Classification by Type of Points

8/4/2019 Classification by Type of Points

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SURGERY

Classification by type of points

All types of scissors can have blunt or sharp blades (A:

Sharp:Sharp, B: Blunt:Blunt).

All types can have either straight or curved blades.

Mayo and Metzenbaum

Mayo scissors (B) are used forcutting heavy

fascia and sutures.

Metzenbaum scissors (A) are more delicate than

Mayo scissors.


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Forceps: consist of two tines held together at one end with a spring device that

holds the tines open. Forceps can be either tissue or dressing forceps.

Dressing forceps have smooth or smoothly serrated tips.

Tissue forceps have teeth to grip tissue. Many forceps bear the name of the

originator of the design, such as Adson tissue forceps.

Rat Tooth: A Tissue Forceps

Interdigitatingteeth hold tissue

without slipping.

Used to holdskin/dense tissue.

Adson Tissue Forceps

Small serratedteeth on edge of

tips.

The Adsonstissue forceps has

delicate serrated

tips designed for

light, carefulhandling of tissue.

Intestinal Tissue Forceps: Hinged (locking) forceps used for grasping and

holding tissue.


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Allis: An Intestinal Tissue Forceps

Interdigitating

short teeth tograsp and hold

bowel or tissue.

Slightlytraumatic, use to

hold intestine,

fascia and skin.

Babcock: An Intestinal Tissue Forceps

More delicate

that Allis, lessdirectly traumatic.

Broad, flared

ends with smooth

tips.

Used toatraumatically

hold viscera

(bowel andbladder).


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Sponge Forceps

Sponge forcepscan be straight or

curved.

Sponge forcepscan have smooth

or serrated jaws.

Used toatraumatically

hold viscera

(bowel and

bladder).

Hemostatic forceps: Hinged (locking) Forceps. Many hemostaticforceps bear the name of the designer (Kelly, Holstead, Crile). They are used to

clamp and hold blood vessels.

Classification by size and shape and size of tips

Hemostatic forceps and hemostats may be curved or

straight.


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Kelly Hemostatic Forceps and Mosquito Hemostats

Both are transversely serrated.

Mosquito hemostats (A) are more delicate

than Kelly hemostatic forceps (B).

Comparison of Kelly and Mosquito tips

Mosquito hemostats (A) have a smaller, finer tip.

Carmalt

Heavier than Kelly.

Preferred forclamping

of ovarian pedicals during

an ovariohysterectomy

surgery because theserrations run

longitudinally.

Doyen Intestinal Forceps
http://cal.vet.upenn.edu/projects/surgery/1289.htmhttp://cal.vet.upenn.edu/projects/surgery/1289.htmhttp://cal.vet.upenn.edu/projects/surgery/1289.htmhttp://cal.vet.upenn.edu/projects/surgery/1289.htmhttp://cal.vet.upenn.edu/projects/surgery/1289.htm


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Doyen intestinal forceps are non-

crushing intestinal occluding

forceps with longitudinal

serrations.

Used to temporarily occlude lumenof bowel.

Payr Pylorus Clamps

Payr pylorus clamp is a crushing

intestinal instrument.

Used to occlude the end of bowel

to be resected.

Needle holder: Hinged (locking) instrument used to hold the needle while

suturing tissue.


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Good quality is ensured with tungsten carbide inserts at the tip of the needle

holder.

Mayo-Hegar

Heavy, with mildly tapered jaws.

No cutting blades.

Olsen-Hegar

Includes both needle holding jaw and scissorsblades.

The disadvantage to having blades within the

needle holder is the suture material may be

accidentally cut.

Retractors

Senn


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Blades at each

end.

Blades can beblunt (delicate) or

sharp (moretraumatic, usedfor fascia).

Hohman

Levers tissue

away from boneduring orthopedic

procedures.

SELF RETATINING FACTORS

Weitlaner

Ends can be blunt or

sharp.

Has rake tips.

Ratchet to hold


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tissue apart.

Gelpi

Has single point

tips.

Ratchet to hold

tissue apart.

SCALPEL AND BLADES

Handles


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#3 Handle

#4 Handle

Handles and Blades

Blades #10, 11, 12, 15 fit the #3 handle.

Blades #22, #23 fit the #4 handle and are commonly usedfor large animals.

Disposable Scalpel

Towel clamps secure drapes to a patient's skin. They may also be used to hold

tissue.

Backhaus Towel Clamp
http://cal.vet.upenn.edu/projects/surgery/1590.htmhttp://cal.vet.upenn.edu/projects/surgery/1590.htm


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Locking forceps with curved, pointed tips.

PROPER INSTRUMENTS HANDLING

Scissors and Hemostats:

The thumb and ring finger are inserted into the rin

of the scissors while the index and middle finger aused to guide the instrument.

The instrument should remain at the tips of the finfor maximum control.

This is the wrong way to hold thescissors. The ring finger should be

inserted into the ring.


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This is also the wrong way to hold the

scissors. The tips of the scissors shouldbe pointing upwards.

