SURGICAL

INSTRUMENTS

BY NURSE LINDA
 
 DEF:A surgical instrument is a tool or device for
performing specific actions or carrying out desired
effects during a surgery or operation such as
modifying biological tissue or to provide access for
viewing it
 KEY TERMS AND
DEFINITIONS

 Approximating -Bringing together.
 Atraumatic -Without injury.
 Crushing Destructive effects of specific instruments.
Some procedures require the use of crushing clamps.
 Cutting - Separating with a sharp instrument or
device.
 Debulking - Decrease in mass or volume using an
instrument or device.
 Dilation - nlarging an opening in a progressive
manner
 
 Dissection - Process of separating tissues through
anatomic planes by using sharp or blunt
instrumentation.
 Evacuating - Emptying a cavity or space.
 Grasping - Holding in a traumatic or atraumatic
manner.
 Instillation - Fluid is slowly introduced into a cavity or
space.
 Occlusion -Closing a lumen for the purpose of the
procedure. The closure can be permanent or temporary.
 
 Percutaneous- Enter directly through the skin; without
incision.
 Retraction - Stabilizing a tissue layer in a safe position
for exposure of a part. A retractor can be manual or
self-retaining
 Sharp- Instrument with a cutting edge or pointed tip(s)
that is used to cut or dissect tissue. These items include
blades, scissors, needles, and other dissection devices.
 Traumatic - Causing injury by penetration or crushing.
 FABRICATION OF METAL
INSTRUMENTS

 some surgical instruments are made of titanium,
cobalt-based alloy (Vitallium), or other metals
 the vast majority is made of stainless steel.
 The alloys used must have specific properties to
make them resistant to corrosion when exposed to
blood and body fluids, cleaning solutions,
sterilization, and the atmosphere.
 The manufacturer chooses the alloy for its durability,
functional capacity, and ease of fabrication for the
intended purpose
 CLASSIFICATION OF
INSTRUMENTS

 Surgical instruments are classified according to their
purpose
 All instruments should be used for their intended
purpose and should not be abused.
 1. Dissecting and cutting
instruments

 Dissection instruments have sharp edges.
 They are used to cut, incise, separate, or excise tissues.
 There are two types of dissecting instruments: sharp and
blunt.
 Sharp dissecting instruments should be kept separate
from other instruments, and the sharp edges should be
protected during cleaning, sterilizing, and storing.
 To prevent injury to the handler and damage to the sharp
edges, proper precautions are necessary to take during
the handling or disposing of all sharps, blades, or scalpels
 scapels

 Vary by size and shape
Surgical knife

 Scissors

 The blades of scissors may be straight, angled, or
curved, as well as serrated, wedge-shaped, sharp,
blunt, or combined sharp-blunt tips.
 The handles may be long or short.
 Some scissors are used only to cut or dissect tissues;
others are used to cut other materials.
 To maintain sharpness of the cutting edges and
proper alignment of the blades, scissors should be
used only for their intended purpose:
Tissue scissors

Suture scissors

Cord scissors

Bone cutters and saws

 2. Debulking instruments

 The purpose of these instruments is to decrease the
bulk of firm tissue and not necessarily cut along
defined tissue planes.
Biopsy forceps

punches

 curettes

 Soft tissue or bone is removed by scraping with the
sharp edge of the loop, ring, or scoop on the end of a
curette
 snares

 A loop of wire may be put around a pedicle to
dissect tissue such as a tonsil or a polyp. The wire
cuts the pedicle as it retracts into the instrument. The
wire is discarded and replaced with a new one after
use
 3. Grasping and Holding
Instruments

 Tissues should be grasped atraumatically and held in
position so the surgeon can perform the desired
maneuver, such as dissecting or suturing
(approximating), without injuring the surrounding
subcutaneous tissues or perforating the skin
 Delicate forceps

 Fine tissues such as eye tissue are held with delicate
forceps
 They can be toothed or smooth, straight or angled
 Adson forceps

 Forceps are used to pick up or hold soft tissues in
approximation during closure
 They can be toothed or smooth.
Toothed forceps

Non-toothed forceps

 Smooth tissue forceps

 They are tapered and have serrations (grooves) at the
tip. They may be straight or bayonet (angled), short
or long, and delicate or heavy. Smooth forceps are
atraumatic and will not injure delicate structures
 Toothed tissue forceps

