Surgical instruments, drains & catheters
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Transcript of Surgical instruments, drains & catheters
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Surgical Instruments
Prof. Dr. Ram Sharan Mehta
1Prof. Dr. RS Mehta, BPKIHS
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Objectives
Describe various surgical instruments
Discuss the names of various surgical instruments
2Prof. Dr. RS Mehta, BPKIHS
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Perform surgical procedures Chosen based on action These tools are used for
Holding Pulling Clamping Cutting Crushing Closing a wound
3Prof. Dr. RS Mehta, BPKIHS
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Definitions
Excision – removal of tissues by surgical cuts Ecraseur – an instrument that permits
excision by a crushing action Incision – surgical cut made into a tissue of
organ Cannula – a tube that is inserted into a body
cavity for drainage of fluid
4Prof. Dr. RS Mehta, BPKIHS
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Surgical Instruments I• Forceps: for compressing or grasping tissue. Thumb
forceps and hemostats are typical forceps. Hemostats aid in compressing tissue, especially blood vessels, to stop bleeding (hemostasis).
• Needle holders: hemostat-like devices that hold needles used to suture wounds closed.
• Needles: permanently attached suture material = swaged-on. Tip may be blunt, tapered, sharp, cutting, or some other configuration
• Scalpel handle and blades: size 10 blade most popular, 11 has a straight edge and a sharp point.15 has a very small cutting edge, used for fine, delicate surgery(e.g. eye). 20 is similar to 10 but larger. 5Prof. Dr. RS Mehta, BPKIHS
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Surgical Instruments II• Scissors: blunt-blunt, blunt-sharp, or sharp-sharp. They
may also be straight or curved. Some scissors are serrated for cutting thick bandages or cartilage.
• Retractors: pull overlying tissue away from the surgical site. Hand-held retractors and self-retaining
• Suture materials: thickest suture is given the number 6. • <6 = smaller diameter. • Sutures having smaller diameter indicated by 0 (“aught”) smallest
suture is designated 12-0 (twelve-aught). • Synthetic = nylon, or natural = silk or gut. • Some absorbed by the body during the healing process, nylon
removed after wound heals, usually in 7–10 days.
• Gauze pads: sponges used for soaking up blood and other fluids from the surgical site. 6Prof. Dr. RS Mehta, BPKIHS
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Scissors Four different types
Utility Suture Surgical Dissecting
SCISSORSTYPES- ACCORDING TO CURVATURE- straight, curved or angled “ “ USE - Dressing, stitch removal, tissue “ “ the Tip - sharp or blunt
7Prof. Dr. RS Mehta, BPKIHS
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Utility Cut material that may dull the blade
8Prof. Dr. RS Mehta, BPKIHS
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Suture Remove sutures Type of utility
9Prof. Dr. RS Mehta, BPKIHS
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Operating Surgical Cut soft tissue Different sizes Blade can be straight, curved, blunt or pointed
10Prof. Dr. RS Mehta, BPKIHS
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Dissecting Separate and differentiate tissues
11Prof. Dr. RS Mehta, BPKIHS
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Forceps Three Types
Thumb forceps Clamping forceps Needle holders
Look like tweezers
12Prof. Dr. RS Mehta, BPKIHS
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Thumb forceps Used for
Grasping Compressing Cutting Pulling tissue
13Prof. Dr. RS Mehta, BPKIHS
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Clamping forceps Hemostats Control blood flow
14Prof. Dr. RS Mehta, BPKIHS
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Needle holders Locking forceps Similar to hemostats Holds suture needles when installing stitches
15Prof. Dr. RS Mehta, BPKIHS
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Scalpels Very sharp knife Handle and blade are packaged separately Used to make surgical cuts called incisions Different sizes and styles Tenotome- dissecting scalpel used for fine
dissection and cutting or dividing tendons
16Prof. Dr. RS Mehta, BPKIHS
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KNIVES
Interchangeable handles and bladesNo 3 handle for # 15 blade – for small incisionsAnd #11 blade – i& d of abscessesN04 handle for #24 etc for larger incisions
17Prof. Dr. RS Mehta, BPKIHS
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Tubes Cannula Wound healing Different lengths Types
