Periop nursing july2011 part 2 equipment
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Perioperative Equipment
Prepared by:
Ronivin Garcia Pagtakhan
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BOXLOCK
JAWS
SHANK
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RATCHET
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Scissors
• All types of scissors can have blunt or sharp blades
• (A: Sharp:Sharp, B: Blunt:Blunt).
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• Mayo and Metzenbaum
• Mayo scissors (B) are used for cutting heavy fascia and sutures.
• Metzenbaum scissors (A) are more delicate than Mayo scissors.
• Metzenbaum scissors are used to cut delicate tissues.
• Metzenbaum scissors have a longer handle to blade ratio.
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• All types can have either straight or curved blades.
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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.
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• Rat Tooth: A Tissue Forceps
• Interdigitating teeth hold tissue without slipping.
• Used to hold skin/dense tissue.
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• Adson Tissue Forceps
• Small serrated teeth on edge of tips.
• The Adsons tissue forceps has delicate serrated tips designed for light, careful handling of tissue.
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• Intestinal Tissue Forceps: Hinged (locking) forceps used for grasping and holding tissue.
• Allis: An Intestinal Tissue Forceps
• Interdigitating short teeth to grasp and hold bowel or tissue.
• Slightly traumatic, use to hold intestine, fascia and skin.
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• Babcock: An Intestinal Tissue Forceps
• More delicate that Allis, less directly traumatic.
• Broad, flared ends with smooth tips.
• Used to atraumatically hold viscera (bowel and bladder).
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• Sponge Forceps
• Sponge forceps can be straight or curved.
• Sponge forceps can have smooth or serrated jaws.
• Used to atraumatically hold viscera (bowel and bladder).
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• Hemostatic forceps: Hinged (locking) Forceps. Many hemostatic forceps bear the name of the designer (Kelly, Holstead, Crile). They are used to clamp and hold blood vessels.
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• 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).
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• Comparison of Kelly and Mosquito tips
• Mosquito hemostats (A) have a smaller, finer tip.
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• Carmalt
• Heavier than Kelly.
• Preferred for clamping of ovarian pedicals during an ovariohysterectomy surgery because the serrations run longitudinally.
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• Doyen Intestinal Forceps
• Doyen intestinal forceps are non-crushing intestinal occluding forceps with longitudinal serrations.
• Used to temporarily occlude lumen of bowel.
•
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• Payr Pylorus Clamps
• Payr pylorus clamp is a crushing intestinal instrument.
• Used to occlude the end of bowel to be resected.
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• Needle holder: Hinged (locking) instrument used to hold the needle while suturing tissue.
• 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.
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• Olsen-Hegar
• Includes both needle holding jaw and scissors blades.
• The disadvantage to having blades within the needle holder is the suture material may be accidentally cut
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• Senn
• Blades at each end.
• Blades can be blunt (delicate) or sharp (more traumatic, used for fascia).
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• Hohman
• Levers tissue away from bone during orthopedic procedures.
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• Weitlaner
• Ends can be blunt or sharp.
• Has rake tips.
• Ratchet to hold tissue apart.
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• Gelpi
• Has single point tips.
• Ratchet to hold tissue apart.
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• Handles
• #3 Handle
• #4 Handle
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• Handles and Blades
• Blades #10, 11, 12, 15 fit the #3 handle.
• Blades #22, #23 fit the #4 handle and are commonly used for large animals.
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• Disposable Scalpel
• Towel clamps secure drapes to a patient's skin. They may also be used to hold tissue.
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• Backhaus Towel Clamp
• Locking forceps with curved, pointed tips.
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TECHNIQUES IN USING SURGICAL EQUIPMENT
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• Scissors and Hemostats: • The thumb and ring finger
are inserted into the rings of the scissors while the index and middle finger are used to guide the instrument.
• The instrument should remain at the tips of the fingers for maximum control.
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• This is the wrong way to hold the scissors. 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 should be pointing upwards.
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• Thumb Forceps:
• Thumb forceps are held like a pencil.
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• 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 placed on the upper edge to help guide the scalpel.
• Long gentle cutting strokes are less traumatic to tissue than short chopping motions.
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Ways to sterilization:
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Autoclave
• An autoclave is a self locking machine that sterilizes with steam under pressure.
• Sterilization is achieved by the high temperature that steam under pressure can reach.
• The high pressure also ensures saturation of wrapped surgical packs.
