Republic of the Philippines

ISABELA STATE UNIVERSITY

COLLEGE OF NURSING
San Fabian, Echague, Isabela 3309 Philippines
Tel Nos.: (078) 333-9999

LAST NAME: AGE: HOSPITAL NUMBER: :

FIRST NAME: SEX:
MIDDLE NAME: ROOM NO.:

OPERATING ROOM SPONGE AND INSTRUMENT SHEET

SPONGE COUNT
SPONGE START ADD TOTAL REMARKS
( ) LOS
( ) SOS
( ) ABDOMINAL PACK
( ) CHERRIES
( ) COTTONAIDS
OTHERS
SUTURES/NEEDLES START ADD TOTAL REMARKS

K,m
INSTRUMENT COUNT
1 COUNT
ST 2ND COUNT FINAL COUNT
INSTRUMENT QTY ADDITIONAL TOTAL TOTAL
Adson w/ tooth
Adson w/o tooth
Allis
Army navy
Bandage scissors
Blade
Blade holder # 3
Blade holder # 4
Bladder retractor
Bobcocks
Kelly curve
Mayo Straight
Mixter
Mosquito Curve
Metz Straight
Needle Holder
Richardson
Thumb Forcep
Tissue Forcep
Towel Clips
Ovum Forceps
Others:

Surgeon: Anesthesiologist:
Initial count by: Final count by:
First Assistant: Scrub nurse:
Circulating Nurse: Anesthesia technique:
Operation Performed
 Republic of the Philippines
ISABELA STATE UNIVERSITY
COLLEGE OF NURSING
San Fabian, Echague, Isabela 3309 Philippines
Tel Nos.: (078) 333-9999

ACTIVITY 2
INSTRUMENTS USE/FUNCTIONS
Scalpel Handle intended to be use with surgical blades for tissue
separation and other procedure that require a sharp
surgical blade to puncture or cut

Operating Scissors S/S Straight Straight scissors are used for cutting suture 

Mayo Dissecting Scissors Straight Straight-bladed Mayo scissors are designed for cutting
body tissues near the surface of a wound. As straight-
bladed Mayo scissors are also used for cutting sutures,
they are also referred to as "suture scissors".

Pratt T-Shaped Clamp Straight Pratt-Smith Grasping Forceps, is a ratcheted, finger ring,
grasping instrument typically used in vaginal or perineal
procedures for grasping mucosa or hemorrhoidal
tissue.

Kelly Forceps Straight Kelly Forceps (also called mosquito forceps when they
are smaller) are a general purpose EMS and surgical
tool used to grasp very small objects when are too
large. They are used in surgery and in EMS operations
to reach and grasp in the tightest areas.

Kelly Forceps curved Kelly Hemostatic Forceps are primarily used

for clamping large blood vessels or manipulating heavy
tissue. They may also be used for soft tissue dissection.
This instrument can be used as a clamp, heat sink, or
third hand.

Rochester-Pean Forceps curved Rochester-Pean Hemostatic Forceps are used

for clamping larger tissue and vessels for hemostasis.
The full horizontal serrations and 8” lengths make these
 Republic of the Philippines
ISABELA STATE UNIVERSITY
COLLEGE OF NURSING
San Fabian, Echague, Isabela 3309 Philippines
Tel Nos.: (078) 333-9999

forceps a versatile instrument used in multiple

procedures.. This product is Curved with full
horizontally serrated jaws, and a length of 8 inches.

Rochester-Pean Forceps Straight Rochester Pean Hemostatic Forceps Straight is made

to clamp the blood vessels. As well, it can grasp the
loosened objects and remove the small root tips.

Rochester-Ochsner Forceps Straight Rochester Ochsner Forceps Straight are a heavy straight
instrument designed to aggressively grasp medium to
heavy tissue or occlude heavy, dense vessels.

Pennington Clamp Straight A Pennington clamp, also known as a Duval clamp, is a

surgical clamp with a triangular eyelet. Used
for grasping tissue, particularly during intestinal and
rectal operations. Also used in some OB/GYN
procedures, particularly caesarian section.

Dressing Forceps Dressing forceps are used when dressing wounds.

They hold gauze and other dressings. They may also be
used during wound debridement to remove infected or
necrotic tissue or debris from the wound. They may
also be used for suturing.

Tissue Forceps 1 x 2 Teeth Tissue Forceps are used for in a various applications
for holding and manipulating various types of tissues.
Tissue forceps are commonly toothed in order to grip
the tissue more firmly than serrated tips alone.

TC Crile-Murray NH Serr The Surgi-OR™ TC Crile-Murray Needle Holder is used

to hold and guide small to medium size needles and
suture materials

TC Mayo-Hegar NH Serr TC Mayo-Hegar Needle Holder is a ratcheted, finger ring

 Republic of the Philippines
ISABELA STATE UNIVERSITY
COLLEGE OF NURSING
San Fabian, Echague, Isabela 3309 Philippines
Tel Nos.: (078) 333-9999

instrument available in a wide range of lengths for

multiple types of surgical procedures.

Allis Tissue Forceps 4 x 5 Teeth Used for lifting, grasping, and retracting dense and/or
slippery tissue. Commonly used for tonsils, vaginal,
breast, and thyroid tissues.

Backhaus Towel Clamp The Backhaus towel clamp is a perforating clamp used
for grasping tissue, securing towels or drapes, and
holding or reducing small bone fractures.

Frazier Suction Tube The Frazier suction tubes are used to remove fluid or
debris from nasal cavities and in laryngeal suction,
where they irrigate and aspirate the throat. They
feature a fenestrated polymer handle with grips for
precise control and an ergonomic design, comfortable
for left and right-handed users.

Metzenbaum Scissors curved Metzenbaum scissors or “Metz” are used for fine

dissection and cutting. They are most frequently slightly
curved. A common mistake is to use Metzenbaums to
cut suture, which dulls the scissors and renders then
less useful for dissection.

Yeoman Rectal Punch The Yeoman (Turrell) Rectal Biopsy Forceps offers a
wide range of surgical advantages. Its principal use is to
atraumatically bite abnormal rectal tissue and mucosa
for diagnosis purposes. To this end, the instrument
features small, alligator-style blades with concave
surfaces to safely harvest the specimens.

Pratt Rectal Speculum The Pratt Rectal Speculum offers a broad range of
surgical advantages. Its principal use is to broaden the
lumen of the anal and rectal canals during explorative
or surgical procedures. For this purpose, the instrument
features a pair of concave blades designed to separate
the rectum's walls.

Hirschman Anoscope Hirschman Anoscope is used to visualize the lower

portion of the rectum and anus. This operating room
 Republic of the Philippines
ISABELA STATE UNIVERSITY
COLLEGE OF NURSING
San Fabian, Echague, Isabela 3309 Philippines
Tel Nos.: (078) 333-9999

anoscope is crafted from premium-grade German

surgical stainless steel.

Buie Suction Tube w/ Valve Novo Surgical Buie Suction Tube is commonly used to
clean up any loose stools or foreign objects from the
rectum before viewing or performing any surgical
procedures
Larry Rectal Probe Novo Surgical Rectal Director is designed to probe the
rectum for any abnormal growths

Pratt Crypt Hook Short Pratt Crypt Hooks are used in various rectal surgeries.
These hooks are made from German surgical stainless
steel. It is available in different sizes, styles, and
patterns.

Foerster Sponge Forceps curved Serr
Foerster Sponge Forceps, also known as Foerster-
Ballenger Sponge Forceps, are commonly used in
surgical procedures to hold gauze squares that will
absorb excess fluids and blood from the surgical site or
hemostasis.