SURGERY

Classification by type of points

All types of scissors can have blunt or sharp blades (A: Sharp:Sharp, B: Blunt:Blunt).

All types can have either straight or curved blades.

Mayo and Metzenbaum

Mayo scissors (B) are used for cutting heavy fascia and sutures. Metzenbaum scissors (A) are more delicate than Mayo scissors.

Forceps: consist of two tines held together at one end with a spring device that holds the tines open. Forceps can be either tissue or dressing forceps. Dressing forceps have smooth or smoothly serrated tips. Tissue forceps have teeth to grip tissue. Many forceps bear the name of the originator of the design, such as Adson tissue forceps. Rat Tooth: A Tissue Forceps
Interdigitating teeth hold tissue without slipping. Used to hold skin/dense tissue.

Adson Tissue Forceps

Small serrated teeth on edge of tips. The Adsons tissue forceps has delicate serrated tips designed for light, careful handling of tissue.

Intestinal Tissue Forceps: Hinged (locking) forceps used for grasping and holding tissue.

Allis: An Intestinal Tissue Forceps

Interdigitating short teeth to grasp and hold bowel or tissue. Slightly traumatic, use to hold intestine, fascia and skin.

Babcock: An Intestinal Tissue Forceps

More delicate that Allis, less directly traumatic. Broad, flared ends with smooth tips. Used to atraumatically hold viscera (bowel and bladder).

Sponge Forceps
Sponge forceps can be straight or curved. Sponge forceps can have smooth or serrated jaws. Used to atraumatically hold viscera (bowel and bladder).

Hemostatic forceps: Hinged (locking) Forceps. Many hemostatic

forceps bear the name of the designer (Kelly, Holstead, Crile). They are used to clamp and hold blood vessels. Classification by size and shape and size of tips
Hemostatic forceps and hemostats may be curved or straight.

Kelly Hemostatic Forceps and Mosquito Hemostats Both are transversely serrated. Mosquito hemostats (A) are more delicate than Kelly hemostatic forceps (B).

Comparison of Kelly and Mosquito tips

Mosquito hemostats (A) have a smaller, finer tip.

Carmalt
Heavier than Kelly. Preferred for clamping of ovarian pedicals during an ovariohysterectomy surgery because the serrations run longitudinally.

Doyen Intestinal Forceps

Doyen intestinal forceps are noncrushing intestinal occluding forceps with longitudinal serrations. Used to temporarily occlude lumen of bowel.

Payr Pylorus Clamps Payr pylorus clamp is a crushing intestinal instrument. Used to occlude the end of bowel to be resected.

Needle holder: Hinged (locking) instrument used to hold the needle while suturing tissue.

Good quality is ensured with tungsten carbide inserts at the tip of the needle holder. Mayo-Hegar Heavy, with mildly tapered jaws. No cutting blades.

Olsen-Hegar
Includes both needle holding jaw and scissors blades. The disadvantage to having blades within the needle holder is the suture material may be accidentally cut.

Retractors

Senn

Blades at each end. Blades can be blunt (delicate) or sharp (more traumatic, used for fascia).

Hohman
Levers tissue away from bone during orthopedic procedures.

SELF RETATINING FACTORS

Weitlaner
Ends can be blunt or sharp. Has rake tips. Ratchet to hold

tissue apart.

Gelpi Has single point tips. Ratchet to hold tissue apart.

SCALPEL AND BLADES

Handles

#3 Handle #4 Handle

Handles and Blades

Blades #10, 11, 12, 15 fit the #3 handle. Blades #22, #23 fit the #4 handle and are commonly used for large animals.

Disposable Scalpel

Towel clamps secure drapes to a patient's skin. They may also be used to hold tissue. Backhaus Towel Clamp

Locking forceps with curved, pointed tips.

PROPER INSTRUMENTS HANDLING

Scissors and Hemostats:

The thumb and ring finger are inserted into the rings of the scissors while the index and middle finger are used to guide the instrument. The instrument should remain at the tips of the fingers for maximum control.

This is the wrong way to hold the scissors. The ring finger should be inserted into the ring.

This is also the wrong way to hold the scissors. The tips of the scissors should be pointing upwards.

