Maintenance of Operation Theatre Instruments and Apparatus Study Guide
Unit Description and Learning Outcomes
Unit Overview: This unit focuses on the competencies required for the maintenance of Operation Theatre (OT) instruments and apparatus. It emphasizes necessary precautions to prevent breakage, accidents, and infection within the specialized OT setting. Additionally, it covers the general repair of these instruments.
Summary of Learning Outcomes:
Preparation for the disassembly and assembly of Perioperation Theatre instruments.
Checking and assembling Perioperation Theatre instruments.
Packing and sterilizing Perioperation Theatre instruments.
Storage of Operation Theatre instruments and apparatus.
Evaluation of the care provided to instruments and apparatus within the Perioperation Theatre.
Definition of Key Terms in Surgical Instrumentation
Alloy: A combination of several different kinds of metals used specifically in the manufacture of stainless steel.
Box Lock: The hinge point of many surgical instruments.
Chisel: An orthopedic instrument used to slice bone; characterized by having one straight side and one beveled side.
Curettage: The process of removing tissue by scraping with a surgical curette.
Dilator: A graduated, smooth instrument used to increase the diameter of an anatomical opening in tissue.
Double-action Rongeur: A bone-cutting instrument featuring two hinges in the middle to increase leverage and strength.
Elevator: A straight instrument with a curved sharp or dull tip used to separate tissue layers, such as the periosteum from the bone.
Gouge: A specialized V-shaped bone chisel.
Hemostat: A surgical clamp used most frequently to occlude blood vessels.
Rongeur: A hinged instrument with sharp, cup-shaped tips used to extract pieces of bone or connective tissue.
Serosa: The delicate outer layer of tissue covering most organs.
Anodized: A process where an instrument is exposed to conditions that create an oxide coating; this makes it relatively impenetrable to atmospheric oxygen and reduces light reflections.
Atraumatic: A term meaning "without injury."
Crushing: The destructive effect caused by specific instruments, such as crushing clamps used in certain procedures.
Cutting: Separating tissue using a sharp instrument or device.
Debulking: The process of decreasing mass or volume using an instrument or device.
Dilation: Enlarging an opening in a progressive manner.
Dissection: The process of separating tissues through anatomic planes using sharp or blunt instrumentation.
Evacuating: Emptying a cavity or space.
Grasping: Holding tissue in either a traumatic or atraumatic manner.
Instillation: The slow introduction of fluid into a cavity or space.
Occlusion: The permanent or temporary closing of a lumen for procedural purposes.
Percutaneous: Entering directly through the skin without an incision.
Retraction: The act of stabilizing a tissue layer in a safe position to expose a specific part; retractors can be manual (hand-held) or self-retaining.
Shank: The area of a surgical instrument located between the box lock and the finger ring.
Single-action Rongeur: A heavy cutting instrument featuring a single hinge.
Tenaculum: A grasping instrument with sharp pointed tips, used to manipulate or grasp tissue like the thyroid or cervix.
Categorization and Classification of Surgical Instruments
Purpose: Instruments act as an extension of the practitioner’s hands, allowing for the dissection, resection, or alteration of tissues while controlling bleeding.
Functional Categories: All surgical instruments are classified into nine primary categories based on their function:
Cutting and Dissecting
Clamping and Occluding
Grasping and Holding
Dilating and Probing
Exposing and Retracting
Aspirating and Suctioning
Stapling and Suturing
Viewing
Accessory instruments
Cutting and Dissecting Instruments
General Use: These are used to cut, separate, incise, dissect, or excise soft or compact tissue using various edges.
Types of Dissection:
Sharp: Instruments with sharp edges (e.g., scalpels, Iris scissors, curettes). These must be kept separate during cleaning and sterilization to prevent injury to staff and damage to the edges.
Blunt: Used for separating planes without cutting.
Scalpels:
Commonly consist of a reusable handle (usually brass) and a disposable blade (carbon steel).
Attachment: Blades are slipped into grooves on the handle using a heavy hemostat (like a Kelly clamp), never fingers.
Note: Needle holders should not be used to load blades as the torque can misalign their jaws.
Knives: Various sizes and configurations, often double-edged and designed for specific tasks (e.g., a cataract knife).
Scissors: High-quality instruments with two pivoting blades.
Mayo Scissors: Used for tough tissues (fascia, tendons); straight or curved with blunt tips.
