Chapter 11 surgical instrumentation


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Chapter 11 surgical instrumentation

  1. 1. Surgical Instrumentation Chapter 11
  2. 2. Objectives: As a result of successfully completing this chapter, students will be able to:  Review the process by which surgical instruments are manufactured  Define basic categories of surgical instruments based upon their functions, and identify the points of inspection, anatomy (features) of, and procedures to measure the following types of instruments:  Hemostatic Forceps  Needleholders  Tissue Forceps  Dressing Forceps  Retractors  Scissors  Suction Devices  Single and Double Action Rongeurs  Kerrison/Laminectomy Rongeurs  Nail Nippers  Graves and Pederson Vaginal Speculums
  3. 3. Objectives:  Identify solutions that can damage stainless steel instruments  Explain procedures to test instruments for sharpness, and to identify (mark) them  Emphasize the importance of instrument lubrication, and review tray assembly safeguards
  4. 4. Central Service Technicians…  …are responsible for the quality of instrument
  5. 5. Martensitic (400 Series) Stainless Steel  Hard, used when sharp cutting edges are needed  Often used for scissors, osteotomes, chisels, hemostatic forceps, and needleholders
  6. 6. Austenitic (300 Series) Stainless Steel  Highly Corrosion Resistant  Not as hard as 400 Series  Used for retractors, cannulas, rib spreaders, suction devices
  7. 7. Instrument Manufacturing  Forging  Grinding and Milling  Assembly  Heat Tempering  Polishing  Passivation  Final Inspection  Etching  Note: Instruments are inspected throughout their manufacturing process
  8. 8. Passivation A chemical process applied during instrument manufacture that provides a corrosion-resistant finish by forming a thin transparent oxide film
  9. 9. Instrument Finishes  The instrument on the left has a matte, or satin-finish  The instrument on the right has a shiny, or mirror finish
  10. 10. Overview of Surgical Instruments  Pages 178 – 187 provide an overview of basic surgical instruments along with tips and techniques for proper inspection
  11. 11. Post-Ooperative Care of Surgical Instruments  Keep instruments moist  Transport to Central Service for cleaning as soon as possible
  12. 12. Solutions that Damage Surgical Instruments  Saline  Betadine  Peroxide  Dish Soaps  Soaking in Water  Soaking in Saline  Bleach  Iodine  Hand Soaps  Laundry Detergents  Long-term Soaking in Rust Remover  Long-term Soaking in Stain Remover  Surgeon’s Hand Scrubs  Household Lubricants  Household Powder Cleaners
  13. 13. Surgical Sharps Testing
  14. 14. Scissors Guidelines  NEVER use them to cut other products  Protect Blades  Test Between Uses
  15. 15. Scissors Testing Material  Use RED Test Material for Scissors greater than 4.5”  Use Yellow Test for Scissors smaller than 4”  Use Single-Ply Facial Tissue for Laparoscopic Scissors
  16. 16. Bone Cutters  Test with an Index Card
  17. 17. Rongeur Testing  Kerrison, Laminectomy and Double Action Rongeurs should be tested using a 3” x 5” index card  Look for clean bites
  18. 18. Curettes, Chisels, and Osteotomes  Test each using a plastic dowel rod  Each should shave off pieces of the rod
  19. 19. Instrument Identification Procedures
  20. 20. Tape  Clean hands thoroughly with alcohol to remove oils and grease  Wipe the part of the instrument where the tape will be placed with alcohol  Cut the tape at an angle  Wrap the tape 1 to 1.5 times around the device  Autoclave the instrument to allow the heat to help bond the tape to the instrument
  21. 21. Acid Etching Process that uses a stencil, solution and electricity to mark and instrument
  22. 22. Heat-fused Nylon A process that leaves a thin color-coded layer on nylon on an instrument
  23. 23. Laser Etching Permanent marking method done by instrument manufacturers and repair vendors
  24. 24. Instrument Lubrication  The use of a neutral pH lubricant extends the life of instruments  Use lubricants in according with instrument manufacturers’ and the lubricant manufacturer’s recommendations  ALL Lubricants must be approved for use as a surgical instrument lubricant
  25. 25. Tray Assembly Tips  Place heavy instruments on the bottom or side of the tray  Select an instrument tray that allows adequate space for weight distribution  Place all curved instruments in the same direction  Nest Tissue and Dressing Forceps  Protect Delicate Instruments  Use Instrument Stringers (holders) to keep instruments open and in place  Avoid metal to metal contact between laser finish instruments