruments: also called hemostats Those instruments are mainly used for clamping blood vessels and/or other tissue to get them away from the field during surgical procedures. Occluding clamps are used to occlude or constrict tissue and to clamp or grasp bowel, ducts, and other structures with lumens They include: Kelly hemostatic forceps( mosquito, straight and curved) Crile Hemostatic Forceps - clamp the blood vessels and tissues before ligation and cauterization in laparotomy practices. Sawtell crushing clamps, crushing and non-crushing doyen intestinal vascular cramps.

37. Clamping and occluding surgical instruments: also called Hemostats Straight Artery forceps( spencer wells) Curved artery forceps( Dunhill) Mosquito artery forceps Doyens intestinal clamps- clamping of the bowels in abdominal surgery and also blood vessels to stop bleeding

38. Crile artery forceps

39. Doyen non crushing forceps commonly used to grasp large organs like intestines to avoid spillage of contents. Bowel and vessels during anastomosis. Jaws are longitudinal fine serrations. Kelly clamp Crushing can also be used to occlude blood vessels.

40. Payrs crushing clamp

41. Sawtell forceps are curved forceps with a serrated end, often used to grasp vessels prior to ligation.

42. Burlisher clamp -clamp deep blood vessels. That with open ring like above is called tonsil forceps rienhoff swan neck clamp

43. RETRACTING AND EXPOSING INSTRUMENTS

44. Retractors assist surgeons to have a better visualization of the surgical field. Surgeons retract tissues away without traumatizing them through using those instruments. They are divided into: Hand held Self retaining Self retaining Balfour abdominal retractor is a common example of surgical instruments used in laparotomy for this purpose. Balfour-self retraining is suitable for abdominal procedures because it has very soft edges for delicate tissues GELPI is a perineal retractor, weitlainer - hold the incisions in the case of orthopaedic surgeries as most of the incisions are shallow. Moreover, it is used in neurosurgical procedures to hold the skin of the scalp in procedures like craniotomy. Bookwalter - chest and abdominal wall Jolls thyroid retractor Boyles Davis mouth gag- used to visualize the oropharynx and keep mouth open during tonsillectomy. Has tongue blades Finochetto - separate ribs in thoracic surgery. Thompson retractor- thyroid, abdomen and chest wall

45. Finochietto is a bone retractor used for sternotomy operations. Hooks, such as skin, bone or spay hooks , are used to retract skin edges in wide-flap dissection in mastectomy or face-lift operations. Some of these hooks are designed with rounded tips to minimize tissue trauma. Czerny retractor -used in general surgical procedures like hernias and laparotomies Senn miller -is a double-end hand-held retractor and commonly used to hold open the tissue or muscle in small surgical sites army navy -retractor shallow or superficial incisions Richardson - retract abdominal or chest incisions. Used for holding back multiple layers of deep tissue. Morris Retractor is used to retract abdominal wall incisions Cerebellar retractor -neurosurgical to retract cerebellum

46. Kelly Retractor has a right-angled blade that has a bent crescent-shaped lip. This retractor is commonly used to pull back, or retract, the edges of wounds in order to expose the surgical area Deaver Retractor is a large, handheld retractor commonly used to hold back the abdominal wall during abdominal surgeries or chest incisions. Volkman Retractor is a handheld retractor commonly used in small bone and joint procedures Murphy retractor -retractor delicate tissues during general surgery Doyen Retractor is a broad based retractor used to pull back soft tissues and widen the surgical field. This is useful in laparotomies and pelvic surgeries like abdominal hysterectomy and caesarean section, as well retraction of the urinary bladder. Can be called bladder retractor Kocher Lagenbeck”s - retract skin edges or big blood vessels Ribbon retractor –non malleable and Malleable Malleable- Used to retract deep wounds . can be bent and customized . It is used to protect intestines during abdominal closure

47. Kelly retractor Murphy / Volkman retractor Gelpi self retaining Beckmann self retaining Cheek retractor Richardson retractor RETRACTORS

48. Deaver retractor -hold the edges of an abdominal or chest incision open so that the surgeon is able to reach the underlying organs EYE lid retractor Czerny retractor -used in general surgical procedures like hernias and laparotomies. Skin hooks -used for day-to-day skin surgeries such as scar revision, wound closure, excision of tumors, and facial lesions. Cats paw/Senn miller -is a double-end hand-held retractor and commonly used to hold open the tissue or muscle in small surgical sites

49. Doyen retractor army navy-retractor shallow or superficial incisions. cushing vein retractor foruring neurosurgery for blood vessels. Kocher - lagenback Balfour -self retaining-suitable for abdominal procedures.(has very soft edges for delicate tissues.

