Rhenier S.

Ilado RN

Classification of Instruments: A. Cutting and Dissecting cutting instruments have sharp edges. used to dissect, incise, separate or excise tissues

1. Scalpels
has reusable handle with a disposable blade a heavy hemostat or Kelly clamp is used to attach and detach, the blade

Sizes and shapes of Blades: No. 10 blade used most often

has rounded cutting edge along one side fits on nos. 3, 7, and 9 handles

No. 11 blade has straight edge that comes to a sharp point

fits on nos. 3, 7 and 9 handles

No. 12 blade shape like a hook, with the cutting edge on the inside curvature

it fits on nos. 3, 7 and 9 handles

No. 15 blade has a smaller and shorter curved cutting edge than a 10 blade

fits on 3, 7 and 9 handles

Nos. 20, 21, & 22 blades are the same shape but are larger, they

fit on no. 4 handles

No. 23 blade/No. 24 blade has a curved cutting edge that comes to more of a point than nos. 20, 21 and 22 blades

fits on a no. 4 handle

2. Scissors
blades are straight, angled or curved, as well as either pointed or blunt at the tips handles may be long or short used to cut or dissect tissues and also to cut other materials

Classifications:
A. Tissue scissors has a sharp blades
1.

Straight Mayo scissors - Used to cut suture and supplies,

2. Curved Mayo scissors - Used to cut heavy tissue (fascia, muscle, uterus, breast). Available in regular and long sizes.

3. Metzenbaum scissors - Used to cut delicate tissue. Available in regular and long sizes.

2. Suture Scissor has blunt points to prevent structures close to the suture from being cut used to cut sutures

2. Wire scissors has short, heavy blades used to cut stainless steel sutures

3.Dressings/Bandage scissors used to cut drains and dressings and to open items such as plastic packets

4. Bone Cutters and Debulking Tools used for cutting into or through bone and cartilage

a. Chisels b. Osteotomes, c. Curette has a sharp edge at the loop and scoop on the end, used to scrape tissue or bone

B. Grasping and Holding used to hold tissue, drapes or sponges

1. Tissue Forceps used to pick up or hold soft tissues and organs

Types:
a. Smooth Forceps also referred to as pick-ups

has serrations or grooved at the tip that does not injure delicate structures

b. Toothed/Thumb Forceps referred to as rat-toothed forceps has single tooth on one side that fits between two teeth on the opposing side provides a firm hold no tough tissues, including skin, fascia

Other Examples: Russian tissue forceps- used to grasp tissue

DeBakey forceps- used to grasp delicate tissue, particularly in cardiovascular surgery.

Adson pick-ups either smooth: used to grasp delicate tissue with teeth: used to grasp the skin other names: Dura forceps

2. Allis Forceps
has scissor action, each jaw curves slightly inward and there is a row of teeth at the end holds tissue gently but securely

3. Babcock Forceps
the end of each jaw is rounded to fit around a structure or to grasp tissue without injury used to grasp delicate tissue (intestine, fallopian tube, ovary).

4. Kocher
used to grasp heavy tissue and also used as clamp jaws either straight or curve other name: Oschner

5. Tenaculums
a curved or angled points on the ends of the jaws used to penetrate tissue to grasp firmly, such as when a uterine tenaculum is used to manipulate the uterus

6. Backhaus Towel Clamps

used to anchor drapes and towels other name: Towel clip

7. Foerster sponge stick

used to grasp sponges. Other names: sponge forcep

C. Clamping or Occluding
1. Hemostatic Forceps clamps used for occluding blood vessels which has two opposing serrated jaws that are stabilized by a box lock and controlled by ringed handles Parts of hemostatic forceps includes: 1. Serrated jaws 2. Box lock 3. Shank 4. Ratchets 5. Ring Handle

a. Hemostat
used to clamp blood vessels either straight or curved that taper to a fine point serrations go across the jaws aka. Crile clamp

b. Mosquito clamp
used to clamp small blood vessels or skin jaws may be straight or curved

c. Kelly clamp
used to clamp larger blood vessels and tissue Available in short and long sizes Other names: Rochester Pean

d. Right Angle
used to clamp hard-to-reach vessels and to place sutures behind or around a vessel. Other names: Mixter.

D. Exposing and Retracting

are

used to hold back or retract organs or tissue to gain exposure to the operative site

1. Handheld Retractors (manual) most retractors have blade on a handle. These blades are usually dull, but some are sharp used in pairs and they are held by the first or second assistant

Types
a. Malleable Retractors may be bent to the desired angle and depth for retraction is used to retract deep wounds - aka. Ribbon retractor

b. Deaver retractor

used to retract deep abdominal or chest incisions

c. Richardson

used to retract deep abdominal or chest incisions

d. Army Navy
used to retract shallow or superficial incisions aka US army

e. Goulet

used to retract shallow or superficial incisions

f. Volkmann Rake

used in retracting skin layers

g. Vaginal speculum

used for visualization of cervix/vagina during Pap smear or D&C

2. Self- Retaining Retractors

are holding devices with two or more blades that can be inserted to spread the edges of an incision and hold them apart have shallow or deep blades have ratchets or spring locks to keep the device open some are attached to the operating bed for stability

Types
1. Weitlaner used to retract shallow incisions

2. Gelpi retractor

used to retract shallow incisions

3. Balfour with bladder blade retractor

used to retract wound edges during deep abdominal procedure used during laparotomy

E. Suturing
1. Needle Holders used to grasp and hold curved surgical needles most needle holders resemble hemostatic forceps but the basic difference is the jaws. the size of the needle holder should match the size of the needle (i.e. heavy jaws for large needles and slim jaws for small needles)

Handling Instruments during Surgical Procedure

1. Know the name and appropriate use 2. Handle instrument individually 3. Handle the surgeon or assistant the correct instrument 4.Pass instruments firmly 5. Watch out for loose instruments

6. With a moist sponge, wipe blood and organic debris from instrument after use 7. Placed used instrument into a tray at the end of the surgical procedure

Thank You For Listening!