Metzenbaum Scissors: Used for delicate soft tissues; long, thin blades.
Operating Scissors: General-purpose cutting of muscles and soft tissues.
Iris Scissors: Small, sharp blades for fine procedures (microsurgery, dermatology).
Tenotomy Scissors: Fine, sharp tips for precision cutting of nerves.
Bandage Scissors: Feature a blunt lower blade to protect the skin while removing dressings.
Suture Scissors: Short blades with one serrated edge to grip sutures.
Wire Scissors: Short, heavy, serrated blades for cutting stainless steel sutures.
Cutters and Saws: Used for bone and cartilage. Examples include rib cutters, drills, and powered reamers.
Debulking Instruments: Designed to remove large amounts of tissue (e.g., tumor removal or biopsy). Includes curettes, snares, and microdebriders.
Grasping and Holding Instruments
Forceps (Pick-ups): Hinged handheld instruments. Some lack ring handles (pick-ups) and can be toothed or smooth.
Specific Types:
Adson Forceps: Used for soft tissue approximation during closure; available in toothed or smooth finishes.
Bayonet (Angled) Forceps: Angled to prevent the user’s hand from blocking the view in small spaces.
Tissue Forceps (Thumb/Smooth): Tapered with serrated tips; atraumatic.
Allis Forceps: Ringed handles with ratchets; jaws curve inward with a row of teeth for secure grasping.
Babcock Forceps: Rounded, circumferentially fenestrated (perforated) jaws to hold tubular structures like fallopian tubes without injury.
Lahey Forceps: Sharp apposing points for grasping tough organs or tumors.
Stone Forceps: Blunt loops or cups without ratchets, used for removing kidney stones or gallstones.
Tenaculum: Single or multiple teeth that penetrate tissue for a firm grip (e.g., uterine tenaculum).
Sponge Holding Forceps: Designed to hold sponges/swabs.
Towel Clips/Clamps: Used for securing drapes or suction lines (e.g., Backhaus or Doyen’s towel clips).
Needle Holders: Feature a clamping mechanism to lock surgical needles in place during suturing.
Lane Tissue Forceps: Used for tough tissues like fascia or cartilage.
Clamping and Occluding Instruments
General Use: Used to apply pressure to structures.
Traumatic (Crushing) Clamps: Designed to crush the structure, which is then removed or sealed (e.g., via electrocoagulation).
Atraumatic (Non-crushing) Clamps: Used for temporary occlusion of bowels or blood vessels to minimize trauma.
Hemostats (Artery Forceps): Primarily used to clamp blood vessels. Generally have ringed handles and ratchets.
Mosquito Forceps: Small, delicate, with transverse serrations for small vessels.
Kelly Forceps: Larger; serrated only on the distal half of the jaws.
Crile Forceps: Similar to Kelly but serrated for the entire jaw length.
Kocher Forceps: Strong, serrated jaws with teeth at the tip for a firm grip on heavy tissues.
Retracting and Exposing Instruments
Purpose: To pull aside soft tissues/muscles to provide visibility of the surgical site. To minimize trauma, their position must be changed frequently.
Hand-held (Manual) Retractors:
Senn: Double-ended; used for surface tissue in plastic or neck surgeries.
Army-Navy: Used for shallow or superficial incisions.
Ribbon (Malleable): Can be bent to various shapes for deep wounds.
Hohmann: Used in orthopedics to expose bone.
Farabeuf: General-purpose, used in dentistry or hernia repair.
Deaver: Used for deep abdominal or chest incisions (e.g., cholecystectomy).
Richardson: One of the most common retractors for holding back deep tissue layers.
Meyerding: Handheld for pulling back muscle in spinal/neurosurgical procedures.
Langenbeck: Used to separate tissue edges.
Volkman: Used in small bone and joint procedures.
Self-Retaining Retractors:
Weitlaner: Used in plastic and joint procedures.
Balfour: Large retractor for deep abdominal procedures like Cesarean sections.
Finochietto Rib Retractor: A rib spreader for thoracic/cardiovascular surgery.
Gelpi: Used for shallow incisions, common in knee and spine surgery.
Bookwalter: Used to hold back ends of incisions in the chest or abdomen.
Jennings Mouth Gag: Self-retaining tool for tonsillectomies to hold the mouth open.
Aspirating and Suctioning Instruments
Mechanism: Application of negative pressure to evacuate blood or fluids. Tips are attached to sterile tubing.