Trocar Catheters
18Prof. Dr. RS Mehta, BPKIHS
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Trocar Release fluid or gas build-ups Sharp stylet inside cannula
19Prof. Dr. RS Mehta, BPKIHS
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Catheters Either metal or rubber Inserted into body structures
20Prof. Dr. RS Mehta, BPKIHS
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Surgical instruments
21Prof. Dr. RS Mehta, BPKIHS
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Scalpels
Bard-Parker Small Handles:
#3
Scalpels
22Prof. Dr. RS Mehta, BPKIHS
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Scalpels
Bard-Parker Small Handles:
#7
23Prof. Dr. RS Mehta, BPKIHS
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Scalpels
Bard-Parker Small Handles:
#9 (round)24Prof. Dr. RS Mehta, BPKIHS
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Scalpels
Bard-Parker Large Handles:
#4
25Prof. Dr. RS Mehta, BPKIHS
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Scalpels
Blades:
26Prof. Dr. RS Mehta, BPKIHS
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Scissors
Mayo
Curved:
Straight:27Prof. Dr. RS Mehta, BPKIHS
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Scissors Metzenbaum
Curved:
Straight:28Prof. Dr. RS Mehta, BPKIHS
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Scissors
Suture Scissors:
29Prof. Dr. RS Mehta, BPKIHS
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Scissors
Lister Bandage Scissors:
30Prof. Dr. RS Mehta, BPKIHS
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Thumb Forceps
31Prof. Dr. RS Mehta, BPKIHS
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Thumb Forceps
Adson:
32Prof. Dr. RS Mehta, BPKIHS
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Thumb Forceps
Adson-Brown:
33Prof. Dr. RS Mehta, BPKIHS
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Thumb Forceps
DeBakey:
34Prof. Dr. RS Mehta, BPKIHS
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Thumb Forceps
Russian:
35Prof. Dr. RS Mehta, BPKIHS
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Needle Holders
Mayo-Hagar:
36Prof. Dr. RS Mehta, BPKIHS
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Needle Holders
Olsen-Hagar:
The ones with built-in scissors37Prof. Dr. RS Mehta, BPKIHS
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Needle Holders
Castroviejo:
38Prof. Dr. RS Mehta, BPKIHS
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Hemostatic Forceps
Halsted Mosquito:
We have the curved ones!39Prof. Dr. RS Mehta, BPKIHS
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Hemostatic Forceps
Kelly:
40Prof. Dr. RS Mehta, BPKIHS
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Hemostatic Forceps
Crile:
41Prof. Dr. RS Mehta, BPKIHS
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Hemostatic Forceps
Rochester-Carmalt:
42Prof. Dr. RS Mehta, BPKIHS
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Hemostatic Forceps
Satinsky:
• cardiovascular • allow occlusion of only a portion of vessel
43Prof. Dr. RS Mehta, BPKIHS
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Hemostatic Forceps
Oschner:
44Prof. Dr. RS Mehta, BPKIHS
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Tissue Forceps
Allis:
45Prof. Dr. RS Mehta, BPKIHS
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Tissue Forceps
Babcock:
46Prof. Dr. RS Mehta, BPKIHS
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Tissue Forceps
Doyen: Intestinal
47Prof. Dr. RS Mehta, BPKIHS
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Other Forceps
48Prof. Dr. RS Mehta, BPKIHS
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Forceps
Vulsellum:
49Prof. Dr. RS Mehta, BPKIHS
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Forceps
Alligator:
50Prof. Dr. RS Mehta, BPKIHS
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Forceps
Serrefine (Bulldog Clamp):
Used for temporary occlusion of medium sized vessels
51Prof. Dr. RS Mehta, BPKIHS
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Towel Clamps Backhaus:
Drape to skin
52Prof. Dr. RS Mehta, BPKIHS
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Towel Clamps
Edna:
Nonpenetrating towel clamp Attach drape to drape or instruments to drapes (suction, cautery)
53Prof. Dr. RS Mehta, BPKIHS
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Hand-held Retractors
54Prof. Dr. RS Mehta, BPKIHS
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Hand-held Retractors
Senn:
55Prof. Dr. RS Mehta, BPKIHS
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Hand-held Retractors
Army-Navy:
56Prof. Dr. RS Mehta, BPKIHS
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Hand-held Retractors
