INSTRUMENTAL AND THEIR CLASSIFICATION 1 SURGICAL NURSING Surgical Instruments PROF ª IRIS CORRÊA INSTRUMENTAL AND THEIR CLASSIFICATION

2 Surgical Instruments The surgical instrument can be classified and divided into special and common. S pecials are those used in only a few times for certain surgeries. Already the co mmon are the basic instrument of any type of surgical intervention in their fund amental times, namely: • dieresis, excision •, • • hemostasis and synthesis. Instrumental common: Their names correspond generally to the name of the author who described it. In a general classification of the various types of instruments could also be group ed as follows: dieresis, hemostasis, hold, separation, synthesis and special. Th is classification are considered only surgical instruments themselves ("chains") . Syringes and needles, drains, rubber or plastic, gauze, bandages and fields ma y also be related to surgical instruments, "sensu lato". INSTRUMENTAL AND THEIR CLASSIFICATION 3 Dieresis in the main instruments are grouped the scalpel and scissors in their v arious sizes and forms. SCISSORS IRIS Treasurer Metzenbaum CABLE SCALPEL In hemostatic grouped all those intended for clamping vessels bloody as the "Hal sted", "Kelly", "Rochester", "Moynihan and others. COLLET KELLY COLLET ROCHESTER INSTRUMENTAL AND THEIR CLASSIFICATION 4 COLLET Halsted COLLET Moynihan In the grip grouped all those intended to understand and handle guts and organs,

such as tweezers "Babcock", "Allis", "Collin", "Duval", etc.. COLLET BABCOKC Using Allis forceps INSTRUMENTAL AND THEIR CLASSIFICATION 5 PINÇACOLLIN COLLET DUVAL In the group of separation devices are all kinds of ret ractors as "Gosset", "Finochietto", "Farabeuf", etc.. Finochietto GOSSET FARABEUF In the group of tools for synthesis are basically grouped the tweezers and the v arious types of needle. INSTRUMENTAL AND THEIR CLASSIFICATION 6 NEEDLE HOLDERS Hegar MATHIEU NEEDLE HOLDER Finally, the group of special instruments, herding all those aimed at specific t imes for certain surgeries, such as "Abadie" used in gastrectomies, tweezers "Ra ndal" for extraction of bile duct calculations, etc.. INSTRUMENTAL AND ITS CLASSIFICATION rack, rings and making them straight or curv ed shapes. 7 Almost all surgical instruments come in various sizes and many This variability in size and shape of this instrument is intended to provide the surgeon with an enormous range of applications to many different surgical situa tions. The scalpel, a cutting instrument, exists in various sizes and shapes of blades. Cables are rated at No. 3 and No. 4 being the first recipient of blades generally smaller and designed for delicate surgical procedures. The second feat ure a larger fit for the blade and is intended for general surgery. Each cable a lso provides variety in their length (3L and 4L), designed to operate in depth. The scalpel blades, can be classified according to its shape and applicability. The scissors also other cutting instrument, we present curves or straight, stron g or delicate, in various sizes. The surgeon's use of scissors is the curved sci ssors. The line is mostly used by the auxiliary to cut wires. The instrument has the capability of hemostatic clamp bleeding vessels as the clamps of the "Kelly " and "Halsted", and these curves provide for ease of handling. "Halsteds" delic ate and smaller (9.5 cm) are called "mosquito forceps, are used in surgery for c hildren. When the clamping involves coarser structures, the "Rochester" this is usually indicated by a pinch more robust. A "Kocher" straight, initially describ ed as a hemostatic, is now used more as a catcher and hanger aponeuroses, enjoyi ng the security that gives its "rat-tooth"

