OR Instruments, Sutures, Principles of Aseptic Techniques

J.A.K.E NCMB 312 RLE

OPERATING ROOM INSTRUMENTS

Classifications of Surgical Instruments
• Cutting and Dissecting (Sharps)
• Clamping and Occluding (Clamps)
• Grasping and Holding (Graspers)
• Exposing and Retracting (Retractors)
• Suturing and Stapling
• Viewing • Iris Scissors
• Suction and Aspirating - Used for fine dissection and cutting fine suture.
• Dilating and Probing - Originally for ophthalmic procedures, but now serves
• Measuring multipurpose role
• Accessory Instruments

Cutting and Dissecting (Sharps)

Knife / Scalpel
- Handle #4 is the first knife used to cut tough tissues.
- Handle #3 is the second knife used to cut delicate tissues, • Bandage Scissors
and is used for minor surgeries. - used to cut the uterus and umbilical cord.

Clamping and Occluding (Clamps)

Hemostatic Forceps
- used temporarily clamp and occlude bleeding vessels.
- can be straight or curved

Scissors • Kelly Forceps – longest; used for deep abdominal layers

• Mayo Scissors (Straight / Curved)
- used to cut tough tissues.
- Heavy scissors available in multiple varieties. Straight
scissors are used for cutting suture (“suture
scissors”), while curved scissors are used for cutting
heavy tissue (e.g., fascia).
and cavities
• Crile Forceps – medium; used for shallow layers
• Mosquito Forceps – shortest; used for minor surgery,
pediatrics, and superficial layers
Mixter Forceps
- used to reach around and ligate blood vessels.

• Metzenbaum Scissors (Straight / Curved)

- used to cut delicate tissues.
- Lighter scissors used for cutting delicate tissue (e.g.,
heart) and for blunt dissection.
- Also called “Metz” in practice
OR INSTRUMENTS 1 of 5
J.A.K.E OR Instruments, Sutures, Principles of Aseptic Techniques NCMB 312 RLE

Ochsner Forceps Babcock Forceps

- used to grasp medium to heavy tissue or occlude heavy, - used to grasp delicate tissue and hold tubular organs
dense vessels - used with intestinal and laparotomy procedures

Ovum Forceps
- used to remove placental fragments inside the uterus

Grasping and Holding (Graspers)

Adson Forceps (Toothed)
- used for handling dense tissue, such as in skin closures

Towel Clips
- used to hold drapes in place, to keep only the operating
field exposed

Adson Forceps (Toothless)

- used for fine surgical procedures to hold delicate or
superficial tissues
- Forceps toothed at the tip used for handling dense tissue,
such as in skin closures.
Bonney Forceps
- Heavy forceps used for holding thick tissue (e.g., fascial
closure)

Thumb Forceps
- used for grasping, holding or manipulating body tissue

Tissue Forceps
- used in surgical procedures for grasping tissue
- designed to minimize damage to biological tissue
- Nontoothed forceps used for fine handling of tissue and
traction during dissection.
Allis Forceps
- used to hold or grasp heavy tissue like bones, tendons,
uterus, and fascia
Exposing and Retracting (Retractors)
Self Retaining Retractors
• Balfour Abdominal Retractor – used in laparotomy
procedures, and for specific abdominal procedures
where the abdomen needs to be held open for
examination or evaluation, such as cesarean sections
and bowel resection

Pennington Forceps
- used for grasping tissue, particularly during rectal
operations
• Mastoid Retractor – used to retract the external canal
skin anteriorly for better visualization of external canal and
middle ear.

OR INSTRUMENTS 2 of 5
J.A.K.E OR Instruments, Sutures, Principles of Aseptic Techniques NCMB 312 RLE

• Malleable Retractor
- used to retract deep wounds and may be bent to
various shapes.

• Gelpi Retractor – used for holding back organs and

tissues while accessing areas below an incision during
lumbar spine procedures
Suturing and Stapling
Needle Holder
- used to hold a suturing needle for closing wounds during
suturing and surgical procedures

Non-Self Retaining Retractors

• Army Navy Retractor
- used for shallow or superficial wounds, and to retract
Skin Stapler
skin or bones
- used to close incisions after surgery

• Richardson Retractor
- used to retract, expose or push tissue, muscles, Viewing
organs or bones during surgery Speculum
- used to see inside a hollow part of the body

• Deaver Retractor
- used to hold back the abdominal wall during
abdominal or thoracic procedures, and to move or Endoscope
hold organs away from the surgical site - used to look deep into the body and used in procedures
called an endoscopy

