Medical Equipment 2023 4th YR(1).pdf

Deﬁnition of terms
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I. Medical Supplies –are any articles (item of expendable
nature) utilized for various purposes in providing health care
for patients
This include
suturing materials
syringes and needles
Surgical dressings
Medical gases
Surgical blades and other similar articles.
2

Cont…
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II. Medical Equipment: deﬁned as set of instruments and
equipment utilized in the measurement of one or more
characteristics or phenomena whereby the information
obtained from the measurements will be in the form that can
be
read,
interpreted,
recorded and
preserved by man
3

Cont…
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Their purpose can be
Diagnosis
Evaluation
Monitoring
control
4

Cont…
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This include;
Sphygmomanometer
ECG
CT scanners and x-ray machines
Medical laboratory equipment
Medical monitors and others
5

cont…
III. Laboratory Reagents: deﬁned as chemicals and biological
agents used in laboratory testing for detecting or measuring
analyte.
6

Introduction

The “Medical Device” Universe
The World Health Organization (WHO) differentiates the mostly
associated terms such as health technology, medical device and
medical equipment. Hence, the following deﬁnitions:
Health Technology: The application of organized knowledge and skills
in the form of devices, medicines, vaccines, procedures and systems
developed to solve a health problem and improve quality of life. It is
used interchangeably with health-care technology.
7

•
•
Medical device: An article, instrument, apparatus or machine
that is used in the prevention, diagnosis or treatment of illness
or disease, or for detecting, measuring, restoring, correcting or
modifying the structure or function of the body for some health
purpose.
Typically, the purpose of a medical device is not achieved by
pharmacological, immunological or metabolic means.
8

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
Medical devices requiring calibration, maintenance, repair, user
training, and decommissioning – activities usually managed by
clinical engineers.
Medical equipment is used for the speciﬁc purposes of diagnosis
and treatment of disease or rehabilitation following disease or
injury; it can be used either alone or in combination with any
accessory, consumable, or other piece of medical equipment.
Medical equipment excludes implantable, disposable or single-
use medical devices.
9

Figure: The Medical Device
Universe
NB: in this course the
concern is on Medical
Equipment
Therefore, according to the above deﬁnitions medical equipment are subset
of medical devices which in turn are type of health technology in the larger
context of health care technology as described in ﬁgure below.
10

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The above ﬁgure also indicates the scope of professionals
associated with medical devices. Accordingly, clinical
engineering is a specialty within biomedical engineering
responsible primarily for applying and implementing medical
technology to optimize healthcare delivery.
Roles of clinical engineers include training and supervising
biomedical equipment technicians, working with governmental
regulators on hospital inspections/audits, and serving as
technological consultants for other hospital staff.
A Clinical Engineer is a professional who supports and
advances patient care by applying engineering and
managerial skills to healthcare technology.“
11

43%
14%
17% USA
Europe
Japan
26% others
Fig: Global statistics on medical device production
(2002)
12

... Introduction
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Concept of “Essential Medical Devices”
The concept of “Essential Medical Devices” is very much
similar to that of Essential Medicines. It promotes having a
limited range of carefully selected essential medicines that
satisfy the priority health care need of the population.
This is believed to lead to better health care, better drug
management, and lower costs. In the same manner, a medical
device should be considered essential only when the following
three criteria are fulﬁlled:
13

Essential Medical Devices…
a)
b)
c)
Its use meetsthebasic needs of health service
Proven to be cost-effective.
Evidence-based (i.e. follows well deﬁned speciﬁcations and
widely accepted consensus by experts) .
14

What is a Medical Device?
•

Medical devices are also deﬁned as instruments, apparatus,
appliances, substances or preparations made from substances or
other articles, used alone or in combination, including
the software necessary for the medical device's proper
application intended by the manufacturer to be used for human
beings, by virtue of their functions.
15

Purpose of medical devices

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diagnosis, prevention, monitoring, treatment or alleviation of
disease,
diagnosis, monitoring, treatment, alleviation or compensation of
injuries or handicaps,
investigation, replacement or modiﬁcation of the anatomy or of a
physiological process,
control of conception
16

•
•
•
The above deﬁnition provides a clear distinction between a medical
device and other products such as drugs/ medicines.
If the primary intended use of the product is achieved through
chemical action or by being metabolized by the body, the product is
usually a drug or medicine.
This includes devices that do not achieve their principal intended
action in or on the human body by pharmacological, immunological,
or metabolic means, but may be assisted in their function by such
means.
17

•
•
In other words,
It is intended to affect the structure or any function of the body of
man or other animals, and unlike drugs it does not achieve its
primary intended purposes through chemical action within or on
the body of man or animals and is not dependent upon being
metabolized for the achievement of any of its primary intended
purpose.
18

Definition in our context
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Based on the above definitions, in this document a medical device
is meant to encompass all items traditionally categorized as
laboratory chemicals and reagents, medical supplies and
consumables and medical equipment. This is also in line with the
definition issued by the Food Medicine and Health Care
Administration and Control Authority (FMHACA).
Though FMHACA preferred the term “Medical Instrument” rather
than “Medical Device”, the content of the definition matches with
what is discussed above.
19


V
According to FMHACA the following deﬁnition is issued (Ethiopian List
of Medical Instruments with minimum speciﬁcation, June 2013):
“...any instrument or supply that may be used on the inner or outer part of
the body for diagnosis or treatment of a disease in human, and includes
various diagnostic, laboratories, surgery, dental medical instruments and
suturing materials, syringes, needles and other supplies.”
20

Classification of medical devices
1.
2.
3.
4.
Factors Influencing Device Classification
The duration of contact of the device with the body
The degree of, and site of, invasiveness into the body
Whether the device deliver medicines or energy to the patient.
Whether the device is intended to have a biological effect on
the body.
21

5.
6.
7.
8.
9.
10.
Intended action on the human body
Local versus systemic effects
The device comes into contact with injured skin.
Whether for diagnosis or treatment,
The ability to be re-used or not, and
Combination of devices
22

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FDA Experience
FDA has established classiﬁcations for approximately 1,700 different
generic types of devices and grouped them into 16 medical specialties
referred to as panels.
Each of these generic types of devices is assigned to one of three
regulatory classes based on the level of control necessary to assure
the safety and effectiveness of the device.
23

•
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The three classes and the requirements which apply to them are
described as follows
Classiﬁed based on controls necessary:
Class I - General Controls
Class II - General and Special Controls
Class III - Premarket Approval
A device should be placed in the lowest class whose level of control
provides reasonable assurance of safety and effectiveness
24

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General Controls Include:
Prohibition against adulterated or misbranded devices,
Good Manufacturing Practices (GMPs),
Registration of manufacturing facilities,
Listing of device types, Recordkeeping, etc.
25

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What Are Special Controls?
Special Controls include:
Performance standards
Post market surveillance
Patient registries
Development and dissemination of guidelines, etc
26

Selection of medical devices: A multidisciplinary team
approach
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Today, there are more than 10,000 types of medical devices
available. The selection of appropriate medical equipment always
depends on local, regional or national requirements; factors to
consider include
the type of health facility where the devices are to be used,
the health work force available and
the burden of disease experienced in the speciﬁc catchment area.
30

•
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A medical equipment selection team comprising doctors,
nurses and technical and administrative personnel should be
formed to select medical equipment.
The following factors must be included in the consideration:
31

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Specific health services needs are met by acquiring equipment.
All equipment needs should be identified and coasted, including
any training of users and servicing staff, physical facilities and
auxiliary supplies, such as water, electricity, air- conditioning,
protection and safety precautions. The equipment supplied should
confirm to local utility factors.
32

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Spare parts and technical support from the local agent must be
ascertained.
Supplier must provide both operation and service manuals.
In evaluating tenders, quotations must be compared and evaluated, not
only in terms of price and delivery time, but also in terms of availability
and quality of back-up support, spare parts and technical staff.
Moreover, the need to standardize must be considered so as to
facilitate the ease of use and maintenance.
33

Medical Instruments Procurement
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Demand /request
Speciﬁcation
Tendering
Hand over/receive
Storage
Distribution
Installation
Training
After sales service
34

Speciﬁcation
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Function/purpose
Operational requirement
Technical speciﬁcation : must be clear and comprehensive
Accessories, consumables , spare parts
Standards/safety
Environmental conditions
Power consumption
Documentation
After sales serving – installation, training, availability of spare parts,
maintenance service in near by
* Specify installation requirements in terms of civil works, data network,
electricity, hot and cold water, special treated water, drainage medical
gases, steam, air conditioning etc. required to the Supplier.
35

•
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Tips!! During procurement of medical equipment
In addition to the requirements indicated in the table above, the
technical specification should clearly stipulate that the following
points are considered in the offer:
Country of origin and source (clarification certificate), date of start
manufacturing this model, date of last upgrading
New catalogue is attached with the offer, including data sheet
36

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Warranty for two years from installation or 30 months from delivery at
least
Warranty for not less than 10 years for spare parts
Service and operation manuals original and copy (2 sets in English) are
included
Certiﬁcates (agency approvals): e.g. FDA, … will be taken into
consideration, the offer must include the certiﬁcates for evaluation
The equipment must pass the acceptance test of MoH Biomedical
Engineering Unit
37

Handling and storage, distribution
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Proper care must be taken on instruments that are easily
breakable, like thermometers, glass wares, safety cabinet with
hepa ﬁlters
It is highly recommended all participants along the supply chain
must follow the manual along with the instruments , for handling,
storage and distribution.
38

Managing Instruments
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•
Follow instrument life cycle
Provision- technology transfer- Technology innovation
cycle
•
•
•
Acquisition- need assessment, procurement , installation,
user training
Utilization- user support, calibration, maintenance,
functional enhancement etc
De-Commissioning- Removal from service, replacement
Technol
ogy
applicat
ion
cycle
39