50. Ribbon –non malleable and Malleable-Used to retract deep wounds. can be bent and customized. It is used to protect intestines during abdominal closure Laster cheek retractor Weitlaner is a self-retaining retractor commonly used in herniotomy Skin hook Bone hook

51. Morris retractor Finochetto -chest wall retractor(rib spread)

52. Harrington retractor Allison lung retractor Jolls self retaining thyroid retractor Cerebellar retractor-neurosurgical to retract cerebellum

53. Laparoscopic fan retractor Farabeuf

54. Riverdin abdominal retractor Murphy gallbladder retractor

55. Bookwalter retrac tor-mainly used in the chest or the abdomen

56. Hip-Retractor

57. Thompson retractor-thyroid, abdomen and chest wall

58. Difference between weitlainer and cerebellar retractor? Weitlainer has blunt fingers. Three on one hand and four on the other hand

59. Question :identify five retractors that are self retaining

60. DILATING AND PROBING INSTRUMENTS Probing instruments are used to enter natural openings, such as the common bile duct, or fistulas. Also called explorers Dilating instruments expand the size of an opening Include: Probes Urethral dilators Urethral sounds Uterine sound 64

61. Cervical dilators Urethral dilators Lacrimal duct probe

62. probes

63. Instruments for improving visualization Special instruments are designed to view deep structures that cannot be seen externally . : collectively called endoscopes (hollow and lens endoscopes) and include: Gastroscope- upper gastrointestinal tract Anoscopes - for visualizing anus Laparoscopes –abdominal cavity Arthroscope- joint Bronchoscope -respiratory tract Colonoscopes Cystoscope- genito urinary system- urethra,bladder Sigmoidoscopes -colon A proctoscope -Used to visualize the anus. Speculums also found here.

64. pederson Vaginal Speculum, characterized by a narrower blade, is a double-bladed instrument with a screw mechanism to keep the blades open once inserted into the vaginal canal. Cusco speculum Sims vaginal speculum ANAL speculum

65. Vaginal speculums are inserted into the vagina to improve visualization. Used in procedures such as: Intrauterine device insertion, pelvic exam, manual vacuum aspiration following spontaneous abortion, cervical stitching etc. Nasal speculum Ear speculums/aural

66. gastroscope INSTRUMENTS FOR IMPROVING VISUALIZTION

67. suctioning and aspiration instruments : Surgical and dental fields may be filled with blood and copious amount of fluids that obscure the underlying structures. Surgeons, thus, use particular instruments to remove these fluids from their filed, for instance, Poole abdominal tips used in laparotomy Frazier tip used in brain and orthopedic operations, Yankauer suction tip used for oropharyngeal procedures .

68. suctioning and aspiration instruments Yankauer sucker Poole abdominal suction tip FRAIZER NOSE SUNCTION

69. Stringer-to hold set of instruments together Gallipot-used to hold liquid or medicines. Kidney dish/tray-receive soiled dressings and other medical waste(placenta) ACCESSORY THEATRE INSTRUMENTS Instrument tray Surgical bowl

70. Measuring instruments Graduated measuring jug Vernier caliper-depth measuring Jameson caliper Depth gauge In orthopedics

71. Suturing and stapling surgical instruments (Tissue unifying instruments and materials Suturing, as well as stapling, instruments are designed to bring the edges of the skin and/or soft tissue adjacent together. The typical suturing kit is composed of a suturing material, a needle, a needle holder, a toothed forceps, and a fine suturing scissor. These Instruments have tungsten carbide jaws/cross hatched are used to eliminate turning and twisting of the needle, enhance instrument life and enable a better grip and balance.

72. Smooth jaws are used with small needles such as those used for plastic surgeries. Staplers and clip appliers are other instruments that can be included in this category. Staplers can be used for stapling terminal end, internal anastomosis, and ends to ends.

73. Suturing and stapling surgical instruments linear surgical stapler Needle holder Clip aplliers Anastomosis stapler

74. PARTS OF A SUTURE Suture material

75. Surgical needles types Classified according to:- According to eye -there is eyeless(swaged) or needles with eyes. According to shape -there is straight or curved or J shaped According to cutting edge -round body, convectional cutting or reverse cutting. According to its tip -triangular, round or blunt tip

76. Characteristics of surgical needles High quality stainless steel Smallest diameter possibly cause minimal trauma to tissues Stable in the needle holder Should be sharp Sterile Corrosive resistant

77. Convectional cutting needle is used to stitch the tough structures like skin and facia,muscles .Very sharp Reverse cutting –very sharp needles .The same as a conventional cutting needle except the third cutting edge is on the outside or convex curvature . These needles are stronger than conventional cutting needles and have a lower chance of cutting through the edge of the tissue. Round body - needles are used for suturing soft and delicate structures like kidney, liver. They dilate/split tissue rather than cut Taper cut- pierce tissues but do not cut(vessels, GI tissue) Blunt point needle -use in Friable tissue that is easily irritated(prone to inflammation, bleeding, or tearing) J shaped - ideal for closing the deep layers of small incisions leading to body cavities. Also applied in vagina and rectum.

