Surgical Instrumentation

Chapter 11

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

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

Central Service Technicians…

…are responsible for the quality of instrument

Martensitic (400 Series)Stainless Steel

Hard, used when sharp cutting edges are needed

Often used for scissors, osteotomes, chisels, hemostatic forceps, and needleholders

Austenitic (300 Series)Stainless Steel

Highly Corrosion Resistant

Not as hard as 400 Series

Used for retractors, cannulas, rib spreaders, suction devices

Instrument Manufacturing Forging Grinding and Milling Assembly Heat Tempering Polishing Passivation Final Inspection Etching

Note: Instruments are inspected throughout their manufacturing process

Passivation

A chemical process applied during instrument manufacture that provides a corrosion-resistant finish by forming

a thin transparent oxide film

Instrument Finishes The instrument on the

left has a matte, or satin-finish

The instrument on the right has a shiny, or mirror finish

Overview of Surgical Instruments

Pages 178 – 187 provide an overview of basic surgical instruments along with tips and techniques for proper inspection

Post-Ooperative Care of Surgical Instruments

Keep instruments moist

Transport to Central Service for cleaning as soon as possible

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

Surgical Sharps Testing

Scissors Guidelines NEVER use them

to cut other products

Protect Blades

Test Between Uses

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

Bone Cutters

Test with an Index Card

Rongeur Testing Kerrison, Laminectomy

and Double Action Rongeurs should be tested using a 3” x 5” index card

Look for clean bites

Curettes, Chisels, and Osteotomes

Test each using a plastic dowel rod

Each should shave off pieces of the rod

Instrument Identification Procedures

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

Acid Etching

Process that uses a stencil, solution and electricity to

mark and instrument

Heat-fused Nylon

A process that leaves a thin color-coded layer on nylon

on an instrument

Laser Etching

Permanent marking method done by instrument

manufacturers and repair vendors

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

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