Ribbon (Malleable):
57Prof. Dr. RS Mehta, BPKIHS
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Hand-held Retractors
Hohmann:
58Prof. Dr. RS Mehta, BPKIHS
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Hand-held Retractors
Farabeuf:
59Prof. Dr. RS Mehta, BPKIHS
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Hand-held Retractors
Meyerding:
60Prof. Dr. RS Mehta, BPKIHS
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Self-Retaining Retractors
61Prof. Dr. RS Mehta, BPKIHS
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Self-Retaining Retractors
Gelpi:
62Prof. Dr. RS Mehta, BPKIHS
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Self-Retaining Retractors
Weitlaner:
63Prof. Dr. RS Mehta, BPKIHS
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Self-Retaining Retractors
Balfour: Abdominal retractor
64Prof. Dr. RS Mehta, BPKIHS
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Self-Retaining Retractors
Finochietto: Rib retractor
65Prof. Dr. RS Mehta, BPKIHS
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Self-Retaining Retractors
Meyerding:
66Prof. Dr. RS Mehta, BPKIHS
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Ovariohysterectomy Hooks
67Prof. Dr. RS Mehta, BPKIHS
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Ovariohysterectomy Hooks
Snook:
68Prof. Dr. RS Mehta, BPKIHS
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Suction Tips
69Prof. Dr. RS Mehta, BPKIHS
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Suction Tips
Poole:
70Prof. Dr. RS Mehta, BPKIHS
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Suction Tips
Yankauer:
71Prof. Dr. RS Mehta, BPKIHS
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Suction Tips
Frazier:
72Prof. Dr. RS Mehta, BPKIHS
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Rongeurs
73Prof. Dr. RS Mehta, BPKIHS
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Rongeurs
Lempert:
74Prof. Dr. RS Mehta, BPKIHS
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Rongeurs
Kerrison:
75Prof. Dr. RS Mehta, BPKIHS
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76
Rumen (Bloat) Trocar
Prof. Dr. RS Mehta, BPKIHS
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Bone-Holding Forceps
77Prof. Dr. RS Mehta, BPKIHS
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Bone-Holding Forceps
Kern:
78Prof. Dr. RS Mehta, BPKIHS
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Bone-Holding Forceps
Serrated Reduction:
79Prof. Dr. RS Mehta, BPKIHS
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80
Galt Trephine
Prof. Dr. RS Mehta, BPKIHS
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81
Osteotome
Prof. Dr. RS Mehta, BPKIHS
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82
Jacob Chuck
Prof. Dr. RS Mehta, BPKIHS
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83
Duckbill Rongeurs
Prof. Dr. RS Mehta, BPKIHS
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84
Bone Rasp
Prof. Dr. RS Mehta, BPKIHS
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85
Tap Handle
Prof. Dr. RS Mehta, BPKIHS
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Retracting and Exposing Instruments A Deaver retractor (manual) is used to retract deep
abdominal or chest incisions. Available in various widths.
86Prof. Dr. RS Mehta, BPKIHS
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EXPOSING & RETRACTING•BALFOUR ABDOMINAL RETRACTOR
Prof. Dr. RS Mehta, BPKIHS 87
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EXPOSING & RETRACTING•ARMY NAVY
FARABEUF Retractor
Prof. Dr. RS Mehta, BPKIHS 88
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EXPOSING & RETRACTING•GELPI Perineal Retractor
Prof. Dr. RS Mehta, BPKIHS 89
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EXPOSING & RETRACTING•Weitlaner Retractor
Prof. Dr. RS Mehta, BPKIHS 90
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EXPOSING & RETRACTING•Senn Retractors
Prof. Dr. RS Mehta, BPKIHS 91
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EXPOSING & RETRACTING•Finochietto Retractor
Prof. Dr. RS Mehta, BPKIHS 92
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A Richardson retractor (manual) is used to retract deep abdominal or chest incisions
Retracting and Exposing Instruments
93Prof. Dr. RS Mehta, BPKIHS
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Retracting and Exposing Instruments An Army-Navy retractor (manual) is used to retract
shallow or superficial incisions. Other names: USA, US Army.
94Prof. Dr. RS Mehta, BPKIHS
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Retracting and Exposing Instruments A goulet (manual) is used to retract shallow or
superficial incisions.