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Autoclave
Settings
Temperature
(F)
Pressure
(PSI) Time (min)
General
Wrapped
Items
250 20 30
Bottled
Solutions 250 20 30
'Flashing' 270 30 4-7
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Preparation for sterilization
• All instruments must be double wrapped in linen or special paper or placed in a special metal box equipped with a filter before sterilization.
• 'Flashing' is when an instrument is autoclaved unwrapped for a shorter period of time. 'Flashing' is often used when a critical instrument is dropped.
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• Color Change Sterilization Indicators
• The white stripes on the tape change to black when the appropriate conditions (temperature) have been met.
• Indicators should be on the inside and outside of equipment pack.
• Expiration dates should be printed on all equipment packs.
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• Biological sterilization indicators contain spores that are supplied in closed containers and are included with the instrument being autoclaved. Inability to culture the spores after autoclaving confirms adequate sterilization. Biological indicators are the most accurate sterilization indicators.
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Ethylene Oxide Sterilization: ETO Gas
• Large Two-Chamber EtO Sterilizer
• Colorless gas, very toxic and flammable.
• Requires special equipment • Odor similar to ether. • Used for heat sensitive
instruments: plastics, suture material, lenses and finely sharpened instruments.
• Materials must be well aerated after sterilization.
• Materials/instruments must be dry.
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Cold (Chemical) Sterilization
• Instruments must be dry before immersion.
• Glutaraldehyde (Cidex) is the most common disinfectant.
• 3 hours exposure time is needed to destroy spores.
• Glutaraldehyde is bactericidal, fungicidal, viricidal, and sporicidal.
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Radiation Sterilization
• High energy ionizing radiation destroys microorganisms and is used to sterilize prepacked surgical equipment.
• Used for instruments that can't be sterilized by heat or chemicals.
• Common sources of radiation include electron beam and Cobalt-60
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SPECIFIC THERAPEUTIC POSITION
• HIGH FOWLERS-60-90’ • FOWLER-45-60’ • SEMI-FOWLERS-30-45’ • LOW-FOWLERS-15-30’ • SUPINE • DORSAL RECUMBENT • LITHOTOMY • SIMS LATERAL • PRONE • KNEE-CHEST • SIDE-LATERAL • ORTHOPNEIC • TRENDELENBURG • MODIFIED TRENDELENBURG
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Autograft After surgery, site is
immobilized: 3-7 days
Burns of face & head Elevate head of bed
Circumferential burns of
extremities
Elevate extremities above the
level of the heart
Skin graft Elevate & immobilize graft site
Avoid weight bearing
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Hypophysectomy Elevate the head
Thyroidectomy Place in Semi-Fowlers
Sandbags or pillows may
be used to support the
head or neck.
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Mastectomy Head of bed elevated at
least 30 0 (Semi-Fowlers)
w/ affected arm elevated
on a pillow
Turn only to the back &
unaffected side.
Perineal &
vaginal
procedures
Place on lithotomy post
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Hemorrhoidectomy Assist to a lateral (side-
lying) post
Gastroesophageal reflux Reverse Trendelenburg’s
post may be prescribed
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Liver biopsy DURING:
Supine, w/ right side of upper
abd exposed
Right arm is raised &
extended over the left shoulder
behind the head
AFTER:
Assist to a lateral (side-lying) post
Place a small pillow or folded
towel under he puncture site for at
least 3 0 to provide pressure to the
site & prevent bleeding
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Bronchoscopy
postop
Place in Semi-Fowlers post (to
prevent choking or aspiration
resulting from impaired ability
to swallow)
Laryngectomy
(radical neck
dissection)
Place in Semi-Fowlers or
Fowler’s post (to maintain a
patent airway & minimize
edema)
1.Sengstaken-
Blakemore (3
lumen) &
Minnesota tubes
( 4 lumen)
Maintain elevation of the head
of bed
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Thoracentesis sitting on the edge of the bed
& leaning fwd over the
bedside table, w/ feet
supported on a stool, or lying
in bed on the unaffected side
w/ head of the bed elevated
about 45 0 Fowler’s post
Thoracotomy Lateral, unaffected side
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Abd aneurysm
resection
After surgery, limit elevation of the
head to 45 0 Fowler’s post (to avoid
flexion of the graft)
May be turn from side to side
Amputation of
lower extremity
1st 24 0 after amputation, elevate foot of
the bed
Consult physician & put in prone post
2x/day for a 20-3o min period
Arterial vascular
grafting of an
extremity
Bed rest is maintained for 24 0,&
affected extremity is kept straight.