INSTRUMENTAL AND THEIR CLASSIFICATION 8 COLLET Halsted (MOSQUITO) COLLET ROCHESTER COLLET KELLY. COLLET KOCHER On occasions that are required hemostasis profound use to "Mixter," the "Moyniha n" and "Crafoord. The first two are used as tweezers to work pedicles as the liv er, the kidney and lung. INSTRUMENTAL AND THEIR CLASSIFICATION 9 COLLET MIXTE COLLET Moynihan The clamps are instruments that aids grip, usually wielded with his left hand, s upporting the various maneuvers, such as clamping of a bleeding vessel cross-sec tion of an organ or structure, etc.. They are found in various sizes, stronger, more delicate, with or without teeth.€When you want cludes structures upon which they refuse to cut up fabrics are preferred to the "Babcock" as if to hold or p ull the bowel. Babcock forceps INSTRUMENTAL AND THEIR CLASSIFICATION 10 The needle holder is used for handling needles and yarn in the synthesis of tiss ues. The two basic types are "Hegar" and "Mathieu". Hegar The clamps field as "Backhaus. MATHIEU Backhaus The static retractors are those that remain open, thus exposing the ope rative field without continuous traction by the assistant surgeon. The retractor "Gosset" is used to keep open the abdominal cavity, and "Finochietto" into the chest cavity. To facilitate the surgery the helper should also be used with dyna mic retractors "Farabeauf" that INSTRUMENTAL AND ITS CLASSIFICATION (static) is used during the maneuvers intraabdominal, removing the spleen, for example. 11 is used during the opening and closing the abdominal wall. The retractor "Doyen" The spatulas are also called "shoes" are rigid or flexible blades also used as r etractors. The clamps are coprostase long toes, flexible rod used to contain the

intestinal fluid. The clamps "Foerster" and "Cheron" are long, used as carrier gas for deep healing. The "Cheron" is often used in the antisepsis of the skin o f the patient. COLLET Cheron COLLET FOESTER The clamps "Abadie" are used in the operations of the stomach. COLLET ABADIE INSTRUMENTAL AND THEIR CLASSIFICATION 12 Parts are indispensable in thoracic surgery and the grinder costótomo. The grind er is used to separate the intercostal muscles of the ribs. Costótomo already ha s the job of slicing the ribs. All the instruments should be handled carefully a voiding that are not damaged. The most delicate scissors should not be used to c ut coarse structures such as gas, surgical threads for not losing their cut. The hemostatic forceps should not hold traction on hard structures to prevent them from suffering deformation. Steel can crack and deform when heated to high tempe ratures, so one should avoid the use of forceps for other purposes except to the clamping of tissues with little consistency. The racks should be kept imprisone d only on the first tooth and should not, when not in use, being used unnecessar ily, thus avoiding wear. Organization table The assembly of the surgical table is intended to facilitate and organize the wo rk of a surgeon. It's a way to streamline the surgical procedure by making it mo re efficient. The training of the work of the instrument is of great importance so that it can meet the needs of the surgeon and his or her assistants. To assemble the table, and auxiliary instrumentation already vested, shall choose the least busy in th e classroom starting systematically organizing the operating table. The auxiliar y tables should be protected with a sheet of rubber, while cushioning the shock of the instruments with the top metal waterproofing cover the table that if wet inadvertently serum or secretions, would lose its power of antibacterial barrier , with the possibility of contamination of the items on it INSTRUMENTAL AND THEIR CLASSIFICATION 13 placed. On rubber sheets are placed protective sterile fields, after which the s tock should approach the box of tools on another small table smaller. Depending upon the position of surgeon to the patient, the table will be mounted. A common position found in some surgical centers is the instrument table under the patie nt, eliminating thus the figure of the instrumentation (described below). The ta ble can also be positioned at 90 degrees to the operating table or in the lower end, or side of the surgeon also eliminating the instrument. Then describe the o rganization of the table from right to left by dividing operating table into twe lve parts or areas. In one area, there is a scalpel with the blade down the left . Certain operations require special types of knives. In area 2, are placed deli cately curved scissors (Metzenbaum) and strong ("Mayo") with the tips facing the instrumentation and buckle down against the table. In Area 3, are placed hemost atic forceps type "Kelly) just as the scissors. Curavas and preferably at least six to eight. Because the meaning is taken from right to left for economy of spa