Thumb Forceps:
Thumb forceps are held like a pencil.

Thumb Forceps are not called 'tweezers'. Thumb Forceps are not held like a knife.

Scalpels:
The scalpel is held with thumb, middle and ring finger while the index finger is placed on the upper edge to help guide the scalpel. Long gentle cutting strokes are less traumatic to tissue than short chopping motions.

The scalpel should never be used in a "stabbing" motion.

SURGICAL HANDWASHING 1) Trimming and Cleaning Nails Trim fingernails and clean with disposable nail file. Down load video of this step.

2) Initial Wash and Scrubbing Fingers Wash for 30-60 seconds with surgical scrub. Scrub fingers with a sterile scrub brush

Make sure to scrub all sides of each finger, including the a between fingers. Down load video of this step.

3) Scrubbing Hands and Forearms Scrub hands and arms with a sterile scrub brush. Make sure to scrub each surface of each hand and arm.

An accepted contact time is 10 brush strokes per surface. Down load video of this step.

4)Rinse

Rinse hands and rescrub as in step 3. During scrubbing, rinsing and drying, hands are held abov This is done so that water will not be dripping from upper lower arms and hands. After both scrubs and rinses, total contact time should be 5 Some surgeons do not rinse off the chlorhexidine in order residual activity. Down load video of this step.

HAND DRYING AND GOWNING

A sterile towel is included within the sterile gown pack. The towel is lifted away from the table and folded in half lengthwise. One hand and forearm are dried by one side of the towel. Always dry in the direction of hand to elbow so that contamination of the upper arm is not spread by the towel to the surgeon's hand. Down Load Video of Drying Hands

The second hand and forearm are then dried by the other side of the towel in the direction of hand to elbow. The towel is then discarded away from the surgeon, making sure that the towel doesn't contact the sterile gown.

All gowns are folded and packaged for sterilization with the inside exposed so that the surgeon may handle the gown without contaminating the outside of the gown. Grasp the exposed inside of the gown and lift the gown away from the table.

Unfold the gown by placing hands into the white arm holes. Continue placing hands and arms through the sleeves. If you are planning on closed gloving, do not thrust hands through the cuffs. Down Load Video of Donning a Gown

An assistant fastens the neck tie and the inside waist tie.Down Load Video

Proceed with closed gloving before the fastening of the final outside tie. Once the surgeon is gloved, the sterile left tie is grasped by the surgeon and the white tab is handed to an assistant.

The assistant pulls the back tie around the surgeon using the white tab. The surgeon grasps the right tie from the white tab (not touching the now contaminated white tab) and right and left are tied together. Down Load Video

CLOSE GLOVING

Closed gloving is performed after the surgeon has donned his/her gown, but BEFORE the surgeon pulls his/her hands through the cuffs of the gown. Step 1: An assistant opens the sterile pack of gloves and drops them into the sterile field.

Step 2: Left hand (within the gown) lifts the right glove by its cuff.

Step 3: Right glove is laid on the palm of the right hand (cuff to cuff with the gown sleeve) with fingers of the glove pointing toward the elbow and the thumb of the glove positioned on top of the surgeon's covered right thumb.

Step 4: The inside of the cuff of the glove is grasped by the right hand (still within the gown) and the left hand folds the cuff of the glove over the back of the right hand.

Step 5: The left had then pulls the cuff of the right glove and sleeve of the right gown towards the elbow as the right hand slides into the glove. Wait to adjust the glove until both gloves are on and sterility is ensured (left fingers may slip out of the gown while trying to adjust the right glove prematurely).

Step 6: With the gloved right hand lift left glove by its cuff and place on palm of left hand (aligned with the cuff of the gown), with glove fingers pointing toward the elbow and the left thumb of the glove over the covered left thumb of surgeon.

Step 7: Left fingers (still within the gown) grasp the inside of the glove and the right hand pulls left glove cuff over the back of the hand.

Step 8: Pull the glove cuff and gown sleeve toward elbow as left hand slides into the glove

Step 9: Now that both gloves are on, pull glove cuffs over gown sleeves and adjust gloves for comfort.