Figure : Health-care technology management cycle
40

Surgical Dressings
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Surgical dressings:
Refers to a wide range of materials used for dressing of
wounds, injured or diseased tissues.
They are employed ascoverings ,absorbents ,protective or
supports for injured or diseased parts and they include:
Gauzes
Bandages
Plasters
Other wound dressing materials
41

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Functions:
Prevent desiccation (drying) & facilitate wound healing
Prevent wound maceration by permitting evaporation or
absorption of exudation, since:-
Excessive moisture induce enzyme & damage repairing tissue
Exudation favors microbial growth – infection!
Reduce heat loss
42

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Functions (cont’d):
Control microbial growth (by incorporating antimicrobials)
Provide support
Reduce pain, increase patient comfort, and improve functional
use of wound site
Reduce odor
Improve the appearance of the wound site eg. scar
Reduce overall costs associated with wound treatment
43

Surgical Dressings
1.
2.
3.
4.
5.
Selection of a Wound Dressing bases on:
The degree of exudation
Presence of likelihood of infection
Presence of necrotic tissue
Anatomical site
The state of wound repair
Note:- The use of a wound dressing cannot be considered in isolation,
but rather in the context of an integrated wound-care program.
44

Features of an ideal dressing
Porous to water vapour
Capable ofabsorbing excess secretions
Non adherent to granulating surfaces and not penetrable by
capillary loops
Free from substances that cause tissue reactions, allergy or a
hypersensitivity response
Impervious to microorganisms
Impervious to ﬂuid from out side
Capable of following joint contours during movement
Unaffected by domestic or industrial ﬂuids such as detergents
and oils
45

Features of an ideal dressing…cont’d
Smooth on both surfaces
Satisfactory tensile strength
Constant physical properties under normal conditions of
storage and use
Non inﬂammable
Capable of being sterilized by conventional means
Capable of preventing excessive movement of wound
Not easily soiled
Inexpensive
Sealable to the skin, if desired, by an agent
46

Classiﬁcation of Dressings
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1.
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Functionally classiﬁed as:
primary dressings
Secondary dressings
Primary/secondary dressings
Primary dressings:
Come in direct contact with the wound
Prevent adhesion of secondary dressing to the wounds.
May provide absorptive capacity of secondary dressings
May prevent desiccation and infection
47

Classiﬁcation of Dressings
2.
•
•
3.
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Secondary dressings
placed over a primary dressing
provide further protection, absorptive capacity, compressions
(ﬁrmness), or occlusion.
Primary /Secondary Wound Dressings
They do have the property of both primary and secondary
dressings.
48

Classiﬁcation…
1.
2.
Sub-classiﬁcations:
1ry dressings :
Plain Gauze, Impregnated Gauze, & Film Dressing
Secondary Wound Dressings :
surgical cotton (absorbent), Nonabsorbent Bleached Cotton,
Surgical gauze, bandages, Adhesive tapes
3. 1ry/2dry dressings : Hydrogels & Hydrocolloids
49

Primary Wound Dressings
1.
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Plain Gauze
Gauze is a bleached cotton cloth of plain weave, used for dressings,
bandages, and absorbent sponges.
It has been used as primary dressing but will stick to all except clean,
incised wound.
Although this property has been used to debride exudative, infected, and
necrotic wounds
This practice may be painful and is often counter productive, causing the
removal of granulation tissue and new epithelium
50

Plain gauze
 Plain gauze compresses are
rarely used nowadays because
of their high tendency to
adhere to the wound.
51

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2. Impregnated Gauze
cotton, rayon, or cellulose acetate gauze has been impregnated with
a variety of substances such as petroleum or paraﬃn , KY jelly , Zinc
saline, or Sodium chloride
is used to reduce adherence to wounds
A 2dry dressing should be used with these dressings to
prevent desiccation,
provide absorbency, and
prevent the entrance of pathogens.
52

•
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3. Film Dressings
These are ﬁlms of polyurethane with acrylic or polyether adhesives that
provide semi permeable membrane to water vapor & oxygen, and yet
are waterproof
In lightly exuding wounds, they permit enough evaporation to promote
moist wound healing & prevent maceration.
They will adhere well to intact skin and have low adherence for wound
tissue.
Permits bathing and observation of the wound
Shouldn’t be used in infected or heavily exuding wounds.
53

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Exclude bacteria from wounds
Film dressings are also used to protect areas vulnerable to pressure,
friction, or shear ulceration or for infusion or cannulation sites.
54
Film dressing

2. Primary /Secondary Wound Dressings
•
a.
•
•
They do have the property of both primary and secondary dressings.
Composite Dressings
Have primary & secondary components that prevent adherence to
the wounds, with some degree of absorbency
consist of lightly absorbent rayon or cotton pads sandwiched
between porous polyethylene ﬁlms.
Examples: Release (Johnson & Johnson), Telfa (Kendall)
55

•
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2. Hydrogels
The hydrogel is typically a cross-linked polymer such as polyvinyl,
cross-linked polyethylene oxide gel, or polyacrylamide
They are non-adherent dressings that through semi permeable ﬁlm
allow a high rate of evaporation without compromising wound
hydration.
Useful in necrotic wounds, burn treatment and hairy areas where
entrapment of hair into the dressing would not be traumatic
57

•
•
•
•
3. Hydrocolloid Dressings
Are dispersions of particles around which water molecules and
solvated ions form a shell-like structure
Fluid absorption occurs principally by particle swelling &
enlargement of this structure
Combine the beneﬁts of occlusion & absorbency
useful for moderately to highly exudative chronic wounds. Ex:
Duoderm, comfeel plus & replicare brands
59

•
•
•
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4. Calcium Alginate Dressings
Is calcium salt of Alginic acid
These ﬁbrous non woven dressings are highly absorbent; used on
moderately to highly exuding wounds
may be held in place with gauze tape or a ﬁlm dressing
may also be used to pack wounds
61

Cont…
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2. Secondary wound dressings:
Placed over primary dressings
Provide further protection, absorptive capacity, compression
(ﬁrmness) or occlusion.
62

Cont…
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I ) absorbents:
Absorbent dressings are used to:
Clean wounds.
Absorb excess wound exudate.
Apply medicaments to the skin.
63

Cont…
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a) Surgical cotton:
There are two types of cotton: absorbent and non absorbent
Absorbent cotton:
is prepared from the raw cotton ﬁber by a series of processes
which remove the natural waxes, all foreign substances and
make the ﬁbers absorbent.
Its absorbency may decrease by prolonged storage, moisture,
heat, dust
Use: absorbing wound exudates, cleaning, swabbing,
medicating wounds, applying antiseptics
64

Cont…
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Non absorbent cotton: the raw cotton ﬁbre, after the seeds have
been removed by gin, is mechanically cleaned of dirt and
compressed into balls of various size.
used for protection, coverings of unbroken surfaces and as
cotton plugs in the bacteriological laboratory.
66

Cont…
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•
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b) Surgical Gauzes:
A soft cotton cloth of plain weave
made from cotton ﬁber which is twisted in to threads, in turn
woven in to an open or close-mesh cloth.
provide an absorbent material of suﬃcient tensile strength for
surgical dressing.
67

Cont…
•
•
•
also known as “Absorbent Gauze USP”.
Classiﬁed based on its mesh or number of threads per inch. The
close-meshed gauze is required for extra strength and greater
protection.
Softer, more absorbent gauzes with a more open structure are
required to absorb purulent matter or other drainage.
68

close-mesh Surgical
gauze open-mesh surgical gauze
69

• Various forms of pads, compresses, and dressings are made
from surgical gauze, alone or in combination with absorbent
cotton, tissue paper, and other material.
Reading Assignment:
Read about various forms of pads, compresses, and dressings
that are made from surgical gauze, alone or in combination with
absorbent cotton, tissue paper, and other material.
70

Cont…
•
•
•
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II) Bandage
Used to :
Provide support
keep a dressing clean
absorb exudates
Could be elastic, inelastic or become rigid after shaping for
immobilization.
71

Cont…
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Types of bandages, common in use:
a) common gauze roller bandage:
prepared from ‘Absorbent Gauze’ in various width and length.
Each bandage is one continuous piece, tightly rolled and free
from loose threads and raveling.
72

Roller bandage for hand Roller bandage for face
73

Cont…
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b) Muslin bandage rolls:
Muslin bandages are strong and are used wherever normal gauze
bandage do not provide suﬃcient strength or support.
Made of heavier unbleached material.
supplied in the same width as the regular gauze bandage.
frequently used to hold splints or bulky compression dressings in
place.
74

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C. Elastic Bandages
are made in several types as described below
i). Woven Elastic Bandage
Is made of heavy elastic webbing containing rubber threads.
Provide good support and pressure
75

Cont…
•
•
•
II) crepe bandages:
Highly elastic but contains no rubber.
conforms closely to the skin for joint surfaces and also allows limited
motion and stretches in case of swelling so that circulation is not
impaired.
used for bandaging varicose veins, sprains, etc
Crepe bandage for wrist
76

III) Conforming bandage
IV) High- bulk bandage
V) Conforming Bandage
77

Cont…
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d) orthopedic bandages:
Plaster of Paris- impregnated gauze has been the standard for
this purpose.
They are used to provide immobilization and support in
treatment of broken bones and in certain condition of bones and
joints.
78

Cont…
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e) Stockinet bandages:
They are made of stockinet (easily stretchable) material woven in
tubular form.
Surgical stockinet is unbleached.
It is soft and stretch comfortably to the arm or leg
Stockinet bandage
80

Cont..
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•
f) Triangular bandage :
Usually are made by cutting a square of
bleached muslin diagonally from corner
to corner, forming two right triangles of
equal size and shape.
Used in ﬁrst aid work for head dressing,
binders, arm slings and as temporary
splints for broken bones.
81