 Toothed forceps provide a firm hold on tough
tissues, including skin. Finer versions have delicate
teeth for holding more delicate tissue .Care is taken
not to perforate the epidermis or dermis when
holding tissue
 Allis forceps

 Allis forceps have ringed handles and lock with
ratchets. Each jaw curves slightly inward, and there
is a row of teeth at the end. The teeth grasp tissue
edges securely
 Used to hold or grasp heavy tissue such as breast
tissue

 Babcock forceps

 Babcock forceps have ringed handles and lock with
ratchets. The end of each jaw of a Babcock forceps is
rounded to fit around a tubular structure (i.e.,
fallopian tube) or to grasp tissue without injury.
 Used to hold or grasp delicate tissues commonly
during laparotomy and intestinal procedures

 tenaculums

 Tenaculums have ringed handles and lock with
ratchets and may have a single tooth or multiple
teeth
 The curved or angled points on the ends of the jaws
of tenaculums penetrate tissue to grasp firmly, such
as when a uterine tenaculum is attached to the cervix
and used to manipulate the uterus during
laparoscopy

Bone holders

Sponge holding forceps

 4. Clamping and Occluding
Instruments

 Instruments that clamp and occlude are used to
apply pressure.
 Some clamps are designed to crush the structure as
the instrument is applied and are considered
traumatic.
 The clamped crushed structure is usually sewn,
clipped, or electrocoagulated and then removed.
 Other clamps are noncrushing (atraumatic) and are
used to occlude or secure tissue, which is restored to
patency at some point during the surgical procedure
 Green armytage

 used to grasp and clamp uterus tissues
 Hemostatic clamps

 Used for occluding blood vessels
 Crushing clamps

 used to crush tissues or clamp blood vessels
 Non-crushing clamps

 Noncrushing clamps are used to occlude bowel or
major blood vessels temporarily, which minimizes
tissue trauma
 5. Retracting and Exposing
Instruments

 Soft tissues, muscles, and other structures should be
pulled aside for exposure of the intended surgical
site.
 Manual retractors

 Solid blade appendiceal retractor
 
 Volkmann rake retractors used for retraction during
small bone and joint procedures.
 
 Double-ended Army-Navy retractor
 Used to retract shallow or superficial incisions
 used in plastic surgery, small bone and joint
procedures, or throidectomy and dissection of neck
tissue.

 Malleable retractor

 A malleable retractor is a flat length of low-carbon
stainless steel, silver, or silver-plated copper that
may be bent to the desired angle and depth for
retraction
 Hooks

 Single, double, or multiple very fine hooks with
sharp points are used to retract delicate structures.
Hooks are commonly used to retract skin edges
during a wide-flap dissection such as a facelift or
mastectomy

Self-retaining retractors

Holding devices with two or more flat or
hooked blades can be inserted to spread
the edges of an incision and hold them
apart
 GUIDELINES FOR USE OF RETRACTING INSTRUMENTS


Undue force is avoided during retraction, to
avoid trauma to the tissues.
Superficial retractors require some
alternation of position during the initial
dissection
 6. Closure and Approximation
Instruments

 Needle holders
 
 Staplers
 7. Viewing instruments

 Surgeons can examine the interior of body cavities,
hollow organs, or structures with viewing
instruments and can perform many procedures
through them.
speculums

endoscopes

 8. Aspiration, Instillation, and
Irrigation Instruments

 ASPIRATION
 Aspiration, or suction, involves the application of
negative pressure (less than atmospheric pressure) for
evacuating blood or fluids, usually for visibility at the
surgical site.
 An appropriate style tip is attached to sterile tubing;
many tips are disposable.
 The style of the suction tip depends on where it is to be
used and the surgeon’s preference
 Disposable styles are preferred because the inner lumen is
difficult to clean.
 
