Ch. 10- Instrumentation, Equipment, and Supplies

What blade is most frequently used and is typically loaded onto the #3 handle?

#10

What blades are typically loaded onto the #7 handle?

#11, #12, and #15

What blade is frequently used with the #3 handle for superficial procedures requiring a small incision?

#15

When would we use the #3L handle?

For use in deep surgical wounds.

What blade is almost exclusively used for a tonsillectomy?

#12

What blade is typically used for long and deep abdominal incisions?

#20

What blades can we load on #3, #7 and #9 handles?

#10, #11, #12, and #15

What blades can we load on #4 handle?

#20-#25

Which blade is used for delicate tissue?

#15

Which blade is used in scope cases?

#11

Oscillating

Side-to-Side

Reciprocating

Back-and-Forth

What motion do drills move in?

Rotary

What is the "Instrument Cycle"?

The handling of instruments' three phases: preoperative, intraoperative, and postoperative tasks.

What happens during the preoperative phase of the instrument cycle?

- Instrument set/other supplies are gathered for the planned surgical procedure according to the surgeon's preference card.

- The instrument container must be opened, and the instrument set removed from the container.

- Instruments, and other supplies, are organized and prepared for use on the back table and Mayo stand.

What happens during the intraoperative phase of the instrument cycle?

- Must be able to anticipate, or predict, the needs of the patient and surgical team members.

What happens during the postoperative phase of the instrument cycle?

- Cleaning and decontamination

- Inspection and maintenance

- Reassembly of the instrument set

- Preparation for sterilization

- Sterilization

- Storage

Why isn't titanium used often for surgical instruments?

The material is very expensive.

How is the 'Pulse Lavage Irrigator' utilized?

- To thoroughly irrigate a traumatic, infected, or surgical wound.

- Also used to clean and debride traumatic wounds.

Reasons an orthopedic surgeon would use a 'Pulse Lavage Irrigator'?

To irrigate contaminated fractures to clean out the debris and in total joint arthroplasties.

Pulse Lavage Irrigator tip designs:

Spray, shower, and single stream

Phacoemulsifier

A machine that uses ultrasonic energy (cavitation) to fragment the lens, and an irrigator/aspirator (I/A) to remove the fragments.

Cryotherapy Units

Uses liquid nitrogen, freon, or carbon dioxide gas to deliver extreme cold through an insulated probe to diseased tissues, creating necrosis without damage to adjacent tissues.

When is it useful to use cryotherapy in surgery?

Removal of vascular tumors, brain tumors, the prostate gland, & repairing retinal detachments and extracting cataracts.

Insufflation

Expansion of the abdominal cavity with gas.

Insufflator

The machine that infuses the gas into the abdominal cavity.

What instruments could potentially be inserted into the abdominal cavity for laparoscopic procedures?

Veress insufflation needle or a Hasson blunt trocar

What does insufflation do?

-Creates a space for insertion and maneuvering of an endoscope and for work within the cavity through cannulas inserted at strategic points through the abdominal wall.

What is the typical intraoperative pressure for laparoscopy?

12 to 15 mm Hg

What do nerve stimulators do?

-They produce very small electric currents that when applied to tissue, help to identify and preserve essential nerves for cranial, facial, neck, or hand reconstructive procedures.

Why are tourniquets used?

- Used on the extremities to restrict blood flow to the surgical site.

- Minimizes patient blood loss

- Visualization of the surgical site for the sterile team members is improved.

Pneumatic

Pertaining to air

Disadvantages of tourniquets-

- Neurovascular damage from incorrect cuff placement, excessive tourniquet pressure, and/or prolonged inflation.

- Improper application of the cuff may also lead to blistering, bruising, pinching, or necrosis of the skin.

Components of electrically operated pneumatic tourniquet-

- Cuff

- Tubing

- Pressure Device

- Power Source

Sequential Compression Devices

Consists of a compressor that is electrically operated, connecting tubing, and one or more sleeves that enclose that patient's limb(s).

Sequential compression devices uses?

- Prevents deep vein thrombosis (DVT); which can lead to pulmonary embolism.

- Treats edema

Characteristics of a Drape:

- Creates barrier

- Reduces SSIs

- Flame retardant

- Puncture resistance

- Fluid resistance

- Lint free

Nonwoven Fabrics-

- Disposable

- Made from compressed synthetic fibers, such as nylon or polyester bonded with cellulose

- Lightweight

- Strong

Fenestration

Opening

Woven Textile Fabrics

- Cheaper

- Impermeable to liquids

- Swell when wet

- Treated with a fluorochemical finish to further increase its fluid-repellent action

-Plastic Adhesive Drapes

- Made of a thin, clear, plastic material that has an adhesive backing and can be applied to the skin without blocking vision.

Incise Drapes

- Adhesive backing that may be impregnated with an antimicrobial iodine agent

- Iodine is slowly released after application to destroy bacteria from the patient's skin during the surgical procedure

Aperture Drapes

- Small, clear plastic drapes with openings that are surrounded by an adhesive backing

- Used to drape eyes and ears

- Allows the surgeon to view landmarks that would normally be covered.

Isolation Aperture Drapes

- Large, clear plastic drapes with an adhesive backing surrounding the fenestration

- Frequently utilized as drapes for hip pinning.

- Allow the surgeon to visualize the patient and the C-arm during fluoroscopy.

Fenestrated Drapes

- Laparotomy or "lap sheet": Abdomen

- Pediatric or "pedi" sheet: Pediatric abdomen

- Transverse lap sheet: Thorax and kidney

- Thyroid sheet: Neck, especially the thyroid

- Extremity sheet: Extremities

- Hip sheet: Hip

- Perineal sheet: Perineum

- Craniotomy sheet: Cranium

- Beach chair drape: Shoulder and arm

Sterile Packs

- General surgery: laparotomy pack; thyroidectomy pack

- Gynecological surgery: vaginal hysterectomy pack; laparoscopy pack

- Orthopedic surgery: arthroscopic pack; total hip pack

- GU surgery: TURP pack

- ENT surgery: ear pack

- Neurosurgery: craniotomy pack

- Cardiovascular surgery: CABG pack

Surgical Sponges-

- Used to absorb blood and tissue fluids

- Blunt dissection of tissues

- Protect important structures during the surgical procedure

- Soft and lint free

- Radiopaque strip

Neurosurgical sponges

- "Patties/Cottonoids"

- Protects delicate neural tissue during suctioning

- Assist with hemostasis during neurosurgical procedures.

- Radiopaque strip

- Moistened with saline before use

- 10 per pack

Tonsil Sponge

- Cotton-filled gauzes with a string attached

- Used during tonsillectomy to pack the bed after tonsil removal

- Typically loaded and passed on a Schnidt (tonsil) clamp

- 5 per pack

Kittner Dissecting Sponges

- Cylinder

- Small rolls of cotton tape

- Used to aid the surgeon in blunt dissection of tissues

- Loaded onto a clamp, such as a Rochester-Pean, for use

- ST should always have one loaded onto an instrument and 4 within the carrier

- 5 per pack

Peanut Sponges

- Round

- Small gauze sponges

- Used for blunt dissection or fluid absorption.

- Loaded onto a clamp for use

Surgical Dressings

-Protect

-Absorb

-Reduce dead space

-Prevent edema

-Aesthetics