•
•
g) Orthoﬂex Elastic plaster bandage
Are plaster of paris bandages containing elastic threads in the fabric.
Are intended for specialized prosthetic uses.
83

Bandages
•
I.
II.
III.
IV.
Classiﬁed into 4 main groups
Non elastic
Elastic
Impregnated
Adhesive
84

I) Non elastic bandage
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a) Triangular calico Bandage
Is a piece of unbleached calics in the shape of a right-angled and with the warp &
weft threads parallel to the two equal sides
Use
As a sling and should be sterile if in contact with broken skin
b) Open-wave bandage (cambric bandage)
Is a cotton cloth of plain weave in which the weft is heavier than the warp which
gives it an additional protection
Uses
To secure and protect dressings
For support and immobilization
To secure splints to the body
85

•
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C) Domette Bandage
Is a union fabric i.e. composed of two kinds of yarn  the warp
is cotton and the weft is wool
Uses
For orthopedic purposes where provision of warmth by the
dressing is often important because of the diﬃculty of
adequately covering the area under treatment with cloths or bed
cloths.
86

II – Elastic bandages
•
i.
•
•
Are bandages of elasticized fabric that provides support and
allows movement
A) Elasticity produced by twisting threads
Crepe bandage:- best known elastic bandage
The warp threads are of cotton and wool
And the weft threads are of cotton
87

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Uses
Conforms well to body contours, allowing limited movement
and stretching of swelling takes place
For giving support to sprains and strains
For correctional purposes
As a compression bandage
88

•
•
ii. Cotton stretch bandage
Used for essentially the same purposes as open wave bandage
but, because of elasticity, is less likely to slip.
Both warp and weft are cotton
89

•
•
B) Elasticity produced by rubber threads
i. Cotton and rubber elastic bandage (cotton elastic bandage)
Has cotton weft but the warp contains rubber threads
Uses:- as for crepe bandage
ii. Cotton and rubber elastic net bandage
The warp threads are of combined cotton and rubber yarn, and the weft
threads are cotton
Uses:- as for crepe bandage
90

•
C) Elasticity produced by crimping
If cotton gauze is mercerized, the ﬁbers become bent (crimped) this
imparts elasticity.
Uses:- to protect and secure dressings.
91

III – Impregnated bandages
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•
a) Plaster of Paris bandages
Cotton weave impregnated with dried CaSO4
Uses
For the immobilization and splinting of fractures
For the construction of body supports and rest splints
b) Zinc paste bandage
An open-wave bandage impregnated with a paste containing zinc oxide
92

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•
Uses
Support and prevent swelling of fractured limbs after removing
plaster
Support varicose veins
Treat ulcers, varicose eczema, phlebitis and edema of the legs
C) Zinc paste and coal tar bandage
Zinc paste and ichthamol bandage
Use :- For chronic skin disorders such as eczemas and leg ulcers
93

IV) Adhesive bandages
•
•
•
•
Has an elastic fabric which is spread with an adhesive mass
Are more suitable than paste bandages for treating ambulant
patients because the elasticity:-
Provides excellent support for the affected region aided by the
adhesive mass which holds the bandage ﬁrmly in place
Ensures that the bandage is not unduly restrictive
94

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a) Lead-based adhesive bandages
Must be warmed before use to make them adhere
e.g. Diachylon elastic adhesive bandage
use
For the treatment of chronic leg ulcers in ambulant patients
For support of varicose veins
95

•
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b) Self-adhesive bandages
Adhere to the skin with out warming e.g. Zinc oxide elastic self-
adhesive bandage
Uses
For support and compression e.g. for fractured ribs and
clavicles, sprains varicose veins and leg ulcers
To secure dressings and appliances ﬁrmly in place
96

Types of surgical dressing
•
1.
2.
3.
4.
5.
There are 5 groups based on nature of the dressing
Fibers
Fabrics
Bandages
Self-adhesive plasters
Compound dressings
97

1- Fibers
A) Cotton - medicated e.g. capsicum cotton wool
- Unmedicated e.g absorbent cotton wool
B) Rayon - Lustrous
-Delustered
C) Wood cellulose
D) Wool
98

A. Cotton
•
I. Capsicum cotton wool
Absorbent cotton wool that has been medicated by pouring over it an
alcoholic solution of capsicum oleoresin, methyl salicylate and a suitable
(usually orange-brown) dye.
Uses
Rubefacient action (capsicum oleoresin)
Analgesic effect (methyl salicylate)
In rheumatic conditions (the warmth produced by the cotton wool)
N.B Must not be used on broken skin in which it causes an intense burning
sensation
99

•
•
•
•
•
•
II. Absorbent cotton wool
Consists of epidermal trichomes for seeds of cultivated species
of
gossypium
Available as rolls or small balls
Absorbs water readily butwater absorbing capacity may be
reduced by
Prolonged storage
Exposure to heat
Medication
100

•
i.
ii.
iii.
iv.
Requirements for absorbent cotton wool
The ﬁbers should be:-
Well carded
Bleached to a good white, to ensure visual cleanliness
Free from pieces of thread
Reasonably free from leaf, shell (seed coat), ﬁber, dust and foreign
matter
101

•
Uses
Absorbing wound exudates
Cleaning, swabbing and medicating wounds and applying
bactericidal solutions to the skin before surgery and in
obstetrics
For these purposes cotton wool balls are convenient
102

B. RAYON(Regenerated cellulose )
•
•
Generally made from spruce-wood cellulose
The ﬁbers are white and highly lustrous but can be given a matt
appearance by dispersing ﬁnely divided
titanium dioxide
throughout the material (delustered rayon)
Cleaning, swabbing & medicating wound
Can be used as a substitute for cotton wool
Compared to cotton it is cheaper, cleaner and softer
Absorbency is not lost on storage
N.B. the titanium dioxide in delustred rayon may delay healing
103

•
C. Cellulose wadding
Prepared from timber (usually pine)
Uses
As an absorbent and protective pad either alone or as a ﬁlling
within another dressing
104

•
•
D. Animal wool for chiropody
Consists of hairs from the ﬂeece of the sheep
Very hygroscopic absorbing up to 50% of moisture
Uses
Mainly for protection
Particularly helpful in retaining dressings on toes
Should not be applied directly to lesions and should be covered
externally because it adheres strongly to raw tissues and fabrics.
105

2- Fabrics
•
A.Unbleached calico
very strong cotton cloth of plain weave
used for triangular bandages and for T-shaped and many tailed
bandages used to retain dressings on various parts of the body.
106

•
•
•
•
B.Absorbent cotton gauze 13 light (absorbent gauze, gauze,
unmedicated gauze)
It is a soft cotton cloth of plain weave
Number of threads per inch or mesh type used as speciﬁcations
Mesh no. determines absorbency capacity
Softer, more absorbent, more open structure required to absorb
heavy exudate
107

Uses
Because the cotton is in the form of spun threads and not loose
ﬁbers (contrast to cotton wool) gauze can be applied directly to
wounds.
Not bulky enough to cope with the exudates from, or give adequate
physical protection, to large wound, thus many thickness should be used
Soft cotton cloth of plain weave, open texture and ﬂimsy appearance
Usually 90cm wide, folded lengthwise and in various lengths.
108

•
•
C. Absorbent Ribbon Gauze (unmedicated Ribbon gauze)
The weft may be of cotton, rayon or cotton and rayon.
Has fast selvedge edges and is supplied in ribbons
Uses
Aid blood clotting, absorb exudates
Protect developing new cells
Provides means of removing exudates, pus and other debris without
excessive damage to the tissues.
To pack dental sockets, sinuses, infected wounds etc.
109

•
•
D. Gauze pad (Absorbent gauze pad, gauze sponge, gauze swab)
Absorbent gauze folded into a square pad.
To minimize adhesion and shedding of ﬁbers, no cut edges
should be visible and the edge of the pad should be stitched.
Uses
Small gauze pads for swabbing during surgery
As wound dressings and for packing wounds.
111

•
•
•
E. X-ray detectable gauze dressings
Absorbent gauze, ribbon gauze and gauze pads are available in
x-ray detectable form
X-ray detectable strands are attached to the gauze
Used during surgery and if accidentally left in the body can be
detected radiologically
N.B All gauzes absorb water readily, but the water retention
coeﬃcient is lower than for cotton wool, rayon wadding or
absorbent lint.
112

•
•
F. Absorbent lint
Originally, this was a linen cloth, hence its name
Has greater absorptive capacity for water than any of other
woven fabrics
Uses:-
Popular in the home and for ﬁrst aid purposes because it is
easily torn in both directions
For applying topical medications
Externally as an absorbent and protective dressing.
113

•
G. Euflavine lint
Absorbent lint medicated with euflavine (a member of the
acridine group of antiseptics)
Uses:-
For first aid treatment of small burns
As a component of several standard dressings
114

•
H. Absorbent muslin
Bleached cotton cloth of plain weave known in commerce as
butter muslin
Uses:-
For applying wet and dry dressings
Has close weave that protects underlying lesions form ﬁbers
Available in large ﬂat rolls –big enough for dressing extensive
burns
115

4- Self-adhesive plasters




a)
•
Consist of a self – adhesive mass spread on a supporting material
Unlike adhesive bandages they are often used in strips (rather than
long lengths) to cover a restricted area
Plain cloth plasters
Elastic cloth plasters
Belladonna self adhesive plaster
Cotton, rayon or mixed cloth spread evenly with a mass containing an
extract of belladonna herb or root.
Use:- counter irritant in rheumatism lumbago and neuralgia
116

•
•
b)Salicylic acid self-adhesive plaster
The medicament is salicylic acid
Use:- as a keratolytic agent
c)Zinc-oxide self-adhesive plaster
The mass contains zinc oxide and the dressing
Use:- square dressings and immobilize small areas
117

