This document provides an overview of instrumentation, equipment, and supplies used in the operating room. It discusses the objectives of understanding their relationship to patient care, safety concepts, and the OR environment. It then describes the various types of basic and specialty instruments used in surgery, including their classifications, care, and handling. The document also outlines the different equipment, such as endoscopes, microscopes, and lights, as well as supplies like drapes, sponges, and dressings needed for surgical procedures.

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CHAPTER 10
Instrumentation,
Equipment, and
Supplies

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Objectives (Slide 1 of 3)
• After studying this chapter, you will be
able to:
– Explain the relationship between
instrumentation, equipment, and supplies
and with quality patient care in the operating
room (OR)
– Explain the relationship between
instruments, equipment, and supplies and
the OR environment with safety concepts

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Objectives (Slide 2 of 3)
– Indicate items that require sterilization prior
to use in the sterile field
– Recognize basic instruments by type,
function, and name
– Demonstrate proper care, handling, and
assembly of instruments
– Differentiate the types of special equipment
utilized in OR practice and demonstrate
proper care, handling techniques, and
safety precautions

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Objectives (Slide 3 of 3)
– Cite the names and functions of accessory
equipment and demonstrate proper care,
handling, and assembly
– Collect and prepare supplies used in the OR

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Instrumentation
• Modern surgical instruments
– Most are made of stainless steel
• Combination of carbon, chromium, iron, and a few
other metals (alloys)
• Chromium increases resistance to corrosion
• Titanium is stronger and lighter in weight, it is also
nonmagnetic and more resistant to corrosion
– Finish types
• High polish
• Satin
• Ebonized

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Classifications (Slide 1 of 8)
• Include:
– Cutting/dissecting
– Grasping/holding
– Clamping/occluding
– Retracting/viewing
– Probing
– Dilating
– Suturing
– Suctioning

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Classifications (Slide 2 of 8)
• Cutting/Dissecting
– Instruments with one or more sharp edges
• Used for incision, sharp dissection, or excision of tissue
• Scalpels/knives
– #20 blade fits a #4 handle; #12 blade is used for
tonsillectomies; #11 blade is used to incise a blood vessel
or create a stab wound for drain placement
• Scissors
– Common scissors are Metzenbaum, tenotomy, and Potts-
Smith; straight Mayo scissors are called suture scissors
• Bone-cutting instruments, saws, drills, biopsy punches,
adenotomes, and dermatomes
• -tome means an instrument for cutting

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Classifications (Slide 3 of 8)
• Grasping/Holding (can be tweezer like or
ringed and ratcheted)
– Instruments designed to manipulate tissue
• Facilitate dissection or suturing or to reduce
and stabilize fractured bone during internal
fixation
• May or may not have a ratcheted locking
mechanism
• Include tissue forceps and bone-holding
clamps

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Classifications (Slide 4 of 8)
• Clamping/Occluding (technical term for clamp is forceps)
– Instruments designed to occlude or constrict tissue
• Construction
– Opposing ring handles for fingers
– Interlocking ratchets
– Two shanks that connect the ringed handles to the box lock, or
hinge joint of the clamp
– Box lock is the joint where one half of the instrument passes
through the other
– Jaw serrations may horizontal, longitudinal, or cross-hatched
and cut in lines in the jaws
• Include vascular clamps, intestinal clamps, and hemostatic clamps

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Classifications (Slide 5 of 8)
• Retracting/Viewing
– Retractors
• Instruments designed for exposure of the operative site
– Viewing instruments
• May provide retraction
• Main function is to allow visualization of a structure
• Self retaining retractors include the weitlaner, Bookwalter,
O’Connor-O’Sullivan and Balfour
• Bookwalter, Greenberg, and Thompson all need to be
attached to the OR table
• Flat malleable retractors can be bent into desired positions

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Classifications (Slide 6 of 8)
• Probing and Dilating
– Probes
• Malleable, wire-like instruments for the exploration of
a structure
• Include fistulas, ducts, or vessels
– Dilators
• Gradually dilate an orifice or duct to allow for
introduction of larger instrumentation or to open a
stricture
• Include urethral dilators
• Examples of dilators are Heaney, Hegar, Van Buren,
and Bougie