95Prof. Dr. RS Mehta, BPKIHS
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A malleable or ribbon retractor (manual) is used to retract deep wounds. May be bent to various shapes.
Retracting and Exposing Instruments
96Prof. Dr. RS Mehta, BPKIHS
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A Weitlaner retractor (self-retaining) is used to retract shallow incisions.
Retracting and Exposing Instruments
97Prof. Dr. RS Mehta, BPKIHS
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A Balfour with bladder blade (self-retaining) is used to retract wound edges during deep abdominal procedures.
Retracting and Exposing Instruments
98Prof. Dr. RS Mehta, BPKIHS
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ELECTROSURGERY
•INITIAL Incision is made by a SCALPEL
•Doubling the current increases the heat produced fourfold
•ARGON Enhanced ESU Tip is held at 60 degree angle, causing LESS Tissue Damage
•BUZZING – the process of coagulating the VESSELS
•BUZZ should not exceed more than 3 SECONDS
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Powered Surgical InstrumentsDRILLBURRBLADEREAMERABRADER
AIR-POWEREDELECTRICALLY POWERED
Prof. Dr. RS Mehta, BPKIHS 100
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VIEWING•Speculums•Endoscopes•Hollow Endoscopes•Lensed Endoscopes
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LASER SURGERY•Light amplification by stimulated emission of radiation (LASER)
•Types of LASES = ARGON, CARBON DIOXIDE, HOLMIUM, KRYPTON, NEODYMIUM, PHOSPHATE, RUBY/XENON
Prof. Dr. RS Mehta, BPKIHS 102
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Prof. Dr. RS Mehta, BPKIHS
WWW.SMSO.NET103
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Thank you
104Prof. Dr. RS Mehta, BPKIHS
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Drains Tubes Catheters
105Prof. Dr. RS Mehta, BPKIHS
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106Prof. Dr. RS Mehta, BPKIHS
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Catheters
Are used for evacuating or injecting fluids. Catheters are sized on a french scale according to the
diameter of the lumen.
107Prof. Dr. RS Mehta, BPKIHS
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Drains and tubes Are devices used to drain fluid from the body when excessive drainage is expected.
108Prof. Dr. RS Mehta, BPKIHS
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A- Respiratory Tubes
109Prof. Dr. RS Mehta, BPKIHS
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A-1- Airway
110Prof. Dr. RS Mehta, BPKIHS
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A-2- Laryngeal tube
111Prof. Dr. RS Mehta, BPKIHS
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A-3-Endotracheal intubation
112Prof. Dr. RS Mehta, BPKIHS
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A-4- Cricothyroidotomy
113Prof. Dr. RS Mehta, BPKIHS
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Cricothyroidotomy
114Prof. Dr. RS Mehta, BPKIHS
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A-5- Tracheostomy tube
115Prof. Dr. RS Mehta, BPKIHS
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A-5- Tracheostomy tube
116Prof. Dr. RS Mehta, BPKIHS
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A-6- Chest Tube
117Prof. Dr. RS Mehta, BPKIHS
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Collection Unit
118Prof. Dr. RS Mehta, BPKIHS
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Thoracic catheters
119Prof. Dr. RS Mehta, BPKIHS
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The Trocar CatheterWith a large trocar needle is
used for a closed thoracostomy.
120Prof. Dr. RS Mehta, BPKIHS
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A-7- Thoracentesis needle
121Prof. Dr. RS Mehta, BPKIHS
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122Prof. Dr. RS Mehta, BPKIHS
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B- Gastrointestinal Tubes
123Prof. Dr. RS Mehta, BPKIHS
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B-1- Nasogastric Tube
124Prof. Dr. RS Mehta, BPKIHS
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Ryle’s Tube
125Prof. Dr. RS Mehta, BPKIHS
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B-2- P.E.G. (Percutaneous Endoscopic Gastrostomy)
126Prof. Dr. RS Mehta, BPKIHS
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B-3- Nasogastric and nasojejunal feeding tube
127Prof. Dr. RS Mehta, BPKIHS
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Feeding NGT
128Prof. Dr. RS Mehta, BPKIHS
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B-4- Rectal Tube
129Prof. Dr. RS Mehta, BPKIHS
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A Rectal Tube
130Prof. Dr. RS Mehta, BPKIHS
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B-5- T Tube- Kehr's T-tube
131Prof. Dr. RS Mehta, BPKIHS
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132Prof. Dr. RS Mehta, BPKIHS
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B-6- Blackemore Sengstaken Tube
133Prof. Dr. RS Mehta, BPKIHS
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C- Genitourinary Tubes &Catheter
134Prof. Dr. RS Mehta, BPKIHS
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C-1- Catheters
135Prof. Dr. RS Mehta, BPKIHS
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-Rubber-Plastic-Silicone
2-ways foley3-ways foley
136Prof. Dr. RS Mehta, BPKIHS
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137Prof. Dr. RS Mehta, BPKIHS
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2Way Foley CathetersTo drain the bladderAn inflatable balloon near the tip
which holds the catheter in place
2 way Foley
138Prof. Dr. RS Mehta, BPKIHS
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3 Way FoleyHas an inlet for irrigation.