5- Compound dressings
•
•
•
•
tissues
Consist of a layer of ﬁbers enclosed in a tube of gauze
Examples
Gauze and cotton tissue
Gauze and cellulose wadding tissue
Gauze and capsicum cotton tissue
Uses:- as an absorbent and protective pad
118







Standard Dressings
Sterile dressings used for first aid treatment
Examples
No 7 :- sterile dressing for fingers and toes
No 10 :-for mild burns of fingers and toes
No 8 and 9 :- sterile dressings for hands and feet and larger areas
Nos 11 & 12 :- for mild burns of larger areas
No s 13,14 & 15 :- for wounds of small, medium and large area
No 16 :-sterile protective covering for the eye
119

Sutures and ligatures
• Surgical ligatures and sutures are threads or strings specially
prepared and sterilized for use in surgery.
Ligatures for tying blood vessels and other tissue
sutures forsewing tissues together.
121



A surgical suture is a strand or ﬁber used to hold wound edges in
position during healing.
Ligature-is a strand or ﬁber used to stop bleeding by tying off injured
blood vessels.
the choice of materials depends on the task it is required for and the
surgeon’s preference .
Skillful wound closure requires knowledge of proper surgical techniques
and sutures.
122

Historical background




There are known reports of surgical suture use in BCs
Sterile catgut was finally achieved in 1906 with iodine treatment.
The chemical industry drove production of the first synthetic thread in
the early 1930s,
Polyglycolic acid was discovered in the 1960s and implemented in
the 1970s.Today, most sutures which are made of synthetic polymer
fibers are in use.
123

Ideal suture characteristics
Sterile
All-purpose (composed of material that can be used in any surgical procedure)
Causes minimal tissue injury or tissue reaction
Easy to handle
Holds securely when knotted (i.e. no fraying or cutting)
High tensile strength
Favorable absorption proﬁle
Resistant to infection
N. B. at present, no single material can provide all of these characteristics.
124

125
•
•
•
•
•
All sutures should be manufactured to assure several
fundamental characteristics :
Sterility
Uniform diameter and size
Pliability for ease of handling and knot security
Uniform tensile strength by suture type and size
Freedom from irritants or impurities that would elicit tissue reaction

Classification of sutures

•
•

•
•

•
•
On the basis of material structure
Monofilament
Multifilament
On the basis of raw material origin
Synthetic
Biological
On the basis of their behaviour in tissue
Absorbable
Non - Absorbable
126

• Monoﬁlament suture • Multiﬁlament suture
128

Monoﬁlament
Advantages
•
•
•
•
Smooth surface
Less tissue trauma
No bacterial harbours
No capillarity
Disadvantages
•
•
Handling & knotting
Ends of suture (stiff)
130

Multiﬁlament
Advantages
•
•
•
Strength
Soft & pliable
Good handling and knotting
Disadvantages
•
•
•
Bacterial harbours
Capillary action
Tissue trauma
131

Absorbable sutures




Those that areabsorbed ordigested by the body cells and tissue ﬂuids
in which they are embedded during and after the healing processes.
a) Natural
Absorption occurs by enzymatic degradation in natural materials.
E.g.
Surgical cat gut :
Its basic constituent is collagen derived from the serosal or
submucosal layer of the mammalian small intestine.
It is uniformly ﬁne-grained and possesses great tensile strength and
elasticity.
133

1.
2.
Two types of cat gut, depending on their resistance to
absorption action by tissue enzyme:
Plain catgut
surgical gut (chromic)
134

Cont..



1. Plain gut
Tensile strength is maintained for 7-10 days post-implantation.
Used for:
Repairing rapidly healing tissues that require minimal support.
Ligating superﬁcial blood vessels.
135

Cont…
•
•
•
2. Surgical gut ( chromic )
Tensile strength is maintained for greater than 20 days.
The absorption rate is slowed by chromium salt (undergone various
intensities of tanning with the salt of chromic acid to delay the tissue
absorption time. )
Tissue reaction is due to the non-collagenous material present in
these sutures.
136

Disadvantage of natural absorbable sutures
•
•
Have a tendency to fray during knot construction.
There is considerable variability in their retention of tensile
strength.
137

b) Synthetic




1) Dexon (polyglycolic acid):
A Polymer derived from condensing the cyclic derivative of glycolic acid
Do not fray and are not slippery when knotted and maintain tensile
strength for a longer period of time than catgut (has excellent knot
security and tensile strength).
Dexon has low rate of reactivity and infection rate, and
A drawback of Dexon is its high friction that binds and snags when wet.
138

Cont…
•
•
•
2. Polyglactin (Vicryl):
a braided multiﬁlament suture of a copolymer of lactide and glycolide
Absorption is minimal for 40 days and complete in 56-70 days.
used in general soft tissue approximation and vessel ligation.
139

Cont…
•
•
•
3. Polydioxanone (PDS II):
This is a polyester monoﬁlament suture made of polydioxanone
Absorption is minimal for the ﬁrst 90 days and essentially complete
within 6 months
used for soft tissue approximation, especially in pediatric,
cardiovascular, gynecologic, ophthalmic
140

Non absorbable ligatures & sutures:
•
•
These are materials which are not broken down by the body,
remaining in place permanently.
They usually are removed after the wound has healed to the point
where suture support is no longer necessary.
142

a) Natural NAS
•
•
•
1)silk:
Natural material obtained from silk worm
made of raw silk which is coated with beeswax.
It trigger acute inﬂammatory reaction.
143

Cont…
•
•
•
•
•
•
2)Linen
Origin from fibers of flax plant, it has a braided construction, spun
and twisted
Relatively flexible and easy to handle
Drags through tissues, knots very securely
Gains strength on wetting
Evokes minor to moderate tissue reaction.
used as a general ligature where a firm tie is essential
144

b. Synthetic NAS:
•
•
•
•
•
1) nylon
This is a polyamide polymer suture material available in monofilament
The elasticity of this material makes it useful in skin closure
Nylon has 81% tensile strength at 1 year, 72% at 2 years, and 66% at 11
years.
The material is stronger than silk suture and elicits minimal acute
inflammatory reaction.
The disadvantage of nylon is the difficulty in achieving good knot security.
Because of this at least 4-5 "throws" (knots) are required to achieve a
secure knot.
145

Cont…
•
•
•
2) Metallic wires:
made of stainless steel (iron-chromium-nickel-molybdenum alloy) as a
monoﬁlament and twisted multiﬁlament
demonstrates high tensile strength with little loss over time and low
tissue reactivity
metallic suture wire is used mainly in orthopedics and thoracic surgery
146

Cont…
•
•
•
3) Metal clips (ligature):
Ligatures of ﬂattened silver or tantalum wire
used in neurosurgery and chest surgery for arresting hemorrhage
from small vessels
The insertion forceps allow their use for this purpose at depths safely
147

Fig 4. metallic clips for cardiac surgery
148

Cont…
•
4) Metal clips (suture):
These are metal clips having two sharp points which when the clip is
closed, these points grip the edges of the skin incision and hold them in
together.
149

150
Absorbable Non-Absorbable
Natural Synthetic Natural Synthetic
Mono-
filament
Multi-
filament
Mono-
filament
Multi-filament Mono-
filament
Multi-
filament
Mono-
filament
Multi-
filament
None E.g.
Catgut
Chromi
um
E.g
Polydio
xanone
E.g.
Polyglactin,
Polyglycoli
c acid
None E.g. Silk E.g.
Polypro
pylene,
Polyami
de
(Nylon)
E.g
Nylon

Suture sizes:



Currently, two standards are used to describe the size of suture materials;
USP and EP. USP standard is more commonly used.
In the USP standard the size is represented by a combination of two Arabic
numerals: a 0 and any number other than 0, like 2-0(or 2/0).
The higher the ﬁrst number, the smaller the suture material. Size greater than 0
are denoted by 1, 2, 3 etc. This standard size also varies with the type of suture
material. Table below summarizes both EP and USP standards.
151

USP Size codes EP Size codes Suture Diameter (MM)
Non synthetic absorbable
materials
Non absorbable and
synthetic absorbable
materials
Absorbable and Non
absorbable materials
Min Max
11/0 0.1 0.01 0.019
10/0 0.2 0.02 0.029
9/0 0.3 0.03 0.039
8/0 0.4 0.04 0.049
8/0 7/0 0.5 0.05 0.069
7/0 6/0 0.7 0.07 0.099
6/0 5/0 1 0.10 0.14
5/0 4/0 1.5 0.15 0.19
4/0 3/0 2 0.20 0.24
3/0 2/0 2.5 0.25 0.29
2/0 0 3 0.30 0.39
0 1 4 0.40 0.49
1 2 5 0.50 0.59
2 3 6 0.60 0.69
3 4 7 0.70 0.79
4 5 8 0.80 0.89
5 6 9 0.90 0.90
6 7 10 1.00 1.09
152

Suture selection
•
•
•
•
•
•
The tensile strength of the suture should never exceed the tensile
strength of the tissue
Anatomic regions like head and neck, eyelid, nose, lip, require less
tensile strength and smaller suture sizes
musculocutaneous area-require maximal long-term tensile strength
Absorbable for GI, urinary, or biliary (heal rapidly)
Non-absorbable or extended up to 6 months for skin, tendons
Use monoﬁlament on the skin as multiﬁlament harbor bacteria
153

Suture indications….cont’d



Mucosal lacerations (mouth, Tongue or genitalia)
Absorbable Suture 3-0 or 4-0
Scalp, Torso (chest, back, abdomen), Extremities
Superﬁcial Non absorbable Suture 4-O or 5-O
Deep Absorbable Suture 4-O
Face, Eyebrow, Nose, Lip
Superﬁcial Non absorbable Suture 6-O
154

