Perioperative Equipment

Prepared by:

Ronivin Garcia Pagtakhan

BOXLOCK

JAWS

SHANK

RATCHET

Scissors

• All types of scissors can have blunt or sharp blades

• (A: Sharp:Sharp, B: Blunt:Blunt).

• Mayo and Metzenbaum

• Mayo scissors (B) are used for cutting heavy fascia and sutures.

• Metzenbaum scissors (A) are more delicate than Mayo scissors.

• Metzenbaum scissors are used to cut delicate tissues.

• Metzenbaum scissors have a longer handle to blade ratio.

• All types can have either straight or curved blades.

• 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 non-crushing 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

• 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.

• 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.

• 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.

TECHNIQUES IN USING SURGICAL EQUIPMENT

• 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.

Ways to sterilization:

Autoclave

• An autoclave is a self locking machine that sterilizes with steam under pressure.

• Sterilization is achieved by the high temperature that steam under pressure can reach.

• The high pressure also ensures saturation of wrapped surgical packs.

Autoclave

Settings

Temperature

(F)

Pressure

(PSI) Time (min)

General

Wrapped

Items

250 20 30

Bottled

Solutions 250 20 30

'Flashing' 270 30 4-7

Preparation for sterilization

• All instruments must be double wrapped in linen or special paper or placed in a special metal box equipped with a filter before sterilization.

• 'Flashing' is when an instrument is autoclaved unwrapped for a shorter period of time. 'Flashing' is often used when a critical instrument is dropped.

• Color Change Sterilization Indicators

• The white stripes on the tape change to black when the appropriate conditions (temperature) have been met.

• Indicators should be on the inside and outside of equipment pack.

• Expiration dates should be printed on all equipment packs.

• Biological sterilization indicators contain spores that are supplied in closed containers and are included with the instrument being autoclaved. Inability to culture the spores after autoclaving confirms adequate sterilization. Biological indicators are the most accurate sterilization indicators.

Ethylene Oxide Sterilization: ETO Gas

• Large Two-Chamber EtO Sterilizer

• Colorless gas, very toxic and flammable.

• Requires special equipment • Odor similar to ether. • Used for heat sensitive

instruments: plastics, suture material, lenses and finely sharpened instruments.

• Materials must be well aerated after sterilization.

• Materials/instruments must be dry.

Cold (Chemical) Sterilization

• Instruments must be dry before immersion.

• Glutaraldehyde (Cidex) is the most common disinfectant.

• 3 hours exposure time is needed to destroy spores.

• Glutaraldehyde is bactericidal, fungicidal, viricidal, and sporicidal.

Radiation Sterilization

• High energy ionizing radiation destroys microorganisms and is used to sterilize prepacked surgical equipment.

• Used for instruments that can't be sterilized by heat or chemicals.

• Common sources of radiation include electron beam and Cobalt-60

SPECIFIC THERAPEUTIC POSITION

• HIGH FOWLERS-60-90’ • FOWLER-45-60’ • SEMI-FOWLERS-30-45’ • LOW-FOWLERS-15-30’ • SUPINE • DORSAL RECUMBENT • LITHOTOMY • SIMS LATERAL • PRONE • KNEE-CHEST • SIDE-LATERAL • ORTHOPNEIC • TRENDELENBURG • MODIFIED TRENDELENBURG

Autograft After surgery, site is

immobilized: 3-7 days

Burns of face & head Elevate head of bed

Circumferential burns of

extremities

Elevate extremities above the

level of the heart

Skin graft Elevate & immobilize graft site

Avoid weight bearing

Hypophysectomy Elevate the head

Thyroidectomy Place in Semi-Fowlers

Sandbags or pillows may

be used to support the

head or neck.

Mastectomy Head of bed elevated at

least 30 0 (Semi-Fowlers)

w/ affected arm elevated

on a pillow

Turn only to the back &

unaffected side.

Perineal &

vaginal

procedures

Place on lithotomy post

Hemorrhoidectomy Assist to a lateral (side-

lying) post

Gastroesophageal reflux Reverse Trendelenburg’s

post may be prescribed

Liver biopsy DURING:

Supine, w/ right side of upper

abd exposed

Right arm is raised &

extended over the left shoulder

behind the head

AFTER:

Assist to a lateral (side-lying) post

Place a small pillow or folded

towel under he puncture site for at

least 3 0 to provide pressure to the

site & prevent bleeding

Bronchoscopy

postop

Place in Semi-Fowlers post (to

prevent choking or aspiration

resulting from impaired ability

to swallow)

Laryngectomy

(radical neck

dissection)

Place in Semi-Fowlers or

Fowler’s post (to maintain a

patent airway & minimize

edema)

1.Sengstaken-

Blakemore (3

lumen) &

Minnesota tubes

( 4 lumen)

Maintain elevation of the head

of bed

Thoracentesis sitting on the edge of the bed

& leaning fwd over the

bedside table, w/ feet

supported on a stool, or lying

in bed on the unaffected side

w/ head of the bed elevated

about 45 0 Fowler’s post

Thoracotomy Lateral, unaffected side

Abd aneurysm

resection

After surgery, limit elevation of the

head to 45 0 Fowler’s post (to avoid

flexion of the graft)

May be turn from side to side

Amputation of

lower extremity

1st 24 0 after amputation, elevate foot of

the bed

Consult physician & put in prone post

2x/day for a 20-3o min period

Arterial vascular

grafting of an

extremity

Bed rest is maintained for 24 0,&

affected extremity is kept straight.