 Blood, body fluid, or tissue may be aspirated
manually to obtain a specimen for laboratory
examination or to obtain bone marrow for
transplantation.
 DISPOSABLE
 FRAZIER SUNCTION TIP

It is used when encountering little
or no fluid except capillary
bleeding and irrigating fluid, such
as in brain, spinal, plastic, or
orthopedic procedures
 Yankaur tip

 Large quantities of blood and fluid can be suctioned
quickly with a Yankauer tip.
 Reusable Yankauer suction tips have a removable
end cap that screws on.
 This must be accounted for at the end of the
procedure. It is easily lost in a patient

 Trocar

 A trocar assembly may be needed to cut through
tissues for access to fluid or a body cavity.
 A trocar has two parts—a sharp obturator and a
sheath or a blunt obturator and sheath.
 The sharp obturator with the sheath is used to
perforate the tissues.
 When the trocar assembly is in place the obturator is
removed, leaving the sheath in position and creating
a stented tunnel for drainage of fluids, introduction
of instrumentation, or instillation of medication

 9. Dilating and Probing
Instruments

 A probe is used to explore a path in the structure or
to locate an obstruction.
 Probes are used to explore the depth of a wound or
to trace the path of a fistula.
 Probes and dilation instruments used as tunneling
devices can make a passage under the skin for a
vascular graft or shunt.

 10. Measuring instruments

 used to determine the precise size needed for an
implant, such as a joint or breast prosthesis
Uterine sound

calipers

 
HANDLING
INSTRUMENTS
 
 Abuse, misuse, inadequate cleaning or processing, or
rough handling can damage and reduce the life
expectancy of even the most durable instrument, and
the cost of repair or replacement becomes
unnecessarily high.
 Instruments do deteriorate from normal use, but
with proper care an instrument should have a life of
10 years or more.
Handling instruments before the
procedure

 SETTING UP THE INSTRUMENT TABLE

 
 1. Handle loose instruments separately to prevent
interlocking or crushing
 2. Instruments are never piled one on top of another
on an instrument table; they are laid side by side on a
rolled sterile towel.
 3.Close the box locks on the instrument to avoid
entanglement when placed on the Mayo stand.
 
 4. Inspect instruments such as scissors and forceps for
alignment, imperfections, cleanliness, and working
condition. Unclean instruments render the entire set
contaminated.
 Remove any malfunctioning instrument from the set. It
should be labeled and sent for repair. Replace it in the
set with a correctly functioning instrument before
processing. If the procedure is in process, the circulating
nurse can obtain a sterile replacement and remove the
broken instrument from the room.
 Be sure to reconcile the count sheet.
 
 5. Scalpel blades should be properly set in handles
using a heavy instrument, not fingers
 6. Teeth and serrations should align exactly.
 7. Tips should be straight and in alignment.
 8.Scissors should be sharp in action
 9. Sort instruments neatly by classifications.
 10. Keep ring-handled instruments together with the
curvatures and angles pointed in the same direction
positioned smallest to largest.
 
 11. Leave retractors and other heavy instruments in a
tray or container, or lay them out on a flat surface of
the table.
 12. Do not permit any instrument to hang over the
edge of the sterile field
 13. Protect sharp blades, edges, and tips. They
should not touch anything. Take care not to perforate
the sterile table cover.
Handling Instruments During
the Surgical Procedure

 
 1. Know the name and appropriate use of each
instrument. Using fine instruments for heavy tissue
damages the instrument.
 2. Handle instruments individually. Tangled
instruments are hard to separate in an emergency.
Instruments on the Mayo stand should be closed to
minimize fumbling for the correct item
 
 3. Hand the surgeon or assistant the correct
instrument for each particular task. Remember the
following principles:
a. Avoid placing fingers in the instrument rings as the
instrument is passed.
b. Select instruments appropriate to the location of the
surgical site; short instruments are used for
superficial work, and long ones are used for work
deep in a body cavity.
 
 c. Hand instruments around the incisional area, not
directly over it, to prevent possible injury.
 d. Knowledge of anatomy is useful for determining
which instrument is needed.
 e. Pass instruments decisively and firmly. When the
surgeon extends his or her hand, the instrument
should be slapped or placed firmly into his or her
palm in the proper position for use.
 