78. Straight – used in oral surgery, can be used without needle holder Curved -1/2 circle,1/4 circle,5/8 circle ,3/4 circle-the most commonly used suture needles . They allow for suturing at sites that allow for less space for maneuvering such as muscle, peritoneum, cardiovascular sites, eyes, nerves and tendons, urogenital tract Side-cutting (spatula) needles are flat on the top and bottom surfaces to reduce tissue injury. allow maximum ease of penetration and control as they pass between and through tissue layers . For ophthalmology

79. SUTURES The different types of sutures can be classified in many ways. First, suture material can be classified as either According to fate -absorbable or nonabsorbable. According to source -natural or synthetic According to structure -monofilament (plain) or multifilament(braided or polyfilament ) Other classifications According to coating -dyed or nondyed. Coated or non coated According to tissue reaction -reactive and non reactive According to handling- easy to handle or difficult BOX OF SIX

80. According to fate Absorbable sutures don’t require the doctor to remove them. This is because enzymes found in the tissues of the body naturally digest them. Nonabsorbable sutures will need to be removed at a later date or in some cases left in permanently. According to the structure . Monofilament/plain sutures consist of a single thread . This allows the suture to more easily pass through tissues. Used to ligate small blood vessels. Braided sutures/multifilament/polyfilament consist of several small threads braided together . This can lead to better security, but at the cost of increased potential for infection.

81. 3 . According to source Natural sutures can be made of collagen from mammal intestines or from synthetic collagen (polymers). Tissue reaction and suture antigenicity lead to inflammatory reactions, especially with natural materials . Catgut is a tough cord made from the intestines of certain animals, particularly sheep. Silk ,linen and cotton are also natural sources Synthetic sutures are made of artificial polymers hence less reaction and inflammatory action. Example vicrly,monocyrl and Polydioxanone (PDS)

82. Examples of absorbable Catgut Chromic catgut Polydiaxone Monocryl Polyglyconate vicryl(polyglactin), polyglycolic Examples of non absorbable Silkworm gut Nylon Cotton Linen Stainless steel polyester fiber polypropylene suture

83. -vicryl

84. Important terms Elasticity -ability of a suture to return to regain original form and length when stretched Plasticity -ability of a suture to expand when stretched and not regain its normal strength Pliability -ease of handling Memory -ability of suture to return to formal shape after being manipulated Knot strength -amount of force needed to cause a knot to slip Tensile strength- also called absorption time

85. Nylon - monofilament,less tissue reaction. Used in skin closure, prosthesis attachment or incase of patient history to absorbable. If used in a body cavity they remain permanently enclosed Vicrly -also called polyglactic acid . polyfilament . Mild tissue reaction. Used in closure of fascia(connective tissue surrounding every organ, blood vessel, bone and muscle),uterus, bowel anastomosis, muscle, peritoneum. Absorption time or tensile strength is 3 months. PDS(poly dioxanone suture material)- monofilament,synthetic absorbable with less tissue reaction. Chromic catgut- absorption time is 21-28 days . Coated in chromion salt to resist degradation by tissue. Tissue reaction moderate. Used in circumcision, subcutaneous tissue approximation and suturing muscle and fascia. Plain catgut- absorption time is 7-10 days . High tissue reaction. Used in circumcision and subcutaneous tissue approximation.

86. monofilament multifilament 1. Single strand Several strand of material 2. Encounter less resistance as they pass through tissue Encounters resistance as they pass through tissues hence coated to smoothen them 3. Well suited for vascular surgery Well suited for Tough tissues eg muscle and fascia 4. Poor knot security Good knot security 5. More knots required Less knots required 6. Less tissue drag More tissue drag 7. memory Easy to handle 8. Doesn’t wick/capillary action-no infection wicks/capillary action hence bacteria infection

87. Characteristics of an ideal suture Can be utilized in any operation Can be handled easily and comfortably Minimal tissue reaction High breaking strength High knot security Does not cut, tear or shrink tissue Non allergenic Non carcinogenic Absorbed predictably without tissue reaction Reasonably priced

88. Color coding for sutures

89. SUTURE SIZES The larger the suture the more stronger it is. 2-0 to 0 -abdominal fascia, stomach and hernia, intestines 7-0 to 5-0 –vascular/small blood vessels, ophthalmic and neural 5-0 –larger blood vessels 5-0 and 6-0 on the face 4-0 or 5-0 on the scalp 10-0 to 8-0 -cornea 9-0 -nerves 4-0 to 3-0 –skin, subcutaneous, bowel ,bladder 1-2 -cutaneous stents

