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Sontec Instruments
7248 South Tucson Way
Englewood, CO 80112
(303)790-9411
(800)821-7496
Fax(303)792-2606
Everything you ever wanted toknow about surgical instrumentsAND A LITTLE BIT MORE...
A guide to ensure you, that every time you need an instrument to work properly, it Does
.
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In 1937 the author first realized the importanceof checking surgical instruments in the operating room. Inthose days most of the surgeons owned their own instru-ments. Problems were many for the Operating Roomsupervisors because the number of surgical instrumentssurgeons had was limited. Surgeons were forced to bor-row from each other to complete their sets, especiallywhen some of their instruments were set aside for repair.In an average hospital it was not uncommon tohave 20 to 25 surgeons each owning his personal instru-ments. It was necessary for Operating Room supervisorsto receive the surgeons permission prior to having hisinstrument repaired. If a surgeon worked in several hos- pitals in a city, his instruments had to be transported fromone hospital to another. In emergencies, the OR supervi-sor had to improvise to make up sets, and much dissensionoccurred among doctors as to who had borrowed their instruments.George Pencer taught many nurses the techniqueof checking instruments, and in hospitals of 200 beds or more , he would actually set up portable repair equipmentallowing the repair and sharpening of instruments withoutremoving them from the hospitals.Since 1937 many advance in the quality, repair,and ownership of surgical instruments have taken place.But we feel this handy check list, reviewing the care andmaintenance of surgical instruments, should still provehelpful for all members of the surgical team.
Forceps and Hemostats
A surgeon faces a most irritating and frequentlyfrustrating problem when a forcep or hemostat does notfunction properly. In most cases, this can be avoided if asurgical nurse knows how to check and test these instru-ments correctly before including them in the surgical sets.Forceps are probably abused more than any other instrument. Experience indicates that breakdown of highquality forceps is often the direct result of their misuse.They are most frequently misused in orthopedic surgery.Here they are often applied to steinman pins, bone plates,screws, and nails-usually when pliers are not avail-able. They also are used to clamp large sponges, tubing,needles, etc. The smaller the misused forcep, for examplea Mosquito or Kelly, the greater the damage. As the jawsof a forcep are overloaded, inevitably misalignment of the jaws occurs and reduction of tension in the shanks. Thus,the instruments effectiveness is greatly impaired. Whenthis situation occurs in a Kelly or similar type instrument,the forcep will not hold tissue securely: therefore, fail-ing to accomplish the job for which it was intended. If asurgeon continues to use the instrument, further damageat an accelerated rate will result. For example: when the jaws of a Allis clamp do not align, the teeth will not mesh properly, and they will break or wear very rapidly. Whenthe jaws of an Ochsner forcep do not align and a surgeoncontinues to use it, the tooth on the male jaw usually breaks off. Thus, not only is the instrument destroyed, but pieces of the tooth may be lost in surgery.
How to test a forcep for jaw alignment
Start with a visual test. Close the jaws of the for-cep lightly. If the jaws overlap, they are out of alignment. On forceps with serrated jaws, observe to see if the teethare meshing properly. Holding the shanks of the forcep ineach hand , with the forcep open, try to wiggle the instru-ment. If the box lock has considerable play, and if it veryloose, this will cause jaw misalignment. If this occurs, theinstrument is faulty and should be repaired.
Forceps and Hemostats which spring open
It is extremely annoying to a surgeon, and hazardous to the patient, when a forcep or hemostat springs open; especiallywhen clamped on a duct or a large vessel, such as a kidney pedicle. Operating room nurses have surely seen this hap- pen.The above problem is usually caused by forcepmisalignment, worn ratchet teeth, or by lack of tension atthe shanks. As ratchet teeth are subject to constant metalto metal wear, they are the fastest wearing parts of a for-cep. By constant strain of closing and opening the instru-ments, there is continues friction and wear; in particular on the first ratchet tooth. Therefore, when a surgeon takesa large bite with the forcep and locks it on the first ratchettooth, a small jar of any kind may cause it to spring open.
How to check the ratchet teeth on instruments
Clamp the forcep on the first tooth only. Whenclamped, the instrument should produce a sounding snap.After the instrument is locked on the first ratchet tooth,take and hold the instrument at the box lock; then tap theratchet teeth portions of the instrument lightly against asolid object (a weighted vaginal retractor is ideal). If theinstrument springs open, it is faulty and should be re- paired.