139Prof. Dr. RS Mehta, BPKIHS
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Robinson CatheterStraight Drainage Of The Bladder.
140Prof. Dr. RS Mehta, BPKIHS
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Nilatone (straight) catheter
141Prof. Dr. RS Mehta, BPKIHS
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Silicone Catheter
142Prof. Dr. RS Mehta, BPKIHS
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suprapubic catheter
143Prof. Dr. RS Mehta, BPKIHS
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C-2- Condom Catheter
144Prof. Dr. RS Mehta, BPKIHS
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C-3 Double J Catheter
145Prof. Dr. RS Mehta, BPKIHS
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C-4- Nephrostomy TubesMalecotPigtail
146Prof. Dr. RS Mehta, BPKIHS
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D-vascular Tube
147Prof. Dr. RS Mehta, BPKIHS
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D-1- Butterfly Needle
148Prof. Dr. RS Mehta, BPKIHS
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D-2- IV Cannula
149Prof. Dr. RS Mehta, BPKIHS
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D-3- Venous Catheter
150Prof. Dr. RS Mehta, BPKIHS
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D-4- IV set (venoset)
151Prof. Dr. RS Mehta, BPKIHS
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D-5- BT (blood transfusion) set
152Prof. Dr. RS Mehta, BPKIHS
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D-6- Fogarty CatheterArterial embolectomy catheter is used to
remove blood clots from an artery.
153Prof. Dr. RS Mehta, BPKIHS
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Differentiate vascular tubes from;
-spinal needle or catheter-peritoneal catheter
154Prof. Dr. RS Mehta, BPKIHS
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Spinal Needle
155Prof. Dr. RS Mehta, BPKIHS
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Peritoneal Catheter
156Prof. Dr. RS Mehta, BPKIHS
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Peritoneal Catheter
157Prof. Dr. RS Mehta, BPKIHS
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Thank you
158Prof. Dr. RS Mehta, BPKIHS
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IMPORTANT TERMS
Atraumatic Dilation Dissection Grasping Retraction Sharp Traumatic Trocar
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CLASSIFICATION OF INSTRUMENTS
Cutting and Dissecting
Grasping and Holding Clamping and
Occluding Exposing and
Retracting Suturing and Stapling Viewing
Suctioning and Aspirating
Dilating and Probing Measuring Accessory
Instruments Microinstrumentatio
n
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CUTTING AND DISSECTING•SCALPELS• Insert Blade using a HEAVY HEMOSTAT of KELLY CLAMP•No. 10 BLADE used MOST OFTEN•No. 11 Blade •No. 12 Blade •No. 15 Blade•No. 23 Blade
•KNIVES•SCISSORS•BONE Cutters and Debulking Tools•Biopsy Forceps and Punches•Curettes•Snares•Blunt Dissectors
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CUTTING AND DISSECTING
•Bone Curette
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CUTTING AND DISSECTING•Mayo Scissors
•Metzenbaum Scissors
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CUTTING AND DISSECTING•Suture Scissors (Blunt /Blunt)
Prof. Dr. RS Mehta, BPKIHS 164
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GRASPING & HOLDING•Tissue Forceps•Smooth Forceps•Toothed Forceps•Allis Forceps•Babcock Forceps•Stone Forceps•Tenaculums•Bone Holders
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GRASPING & HOLDING•Rat-Toothed Tissue Forceps
Prof. Dr. RS Mehta, BPKIHS 166
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GRASPING & HOLDING•Allis Tissue Forceps
Prof. Dr. RS Mehta, BPKIHS 167
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GRASPING & HOLDING•Babcock Intestinal Forceps
Prof. Dr. RS Mehta, BPKIHS 168
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GRASPING & HOLDING•Backhaus Towel Clamps
Prof. Dr. RS Mehta, BPKIHS 169
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CLAMPING & OCCLUDING•Hemostatic Forceps•Hemostats•Crushing Clamps•Noncrushing Vascular Clamps
Prof. Dr. RS Mehta, BPKIHS 170