E
E
E
E
E
E
Ear, Eyelid
Hand
Foot or sole
Superﬁcial Non absorbable Suture 3-O or 4-O
Penis
Superﬁcial Non absorbable Suture5-O or 6-O
155
Suture indications….cont’d

Surgical needle
•
•
•
Are needles with varying sizes and shapes for wound closure.
produced from stainless steel alloys, which have excellent resistance
to corrosion (minimum of 12% chromium).
The needle may be coated with silicone to permit easier tissue
passage
156

Cont…
•
•
•
•
•
•
•
Ideal surgical needle characteristics
High quality stainless steel
Smallest diameter possible
Stable in the grasp of the holder
Capable of implanting suture material with minimal trauma
Sharp enough to penetrate tissue with minimal resistance
Sterile and corrosion resistant.
157

Cont…
Fig: Needle passing through skin
159

Cont…
•

•
•
•
Point types:
Cutting : the needle has at least 2 opposing cutting edges and designed
for penetration through dense, irregular and thick tissues.
Conventional cutting: the needle has 3 cutting edges (triangular cross-
section) where the third cutting edge is on the inner concave curvature.
Reverse cutting: the 3rd cutting edge is on the outer convex
curvature of the needle and designed for tissues that are tough to
penetrate.
It has reduced risk of cutting out tissue.
161

Cont…
•


Side cutting: these needles are ﬂat on the top and bottom surfaces to
reduce tissue injury.
Taper point (round needle) : this type of needle penetrate and passes
through tissues by stretching with out cutting.
used for easily penetrated tissue
e.g. peritoneum, abdominal viscera
162

Cont…





Body types:
Straight: this body type is used to suture easily accessible tissue
that can be manipulated directly by hand; e.g. Keith and Bunnell
needles
Half-curved ski: needle with some straight and curved portions-
rarely used due to diﬃculty of handling.
Curved: a semi-circular provide an optimal course for sutures
through tissues and renders even distribution of tension.
Compound curved: the body has a tight 80 Degrees curvature at
the tip which becomes a 45 Degrees curvature throughout the
remainder of the body.
165

Follow-up care




Following the placement of the sutures and cleanse the suture site with
normal saline.
Cover with an appropriate size sterile non-adherent dressing.
Depending on nature and extent of the wound, antibiotic therapy or
Tetanus Toxoid may be indicated.
Inform the patient that the suture site needs to be checked in
approximately 24 hours for signs of infection or complications.
167

Suture removal timing
Times will vary according to the location and depth of the wound. However,
the average time frame is 7-10 days after application.
The following general rules can be sued in deciding when to remove sutures:
organ Removal time
Scalp 6-8 days
Face, Eyelid, Eyebrow, Nose, Lip 3-5 days
Ear 10-14 days
Chest and abdomen 8-10 days
Back 12-14 days
Extremities 12-14 days
Hands 10-14 days
168

Labeling










The label must states:-
The length of the strand in centimeters or in meters;
The gauge number;
For single use only;
Where applicable, the Needle length, curvature and proﬁle;
Lot number
Manufacture date;
Expiry date
Sterilization method;
Storage instructions;
Manufacturers Name & Address.
169

Pharmaceuticals Fund and Supply Agency ( PFSA )
List of Suturing materials for National procurement
Description of items Unit Remark
Catgut chromic gauge 2.0(4/0) 75cm on 17 -19 mm ½ circle Cutting
Needle
Dozen

Catgut chromic gauge 2.0(4/0)75cm on 14 -16 mm ½ circle round Bodied
Needle
Dozen

Catgut chromic gauge 3.0(3/0) 75cm on 18-20mm ½ circle Round Bodied
Needle
Dozen

Catgut chromic gauge 3.0(3/0) 75cm on 30-32mm ½ circle Round Bodied
Needle
Dozen

Catgut chromic gauge 3.5(2/0) 75cm on 25-27mm ½ circle round Bodied
needle
Dozen

Catgut chromic gauge 3.5(2/0) 75cm on 38-40mm ½ circle round Bodied
Heavy needle
Dozen

Catgut chromic gauge 3.5(2/0) 75cm on 45mm ½ circle round Bodied
Heavy needle
Dozen

171

PFSA supplies procurement List
172
Catgut chromic gauge 3.5(2/0) 75cm on 45mm ½ circle round Bodied Heavy needle Dozen
Catgut chromic gauge 4.0(0) 75cm on 30-32mm ½ circle round Bodied Needle Dozen
Catgut chromic gauge 4.0(0) 75cm on 37-40mm ½ circle round Bodied Needle
Dozen
Catgut chromic gauge 5.0(1) 75cm on 38-40mm ½ circle round Bodied Heavy needle
Dozen
Catgut chromic gauge 5.0(1) 75cm on 48-50mm ½ circle round Bodied Heavy needle
Dozen
Catgut chromic gauge 6.0 (2) 75cm on 45mm ½ circle round Bodied Heavy needle
Dozen
Catgut chromic gauge 6.0(2) 75cm on 35-37mm ½ circle round Bodied needle
Dozen
Catgut chromic gauge 6.5(3) 75cm on 50 mm ½ circle round Bodied Heavy needle
Dozen
Poly Dioxanone Monofilament gauge 3.0 (2/0), 90cm on 38-40 ½ Circle Round bodied needle. Pk
Poly Dioxanone Monofilament gauge 3.5 (0),70cm on 25-27mm ½ Circle Round Bodied Needle. Pk
Poly Dioxanone monofilament gauge 5.0(2) 90cm on 48-50mm ½ circle taper point heavy needle. Pk
Polydioxanone monofilament gauge 3.0 ( 3/0 ), 75cm on 38-40 ½ circle round bodied needle Dozen
Polyglycolic acid absorbable 2/0, braided Violet 75cm on 25-27 ½ circle reverse cutting needle Dozen

Hypodermic Needles
E
E
A Hypodermic Needle is a hollow needle commonly used with a syringe
to inject substances into the body or to extract liquids from the body.
Needles join syringes in two ways: Luer-Lok & Luer-Slip
Luer- Lok - the hub on the needle screws into threads in a sleeve on
the syringe tip
Luer- Slip - simply conform to the syringe tip and are pressed
together and held by friction (they have no threads).
174

Hypodermic Needles…
Composition: needles are made of :-
stainless steel,
hyper chrome steel,
carbon steel,
chromium,
nockeloid,
platinum,
platinum-iridium,
silver, or gold.
175

1.





Main Physical Characteristics:
Size (Gauge):
outside diameter of needle shaft
The smaller the diameter the larger the gauge is
Commonly ranges from 13 (largest) to 32 (smallest)
Needle diameter depends on purpose of use
For injection, use gauge not greater than 16 G (1.65 mm)
176







2. Length:
Length of needle shaft (starting from the hub & shaft
junction point)
Depends on Purpose
Usually ranges from 0.25 to 3.5 inches
3. Bevel:
Slanting cutting edge with tapering reinforced tip
Facilitates penetration & injection
Bevels vary with purpose
177




Factors that dictate length, gauge & bevel:–
safety/comfort of patient,
rate of ﬂow of administered liquid &
depth of penetration
i.e.1. route of administration,
2. type of therapy &
3. whether patient is child or adult
179

Purpose Gauge Length Bevel
Local
anesthesia use
20 to 26 G 0.25 t0 6 inches long bevel
SC use 24 to 25 G, ¼ to 5/8 inches long bevel
IM use 19 to 22 G 1 to 2 inch
IV use 16 to 25 G 1 to 2 inch
180

Syringes
Syringes are instruments intended for instillation of liquids into
the body or its cavities,
OR
to withdraw body ﬂuids from the body cavities
Types : Hypodermic, Bulb, Gravity
182

A. Hypodermic syringes
•
•



•
Hypodermic Syringe: a simple piston pump consisting of a plunger that fits
tightly in a tube (barrel)
plunger movement (pull & push) inside the barrel allows the syringe to take
in and expel a liquid or gas
The open end of the syringe may be fitted with:
a hypodermic needle
a nozzle
tubing
to help direct the flow into and out of the barrel
The barrel of a syringe is made of plastic or glass
183

Hypodermic syringes
•
•
•
•


Usually graduated in units of volume (mL)
Nearly always transparent
Glass syringes may be sterilized in an autoclave
Most modern medical syringes are plastic with a rubber piston
because:
cheap enough to dispose of after being used only once
reduce risk of spreading blood-borne diseases
184

Hypodermic syringes





re-use
spread HIV, Hepatitis….
safe for insulin injection at home, if used only by one person.
Medical syringes are sometimes used without a needle for:
Oral admin of liquid medicines to young children or animals, or
Oral feeding of milk to small young animals
185

Hypodermic syringes


•
•
•
•
•
Pre-ﬁlled syringes:
Supplied as a standard dosage container
each carry a single dose of sterile medication
Graduation:
Syringes are usually graduated in mL
Common size ranges from 2 mL to 50 mL
Up to 200 mL avail for vet use & transfusion
≤ 1 mL syringes graduated in 0.1- or 0.01-mL
Also graduated with special units e.g. Insulin U
186

Hypodermic syringes
•
•
•
Insulin Syringes:
Shorter needle – as the route is SC, not IM
Finer gauge needles, for less pain
Markings in insulin units of 10 divisions to simplify drawing a
measured dose of insulin
N.B
U-100 insulin syringe has a capacity to withdraw 100 U insulin i.e.
1ml insulin dispersion preparation
187

B. Bulb Syringes
•
•
•
•
•
Nasal
Ophthalmic
Wound/Ulcer
Vaginal
Rectal
189

Bulb syringes
•


•
•
preferred when
sterility is not required and
plunger type syringes are dangerous to use because of their
force
Particularly important in nose and ear and for wound and urinary
irrigation
Are one piece molded bulbs of soft, ﬂexible rubber with long
and narrow nozzles employed in treating the eye, ear, nose and
also for irrigation of any open cavity like rectum and vagina or
ulcer
190