Suction Tips:
Yankauer (Tonsil) Tip: Hollow tube with an angled shaft and perforated round-ball tip. Used for large quantities of fluid.
Poole Abdominal Tip: Straight tube with a perforated outer filter shield to prevent tissue from being sucked in during laparotomy.
Frazier Suction Tip: Right-angle, small diameter tube for brain, spinal, or orthopedic work. The vacuum is controlled by a hole covered by the user’s thumb.
Dilating and Probing Instruments
Probes: Used to enter natural openings (bile ducts), trace fistulas, or explore wound depth.
Examples: Lacrimal probes, Common duct probes.
Dilators: Gradually expand narrow passages or orifices.
Examples: Uterine dilators (Hegar and Hank), Vessel dilators, Tracheal dilators.
Trocars: A combination of a sharp stylet and a cannula used to create artificial access points.
Viewing Instruments
Endoscopes: Long, flexible tubes with a light and camera to visualize the interior of hollow organs.
Specula: Used to illuminate and expand cavities (e.g., Nasal specula, Vaginal specula).
Stapling and Suturing Instruments
Classification of Sutures:
Absorbable: Digested by body enzymes. Examples: Catgut (natural), Polydioxanone (PDS), Poliglecaprone (Monocryl), Polyglactin (Vicryl).
Non-absorbable: Must be removed or left in permanently. Examples: Nylon, Polypropylene (Prolene), Silk, Polyester (Ethibond).
Suture Structure:
Monofilament: Single thread; lower infection risk but harder to handle.
Multifilament (Braided): Several filaments twisted together; easier knot security but can harbor bacteria.
Suture Size: Measured such that larger numbers indicate smaller diameters (e.g., is smaller than ).
Surgical Needles:
Anatomy: Consists of the Swaged end (points to suture), Needle Body (shaft), and Needle Point.
Point Geometry:
Round Bodied: Spreads tissue (liver, kidney) rather than cutting it.
Cutting: Triangular; 3 cutting edges for tough tissue like skin.
Reverse Cutting: Triangular with the cutting edge on the outer (convex) curve; reduces risk of cutting through tissue.
Blunt: Used for abdominal wall closure in friable tissue to reduce needlestick injury risk.
Needle Shape: Described by the proportion of a circle ().
Staplers: Skin staplers are used for external closure; staple removers are used once healing is sufficient.
Tools for Assembly and Maintenance
General Tools: Screwdrivers (Flat-head, Phillips, Torx), wrenches, pliers, pry bars, extractors, and pullers.
Complex Tools:
Torque Wrenches: Ensure precise tightening specifications.
Impact Wrenches: For high torque requirements.
Induction Heating: For installing or removing cylindrical bearings.
Operation Theatre (OT) Practices
Core Aims: Prevent infection, maintain a sterile field, and manage equipment/personnel.
Operational Standards:
Environment: Temperature between ; Relative Humidity between .
Infrastructure: Earth-connected semi-conducting floors; smooth, crack-free surfaces.
Safety: Proper PPE (masks, caps, gowns, gloves), sterile draping, and hand hygiene.
Management: Regular microbiological monitoring of air and surfaces; strict waste management (sharps and infectious materials).
Inspection and Establishing Working Conditions
Proactive Checking: Instruments should be inspected during preparation or after disinfection.
Inspection Factors:
Mechanical Damage: Look for surface defects, pitting, or cracks.
Sharpness: Test scissors by cutting through a surgical glove (should be no resistance).
Alignment: Hinged instrument tips should meet perfectly; joints should move smoothly.
Center Screws: Should be snug but not tight; worn screws must be addressed.
Referral of Faulty Equipment and Apparatus
Safety Protocol: Defective equipment must be taken out of service, disinfected, and clearly labeled to prevent accidental use.
Standard Operating Procedure (SOP) Requirements:
Specific disinfection procedures.
Labeling requirements (indicating both the defect and disinfection status).
Appropriate packaging for transport to prevent further damage.
Validation: Repaired equipment must be validated (tested against predefined performance requirements) before returning to service.
Documentation: Records of maintenance and validation must be signed and archived by an Equipment Officer in the equipment file.
Questions & Discussion
Question/Note on Exam Content: The transcript emphasizes a thorough review of safety practices regarding machines like anesthetic, X-ray, and Diathermy machines, as these will be included in the exam.