 Remember the following when passing an
instrument to a surgeon:
 a. If the surgeon is on the opposite side of the
operating bed, pass across right hand to right hand
(or with the left hand to a left-handed surgeon). The
curve of the instrument should match the curve of
the surgeon’s hand.
 
 b. If the surgeon or assistant is on the same side of
the operating bed and to the right, pass with your
left hand; if the surgeon or assistant is to your left,
pass with your right hand.
 c. Ring-handled instruments are held near the box
lock by the scrub person and passed by rotating the
wrist clockwise to place the handle directly into the
surgeon’s waiting hand


 
 Sharp and delicate instruments may be placed on a
flat surface for the surgeon to pick up
 4. With a moist sponge, wipe blood and organic
debris from instruments promptly after each use.
This is referred to as point of use cleaning.
 5. Flush the suction tip and tubing with sterile
distilled water periodically to keep the lumens
patent
 6. Remove debris from electrosurgical (ESU) tips to
ensure electrical contact
 
 7. Place used instruments that will not be needed
again (except sharp, cutting, delicate, or powered
instruments) into a tray or basin during or at the end
of the surgical procedure
 8. Keep instruments accessible for final counts
 Dismantling the instrument table

 The scrub person breaks down the instrument table at
the end of the surgical procedure while wearing the
gown and full PPE.
 This process may be delayed and the scrub person
and instrument table maintained as sterile for a short
time if the patient is in critical condition.
 The breakdown should not be started until a critical
patient is out of the OR and admitted to PACU
 When the scrub person is assured that the patient will
not return to the OR, the table breakdown can begin.
 
 Whether used or unused, all instruments on the
instrument table are considered contaminated and
must be promptly and properly
decontaminated/cleaned, inspected, terminally
sterilized, and prepared for subsequent use.
 Wearing gloves, a gown, a mask, and protective
eyewear, the scrub person prepares instruments for
the cleaning process. Instruments are cleaned in a
designated instrument processing area, not in the
OR.
 
 Key points in handling instruments when
dismantling the instrument table include the
following:
 1. Check drapes, towels, and table covers to be sure
that instruments do not go to the laundry or into the
trash. A final quick count is a safeguard.
 2. Collect instruments from the Mayo stand and any
other small tables, and collect those that may have
been dropped or passed off the sterile field
 
 3. Separate delicate, small instruments and those
with sharp or semisharp edges for special handling
 4. Disassemble all instruments with removable parts
to expose all surfaces for cleaning
 5. Open all hinged instruments to expose box locks
and serrations.
 
 6. Separate instruments of dissimilar metals.
Instruments of each type of metal should be cleaned
separately to prevent electrolytic deposition of other
metals.
 7. Flush cold, distilled water through hollow
instruments or channels, such as suction tips or
endoscopes, to prevent organic debris from drying.
 8. Rinse off blood and debris with demineralized
distilled water or an enzymatic detergent solution
 
 9. Follow the procedures for preparing each
instrument for decontamination or terminal
sterilization
 10. Wrap the instrument for sterilization.
 11. Sterilize the equipment
 Care and handling of general
instruments

 Alignment - examine instruments for proper
alignment such as
 Observing the jaws- For example a pair of forceps
that is equally thick and the curved jaws is bent to a
smooth even curve
 
 Serrations –
 Examine the serrations that they mesh properly and
that they are beveled at the edges of the jaws
 and that the jaws close evenly, starting at the joint
and being fully closed when the last ratchet has been
reached.
 Ratchet- The ratchet should glide smoothly over
each other, hold firmly, and open easily
 
• Teeth of forceps –
• It is important to note that teeth of all kinds of forceps
are even, of proper shape and are sharp and mesh
properly.
• There should be no sharp points or edges, which may
scratch or tear gloves
 
 Joints of instruments -The joints of instruments
should be checked.
 Instruments may have two types of joints:
 Screw joints- The joint is checked and tightened
periodically, as the screw may become loose.
 Box – joint instrument in this type one arm passes
through a slot in the other arm
 
 Apposition -The appositions of instruments, such as
clamp tips are necessary for its smooth functioning
and should be periodically checked.
 Scissors -Scissors should close smoothly and cut at
all points along the entire edge
 
Corrosion of instruments- Investigations
have revealed that damage of instruments
occur due to
Defective instruments
Incorrect handling
Use of incompatible detergents or
combination of all these factors.

 ASSIGNMENT

 1. Being a theatre technician, you are tasked with the
maintenance of instruments and equipment
A. Outline the causes of malfunctioning of theatre
instruments and equipment (8 Marks)
B. Explain how you will check for functionality of
instruments (10 Marks)
C. Elaborate the process you will follow to report
faulty instruments and equipment (6 Marks)
D. Discuss the storage of instruments and equipment
in theatre (6 Marks)