Gloves
•


•
•

Medical Gloves:
used during
medical examinations and procedures
collection & handling of lab specimens
help prevent contamination between caregivers and patients
must be discarded after each patient care contact
Examination/Disposable gloves:
non sterile, packed in bulk, single use only
193

Gloves……..
•
•
Surgical gloves:
Sterile, Every pair packed separately.
Used in performing sterile procedures.
Size:
X-small (5)
Small (6)
Medium (7)
Large (8)
X-large (9)
194

Gloves ……..
•
❶
•
•
•
Material:
Made of either latex or non latex synthetic polymers
Latex gloves:
Made of a natural latex rubber collected from plants –
similar to latex condom
more comfortable & elastic
Less expensive than the synthetic counter parts
195
Latex glove

Gloves…..
•
•
•
•

Allergy to latex gloves:
The natural latex emulsion consists of proteins, alkaloids, starches,
sugars, oils, tannins, resins, and gums
Latex can also be synthesized
Many people are allergic to natural latex
Latex may cause Type I hypersensitivity (includinganaphylactic
shock ), Type IV (allergic contact
dermatitis ) & Irritant contact
dermatitis
People at greater risk: Health care providers, people who have had
multiple surgical procedures.
196

Gloves
•



Alternative materials:
Synthetic Polymers – Polyisoprene such as neoprene rubber,
Nitrile rubber and Vinyl polymers such PVC
The synthetics are less comfortable, less ﬂexible & more
expensive
Vytex Natural Rubber Latex:
latex processed with chemicals [Al(OH)3] to reduce
amount of antigenic natural proteins
Al(OH)3 binds the proteins
processing may increase cost
198
Neoprene glove
Nitrile glove

Gloves…..




Lubricants of Gloves:
Gloves may be powdered (lubricated) or non-lubricated
Examples of lubricants: Talc, zinc oxide, corn starch
Lubricating facilitate to put gloves on hands
Talc &Zinc oxide may irritate hands
Corn starch can impede healing & not used for surgical gloves
N.B: No lubricant is recommended for surgical gloves
199

Masks
•

•
•
1. Surgical mask / procedure mask
Intended to be worn by health professionals:
during surgery and other times to catch the bacteria shed in liquid droplets
and aerosols from the wearer's mouth and nose.
Protect wearers from being splashed in the mouth with body ﬂuids.
Made from paper or other materials, and should be discarded after each
use.
200

Cont…
•
•
•
A special types of mask called respirators are now commonly used
Recommended for situations in which filtering inhaled air is
important
Contain multiple layer of filter materials and fit the face tightly
201

Cont…
•

Question
Can surgical mask protect the wearer from inhaling particles
like bacteria?
They will trap some particles but are much less effective than
respirators, which are designed for this purpose.
203

Cont…
•
•
•
•
2. Anesthesia masks
Are face masks that are designed to administer anesthetic gases to a
patient through inhalation.
Made from silicon or rubber; are either black or clear
Fit over the mouth and nose and have a double tube system.
One tube carries inhaled anesthetic to the mask and the other brings
exhaled anesthetic back to the machine for recycling.
204

Cont…
•
•
3. Oxygen mask
An oxygen mask provides a method to transfer breathing oxygen gas
from a storage tank to the lungs
Oxygen masks may cover the nose and mouth (oral nasal mask) or
the entire face (full-face mask)
205

Cont…
•
•
•
Plastic oxygen masks
As they are light in weight, they are more comfortable than some other
masks, increasing patient acceptance.
Transparent plastic masks also leave the face visible, allowing care
providers to better ascertain patients’ conditions.
Silicon & rubber oxygen masks
Silicone and rubber oxygen masks are heavier than plastic masks. They
are designed to provide a good seal for long-duration use.
206

Cont…
•
•
4. Face shield
Is a device used to protect wearer's entire face.
In medical areas it is used to protect a medical professional during a
procedure that might expose the worker to blood or other potentially
infectious ﬂuid.
207

Scissors
•




Instrument that consists of two halves over a stable joint and their
blades over-ride each other to cut tissues
Used
To cut and dissect tissue
To cut sutures, clothing and bandages
In stabbing - When it is sharp pointed
209

Cont…
•




Various types of scissors are available
Long or short
strong or ﬁne
blunt and/or sharp pointed
straight or curved either on the ﬂat side or on the edge
210

Cont…
•
•
•
•
The choice depends on many factors:
For surface cutting, short scissors are appropriate
For deep dissection as in thoracic or pelvic surgery – long scissors
Curved scissors are very popular fordissection because, the
surgeon can see the structures being cut on both sides of the tip
Surgeon’s preference
211

Cont…





Scissor types
Super cut scissors
Operating scissors
Dissecting scissors
Tungsten carbide scissors
212

Supercut scissors




Made from stainless steel
Black handle for easy identiﬁcation
Have one razor sharp cutting edge and one regular cutting edge-
super cut
Edges retain sharpness longer
E.g. mayo’s scissors and metzenbaum’s scissors
213

Operating scissors



Made from stainless steel
Have one sharp and one blunt tips with two regular cutting edges
Used in general surgery
214

Dissecting scissors



Used to dissect tissues
Have curved tips
Smaller sizes are used at the surface, the larger sizes deeper in the
cavities
215

Tungsten carbide scissors
•
•
•
Provide greater durability
Golden handle for easy identiﬁcation
Tungsten carbide scissors are especially
good for cutting cartilage or for many
repeated cuts such as in necropsy
studies.
216

Forceps
•
•
•
•
Instrument used to grasp, hold ﬁrmly or exert traction upon tissue or material
are carbon steel - can withstand repeated sterilization in high-temperature
autoclaves
Initially these instruments were smooth, teeth have been introduced ,which
improved its grip
The shape and nature of jaws vary widely and determine particular functions
217

Types of forceps




Dissecting forceps
Hemostatic/artery forceps
Tissue forceps
obstetric forceps
218

Dissecting forceps
•
•
•
•
•
•
Used to grasp tissues to facilitate dissection or suturing
Also called thumb forceps because their shafts are closed by the surgeon’s
thumb
Also used to place or remove wound dressings
They can be toothed or non-toothed
Teeth can be single or multiple
Toothed forceps give a better grip but they are traumatic
219

Hemostatic forceps/artery forceps


•
•
Used to compress a bleeding vessel to forestall bleeding
Used for both arteries and veins
E.g Kocher (oschner) hemostatic forceps
Used to hold bleeding vessel in a tough/ﬁbrous background or vessels
having a tendency to retract
Has a terminal tooth, so that the tissues do not slip
221

Tissue forceps
•
•
•
Designed to grasp tissues without crushing them so as to allow their
manipulation
The blades approximate only at the tips to leave a space along the shaft for
the tissue held
Tips made in the form of teeth to improve grip
Allis Tissue forceps
222

Obstetric Forceps
•
•
•
•
Aid in the vaginal delivery of a baby
Are smoothly shaped and curved forceps having two blades and a
handle designed to hold and pull the baby properly without causing
any damage
Consist of two branches that are positioned around the fetal head
Also known as brain forceps
223

Catheter
•
•



A catheter is a tube that can be inserted into a body cavity, duct or
vessel to allow drainage, injection of ﬂuids or access by surgical
instruments.
Placement of a catheter into a particular part of the body may allow:
Draining urine from the urinary bladder e.g. Foley catheters
Drainage of urine from the kidney by percutaneous nephrostomy
Drainage of ﬂuid collection, e.g. an abdominal abscess
226





Administration of intravenous ﬂuids, medications or parenteral
nutrition with a peripheral venous catheter
Direct measurement of BP in an artery or vein
Direct measurement of intracranial pressure
Administration of anesthesia medication into the epidural
space, the subarachnoid space
227



A range of polymers used to construct catheters include:- silicone
rubber, latex and thermoplastic elastomers.
Silicone is one of the most common choices because it is inert and
unreactive to body ﬂuids and a range of medical ﬂuids with which it
might come into contact.
228

•
•
•
•
Indwelling catheter:
A catheter left inside the body, either temporarily or permanently.
Uses:
Common indications to catheterize a patient include acute or chronic
urinary retention - (which can damage the kidneys) E.g. Foley
catheter
Drainage of ﬂuid e.g. an abdominal abscess
Administration of intravenous ﬂuids, medication or parenteral
nutrition with a peripheral venous catheter
229

Catheter types
VFoley catheter: retained by means of a balloon at the tip which
is inﬂated with sterile water.
230

Cont…
•
•
•
•
•
•
•
•
Foley catheters: are ﬂexible (usually latex) tubes that are passed through the urethra
during urinary catheterization and in to the bladder to drain urine.
Foley catheters are used during the following situations:
On patients who are anesthetized or sedated for surgery or other medical care
On comatose patients
On some incontinent patients
On patients with acute urinary retention
On patients who are unable, due to paralysis or physical injury, to use either
standard toilet facilities
Following urethral surgeries
231

•
•
•
The ﬂuid is retained by means of a balloon at the tip which is inﬂated
with sterile water.
The balloon typically come in two different sizes: 5cc and 30 cc. They
are commonly made in silicone rubber or natural rubber.
The relative size of a foley catether is described using French units (F).
The most common sizes are 10F to 28F. 1F is equivalent to 0.33mm.
The size in F is roughly equal to the circumference of the catheter in mm.
233

234
2-Way 3-Way
Size in FG Balloon Capacity Size in FG Balloon Capacity
8 & 10
12 & 14
16,18,20,22, 24,26
3 cc
15 cc
30 - 50 cc
16, 18, 20, 22, 24, 26 30 - 50 cc