90. Methods of suturing Continuous suturing -closure of peritoneum. Also called uninterrupted. made with a single strand of suture material Interrupted -most common method for suturing skin. The individual stitches aren't connected; they are separate Superficial suturing Deep suturing Simple buried- reduce tension on the wound edges, allowing better epidermal approximation of the wound and avoids dead space(space remaining in the tissues as a result of failure of proper closure causing accumulation of blood). Purse string suture -for burying stump of appendix Tension suture -put 5cm laterally away from original suture of incision to reduce the tension at the incision and prevent gaping of abdomen in very fatty patients. Mattress suturing -cut muscles and tendons. Blanket or bottom hole suturing -skin Retention suturing -heavy gauge percutaneous sutures, usually with some form of skin protection, used in high tension wound closures to support primary wound closure Figure of eight- sealing two layers of tissue at the same time Criss-cross

91. Purse string

92. Mattress suturing Blanket stitch

93. Retention suturing Deep suturing

94. Figure of eight Criss cross

95. Suture removal for non absorbable When your sutures are removed will depend on where they are on your body. scalp: 7 to 10 days face: 3 to 5 days chest or trunk: 10 to 14 days arms: 7 to 10 days legs: 10 to 14 days hands or feet: 10 to 14 days palms of hands or soles of feet: 14 to 21 days NB.To remove the sutures, the doctor will first sterilize the area. They’ll pick up one end of your suture and cut it, trying to stay as close to your skin as possible. Then, they’ll gently pull out the suture strand.

96. Classification of sets Specific sets for specific type of surgeries i.e. CS set, ENT set, laparotomy set, craniotomy sets, orthopaedic set, dental set, opthamology set General set This a collection of general useful instruments used in most operations.Additional instruments may be added for a particular operation

97. Instruments in the major set 5 allis, 5babcock, 5 cockers, 10 haemostat, 5 towel clips, 2 bowls, 2dissecting forceps, 2 thumb forceps, 2 blade holders, 2 suture holders, 2 scissors, 2 retractors, 5 Rampley sponge holding forceps ,1 Yankaur Sucker Tube 2 needle holders, 5 towel clips Basic pack contains : 2 bundles raytec gauze (20), 10 green towels 1 abdominal sheet, 1 chest sheet ,1 Mayo cover

98. Different operation sets & functions Minor Basic Instrument Set includes all the essential instruments required for minor surgical procedures. Major instruments set-Total- instruments in Major Basic Surgical Instruments are 159 and individual instruments are 58.For major surgery.*( ASSINGEMENT)

99. Instruments specifications and their uses Rampley’s sponge holding forceps Heavy metal instrument 23-75cm Shafts are thin ,blades fenestrated(have a window)at the distal end Has a ratchet to give it firmness while holding anything Uses Cleaning operative field Swabbing or packing body cavities like vagina Catch soft organs of the body like ovary, cervix Used for blunt dissection in deeper areas Substituted In place ovum forceps

100. Towel clips The most common types are: Mayo’s towel clamp or Backhau’s towel clip Doyen’s towel clip Jones towel clip Moynihan’s tetra skin clip Lorna edna towel clamp They have a catch lock near by the proximal end to fix the grip of drapes Distal ends are curved to two harp points teeth to catch drapes firmly Shanks are short and handles curved

101. Mayo/ backhaus doyen jones Lorna edna

102. Uses of towel clips Fix drapes In any manner To fix tubing's like sunction tubes to the drapes To hold or elevate the ribs in chest injuries Can be used as tongue holding however can perforate the tongue Hold and retract the cord during hernia repair

103. Moynihan’s tetra clip Its like any other towel clip but has four teeth at distal end and the shank is longer than other towel clips. Used to cover the incisioned skin with drapes so that chances of contamination are reduced. Used after an incision has been made

104. Bard parker knife handle Metal instrument used to attach different types of blades at the distal end. Shaft/shank is flat with 1cm breath at the middle Distal end narrow enough to attach blades with an adjustment to fit on the handle Different handles needed to fix different sizes of blades Handling the BP handle and blades should be in the : dinner knife position Writing position Fiddle bow position –like violin

105. Sizing of blade holder The #3 knife handles are used to hold blades 10 thru 15 #7 –blades no 10-17 surgical Knife Handle #4 is an extra fine style that is used to accommodate surgical blades 20-25 to make long incisions in various surgical operations . Other compatible scalpel blades sizes include No. 18, 19, 20, 21, 22, 22A, 24, 25, 25A, 26, 27 and 36.

