Use of Medical Instrument

2. 1. Surgical Instrumentation
3. 2. IMPORTANT TERMS• Atraumatic • without trauma• Traumatic • Causing Injury by penetration or crushing• Dilation • Enlarging an opening in a progressive manner• Dissection • Process of separating tissues through anatomic planes by using sharp or blunt instrumentation
4. 3. IMPORTANT TERMS• Grasping • Holding in a traumatic or atraumatic manner• Retraction • stabilizing a tissue layer in a safe position for exposure of a part• Sharp • Instrument with a cutting edge or pointed tip(s) that is used to cut or dissect tissue
5. 4. IMPORTANT TERMS• Trocar • A device used for penetration of tissue layers. It is commonly used for percutaneous endoscopy. It is used as a temporary pathway for gases, other instrumentation, or the removal of an organ or substance.
6. 5. CLASSIFICATION OF• Cutting and INSTRUMENTS • Suctioning and Dissecting Aspirating• Grasping and Holding • Dilating and Probing• Clamping and • Measuring Occluding • Accessory• Exposing and Instruments Retracting • Microinstrumentation• Suturing and Stapling• Viewing
7. 6. CUTTING ANDDISSECTING•SCALPELS• Insert Blade using a HEAVYHEMOSTAT of KELLY CLAMP•No.•No. 11 Blade•No. 12 Blade•No. 15 Blade•No. 23 Blade•KNIVES•SCISSORS•BONE Cutters and DebulkingTools•Biopsy Forceps and Punches•Curettes•Snares•Blunt Dissectors
8. 7. • Scalpels (disposable) Adv. Knives(reusable), Ortho, GS, Amputation• Handle 4 – Blade 20-24 (SIZES)• Blade 20 – Initial for SKIN knife• Blade 10 – most common• Blade 11 – Vascular, To puncture Aorta, To cut blood vessel• Blade 12 – EENT, Tonsilectomy• Blade 15 – Plastic, Pedia• Bone Cutters – to Cut RIBS, THORACOTOMY
9. 8. CUTTING ANDDISSECTING•Bone Curette• used by Ortho, NeuroSurgeon forLaminectomy•Maybe straight orangulated(spine surgery)Laminectomy – Laminaremoving ofintervertebral disk, toremove tissues, debris,
10. 9. CUTTING ANDDISSECTING•Mayo Scissors•Tough tissues,curve mayo, ob-gyn(to cutligaments)•MetzenbaumScissors•delicate tissues,Plastic surgeon,Intestine, delicatetissue
11. 10. CUTTING ANDDISSECTING•Suture Scissors (Blunt /Blunt)•Nursing Scissor – Blunt/Pointed
12. 11. GRASPING & HOLDING•Tissue Forceps•Smooth Forceps•Toothed Forceps•Allis Forceps•Babcock Forceps•Stone Forceps•Tenaculums•Bone Holders
13. 12. GRASPING & HOLDING•Rat-Toothed Tissue Forceps•General Surgery Skin
14. 13. GRASPING & HOLDING•Allis TissueForceps•To grasp OBtissues (atraumatic), AP repair
15. 14. GRASPING & HOLDING•Babcock Intestinal Forceps
16. 15. GRASPING & HOLDING•Backhaus Towel Clamps•Towel clips on the edges ofdrapes, hide the towel clamps
17. 16. CLAMPING & OCCLUDING•Hemostatic Forceps•Hemostats•Crushing Clamps•Noncrushing Vascular ClampsMost commonly used, to clampblood vesselsKocher and Oschner forceps
18. 17. CLAMPING & OCCLUDING•Pean Intestinal forceps•Intestinal / serrations is horizontal
19. 18. CLAMPING & OCCLUDING•Hemostatic Forceps•Hemostats•Crushing Clamps•Noncrushing Vascular Clamps
20. 19. CLAMPING & OCCLUDING•Hemostatic Forceps•Hemostats•Crushing Clamps•Noncrushing Vascular Clamps
21. 20. EXPOSING & RETRACTING•BALFOURABDOMINALRETRACTOR •Laparotomy •Retractors assist in the visualization of the operative field while preventing trauma to other tissues
22. 21. EXPOSING & RETRACTING•ARMY NAVYFARABEUF Retractor
23. 22. EXPOSING & RETRACTING•GELPI PerinealRetractor •Self retraining •Biopsy , Skin
24. 23. EXPOSING & RETRACTING•Weitlaner Retractor
25. 24. EXPOSING & RETRACTING•Spay Hook•Bone hook, skinhook, to retract skinedges during a wideflap dissection, suchas a face-lift ormastectomy.Some have styles ofhooks that have balltips, which causesless trauma to tissues
26. 25. EXPOSING & RETRACTING•Senn Retractors
27. 26. EXPOSING & RETRACTING•FinochiettoRetractor•For sternotomy ,
28. 27. SUTURING & STAPLING•Needle Holders•Tungsten Carbide Jaws•Crosshatched Serrations•Smooth Jaws•Staplers•Clip Appliers•Terminal End Staplers•Internal Anastomosis Staplers•End-to-End Circular Staplers
29. 28. SUTURING & STAPLINGA needle holder should not beplaced on a magnetic pad, becauseit may become magnetized.Tungsten Carbide jaws – eliminatethe twisting and turning of theneedleCrosshatching – provides asmoother surface and preventsdamage to the needleSmooth jaws – used with smallneedles such as those used forplastic surgery