Cont…
V
•
Robinson catheter: ﬂexible catheter used for short term drainage of
urine.
Unlike foley catheter, it has no balloon on its tip and hence can’t
stay in place unaided.
235

Cont…
V

Coude catheter: designed with a curved tip that makes it easier to
thread the catheter pass the prostate or obstructions in the urethral
canal.
A coude catheter tip may be provided with a balloon or not.
236

Cont…
V

Irrigation catheter: has a separate lumen to carry irrigation ﬂuid into the
bladder.
This is useful followingendoscopic surgical procedures or in the case
of
gross hematuria .
237

Urine drainage bag
•

•

2000 ml
Used for short and long term urine drainage
100ml
Used for urine collection in infants
238

Endotracheal tube (Breathing tube)
•
•
Manufactured from non-toxic, non-irritant medical grade
polyvinylchloride (PVC) compound.
The tube is inserted into a patient’s trachea in order to ensure that
the airway is not closed off and that air is able to reach the lungs. It
connects the respiratory system of the patient.
239

…..
•
•






Used in general anesthesia, intensive care unit ICU) and emergency medicine
for airway management, mechanical ventilation and as an alternative route
for many drugs if an IV line cannot be established.
Types of ETT include
oral or nasal,
cuffed or uncuffed,
performed,
reinforced tubes,
double-lumen tubes and
tracheostomy tubes.
240

•
•

Size in mm (internal diameter)
Plain : 2.0 mm, 2.5 mm, 3.0 mm, 3.5 mm, 4.0 mm, 4.5 mm, 5.0 mm,
5.5 mm
Cuffed : 4.5 mm, 5.0 mm, 5.5 mm, 6.0 mm, 6.5 mm, 7.0 mm, 7.5 mm,
8.0 mm, 8.5 mm, 9.0 mm, 9.5 mm, 10.0 mm.
The size is chosen based on the patient’s body size, with the smaller
size being used for pediatric and neonatal patients. Tubes larger than
6 mm Internal Diameter usually have an inﬂatable cuff.
242













Endotracheal tube size 3.0 CH
Endotracheal tube size 3.5 CH
Endotracheal tube, sterile CH 4
Endotracheal tube, sterile CH 4.5
243

Nasogastric tube (NG tube)
•
•
•
NG tube is a clear plastic tube that passes through the patient’s nose
and throat and ends in the patient’s stomach.
This tube allows for direct “tube feeding” to maintain the nutritional
status of the patient or removal of stomach acids.
The main use of NG tube is for feeding and for administering drugs
and other oral agents.
244

•
•
•
Nasogastric aspiration (suction) is the process of draining the stomach’s
contents via the tube.
NG aspiration is mainly used to remove gastric secretions and swallowed air
in patients with gastrointestinal obstructions.
NG aspiration can also be used in poisoning situations when a potentially
toxic liquid has been ingested, for preparation before surgery under
anesthesia and to extract samples of gastric liquid for analysis.
246

•
•
•
•
Tubes of various sizes have been used, and selection of an
appropriate size is largely dependent on the intended use for the tube
and the anticipated duration it will be in situ.
Adult: 14-18 Fr
Infant/Child: 10-14 Fr
Soft, ﬂexible, small-diameter (8 Fr to 12 Fr) tubes are frequently used
for patients who require enteral feeding for
less than 6 weeks .
247

• However ﬁrmer, less ﬂexible, large-diameter tubes (14 Fr or larger)
are used to administer medications, gastric decompression, and for
short term feeding (usually shorter than 1 week).
248

249
Naso gastric tube, adult size sterile CH16
Naso gastric tube, infant size sterile CH10
Naso gastric tube, infant size sterile CH 8
Naso gastric tube, infant size sterile CH 6
Nasogastric tube pediatric sterile size CH4

Intravenous Cannula (Vigo)
•
•
An intravenous Cannula is a ﬂexible tube which when inserted into
the body is used either to withdraw ﬂuid or administer medication.
Cannula normally come with a trocar (a sharp pointed needle)
attached which allows puncture of the body to get into the intended
space.
250

251
Size Color Length (mm) Internal diameter (mm)
14G
16G
17G
18G
20G
22G
24G
26G
Orange
Gray
White
Green
Pink
Blue
Yellow
Violet
45
45
45
45
32
25
19
19
1.7
1.3
1.1
0.9
0.8
0.6
0.5
0.4
Larger

Rectal tube
•
•
•
•
A rectal tube is made of PVC and used to expel ﬂatus from the rectum
unresponsive to medications.
Rectal tubes and Colon tubes are basically the same thing the only
difference is the length. Colon tubes are longer.
Types: Rectal tubeopen end , rectal tube close end
Size(Fr.) 18, 20, 22, 24, 26, 28, 30, 32
252

Tourniquet






Is latex elastic reusable, non-sterile strip used to
facilitate the puncture of veins
Length:75-100 cm
Must be cleaned and disinfected as often as necessary.
Types of tourniquet
Latex type
Rubber type (for adult, child)
253

Colostomy bag
•
•
Colostomy refers to a surgical procedure where a portion of the
large intestine is brought through the abdominal wall to carry stool
out of the body.
Colostomy bag is used to collect stool after colostomy.
254

Equipment's used in Anesthesia, Ophthalmology,
Dentistry and Surgery
255

1. Equipments used in anesthesia
•
Continuous anesthetic ﬂow machine
Used to provide a measured and continuous supply of gases
(oxygen, nitrous oxide, etc), mixed with a required concentration
of anesthetic vapor to the patient at a required pressure and
rate.
256

Cont…
•
Suction catheter
Suction catheters used to remove secretions from the mouth,
oropharynx, trachea and bronchi
258

Cont…
•
•
Tracheotome tube
A tracheotome is a medical instrument used to perform an
incision in the trachea with a cutting blade operated by a
powered cannula.
it is used to keep an artiﬁcial opening in front of the neck into
the trachea open to act as an alternative pathway for respiration.
259

•
•
It is often called a tracheostomy tube because once it enters the
stoma in the trachea, a breathing tube is connected to a ventilator
and oxygen is provided to the lungs.
They can be made of metal, plastic or silicone. Plastic and
silicone are widely used since they reduce the complications from
the tracheotomy procedure such as subglottic stenosis and
erosion of large blood vessels
260

Equipment's used in ophthalmology
•
•
•
•
1.Glasses (eyeglasses, spectacles, specs)
are frames bearing lenses worn in front of the eyes for vision
correction or eye protection.
Different types:
Safety glass
Sunglass
Corrective glass
263

Cont…
•
•
Corrective glass
Corrective lenses are used to correct refractive errors of the eye
by modifying the effective focal length of the lens
Corrective glass can compensate for three vision deﬁciencies.
264

Cont.…
•
A) Myopia/ near sightedness
Individuals suffering from myopia are prescribed eyeglasses with
concave lenses which compensate for refraction error by moving
the image of the distant objects backward onto the retina.
265

Cont…
•
B ) Hypermetropia /farsightedness
Eyeglasses with convex lenses compensate for the refraction
errors by moving the image of a distant object forward onto the
retina
266

Cont…
•
C ) Presbyopia- reduced ability of the lens to accommodate
It is more common in people over 40 and is corrected with
bifocal lenses
267

Cont…
•
•
•
2.Contact lenses
Is a corrective or cosmetic lens usually placed on the cornea of
the eye
Allows for correct focusing of light onto the retina
Their application is the same as that of glass
268

Cont…
•
3. Ishihara's chart
to determine the type of color blindness.
270

Equipment's used in Dentistry
•
•
A .Mirror
Dental mirrors are used by the dentist to view a mirror image of
the teeth in locations of the mouth where visibility is diﬃcult or
impossible.
They also are useful for reﬂecting light onto desired surfaces,
and with retraction of soft tissues to improve access or vision.
271

Cont…
•
•
B . Hand-held probes
Several different kinds probes are used by the dentist.
They allows the dentist to detect depth and ﬁssures.
Eg . A periodontal probe measures the depth of periodontal
pockets.
273

Cont.…
•
C. Dental drill
is a small, high-speed drill used in dentistry to remove decayed
tooth material prior to the insertion of a dental ﬁlling.
275

Cont…
•
D. Pliers
a tool of pincer design with jaws of varying shapes; used for
extraction of teeth.
276

4.Surgical instrument
•
•
Classiﬁcation of surgical instrument
The surgeon dissect, resects, or alters tissue/and organ to
restore or repair bodily function.
Whether they are small or large, short or long, straight or curved,
sharp or blunt all instrument can be classiﬁed by their function.
277

Cont…
•
•
1.Cutting and dissecting
Cutting instruments have sharp edge
They demand careful handling at all time to prevent injury to the
handler and damage to the sharp edge
a) Scalpels -A scalpel is a small and extremely sharp bladed
instrument used for anatomical dissection.
278

Cont…
•
•
•
b) Knives
They usually have a blade at one end, like kitchen parting knife
The blade may have one or two cutting edges
These knife are designed for very speciﬁc purpose
280

Cont…
•
•
c)Biopsy forceps and punches
A small piece of tissue may be removed for pathologic
examination with punches
These instrument may be used through endoscope
281

Cont.…

•
•
•
2.Grasper
Needle holder
is used to grasp and hold curved surgical needles.
Most needle holders resemble hemostatic forceps, the basic
difference is the jaw.
A needle holder has short, secure jaws for grasping a needle
without a damage.
283

Deﬁnition
•
•
Medicinal gas is any gas which is intended for administration to a
patient in anesthesia, therapy, or diagnosis.
Example
Oxygen
Nitrous oxide
Carbon dioxide
Are stored in cylinders made of steel and are designed to
withstand pressures of over 200 bar
The nominal size of cylinders varies from 36 to 5112 L capacity
285