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CLAMPING & OCCLUDING•Hemostatic Forceps•Hemostats•Crushing Clamps•Noncrushing Vascular Clamps- used to occlude peripheral or major blood vessels
Prof. Dr. RS Mehta, BPKIHS 171
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CLAMPING & OCCLUDING•Pean Intestinal forceps
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CLAMPING & OCCLUDING•Hemostatic Forceps•Hemostats•Crushing Clamps•Noncrushing Vascular Clamps
Prof. Dr. RS Mehta, BPKIHS 173
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CLAMPING & OCCLUDING•Hemostatic Forceps•Hemostats•Crushing Clamps•Noncrushing Vascular Clamps
Prof. Dr. RS Mehta, BPKIHS 174
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EXPOSING & RETRACTING•BALFOUR ABDOMINAL RETRACTOR
Prof. Dr. RS Mehta, BPKIHS 175
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EXPOSING & RETRACTING•ARMY NAVY
FARABEUF Retractor
Prof. Dr. RS Mehta, BPKIHS 176
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EXPOSING & RETRACTING•GELPI Perineal Retractor
Prof. Dr. RS Mehta, BPKIHS 177
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EXPOSING & RETRACTING•Weitlaner Retractor
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EXPOSING & RETRACTING
•Spay Hook
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EXPOSING & RETRACTING•Senn Retractors
Prof. Dr. RS Mehta, BPKIHS 180
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EXPOSING & RETRACTING•Finochietto Retractor
Prof. Dr. RS Mehta, BPKIHS 181
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EXPOSING & RETRACTING•Ribbon Retractor
Prof. Dr. RS Mehta, BPKIHS 182
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SUTURING & STAPLING•Needle Holders•Tungsten Carbide Jaws•Crosshatched Serrations•Smooth Jaws•Staplers•Clip Appliers•Terminal End Staplers•Internal Anastomosis Staplers•End-to-End Circular Staplers
Prof. Dr. RS Mehta, BPKIHS 183
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SUTURING & STAPLING•Terminal End Staplers•Internal Anastomosis Staplers•End-to-End Circular Staplers
Prof. Dr. RS Mehta, BPKIHS 184
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VIEWING•Speculums•Endoscopes•Hollow Endoscopes•Lensed Endoscopes
Prof. Dr. RS Mehta, BPKIHS 185
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SUCTIONING & ASPIRATING•Suction•Poole Abdominal Tip•Frazier Tip•Yankeur Tip•Autotransfusion•Aspiration•Trocar•Cannula
Prof. Dr. RS Mehta, BPKIHS 186
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SUCTIONING & ASPIRATING•Suction•Poole Abdominal Tip•Frazier Tip•Yankeur Tip•Trocar•Cannula
Prof. Dr. RS Mehta, BPKIHS 187
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DILATING & PROBING
Prof. Dr. RS Mehta, BPKIHS 188
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MEASURING
Prof. Dr. RS Mehta, BPKIHS 189
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ACCESSORY INSTRUMENTS
Prof. Dr. RS Mehta, BPKIHS 190
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MICROINSTRUMENTATION
Prof. Dr. RS Mehta, BPKIHS 191
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Powered Surgical InstrumentsDRILLBURRBLADEREAMERABRADER
AIR-POWEREDELECTRICALLY POWERED
Prof. Dr. RS Mehta, BPKIHS 192
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HANDLING INSTRUMENTS
•Standardized BASIC sets
•Scrub Person counts ALL instruments, sharp and sponges with the CIRCULATOR
•Handle Loose Instruments SEPARATELY
•Sort by CLASSIFICATION
•PROTECT Sharps
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Handling INSTRUMENTS during SURGERY
• Know the NAME and USE
• Handle INDIVIDUALLY
• Use for the INTENDED purpose
• Use of HAND SIGNALS
• Short INSTRUMENTS = Superficial Work
• LONG Instruments = DEEP
• PASS instruments DECISIVELY and FIRMLY
• FREE-HAND TECHNIQUE
• Watch the sterile field for LOOSE instruments
• With a MOIST, SPONGE wipe blood and organic debris from instruments using a DEMINERALIZED STERILE, DISTILLED H20
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ELECTROSURGERY
•INITIAL Incision is made by a SCALPEL
•Doubling the current increases the heat produced fourfold
•ARGON Enhanced ESU Tip is held at 60 degree angle, causing LESS Tissue Damage