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Classifications (Slide 7 of 8)
• Suturing and Suctioning
– Suturing: Needle holders
• Used to hold a curved suture needle for suturing
• Have cross hatch serrations for needle immobilization and some
have tungsten carbide inserts
• Refer to Figure 10-11
• When passing suture to the surgeon, next step should be to pass
straight Mayo scissors to assistant
– Suctioning
• Removal of blood and body fluids from an operative site to
provide better visualization
• Refer to Figures 10-12 and 10-13
• Yankauer is also called tonsil or oral, Poole suction has multiple
holes to prevent intestine getting caught in suction

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Classifications (Slide 8 of 8)
• Microinstrumentation
– Instruments used to perform microsurgery
• Small, delicate, and precise devices
• When used with an operating microscope,
allow manipulation and repair of very small
structures or tissue
• Typically made of titanium or stainless steel
• Designed to be held with the thumb and
forefinger

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Instrument Care and Handling
• Instrument cycle includes three phases of instrument handling:
– Preoperative tasks
– Intraoperative tasks
• Should be handed to the surgeon in a functional manner that allows the surgeon
to use it without repositioning
– Postoperative tasks
• Surgical instruments must be handled with great care during all phases
– Prevents injury
– Extends instrument life
– Allows correct and consistent performance

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Types of Instrument Sets
• Instruments are typically assembled into sets,
sterilized, and stored for later use
– Instruments within each type of set are
standardized according to the procedure and
facility needs
• Refer to Figure 10-14
– Some procedures require a smaller secondary
set of specialized instruments

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Laparotomy Set
• Used in general abdominal procedures
Refer to Table 10-1
• Typically requires a major and a minor
laparotomy set
• Examples include peripheral vascular disease,
bowel resection, cardiothoracic, craniotomy,
orthopedic

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Instrument List/Count Sheet
• Lists the type and number of instruments in a
set
– Referred to by the assembler to minimize
errors
– Count may be waived for the procedure due
to an emergency
– Refer to Figure 10-14

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Specialty Equipment (Slide 1 of 2)
• Endoscopes
– Used for diagnosis, biopsy, visualization, and/or repair of a structure
within a body cavity or the interior of a hollow organ
– Refer to Figure 10-15
– Flexible ureteroscopes are used to view the renal pelvis
• Powered Instruments
– Instruments used in the OR that are powered by compressed air,
nitrogen, electricity, or battery
– Many uses
– Refer to Figure 10-16
– Power instruments use reciprocating, oscillating, and rotary motions

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Specialty Equipment (Slide 2 of 2)
• Microscopes
– Refer to Figure 10-17
– Objective lenses are most proximal to the target tissue
• Magnification
– Resolving power
• Additional
– Illuminators, video monitors, recorders, cameras
– Fiber-optic headlamps and light sources
– Pulse lavage irrigator, phaco-emulsifier and irrigation/aspiration units
– Cryotherapy units
– Insufflators
• Typical intraoperative pressure is 12-15 mmHg
– Nerve stimulators
• Nonsterile or sterile item used by surgeons and anesthesia providers

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Accessory Equipment (Slide 1 of 3)
• Suction system components
– Vacuum source, vacuum source tubing, minimum of 2 per
room
– Collection unit, tubing, suction tip
• Lights
– Necessary for any surgical procedure
– Refer to Figure 10-19
– White fluorescent overhead lights
• Provide general illumination for the room
– Ceiling-mounted overhead operating lights
• Provide focused lighting for precision illumination
• Open Heart rooms usually have 4 lights

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Accessory Equipment (Slide 2 of 3)
• Pneumatic tourniquets
– Tourniquet purposes
• Amount of blood lost is minimized
• Visualization of the surgical site is improved
– Electrically operated pneumatic tourniquet components
• Cuff, tubing, pressure device, and power source
• Refer to Figure 10-20
• Refer to Technique 10-1
• Tourniquet should be deflated after 60 minutes on an
upper extremity and 2 hours on lower extremity

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Accessory Equipment (Slide 3 of 3)
• Sequential Compression Devices
– Components
• Compressor that is electrically operated
• Connecting tubing
• One or more sleeves that enclose that
patient’s limb(s)
– Uses
• Prevent venous stasis
• Treat edema