Limit movt & avoid flexion of the hip &
knee
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Cardiac
catherization
If femoral artery was used, maintain
on bed rest for 3-4 0; client may turn
from side to side
Affected extremity is kept straight &
head is elevated no > 30 0 until
hemostasis is adequately achieved.
1. CHF & pulmonary
edema
Post upright, preferably w/ legs dangling
over the side of the bed
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Peripheral arterial disease Obtain physicians order for positioning
Because swelling can prevent arterial blood flow,
advise to elevate feet at rest, but not raise legs
above the level of the heart (extreme elevation
slows blood flow), some are advised to maintain a
slightly dependent post (to promote perfusion)
DVT If extremity is red, edematous & painful &
traditional heparin therapy is initiated, bed rest w/
leg elevation may be prescribed
If receiving low-molecular-weight heparin,
usually can be out-of-bed after 24 0 if pain level
permits.
Varicose veins Leg elevation above heart level; minimized prolonged
sitting or standing during daily activities
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1. Cataract surgery Post-op: elevate head of bed
(Semi-Fowlers or Fowler’s) post
on the back or the non-operative
side (to prevent the devt of edema
at the operative site)
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1. Retinal
detachment/
If detachment is large, bedrest &
bilateral eye patching may be
prescribed (to minimize eye movt &
prevent extension of the detachment)
Restrictions in activity & post ff a
repair of detachments depends on
the physician’s preference &
surgical procedure performed
If gas bubble has been injected to
flatten the retina & reinforce
repair, post so that the gas rises in
the eye & presses against the repair
(usually face down or angled toward
the unoperative site)
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1. Autonomic dysreflexia Elevate head of bed to High
Fowler’s post (to adequate
ventilation & assist in the
prevention of HPN stroke)
1. Cerebral aneurysm Bed rest is maintained w/ the
head of the bed elevated 30-45 0 Semi-Fowlers or Fowler’s
post (to prevent pressure on
the aneurysm site)
1. Cerebral angiography Maintain bed rest for
12-24 0 as prescribed
The extremity into w/c
the contrast medium is
injected is kept straight
& immobilized for 8 0
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1. CVA W/ hemorrhagic stroke, head of bed is
elevated to 30 0 (to reduce ICP & facilitate
venous drainage)
W/ ischemic stroke, head of bed is kept flat
Maintain head in midline, neutral post (to
facilitate venous drainage from the head)
Avoid extreme hip & neck flexion (extreme
hip flexion may increase intrathoracic
pressure; extreme neck flexion prohibits
venous drainage from the brain)
1. Craniotomy Don’t post on the operated site, esp if the bone
flap has been removed (because the brain has
no bony covering on the affected site)
Elevate head of bed to 30-45 0 Semi-Fowlers
or Fowler’s post & maintain head in midline,
neutral post (to facilitate venous drainage
from the head)
Avoid extreme hip & neck flexion
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1. Laminectomy
- surgical cutting
into the
backbone to
obtain access
into the spinal
cord.
Logroll the client
When out of bed, back is kept straight
(placed in straight-backed chair) w/
feet resting comfortably on the floor
1. ICP Elevate head of bed to 30-45 0 Semi-
Fowlers or Fowler’s post & maintain
head in midline, neutral post (to
facilitate venous drainage from the
head)
Avoid extreme hip & neck flexion
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1. Lumbar puncture DURING:
Assist to a lateral (side-lying) post,
w/ back bowed at the edge of the
examining table, knees flexed upto
abd, & head bent so that chin is
resting on the chest.
AFTER:
Place in supine post for 4-12 0 as
prescribed
1. Myelogram postop If water soluble dye is used, head of
bed is elevated to 30-60 0 for 12 0 (to
keep the dye from irritating the
cerebral meninges)
If oil-based dye is used, a supine post
for several hours after the dye has
been removed (to prevent leakage of
CSF)
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Spinal cord injury/ Immobilize on spinal
backboard, w/ head in
neutral post (to
prevent complete
injury from becoming
complete)
Prevent head flexion,
rotation or extension;
head is immobilized
w/ a firm, padded
cervical collar.
Logroll the client; no
part of the body
should be twisted or
turned nor allowed to
assume a sitting post.
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Total hip
replacement
Post depends on surgical technique
used, method of implantation &
prosthesis
Avoid extreme internal & external
rotation
Avoid adduction
Maintain abduction when in supine
post on the unoperative side
Check physician’s order re
elevation of head of bed; flexion is
usually limited: 60 0 : 1st post-op
week
90 0 : 2-3 mos thereafter
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• Thank you!!!!