106. Fiddle bow writing Dinner knife

107. Major abdominal incisions

108. Kocher - open exposure of gallbladder and biliary duct Midline -variety of abdominal surgeries including emergencies. Has minimal blood loss but will cause significant scars. Gridion muscle splitting or McBurney point- appendicectomy Battle incision- appendicectomy Paramedian -access to kidneys, spleen and adrenal gland Lanz incision -appendicectomy Transverse incision -gain access to pelvic structures Rutherford incision -colon, retroperitoneum and aorta and Ven cava Pfannenstiel – ceserean and gynaecological procedures.has minimal complications and for cosmetic purposes.

109. Needle holder Has long handles and small blades resembling artery forceps. Blades have good cross hatched serrations. Has a groove to catch the needle in its inner surface. May be straight or curved, Straight to hold needles when suturing at surface and curved when suturing inside a cavity or working at depth.

110. Types of needle holder

111. Mayo Hegar Needle Holder It is used to drive curved needles during surgeries. It has a broader jaw with a rounded tip. These needle holders have straight and cross-serrated inserts which provide greater precision during the suturing process.

112. Crile wood Crile-Wood Needle Holder is used to hold and guide small to medium size needles and suture materials. The Crile-Wood Needle Holder has a gently tapered, blunt tip and is generally more delicate than the Mayo-Hegar but slightly less delicate than Webster, Halsey, or DeBakey needle holders.

113. Derf needle holder short serrated jaws that hold small needles and commonly 5-0 and 6-0 sutures. Frequently utilized in ophthalmic, dental

114. Cheatle’s forceps Large heavy metal with remarkably curved blades. Inside the blades are large serrations to help get firm grip while taking instruments, gauzes ,vessels or linen. Has no lock. Used to: Select, pick and safely transfer steriled articles like drapes, instruments ,bottles or gauzes from steriled drums or autoclave

115. speculums Lang’s eye speculum -retract eyelids during eye operations. Aural speculum -examination of external ear Nasal speculum -retract tissues in nasal surgery or nasal examination Anal speculum Vaginal speculum Sims vaginal speculum Cusco’s bivalved speculum- self retaining with special screw arrangements. Has two blades which can be opened laterally and adjusted. Introduced closed into the vagina. Pederson vaginal speculum

116. Sims speculum Cuscos speculum Eye speculum Langs Eye speculum Ear speculum Nasal speculum

117. Pederson speculum

118. Trocar and cannula used to puncture abdominal wall incase of laparoscopic surgeries(keyhole surgeries) Used to introduce rubber drainages freely in any cavity without strain and pain to the patient like ears,nose,cavity of abscess for drainage purposes Also puncture ovarian cysts to reduce size before its final removal.

119. Sunction nozzle and tubing's Sunction nozzle is used to suck off blood or fluids from cavities like mouth, abdomen or fluids from large ovarian cyst.it is attached to distal end of rubber tubing and proximal end of rubber tubing attached to suction bottle .

120. Aneurysm needle Metal instrument resembling a hook. Tip blunt to avoid injury to surrounding tissues. Has an eye at the tip Uses Ligation of aneurysm Ligation of vessels in continuity ligate ducts

121. probe Very thin and long metal instrument about 24cm in length. Distal end round and smooth to be introduced in any cavity smoothly. Uses Introduced into cavity to measure depth Also to identify the hole of cervix in pinhole cervix before introducing uterine sound or dilator

122. TUBES T Tube - is a draining tube placed in the common bile duct after common bile duct (CBD) exploration with supra-duodenal choledochotomy(incision of bile duct. It provides external drainage of bile into a controlled route while the healing process of choledochotomy is maturing

123. Ryle tube -A nasogastric tube is a narrow-bore tube passed into the stomach via the nose. It is used for short- or medium-term nutritional support, and also for aspiration of stomach contents - eg , for decompression of intestinal obstruction Jackson pitt drain -closed-suction medical device that is commonly used as a post-operative drain for collecting bodily fluids from surgical sites Flatus tube- facilitate expulsion of flatus Ryle tube

124. Gynecologic/obstetric instruments Dealing with the female reproductive system Uterine sound -light weight metallic graduated on its stem in 30cm length and curved at its distal end used to ascertain length of cervix and uterus before any operation through the vagina. Vaginal speculum Hegars cervical dilator -dilating the cervix when approach is required example curetting the uterine contents or surgery Curette -has a small spoon at distal end for scrapping to wash out uterine cavity(dilatation and curratage ). Its stem is hollow to allow passage of fluids during wash out Ovum forceps -has cupped blades with fenestrations(holes)to remove products of conception from the uterus or any foreign body or anything retained in the uterus like placenta membrane pieces. Tenaculum forceps- used to hold anterior lip of the cervix transversely to stabilize it before doing a procedure Episiotomy scissor -used to do episiotomy(widen the vagina by cutting )during second stage of labour to allow passage of baby incase of tight perineum. Uterine packing forceps -used to pack vagina and uterine cavity in emergencies to control bleeding till medical aid is available. Elliot's ,Simpsons forceps -used when there is substantial molding during child birth, that is, temporary elongation of the fetal head as it moves through the birth canal. Simpons more elongated cephalic curve