ce find themselves overlapping, with the upper right arising in relation to the other and so on. Area 4,€also called the area of versatile use; arise instrument s such as "Mixter" (2-4), "Moynihan" (2-4), and the type hemostatic, according t o the surgery. In the five will be placed on "Kocher" Straight (4). In the six c lamps are placed with and without teeth. 7 are arranged in the area the needle h older (2), being the only exception in the table of the instrumentation, which a rises with the rings down. In case, already holding needles INSTRUMENTAL AND ITS CLASSIFICATION and not defile himself. 14 mounted. Note that the needle points upward so as not to pierce the plane of the table N area 8, there are clamps grip type "Babcock" (4), "Allis" (4) and "Duval" (2-4 ), or other complementary instruments of the same type, dictated by the needs of surgical intervention in question. In the nine places to the clamps of the "Bac khaus," at least 4 in area 10 arise tweezers, scissors, tweezers, long. In the 1 1 pads are placed folded wires that hold pre-cut like silk or cotton, and about her or other types of yarns and needles. In the area 12 is versatile for use in this case presenting staples. The diagrams and figures representing the descript ion above are in the addendum at the end of the work. A second table that can al so be mounted on the table is the wizard. This is divided into six parts being a ssembled from left to right or right to left depending on the position of the su rgeon in the surgical field. In this table the cables of the instruments are mea nt to assist, since these instruments are for personal use. Surgical Instrumenta tion The instrumentation is a key element in the surgical team. Its primary func tion is to provide the surgical instrument to the surgeon and the assistant, bei ng possible to perform the functions of a second assist when the first is busy. A / O instrumentation (the) capable (the) well-trained and is instrumental in th e smooth course of the surgery. INSTRUMENTAL AND THEIR CLASSIFICATION to the surgeon and then to help. 15 Must obey the orders of the surgeon and his assistant. In order, she will first meet It is the obligation of the instrumentation (a) and all components of the surgic al team withdraw from any contamination that may occur by violating the laws of asepsis. He must know the technique used during surgery to anticipate the surgeo n's orders when requesting a surgical instrument. Before surgery, along with the helper should make sure that everything is in order, from the yarn and needles until the special instruments. Should not be distracted at any time during cours e of the surgery because the surgeon's anticipation of requests depends on it. I n summary, the main tasks of a good (a) means (a) are: to know the instruments b y their names and put them on the auxiliary tables; be responsible for cleansing , cleaning and accommodation orderly and methodical instruments, keeping the tab le organized even in the course of surgery, deliver promptly to the instrument s ignal or verbal request of the surgeon, putting it in your hand in a precise and accurate for immediate use; intervene eventually, in the operative field as a s econd assistant; requires it to the circulating room necessary material; synchro nize time and manual actions. Like any other team members, the instruments (a) A deve be governed by rules of conduct applicable to his position as well as profe ssional secrecy. The principles of Halsted are essential both for initiating the study of surgical technique, as the professionals who practice the profession f or years. The precepts of diaeresis, hemostasis and synthesis are basic, but nes cessário smooth progress of surgery and evolution of the surgical wound. The die

resis must obey these principles with regard to regular borders that can only be performed using proper technique that should be the domain of surgeons. INSTRUMENTAL AND THEIR CLASSIFICATION 16 The hemotasia should always be achieved in order to avoid complications from the surgical wound and also reducing the surgeon's view during the surgery itself. The methods for achieving hemostasis depend on both the requirements regarding t he patient from the intervention and the conditions that surgical technique allo ws the surgeon to perform them. The synthesis objective aid to surgical closure, the surgeon should make use of appropriate tools and technique so that we can accomplish such a procedure. The surgical instrument should be used to meet the three basic times of surgery and the special times that some procedures require. For this we must rely on instrum ents from various genres,€sizes and shapes that can be generally categorized as hemostasis, and removal of dieresis and synthesis. These instruments are in cons tant evolution and are created or brought to disuse due to the evolution of surg ical techniques and creativity of surgeons who, when faced with new challenges, adapt leading to surgery to walk the large palaces for centuries. Nothing would be valid if these instruments were not within reach of the surgeon to quickly an d accurately. Soon it becomes necessary to organize a systematic instrument tabl e and a professional who can perform this task as best as possible. There are se veral ways to dispose of the materials on the table for instrumentation, which c hecks the relevant discussions between the various schools and surgeons to this day. But most important is that each surgeon should choose a way that best meets your needs during surgery, because only then it can perform a correct intervent ion, successful and, above all, with the best possible benefit to the patient. W hatever the instrumentation, surgical technique and principles to be followed, t he patient should always come to the fore, and all of us, we make sure that your recovery is always the best.