Surgical Instruments
Medical and Surgical Instruments for Nursing
Surgical InstrumentsDefinitionSurgical instruments are tools or devices that perform such functions as cutting, dissecting,grasping, holding, retracting, or suturing. Most surgical instruments are made from stainlesssteel. Other metals, such as titanium, chromium, vanadium, and molybdenum, are also used.PurposeSurgical instruments facilitate a variety of procedures and operations. Specialized surgicalpacks contain the most common instruments needed for particular surgeries.Surgical instruments are used in all hospitals, outpatient facilities, and most professionaloffices. Instrument users include surgeons, dentists, physicians, and many other health careproviders. Millions of new and replacement instruments are sold each year. Many surgicalinstruments now have electronic or computerized components.DescriptionBasic categories of surgical instruments include specialized implements for the followingfunctions:cutting, grinding, and dissectingclampinggrasping and holdingprobingdilating or enlargingretractingsuctioningScissors are an example of cutting instruments. Dissecting instruments are used to cut orseparate tissue. Dissectors may be sharp or blunt. One example of a sharp dissector is ascalpel. Examples of blunt dissectors include the back of a knife handle, curettes, andelevators. Clamps, tenacula, and forceps are grasping and holding instruments. Probinginstruments are used to enter natural openings, such as the common bile duct, or fistulas.Dilating instruments expand the size of an opening, such as the urethra or cervical os.Retractors assist in the visualization of the operative field while preventing trauma to othertissues. Suction devices remove blood and other fluids from a surgical or dental operativefield.
Sharps and related items should be counted four times: prior to the start of the procedure;before closure of a cavity within a cavity; before wound closure begins; and at skin closureor the end of the procedure. In addition, a count should be taken any time surgicalpersonnel are replaced before, during, or after a procedure. Instruments, sharps, andsponges should be counted during all procedures in which there is a possibility of leaving anitem inside a patient.The misuse of surgical instruments frequently causes alignment problems. Instrumentsshould always be inspected before, during, and after surgical or dental procedures.Inspection is an ongoing process that must be carried out by all members of a surgical team.Scissors must be sharp and smooth, and must cut easily. Their edges must be inspected forchips, nicks, or dents.After a procedure, staff members responsible for cleaning and disinfecting the instrumentsshould also inspect them. The instruments should be inspected again after cleaning andduring packaging. Any instrument that is not in good working order should be sent forrepair. Depending on use, surgical instruments can last for up to 10 years given proper care.PreparationInstruction in the use and care of surgical instruments may range from the medical trainingrequired by physicians and dentists to on-the-job training for orderlies and aides.Surgical instruments are prepared for use according to strict institutional and professionalprotocols. Instruments are maintained and sterilized prior to use.Surgical instruments must be kept clean during a procedure. This is accomplished bycarefully wiping them with a moist sponge and rinsing them frequently in sterile water.Periodic cleaning during the procedure prevents blood and other tissues from hardening andbecoming trapped on the surface of an instrument.Instruments must be promptly rinsed and thoroughly cleaned and sterilized after aprocedure. Ultrasonic cleaning and automatic washing often follow the manual cleaning ofinstruments. Instruments may also be placed in an autoclave after manual cleaning. Themanufacturer's instructions must be followed for each type of machine. Staff membersresponsible for cleaning instruments should wear protective gloves, waterproof aprons, andface shields to protect themselves and maintain instrument sterility.AftercareObservation of the patient after surgical or dental procedures provides the best indicationthat correct instrument handling and aseptic technique was followed during surgery. Afteran operation or dental procedure, individuals should show no evidence of the following:retained instruments or spongesinfection at the site of the incision or operation
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