125. Tenaculum Uterine packing forceps Ovum forceps Episiotomy scissors

126. Uterine sound Cervical dilators currete

127. Laparoscopic Sopher ovum forceps Simpsons

128. Delivery forceps

129. Manual vaccum aspiration kit-(MVA KIT) - used for rapid uterine aspiration / uterine evacuation in Gynecology procedures like treatment of miscarriage ,incomplete abortion, silent miscarriage, terminate molar pregnancy treatment of abnormal uterine bleeding and obtain endometrial biopsy or treat endometriosis Tip rounded to prevent trauma to the uterus Barrel is 60 cc. Cannulas are of size 4,5,6 for single valve and 6,7,8,9,10 and 12 for double valve are attached to the syringe Single or double valve system is locked to allow creation of vacuum of up to 610-660mm Hg pressure canula inserted and then valve opened to release the vacuum created with precision and immediately upon depression reducing incidence of “slow” gradual suction pressure, which can be a major source of uterine bleeding with inadequate vacuum. Syringe lock removed to empty contents into the red bin.

130. ORTHOPEDIC INSTRUMENTS Mallet -heavy instrument also called hammer used to strike chisel or gauge for removing bone chip Chisel -heavy metal instrument with head ,shaft and cutting edge used to remove sleeves of bone example for grafting and also to remove benign growth from bones. Osteotome -just like a chisel except that the cutting edge on both sides to allow cutting through cutting of a bone. Used to cut bone in various lengths in osteotomy. Manual Amputation saw -cut bone with a regular surface incase of amputation especially in gangrene or crush injuries of bone.

131. osteotome Bone chisel Bone mallet

132. Gigli’s wire saw -consist of two or four strong flexible metal wires braided close together for strength and efficiency to cut the skull in order to reflect an osteoplastic flap in burrhole operation. Jig saw wire Bone cutter -cut long bones like metarcarpals in gangrene or crush injuries. Bone nibbler ronguer -used to make pieces of bones for biospy . Periosteal elevator -used to lift and separate the periosteum before removing bone for grafting. Femoral head extractor- used to extract the head of femur from the acetabulum incase of fracture of the neck of femur. Bone rasps -specifically designed for orthopedic procedures to shape or trim bone surface and cartilage Bone files –used to smooth out the acromial resection Bone clamp -hold and stabilize bone during orthopedic implant and other procedures Bone drill Depth gauge -measure the depth of a hole to estimate sign of plate to be inserted

133. Giglis wire Bone cutter Bone nibbler ronguer Periosteal elevator Femoral head extractor Bone rasps

134. Vibration saw Bone Clamp Hohmann bone lever/retractor Knee retractor

135. EAR NOSE AND THROAT INSTRUMENTS Boyle – davis mouth gag -open jaws and retract in oral surgery like tonsillectomy. Alligator forceps and Crocodile punch biopsy forceps -take biopsy(piece of tissue through endoscope. laryngeal forceps -take biopsy from larynx Frer septal knife -incise mucosa over deviated septum Tonsil holding forceps -has fenestrated tip to allow bulk of tissue to bulge out and give good grip Tonsillar snare -crush and cut tonsil pedicle Lacks spatula -a tongue depressor used to examine oropharynx

136. Pillar retractor and Hurd dissector- may be used to pull the anterior pillar of the tonsil, while the dissector aids in excising the mass from the tonsillar bed. Myringtome -slender with short sharp tip to cut tympanic membrane in suppurative otitis media. Fallop ring applicator is used for the application of a Silastic ring to perform tube ligation Adenoid curette -used for smooth shaving of the adenoid tissue incase they enlarge as a result of infection

137. Boyle davis mouth gag Crocodile punch forceps

138. Larygneal forceps Tonsil holding forceps Tonsillar snare Lack tongue depressor Green thyroid retractor

139. Jolly's thyroid retractor Yaunker sucker sanction tip

140. Pillar retractor and Hurd dissector Myringtome

141. Laryngeal mirror Nasal cutting forceps-short jaw sharp tipped Beckman adenoid currete Thompson adenoid currete with guard