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Supplies
• Drapes
– Barrier to isolate and protect the operative site
• Drape materials
– Nonwoven fabrics; nylon, polyester bonded with cellulose, aluminum
coated
– Woven textile fabrics
– Plastic adhesive drapes
• Incise and aperture drapes
• Drape types
– Fenestrated (opening) and nonfenestrated
– Stockinettes
– Aperture are used for eyes and ears
– Towels are used to “square-off” the incision site

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Supplies
• Sterile Packs
– Become highly specialized for surgical specialties
• Basic sterile pack components:
– Mayo stand cover
– Two gowns
– Suture bag
– Four sticky paper drapes for square draping
– Two paper towels for hand drying

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Supplies
• Sponges
– Can not be impregnated with iodine or antimicrobial agents
– Contains a radiopaque strip so they can be located with x-ray
– Absorb blood and tissue fluids
– Blunt dissection of tissues
– Protect important structures
– Lap sponges come 5 to a pack
– Ray tecs come 10 to a pack, they can only be used on a sponge
stick during open abdominal cases
– Neurological sponges are called cottonoids, they come 10 to a
pack
– Tonsil sponges come 5 to a pack
– Kittner sponges come 5 to a pack

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Supplies
• Surgical dressings
– Applied to most wounds
– Depend on location of incision or wound,
type and amount of drainage expected, and
condition of the incision/wound
– Several functions

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Supplies
• Dressing types
– Biologic dressings
– Skin grafts
– One-layer used to cover small incisions (Op-site, collodion,
adhesive gel, and Steri-Strips)
– Three-layer dressings: intermediate (absorbent) layer is
placed over the contact layer to absorb secretions (4x4s,
Kelix, ABD pad)
• Montgomery straps used in situations that may require
frequent wound inspections
– Pressure dressing

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Supplies
– Bulky dressing
– Rigid dressings include Spica Cast and Minerva Jacket
– Specialty dressings
• Wet to dry is gauze soaked in saline, antibiotic solution, or
Dakin’s solution then applied to the wound and allowed to
dry
• Drain dressing is a gauze sponge cut into Y shape to
allow for the drain
– Packing material
– Negative pressure wound therapy

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Catheters, Tubes, and Drains
• Catheters
– Used to remove fluid or other objects
• Urinary catheters: typically used to drain urine, but may have
other applications
• Three way Foleys have an additional port for irrigation
• Suprapubic catheter is placed through the abdominal wall
and secured with a heavy suture as an anchor
• Ureteral catheter is used to drain the kidney
• Intravascular catheters: used to infuse fluids, obtain a
diagnosis, monitor body functions, and remove thrombi
• Specialty catheters: several types
– Broviac or Hickman catheter is used to monitor central venous
pressure

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Catheters, Tubes, and Drains
• Tubes
– Used to remove air and fluids from the body for the purpose of
decompression
• Gastrointestinal tubes: used to aspirate air and fluids from the
gastrointestinal tract
• Airway tubes: used to maintain patency of the upper respiratory
tract
• Chest tubes: inserted percutaneously to treat pneumothorax or
following cardiothoracic surgical procedures to evacuate air and
fluid
– Water-seal drainage system uses water in the collection unit to
prevent air from re-entering the pleural space, thereby
maintaining the negative pressure necessary for effective
respiration

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Catheters, Tubes, and Drains
• Drains
– Used to evacuate air and fluids from a surgical or traumatic
wound
• Passive drains: allow a pathway for fluid or air to move
from an area of high pressure to one of lower pressure
– Penrose drain uses capillary action
– Cigarette drain uses wicking action
• Active drains: make use of negative pressure

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Irrigators and Syringes
– Used to irrigate wounds, aspirate fluids, or
inject medications
– Made of plastic, glass, metal, rubber or any
combination
– Vary in sizes
– Include: insulin syringes, tuberculin syringes,
three-ring or control syringes, and irrigation
syringes
– Bulb/ear syringes do not have calibrations

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Summary
• This chapter reviewed:
– The relationship between instrumentation,
equipment, and supplies and with quality
patient care in the operating room
– Basic instruments by types and functions
– Proper care, handling, and assembly of
instruments
– Special equipment utilized in OR practice
– Supplies used in the OR