Thumb Forceps:Thumb forceps are held like a pencil.

Thumb Forceps are not called'tweezers'.

Thumb Forceps are not held like a

knife.


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Scalpels:

The scalpel is held with thumb, middle and

ring finger while the index finger is placedon the upper edge to help guide the scalpel.

Long gentle cutting strokes are less

traumatic to tissue than short choppingmotions.

The scalpel should never be used in a

"stabbing" motion.

SURGICAL HANDWASHING

1) Trimming and Cleaning Nails

Trim fingernails and clean with disposable nail

Down load video of this step.
http://cal.vet.upenn.edu/projects/surgery/images/videos/scrub1.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/scrub1.mov


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2) Initial Wash and Scrubbing Fingers

Wash for 30-60 seconds with surgical scrub.

Scrub fingers with a sterile scrub brush

Make sure to scrub all sides of each finger, includibetween fingers.


3) Scrubbing Hands and Forearms

Scrub hands and arms with a sterile scrub brush

Make sure to scrub each surface of each hand and

An accepted contact time is 10 brush strokes per


4)Rinse

Rinse hands and rescrub as in step 3.

During scrubbing, rinsing and drying, hands are he

This is done so that water will not be dripping fromlower arms and hands.

After both scrubs and rinses, total contact time shoSome surgeons do not rinse off the chlorhexidine i

residual activity.

http://cal.vet.upenn.edu/projects/surgery/images/videos/scrub2.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/scrub3.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/scrub4.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/scrub2.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/scrub3.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/scrub4.mov


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HAND DRYING AND GOWNING

A sterile towel is included within the sterile

gown pack. The towel is lifted away from the

table and folded in half lengthwise. One hand

and forearm are dried by one side of the towel.Always dry in the direction of hand to elbow so

that contamination of the upper arm is not spreadby the towel to the surgeon's hand.Down LoadVideo of Drying Hands

The second hand and forearm are then dried by the other side of the towel in

the direction of hand to elbow. The towel is then discarded away from the

surgeon, making sure that the towel doesn't contact the sterile gown.
http://cal.vet.upenn.edu/projects/surgery/images/videos/towela.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/towela.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/towela.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/towela.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/towela.mov


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All gowns are folded and packaged for sterilization with the inside exposed so

that the surgeon may handle the gown without contaminating the outside of the

gown. Grasp the exposed inside of the gown and lift the gown away from the

table.
http://cal.vet.upenn.edu/projects/surgery/2460.htmhttp://cal.vet.upenn.edu/projects/surgery/2460.htm


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Unfold the gown by placing hands into the white arm holes. Continue placing

hands and arms through the sleeves. If you are planning on closed gloving, do

not thrust hands through the cuffs. Down Load Video of Donning a Gown

An assistant fastens the neck tie and the inside waist tie.Down Load Video

Proceed with closed gloving before the fastening of the final outside tie. Once

the surgeon is gloved, the sterile left tie is grasped by the surgeon and the white

tab is handed to an assistant.
http://cal.vet.upenn.edu/projects/surgery/images/videos/gown1a.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/gown2a.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/gown1a.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/gown2a.mov


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The assistant pulls the back tie around the surgeon using the white tab. The

surgeon grasps the right tie from the white tab (not touching the now

contaminated white tab) and right and left are tied together. Down Load Video

CLOSE GLOVING

Closed gloving is performed after the surgeon has donned his/her gown,

but BEFORE the surgeon pulls his/her hands through the cuffs of the

gown.

Step 1: An assistant opens the sterile pack of gloves and drops them into the

sterile field.
http://cal.vet.upenn.edu/projects/surgery/images/videos/gown3a.movhttp://cal.vet.upenn.edu/projects/surgery/images/videos/gown3a.mov


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Step 2: Left hand (within the gown) lifts the right glove by its cuff.

Step 3: Right glove is laid on the palm of the right hand (cuff to cuff with the

gown sleeve) with fingers of the glove pointing toward the elbow and the

thumb of the glove positioned on top of the surgeon's covered right thumb.

Step 4: The inside of the cuff of the glove is grasped by the right hand (still

within the gown) and the left hand folds the cuff of the glove over the back of

the right hand.


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Step 5: The left had then pulls the cuff of the right glove and sleeve of the right

gown towards the elbow as the right hand slides into the glove. Wait to adjust

the glove until both gloves are on and sterility is ensured (left fingers may slip

out of the gown while trying to adjust the right glove prematurely).

Step 6: With the gloved right hand lift left glove by its cuff and place on palmof left hand (aligned with the cuff of the gown), with glove fingers pointing

toward the elbow and the left thumb of the glove over the covered left thumb of

surgeon.

Step 7: Left fingers (still within the gown) grasp the inside of the glove and the

right hand pulls left glove cuff over the back of the hand.


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Step 8: Pull the glove cuff and gown sleeve toward elbow as left hand slides

into the glove

Step 9: Now that both gloves are on, pull glove cuffs over gown sleeves and

adjust gloves for comfort.

Classification by Type of Points

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