142. Hartmann tongue depressor

143. Dental set Sterilization cassette Crane pick-used as a lever to elevate broken roots from socket Woodward chisel-remove, smooth, and contour areas of bone so that implant hardware can be inserted. Osteome Mallet Yaunker Suction tip Iris scissor curved Noyes scissors(curved)-cutting and dissecting gums Mosquito forceps Mayo hegar needle holder/crile wood needle holder Adson forceps Self aspirating syringe Cryer elevators Minnesota retractor London college forceps Amalgam wall-amalgam is a dental filling material used to fill cavities Lower molar Gauze picker Fredman bone ronguer Mouth inspection mirror with handle Periosteal elevator Howard bone file Periodontal probe Scalpel handle Debakey tweezers Sternberge retractor-cheek retractor

144. Noyes scissors(curved Mouth mirror

145. amalgam Periodontal probe Aspirating syringe Minnesota retractor Cryer elevator

146. Cheek retractor

147. Craniotomy set /BURR HOLE Knife handle Mayo dissecting scissors Metzenbaum scissors Potts-smith scissors-vascular scissor Toennis Adson scissor-blunt dissection and slicing of delicate and dense tissues during Semkim (thumb)tissue forceps Adson dressing forceps Cushing tissue forceps Halsted mosquito forceps Dandy scalp hemostat Backhaus towel clamp Sponge forceps Crile wood needle holder Michel wound clips Wire cutting scissor Senn retractor Jansen retractor Beckhman retractor Frazier suction tube Allis Adson periosteal elevator Scoville Brain spatula -retracting, mobilizing and manipulating the delicate brain parenchyma Cranial ronguer

148. Potts smith scissor Jansen retractor Toennis Adson scissor Adson forceps Love nerve retractor

149. Hudson brace -to drill single or multiple holes in the skull in preparation for the removal of a section of the skull. Frazier suction tube

150. Gigli’s wire saw- consist of two or four strong flexible metal wires braided close together for strength and efficiency to cut the skull in order to reflect an osteoplastic flap in burrhole operation.

151. Beckhman retractor Brain spatula-malleable

152. Adson periosteal elevator Cranial ronguer Murphy retractor Dandy scalp hemostat

153. INSTRUMENTS TO ASSIST IN ANESTHESIA LARYGNOSCOPE -metal instrument containing a battery , handle and blade attached to it by hinge with a small electric bulb situated half way along top surface which is lit by moving blade to 90 degrees activating hinge switch. Blade is “z” shaped to allow tongue to be pushed to opposite side of the mouth Uses Examination of larynx For intubation during anesthesia The two most commonly available types of laryngoscope blades are the straight (Miller)- size 1 recommended for intubation in infants, due to the large size and flexibility of the infant epiglottis,00 infants and the curved (Macintosh, Mac) for adults. With Laryngoscope Blade held next to patient's face. Blade should reach between lips and Larynx (or lips to angle of jaw) . Better to choose a blade too long than too short. Estimate 1 cm longer than needed. Blades are available in different sizes for every age

154. Tongue blades Lamp socket handle flange Battery inside Fiberoptic bundle inside SPINAL NEEDLE - used for lumbar puncture for spinal anesthesia or diagnostic puncture of the spinal canal

155. Artificial manual breathing unit-(AMBU BAG)

156. Common AMBU BAG Pitfalls Here are a few things to avoid: 1. Not properly positioning the airway. Failing to open the airway, or not maintaining an open airway once it has been positioned doesn’t allow air into the lungs. 2. Pushing the mask into the face. Pushing the mask down on the face, instead of lifting the jaw into the mask, pushes the tongue against the back of the throat and obstructs the airway causing suffocation. 3. Not maintaining an effective seal. 4. Over-ventilating and hyperventilating. Giving too much volume or going too fast could push air into the stomach, resulting in gastric insufflation. This could lead to vomiting and subsequent airway obstruction or aspiration.

157. Complications of improper AMBUBAG use Stomach inflation causing regurgitation hence lung aspiration Lung injury air embolism into pulmonary artery Tension pneumothorax

158. AIRWAY AND BREATHING DEVICES

159. Airway adjuncts are equipment's used to maintain or open airway by preventing tongue from covering epiglottis blocking breathing. Endotracheal tube Made up of red rubber, or other synthetic material like pvc and polyethylene. The tubes may be cuffed or non cuffed and come in different diameters of tubes. They are used to administer anesthesia where face mask cannot be used. 2. Guedel’s orophargneal airway Made of hard rubber or plastic tube bend at its shaft according to the curve of the oropharynx with full opening of the tube at the tip. Uses Used to prevent biting and obstruction of endotracheal tube. Prevent obstruction of natural air passage by relaxed tongue and soft pharyngeal tissue after relaxation by muscle relaxants during induction and recovery of anesthesia. Facilitates sunctioning of phargneal secreations AIRWAY ADJUNCTS

160. 3. Nasopharyngeal Airways Made of hard hollow rubber or plastic designed with metal connection at proximal end. Inserted into the nostril and directed to the floor of the nose to nasopharynx to prevent tongue from blocking off air in unconscious patient.