How to check the tension between the shanks
Close the forceps lightly. When the jaws touch,there should be a clearance of
1/16
" or
1/8
" between theratchet teeth of each shank. Such clearance provides ad-equate tension at the jaws when closed.For a forcep to work effectively and efficiently,the jaws must align and meet exactly; the serrations shouldmesh correctly; the shanks should be flexible and resilientto compensate for a larger bite. The ratchets must hold.The forceps, when closed, must not spring open. Theratchet teeth should slide over each other smoothly whenopening and closing. In short, the forceps should open and
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close easily, permitting the surgeons to work rapidly andefficiently.
Orthopedic Instruments
Chisels, osteotomes, and gouges in constant useneed sharpening and honing at frequent intervals. If theyare accidentally misused, such as on a steinman pin, bone plate, or screw, the edges become dull and nicked. In thesecases, the instrument should be sharpened immediately.Your author has been told that it is difficult for a surgeonnot to occasionally encounter a pin, a bone plate, or ascrew with an osteotome; particularly when it is neces-sary to remove an old plate which has some bone growtharound it. In such a situation , it is prudent to have an older or special osteotome or chisel available for the surgeon. Inthe regular course of cleaning and sterilization, care must be exercised not to hit the edges of the chisels, gouges, andosteotomes against each other or other instruments. Such jostling not only dulls the edges of the instruments, but itcan also chip or dent the sharp edges.
Visual test for checking orthopedic instruments
Check for nicks and burrs on edges on chiselsand osteotomes. On bone cutting forceps and doubleaction ronguers, one should again check to see whether the jaws align. If the screws at the fulcrum are slightlyloose, the jaws inevitably become misaligned; conse-quently damage occurs to the jaws when the instrumentsare used. Frequently, a bone cutting forcep or ronguer isused to cut wire or a pin. To preclude this practice, it isvery important to have wire cutter or pin cutter availableto the surgeon. Orthopedic instruments are very expensive;therefore, they merit exceptional care.
Tonsil Instruments
Adenotomes
The proper fitting of the adenotome blades is a problem. An adenotome blade should slide smoothly in thechannels of an adenotome. When closed the blades shouldnot overlap the adenotome. If overlapping does occur,the blade is too long and could be hazardous in use. If the blade is to short , it will not close completely, causing tear-ing of tissue rather than a clean cut.Check the blades. Be sure they slide smoothlyand close so that no visible light can be seen between thetip of the blade and the adenotome. When ordering new blades, send your adenotomes to your surgical instrumentrepair company and have the blades fitted to each adeno-tome. This is very important because no two adenotomesare alike, even though they may be the same size. Also, be sure to have each blade stamped or lettered with thesame code number as the adenotome. For instance, if theadenotome is coded 1-A, the blade should be coded 1-A.This identification procedure insures a proper fitting bladefor each adenotome.
Tonsiltomes
If blades do not close properly, the sluder presentsthe same problem as ill-fitted adenotomes. In checking, be sure the blade slides close, so that no light is visible be-tween blade and tip of tonsiltome. Also, the blade shouldnot extend beyond the tip of the tonsiltome.
Tonsil Snares
On tonsil snares, Tydings and Eves type, oneshould inspect the tip of the cannulas. Tonsil snare wireshave a tendency to wear grooves into the tips of the can-nulas, thus causing the wire to stick or catch and not pullthrough the cannula completely. If the wire sticks, it willhave a pulling and tearing effect on the tissue instead of a clipping effect. If grooves are visible in the tips of thecannulas, the instrument should be repaired.
Eye Instruments
Cataract Knives, Keratomes
It is very important to know how to test a cataractknife correctly. Once the eye surgeon penetrates the con- junctiva of the eye with a cataract knife only to discover itwill not cut, he is in trouble.A small buckskin is the proper device for de-tecting a faulty knife. This item is a must for testing eyeknives. To make the test, lay the handle portion of the eyeknife across the palm of your hand. Do not touch it withyour fingers. Hold the buckskin drum in your other hand.Then, push or slide the knife blade through the buckskindrum while it still rests in you palm. The blade should penetrate the drum as though it were passing through butter. If it sticks or has a tearing effect, then the knife isin need of repair. The same procedure is used for testingKeratomes.Extreme care should be taken in handling all eyeinstruments. Too much emphasis cannot be given to thismatter. During cleaning and sterilization, caution must betaken to prevent the instruments from touching each other.Metal to metal contact should never be permitted. Eyeinstruments, even at best, can stand improvement.There are a number of other fine eye cuttinginstruments which are too numerous to mention in thisarticle; however, the same procedure of care should befollowed on them as on the cataract knives previouslydiscussed.
Scissors
Scissors, especially Mayo operating and Metzen- baum dissecting, which do not cut on the tip of the bladescan cause surgical havoc. Not only should a dissecting,or an operating scissor, cut tissue on the tips, but it is also
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Cleaning Catalog
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| Upload Date: | 01/11/2009 |
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