•BUZZING – the process of coagulating the VESSELS
•BUZZ should not exceed more than 3 SECONDS
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LASER SURGERY•Light amplification by stimulated emission of radiation (LASER)
•Types of LASES = ARGON, CARBON DIOXIDE, HOLMIUM, KRYPTON, NEODYMIUM, PHOSPHATE, RUBY/XENON
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PATIENT SAFETY in LASERS Eyes and Eyelids should
be adequately protected (aluminum foil, moist pads)
Antiseptics must be NONFlammable
Rectum should be packed with a MOISTENED sponge to prevent escape of METHANE gas
Anesthetic Agents should be NONCombustible
Flexible metallic or insulated silicone endotracheal tubes
Wear high filtration MASKS for CO2 laser ablation such as condylomata (Venereal warts)
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Advantages of LASERS
Precise CONTROL = ACCURATE incision
Access to HARD to REACH areas (endoscopes, rhodium reflector mirrors)
Unobstructed view of the surgical site
Minimal TRAUMA to tissues
DRY, Bloodless SURGICAL Field
Minimal THERMAL effect
Reduced RISK for INFECTION
Prompt Healing Reduced OPERATING
TimeProf. Dr. RS Mehta, BPKIHS 198
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Prof. Dr. RS Mehta, BPKIHS
WWW.SMSO.NET199
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THANK YOU
Free Nursing Lectureshttp://nursinglectures.blogspot.com
200Prof. Dr. RS Mehta, BPKIHS
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BASIC SURGICAL INSTRUMENTS
Fundamentals of Primary Health Care B
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BASIC SURGICAL INSTRUMENTS Basic laparotomy instruments are essential to
accomplish most types of general surgery. Each instrument can be placed into one of the four following basic categories: Retracting and Occluding Instruments Cutting and Dissecting Instruments Clamping and Occluding Instruments Grasping and Holding Instruments
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Retracting and Exposing Instruments used to hold back or retract organs or tissue to gain
exposure to the operative site. They are either "self-retaining" (stay open on their own) or "manual" (held by hand). When identifying retractors, look at the blade, not the handle.
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Retracting and Exposing Instruments A Deaver retractor (manual) is used to retract deep
abdominal or chest incisions. Available in various widths.
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A Richardson retractor (manual) is used to retract deep abdominal or chest incisions
Retracting and Exposing Instruments
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Retracting and Exposing Instruments An Army-Navy retractor (manual) is used to retract
shallow or superficial incisions. Other names: USA, US Army.
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Retracting and Exposing Instruments A goulet (manual) is used to retract shallow or
superficial incisions.
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A malleable or ribbon retractor (manual) is used to retract deep wounds. May be bent to various shapes.
Retracting and Exposing Instruments
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A Weitlaner retractor (self-retaining) is used to retract shallow incisions.
Retracting and Exposing Instruments
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A Gelpi retractor (self-retaining) is used to retract shallow incisions.
Retracting and Exposing Instruments
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A Balfour with bladder blade (self-retaining) is used to retract wound edges during deep abdominal procedures.
Retracting and Exposing Instruments
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Cutting and Dissecting Instruments are sharp and are used to cut body tissue or surgical
supplies.
Knife Handle, Scissors(left to right)
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Cutting and Dissecting Instruments 7 handle with 15 blade (deep knife) - Used to cut
deep, delicate tissue. 3 handle with 10 blade (inside knife) – Used to cut
superficial tissue. 4 handle with 20 blade (skin knife) - Used to cut
skin.