30. 29. SUTURING & STAPLING•Terminal End Staplers•Internal Anastomosis Staplers•End-to-End Circular Staplers
31. 30. VIEWING•Speculums•Endoscopes•Hollow Endoscopes•permits viewing in a forwarddirection, with a light carriersupplied by a fiberoptic cableprovides illumination•Lensed Endoscopes•have either rigid or flexiblesheaths, used in combination withvideo assisted technology, canrecord action videos and still digitalphotography
32. 31. SUCTIONING & ASPIRATING•Suction•Suction devices remove blood andother fluids from a surgical or dentaloperative field.•Used in abdominal laparatomy orwithin a cavity with copiousamounts of fluid. The outer filtershield prevents the adjacent tissuesfrom being suctioned in to theapparatus.•Poole Abdominal Tip•Frazier Tip•Yankeur Tip•Autotransfusion•Aspiration•Trocar•Cannula
33. 32. SUCTIONING & ASPIRATING•Suction•Poole Abdominal Tip•Frazier Tip - forbrain, spinal, plastic, ororthopedicprocedures, used whenencountering little or nofluid•Yankeur Tip -Standard tipfor suctioning. Has anangle for mouth andthroat, also useful forvisualization of rupturedaneurysm•Trocar•Cannula
34. 33. DILATING & PROBINGProbing instruments areused to enter naturalopenings, such as thecommon bile duct, orfistulasDilating instrumentsexpand the size of anopening, such as theurethra or cervical os
35. 34. MEASURING
36. 35. ACCESSORYINSTRUMENTS
37. 36. MICROINSTRUMENTATION
38. 37. Powered SurgicalInstrumentsDRILLBURRBLADEREAMERABRADERAIR-POWEREDELECTRICALLYPOWERED
39. 38. HANDLING INSTRUMENTS•Standardized BASIC sets•Scrub Person counts ALLinstruments, sharp andsponges with theCIRCULATOR•Handle LooseInstruments SEPARATELY•Sort by CLASSIFICATION•PROTECT Sharps
40. 39. Handling INSTRUMENTS during SURGERY • FREE-HAND TECHNIQUE• Know the NAME and USE• Handle INDIVIDUALLY • Watch the sterile field for LOOSE instruments• Use for the INTENDED purpose • With a MOIST, SPONGE wipe• Use of HAND SIGNALS blood and organic debris from instruments using a• Short INSTRUMENTS = Superficial DEMINERALIZED STERILE, Work DISTILLED H20• LONG Instruments = DEEP• PASS instruments DECISIVELY and FIRMLY
41. 40. Handling INSTRUMENTS during SURGERY• Instruments are maintained and sterilized prior to use.• Surgical instruments must be kept clean during a procedure. This is accomplished by carefully wiping them with a moist sponge and rinsing them frequently in sterile water. Periodic cleaning during the procedure prevents blood and other tissues from hardening and becoming trapped on the surface of an instrument.
42. 41. ELECTROSURGERY•INITIAL Incision is madeby a SCALPEL•Doubling the currentincreases the heatproduced fourfold•ARGON Enhanced ESUTip is held at 60 degreeangle, causing LESSTissue Damage•BUZZING – the processof coagulating theVESSELS•BUZZ should not exceedmore than 3 SECONDS
43. 42. Electrosurgery precautions• ESU should not BE USED in the mouth, trachea, around the HEAD, or in the pleural cavity• ECG electrodes should be placed as far as possible, BURNS can occur• Rings and jewelry should be removed• DON’T USE Flammable agents• DO not immerse an active electrode in liquid• DRY Sponges can IGNITE• Investigate a repeated request for more current
44. 43. LASER SURGERY• Light amplification by stimulated emission of radiation (LASER)• Types of LASERS = ARGON, CARBON DIOXIDE, HOLMIUM, KRYPTON, NEODYMIUM, PHOSPHATE, RUBY/XENON
45. 44. PATIENT SAFETY in LASERS Eyes and Eyelids  Anesthetic Agents should be adequately should be protected (aluminum NONCombustible foil, moist pads)  Flexible metallic or Antiseptics must be insulated silicone NONFlammable endotracheal tubes Rectum should be  Wear high filtration packed with a MASKS for CO2 laser MOISTENED sponge ablation such as to prevent escape of condylomata (Venereal METHANE gas warts)
46. 45. Advantages of LASERS Precise CONTROL =  Minimal TRAUMA to ACCURATE incision tissues Access to HARD to  DRY, Bloodless REACH areas SURGICAL Field (endoscopes,  Minimal THERMAL rhodium reflector effect mirrors)  Reduced RISK for Unobstructed view of INFECTION the surgical site  Prompt Healing  Reduced OPERATING Time