Storage of medicinal gas




Should be stored under cover and not subjected to extremes of
heat
be kept dry, clean and well ventilated
allow for segregation of full and empty cylinders and permit
separation of different gases within the store
Should be totally separated from any non medical cylinder
286

Cont…


be sited away from storage areas containing highly ﬂammable
liquids and other combustible materials
have warning notices posted prohibiting smoking and naked
lights within the vicinity of the store
287

Oxygen
V




V
Indication
its primary indication is acute or chronic hypoxia
respiratory depression and respiratory failure
severe trauma
acute myocardial infarction (heart attack)
During surgical interventions, post-anesthesia
Treatment of carbon monoxide poisoning
288

E
•
•
•
E
•
•
E
reduction of the circular blood volume in
coronary failure
collapse of peripheral circulation
shock
reduction of the oxygen-carrying capacity of the blood due to
severe anemia
hemorrhage
To increase radiation eﬃciency in tumor therapy
289

Ways of delivering oxygen
•
A. low-ﬂow system
1. nasal cannula
The prongs ﬁt into the patient’s nares (nostrils) and the tubing is
secured around his ears and face.
290

Cont….
•
•
•
Cannulas can usually deliver 24% to 40% of oxygen
Draw back
runny nose (rhinitis),
skin irritation over the ears, or under the chin, nose, and across
the face where the tubing lies.
291

Cont…
•
•
•
•
2.Simple face mask
covers the patient’s nose and mouth.
Has numerous holes in its sides that allow room air to enter and exit.
A face mask provides approximately 35% to 50% of oxygen per liter
used for short-term therapy or in emergency situations
292

Cont…
•
•
•
•
3.venturi mask
provide oxygen concentrations of 24% to 55%
The oxygen is delivered through the constricted opening that
regulates the percentage of oxygen
Delivers a speciﬁc and consistent percentage of oxygen
The patient’s respiratory rate and pattern don’t affect the oxygen
concentration
294

Cont….



b. High-ﬂow system
Non-rebreather mask
it allows for a tight seal over the nose and mouth
It delivers about 60% to 80% oxygen depending on the oxygen
ﬂow and breathing pattern
has a one-way valve that prevents exhaled air from reentering
the reservoir bag
296

Cont…
•

•

•
Toxicity
High concentrations of oxygen can be toxic
Symptoms of toxicity include nausea, mood changes, vertigo,
convulsions and loss of consciousness
Patients receiving long-term oxygen may develop
Regular headaches, altered breathing patterns
Safety & precautions:
Safety has to be a concern because of the risk of explosion and
ﬁre.
298

Nitric oxide (NO)
•
•
•
•
Indication
Dilates blood vessels in only those lung segments that are actively
participating in gas exchange (oxygen & carbon dioxide) at the alveolar-
capillary level
To reduce pulmonary artery pressures due to pulmonary hypertension.
To reduce pulmonary vascular resistance
Nitric oxide is considered an antianginal drug: it causes vasodilation
299

Cont…
•
•
Delivery system
The basic design and goal of each system is to provide a system for
safe gas delivery and monitoring
Toxicity
Inhaling very high levels of NO can be lethal causing a severe and
acute accumulation of ﬂuid in the lungs (pulmonary edema)
300

Nitrous oxide/laughing gas
•


At room temperature, it is a colorless, non-ﬂammable gas, with
a slightly sweet odor and taste
Nitrous oxide is a weak general anesthetic, and so is generally
not used alone in general anesthesia
It is normally administered as a mixture with 30% gas and 70%
oxygen
301

Cont…
•
Indication
Inhalation of nitrous oxide is frequently used to relieve pain associated
with childbirth, trauma, oral surgery, dentistry, and acute coronary
syndrome ( heart attacks)
Toxicity/safety
an asphyxiation risk
Long -term exposure can cause vitamin B12 deﬁciency, numbness,
decreases in mental performance, audiovisual ability, reproductive
side effects
302

Carbon dioxide
•
•
•
•
It is colorless, odorless and tasteless
Indication :
At concentrations up to 5% carbon dioxide is a powerful
respiratory stimulant and vasodilator
For treating respiratory depression by drugs such as
depressants, hypnotics and anesthetics and has been used for
treating diﬃcult hiccup
CO2 is used in Laparoscopic surgeries to distend the abdomen
303

Cont…
•
Toxicity
At concentrations above 6%, carbon dioxide produces an
increasing central depression and acidosis
304

Helium
•
•
It is used for its physical properties, in particular it has a very
low density which makes it easier to breathe.
Indication
In combination with oxygen used for the treatment of
respiratory conditions such as upper-airway obstruction, sever
asthma, severe chronic obstructive pulmonary disease.
Mixtures are available in concentrations of 60 percent to 80
percent helium.
305

Infection control, sterilization and care of
surgical instruments
306

Terms
•
•

Sterility: state in which there are no living microorganisms
present
Disinfection: state in which the number of disease-producing
microorganisms have been greatly reduced
Does not necessarily kill all microorganisms, especially resistant
bacterial spores; it is less effective than sterilization
307

Cont…
•
•
Antiseptics: substances that destroy or inhibit the growth of
microorganisms, but do not sterilize the area, and can be used on
living tissue
Disinfectants: are substances that are applied to non-living objects to
destroy microorganisms that are living on the objects
308

Care and handling of surgical instruments
•
•
Surgical instruments may be damaged if used for unintended
purpose
Keeping the instrument clean, ensure surgical instrument
perform as intended and extend their useful life
309

Infection control
•
•
•
Infection control is the discipline concerned with preventing healthcare-
associated infection
Infection control addresses factors related to the spread of infections
within the health-care setting (whether patient-to-patient, from patients
to staff and from staff to patients, or among-staff)
Sterilizing and disinfecting instruments – one method of infection
control
310

Aseptic technique
•
•
•
•
•
•
Entering the theater with:
Gowning
Gloving
Wear Eye or face shields should be worn during procedures that are
likely to generate blood droplets of blood or other body ﬂuids to
prevent exposure of mucous membranes of the mouth, nose and
eyes.
Cleaning the theater
Decontamination of furniture and ﬁxed equipment
311

•
•
•
•
•
Sterilizing and disinfecting instrument s
Antiseptic solutions
Boiling
Hot air ovens
autoclave
312

Sterilization


Refers to any process that eliminates all forms of life, present on a
surface, contained in a ﬂuid or in a compound such as biological
culture media
Can be achieved by applying the proper combinations of heat,
chemicals, irradiation, high pressure, and ﬁltration.
313

I. Heat sterilization
•
•
•
a) Steam sterilization(autoclave)
Widely used method for heat sterilization is the autoclave
To achieve sterility, a holding time of at least 15 minutes at 121 °C or
3 minutes at 134 °C is required
Additional sterilizing time is usually required for liquids and
instruments packed in layers of cloth, as they may take longer to
reach the required temperature
314

Cont…
•
•




Proper autoclave treatment will inactivate all microorganism
Steam sterilization requires four conditions in order to be efficient:
Sufficiently high temperature
Sufficient moisture
Adequate contact and
correct holding time
315

Cont…
•


b) Dry heat ( an oven)
Dry heat sterilization is performed at 170 °C for one hour or two hours at a
temperature of 160 °C
Advantage and disadvantage of dry heat!!
can be used on powders and other heat-stable items that are adversely
affected by steam
It can only be used to disinfect instruments that are made of metal or
glass
317

II. Chemical sterilization
•
•


A) Ethylene oxide
Used to sterilize objects sensitive to temperatures greater than 60
°C and radiation such as plastics
Treatment should last for at least three hours
Ethylene oxide can kill all known viruses, bacteria and fungi, including
bacterial spores and is compatible with most materials even when
repeatedly applied
Disadvantage
it is highly ﬂammable, toxic and carcinogenic.
318

Cont…
•
•
B) Glutaraldehyde and formaldehyde
Glutaraldehyde and formaldehyde solutions are accepted liquid
sterilizing agents, provided that the immersion time is suﬃciently
long
When glutaraldehyde is used, the instruments are soaked in a 2-4%
solution for at least 10 hours while a solution of 8% formaldehyde will
sterilize the items in 24 hours or more.
319

Cont…
•
•

Disadvantage
It is mandatory to rinse with sterile water to remove the residues of
the liquid after the instruments have been soaked
Formaldehyde is more irritating to the eyes, skin and respiratory tract
classiﬁed as a potential carcinogen
320

Cont…
•
•
•
•
C) Hydrogen peroxide
Is a strong oxidizer at high concentrations (> 10% w/w).
These oxidizing properties allow it to destroy a wide range of pathogens
Used to sterilizeheat sensitive articles such as rigid endoscopes
In medical sterilization H2O2 is used at higher concentrations, ranging
from around 35% up to 90%.
321

Cont…

•
•
D) Other methods
Other heat methods include ﬂaming, boiling, radiation
Flaming: is done to loops and straight-wires in microbiology labs
Leaving the loop in the ﬂame of a Bunsen burner or alcohol lamp until it
glows red ensures that any infectious agent gets inactivated
This is commonly used for small metal or glass objects, but not for large
objects
322

Cont…

Boiling in water: for ﬁfteen minutes will kill most vegetative bacteria
and inactivate viruses, but boiling is ineffective against many
bacterial and fungal spores; therefore boiling is unsuitable for
sterilization
However, since boiling does kill most vegetative microbes and
viruses, it is useful for reducing viable levels if no better method is
available
323

Cont…
•
Radiation sterilization: Methods of sterilization exist using radiation
such as electron beams, X-rays, gamma rays, Ultraviolet light
irradiation
Gamma rays are very penetrating and are commonly used for
sterilization of disposable medical equipment, such as syringes,
needles, cannulas and IV set
324

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