Limit movt & avoid flexion of the hip &

knee

Cardiac

catherization

If femoral artery was used, maintain

on bed rest for 3-4 0; client may turn

from side to side

Affected extremity is kept straight &

head is elevated no > 30 0 until

hemostasis is adequately achieved.

1. CHF & pulmonary

edema

Post upright, preferably w/ legs dangling

over the side of the bed

Peripheral arterial disease Obtain physicians order for positioning

Because swelling can prevent arterial blood flow,

advise to elevate feet at rest, but not raise legs

above the level of the heart (extreme elevation

slows blood flow), some are advised to maintain a

slightly dependent post (to promote perfusion)

DVT If extremity is red, edematous & painful &

traditional heparin therapy is initiated, bed rest w/

leg elevation may be prescribed

If receiving low-molecular-weight heparin,

usually can be out-of-bed after 24 0 if pain level

permits.

Varicose veins Leg elevation above heart level; minimized prolonged

sitting or standing during daily activities

1. Cataract surgery Post-op: elevate head of bed

(Semi-Fowlers or Fowler’s) post

on the back or the non-operative

side (to prevent the devt of edema

at the operative site)

1. Retinal

detachment/

If detachment is large, bedrest &

bilateral eye patching may be

prescribed (to minimize eye movt &

prevent extension of the detachment)

Restrictions in activity & post ff a

repair of detachments depends on

the physician’s preference &

surgical procedure performed

If gas bubble has been injected to

flatten the retina & reinforce

repair, post so that the gas rises in

the eye & presses against the repair

(usually face down or angled toward

the unoperative site)

1. Autonomic dysreflexia Elevate head of bed to High

Fowler’s post (to adequate

ventilation & assist in the

prevention of HPN stroke)

1. Cerebral aneurysm Bed rest is maintained w/ the

head of the bed elevated 30-45 0 Semi-Fowlers or Fowler’s

post (to prevent pressure on

the aneurysm site)

1. Cerebral angiography Maintain bed rest for

12-24 0 as prescribed

The extremity into w/c

the contrast medium is

injected is kept straight

& immobilized for 8 0

1. CVA W/ hemorrhagic stroke, head of bed is

elevated to 30 0 (to reduce ICP & facilitate

venous drainage)

W/ ischemic stroke, head of bed is kept flat

Maintain head in midline, neutral post (to

facilitate venous drainage from the head)

Avoid extreme hip & neck flexion (extreme

hip flexion may increase intrathoracic

pressure; extreme neck flexion prohibits

venous drainage from the brain)

1. Craniotomy Don’t post on the operated site, esp if the bone

flap has been removed (because the brain has

no bony covering on the affected site)

Elevate head of bed to 30-45 0 Semi-Fowlers

or Fowler’s post & maintain head in midline,

neutral post (to facilitate venous drainage

from the head)

Avoid extreme hip & neck flexion

1. Laminectomy

- surgical cutting

into the

backbone to

obtain access

into the spinal

cord.

Logroll the client

When out of bed, back is kept straight

(placed in straight-backed chair) w/

feet resting comfortably on the floor

1. ICP Elevate head of bed to 30-45 0 Semi-

Fowlers or Fowler’s post & maintain

head in midline, neutral post (to

facilitate venous drainage from the

head)

Avoid extreme hip & neck flexion

1. Lumbar puncture DURING:

Assist to a lateral (side-lying) post,

w/ back bowed at the edge of the

examining table, knees flexed upto

abd, & head bent so that chin is

resting on the chest.

AFTER:

Place in supine post for 4-12 0 as

prescribed

1. Myelogram postop If water soluble dye is used, head of

bed is elevated to 30-60 0 for 12 0 (to

keep the dye from irritating the

cerebral meninges)

If oil-based dye is used, a supine post

for several hours after the dye has

been removed (to prevent leakage of

CSF)

Spinal cord injury/ Immobilize on spinal

backboard, w/ head in

neutral post (to

prevent complete

injury from becoming

complete)

Prevent head flexion,

rotation or extension;

head is immobilized

w/ a firm, padded

cervical collar.

Logroll the client; no

part of the body

should be twisted or

turned nor allowed to

assume a sitting post.

Total hip

replacement

Post depends on surgical technique

used, method of implantation &

prosthesis

Avoid extreme internal & external

rotation

Avoid adduction

Maintain abduction when in supine

post on the unoperative side

Check physician’s order re

elevation of head of bed; flexion is

usually limited: 60 0 : 1st post-op

week

90 0 : 2-3 mos thereafter

• Thank you!!!!