161. 4.Larygneal mask airway Used as a temporary method to maintain an open airway during the administration of anesthesia or as an immediate life-saving measure in a patient with a difficult or failed airway.

162. 5. Tracheostomy tubes Opening created at the front of the neck so a tube can be inserted into the windpipe (trachea) to help you breathe. The tube can be connected to an oxygen supply and a breathing machine called a ventilator. connectors

163. 6. Supraglottic airway devices a group of airway devices that can be inserted into the pharynx to allow ventilation, oxygenation, and administration of anesthetic gases, without the need for endotracheal intubation

164. 1..Simple face masks oxygen delivery devices

165. 2. Venturi mask Delivers a known oxygen concentration to patients on controlled oxygen therapy. Important for those at risk of hypercapnic respiratory failure and to accurately assess ventilation and gas exchange.

166. 3.Non rebreather mask

167. 4. Nasal prongs

168. 5. High flow nasal cannula

169. 6. Face tent

170. 7.Artificial manual breathing unit

171. 8.BPAP-BILEVEL POSITIVE AIRWAY PRESSURE DEVICE

172. 9.Continous positive airway pressure

173. Equipment's needed during intubation Laryngoscope with several blades Endotracheal tubes Malleable stylet -an introducer which fits inside the endotracheal tube and allows for manipulation of the tube shape; to facilitate passage of the tube through the laryngeal inlet. 20 ml and 10 ml syringe Magill forceps -used as an aid for nasotracheal intubation as well as to remove foreign bodies. Water soluble lubricant

174. Functional suction machine or unit Suction tube correct size Paralytic agents/neuromuscular blocking agents- For rapid sequence induction (RSI), succinylcholine and rocuronium are commonly used sedative agents used during rapid sequence intubation include etomidate, ketamine, and propofol.

175. Tape Tongue depressor or tongue block Nasal or pharyngeal airways –assorted AMBU BAG Yaunker sucker or sunction tube-Size of ETT multiplied by 2

176. Malleable stylet Magill forceps

177. Parts of ET tube

178. Types of ET tubes Non cuffed- used in pediatric because their cricoid ring is sufficiently narrow to form seal by itself Cuffed- used in adults because their trachea is considerably wider hence nee of cuff to seal trachea and positive pressure cannot escape from lower airway and to seal upper airway to prevent aspiration from materials above glottis. Diameters are from 2mm to 16mm.size of tube determined by Internal diameter= +4 Average female size is 7.5mm-8.0 mm Average male size is 8.5mm-9.0mm Roughly ,the diameter of child is child little finger estimate. From 6 months to one year is (4.5 to 5)mm  

179. Complications of ETT Infection Hemorrhage Hypoxia Trauma to laryngeal nerve- hoarseness,difficulty in swallowing and breathing and loss of voice Damage to esophagus Pneumothorax -air leaks into the pleural space Emphysema –the air sacs in the lungs (alveoli) are damaged

180. OPTHALMIC INSTRUMENTS Dealing with the eye Chalazion eye currete -a surgical instrument designed for scraping or debriding biological tissue or debris in a biopsy, excision, or cleaning procedure Cataract knife -making incision during cataract incision Eye lid retractors Enucleation scissor- to cut optic nerve Bowman’s heat cautery -cauterize bleeders in iris Iris forceps- holding iris Iris scissor

181. Chalazion eye currete Cataract knife Eye lid retractor Eyelid retractor Enucleation scissor Iris forceps

182. Bovie cautery Iris scissor

183. UROLOGIC INSTRUMENT Used in surgical procedures of the urinary system Urethral dilators -dilating urethral strictures which restrict urine flow Bladder sound -used before introduction of radiography. Thomson walker bladder retractor Morris kidney retractor Renal pedicle clamp- clamp pedicles in depth

184. Urethral dilators Bladder sound Moris single end and double end Thompson walker bladder retractor Renal pedicle clamp

185. TURP SET Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems that are caused by an enlarged prostate TURP is carried out using a device called a resectoscope, which is a thin metal tube containing a light, camera and loop of wire. This is passed along your urethra until it reaches your prostate, which means no cuts (incisions) need to be made in your skin. Has: Lens Resectoscope sheath 24 fr or 27 fr Hf resection electrodes for coagulation Ellic evacuator-to remove tissue sections during transurethral prostatectomy, bladder biopsy, and for removing calculi from urinary bladder Electrolyte free and sterile irrigation fluid Lubricant- ky jelly Suprapubic catheter for irrigation Specimen bottle

186. Resectoscope Hf resection electrodes Ellic evacuator- Three Folley catheter