#7, #3, #4(left to right) 213Prof. Dr. RS Mehta, BPKIHS
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Straight Mayo scissors - Used to cut suture and supplies. Also known as: Suture scissors.
EX: Straight Mayo scissors being used to cut suture.
Cutting and Dissecting Instruments
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Curved Mayo scissors - Used to cut heavy tissue (fascia, muscle, uterus, breast). Available in regular and long sizes.
Cutting and Dissecting Instruments
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Metzenbaum scissors - Used to cut delicate tissue. Available in regular and long sizes.
Cutting and Dissecting Instruments
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are used to compress blood vessels or hollow organs for hemostasis or to prevent spillage of contents.
Clamping and Occluding Instruments
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A hemostat is used to clamp blood vessels or tag sutures. Its jaws may be straight or curved. Other names: crile, snap or stat.
Clamping and Occluding Instruments
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Clamping and Occluding Instruments A mosquito is used to clamp small blood vessels. Its
jaws may be straight or curved.
hemostat, mosquito (left to right)
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A Kelly is used to clamp larger vessels and tissue. Available in short and long sizes. Other names: Rochester Pean.
Kelly, hemostat, mosquito (left to right)
Clamping and Occluding Instruments
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A burlisher is used to clamp deep blood vessels. Burlishers have two closed finger rings. Burlishers with an open finger ring are called tonsil hemostats. Other names: Schnidt tonsil forcep, Adson forcep.
Clamping and Occluding Instruments
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A right angle is used to clamp hard-to-reach vessels and to place sutures behind or around a vessel. A right angle with a suture attached is called a "tie on a passer." Other names: Mixter.
Clamping and Occluding Instruments
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A hemoclip applier with hemoclips applies metal clips onto blood vessels and ducts which will remain occluded.
hemoclip applier with hemoclips
Clamping and Occluding Instruments
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Grasping and Holding Instruments are used to hold tissue, drapes or sponges.
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An Allis is used to grasp tissue. Available in short and long sizes. A "Judd-Allis" holds intestinal tissue; a "heavy allis" holds breast tissue.
Grasping and Holding Instruments
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Grasping and Holding Instruments A Babcock is used to grasp delicate tissue (intestine,
fallopian tube, ovary). Available in short and long sizes.
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A Kocher is used to grasp heavy tissue. May also be used as a clamp. The jaws may be straight or curved. Other names: Ochsner.
Grasping and Holding Instruments
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A Foerster sponge stick is used to grasp sponges. Other names: sponge forcep.
Foerster sponge stick EX: Sponge sticks holding a 4 X 4
and probang.
Grasping and Holding Instruments
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A dissector is used to hold a peanut.
Grasping and Holding Instruments
dissector EX: Dissector holding a peanut.
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A Backhaus towel clip is used to hold towels and drapes in place. Other name: towel clip.
Backhaus towel clip Large & small towel clips
Grasping and Holding Instruments
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Pick ups, thumb forceps and tissue forceps are available in various lengths, with or without teeth, and smooth or serrated jaws.
Grasping and Holding Instruments
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Russian tissue forceps are used to grasp tissue.
Grasping and Holding Instruments
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Adson pick ups are either smooth: used to grasp delicate tissue; or with teeth: used to grasp the skin. Other names: Dura forceps.
Grasping and Holding Instruments
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Grasping and Holding Instruments Long smooth pick-ups are called dressing forceps.
Short smooth pick-ups are used to grasp delicate tissue.
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DeBakey forceps are used to grasp delicate tissue, particularly in cardiovascular surgery.
Grasping and Holding Instruments
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Grasping and Holding Instruments Thumb forceps are used to grasp tough tissue
(fascia, breast). Forceps may either have many teeth or a single tooth. Single tooth forceps are also called "rat tooth forceps."
single tooth forceps, many teeth forceps(top to bottom)
236Prof. Dr. RS Mehta, BPKIHS
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Mayo-Hegar needle holders are used to hold needles when suturing. They may also be placed in the sewing category.
Grasping and Holding Instruments
short, medium & long(top to bottom)
EX: Needle holder with suture.
237Prof. Dr. RS Mehta, BPKIHS