• Murphy Rake Retractor

- used to gently retract tissue and give better visibility to
the surgical field

• Senn Retractor
- used to retract fat tissue in minor sugery

OR INSTRUMENTS 3 of 5
J.A.K.E OR Instruments, Sutures, Principles of Aseptic Techniques NCMB 312 RLE

Suction and Aspirating Accessory Instruments

Suction Mallet
- used to remove substances such as blood, saliva, mucus, - used with a chisel to split teeth and reshape or remove
and vomit bones

SUTURES
- a stitch or row of stitches holding together the edges of a
wound or surgical incision
- can classified into Absorbable and Non-Absorbable
- Absorbable sutures are broken down by the body via
enzymatic reactions or hydrolysis. The time in which this
absorption takes place varies between material, location
Dilating and Probing
of suture, and patient factors. Examples:
Urethral Sounds
- used in urological surgery for dilatation of strictures or for • Vicryl
obtaining access to the bladder • PolyDioxanone Suture (PDS)
• Monocryl
- Non-Absorbable sutures are used to provide long-term
tissue support, remaining walled-off by the body’s
inflammatory processes (until removed manually if
required). Examples:
• Nylon
• Prolene
• Silk
Surgical Probes
- a blunt-ended surgical instrument used for exploring a Suture Size
wound or part of the body - The diameter of the suture will affect its handling
properties and tensile strength.
- The larger the size ascribed to the suture, the smaller the
diameter is, for example a 7-0 suture is smaller than a 4-0
suture.

Measuring
Caliper
- used in plastic surgery procedures to ascertain precise
measurements

Surgical Needles
- The surgical needle allows the placement of the suture
within the tissue, carrying the material through with
minimal residual trauma.
- Characteristics:
Ruler
• rigid enough to resist distortion, yet flexible enough
- used to obtain precise measurements during orthopedic
to bend before breaking
surgical procedures
• as slim as possible to minimize trauma
• sharp enough to penetrate tissue with minimal
resistance
• stable within a needle holder to permit accurate
placement.
Surgical Needles – 3 Parts
• Swaged end - connects the needle to the suture
OR INSTRUMENTS 4 of 5
J.A.K.E OR Instruments, Sutures, Principles of Aseptic Techniques NCMB 312 RLE

8) Sterile areas are continuously kept in view.

9) Sterile persons keep well within the sterile area.
10) Sterile persons wear gown and gloved.
11) Unsterile persons avoid sterile area.
12) Destruction of integrity of microbial barriers results in
contamination.
13) Microorganisms must be kept to an irreducible minimum.

Surgical Needles – 3 Parts

• Needle Body or Shaft - the region grasped by the needle
holder, and can be round, cutting, or reverse cutting.
- Round bodied needles are used in friable tissue such
as liver and kidney.
- Cutting needles are triangular in shape, and have 3
cutting edges to penetrate tough tissue such as the
skin and sternum, and have a cutting surface on the
concave edge.
- Reverse cutting needles have a cutting surface on
the convex edge, and are ideal for tough tissue such
as tendon or subcuticular sutures, and have reduced
risk of cutting through tissue.
Surgical Needles – 3 Parts
• Needle point - acts to pierce the tissue, beginning at the
maximal point of the body and running to the end of the
needle, and can be either sharp or blunt.
- Blunt needles are used for abdominal wall closure,
and in friable tissue, and can potentially reduce the
risk of blood borne virus infection from needlestick
injuries.
- Sharp needles pierce and spread tissues with
minimal cutting, and are used in areas where leakage
must be prevented.
Surgical Needles – Shapes
- The needle shape vary in their curvature and are
described as the proportion of a circle completed – the ¼,
⅜, ½, and ⅝ are the most common curvatures used.
- Different curvatures are required depending on the access
to the area to suture.

PRINCIPLES OF ASEPTIC TECHNIQUE

1) Only sterile items are used within the sterile field.
2) Gowns are considered sterile only from the waist to
shoulder level infront and the sleeves.

3) Tables are sterile at table level.

4) Sterile persons touch only sterile items or areas . Unsterile
persons touch only unsterile items or areas.
5) Unsterile avoid reaching over sterile field. Sterile persons
avoid leaning unsterile areas.
6) Edges of anything that encloses sterile content are
considered unsterile.
7) Sterile fields is created as close as possible to time of use.

OR INSTRUMENTS 5 of 5