2.1. surgical instruments

Surgical Instruments
Prof. Dr. Ram Sharan Mehta

Objectives
Describe various surgical
instruments
Discuss the names of
various surgical instruments

 Perform surgical procedures
 Chosen based on action
 These tools are used for
 Holding
 Pulling
 Clamping
 Cutting
 Crushing
 Closing a wound

Definitions
 Excision – removal of tissues by surgical cuts
 Ecraseur – an instrument that permits
excision by a crushing action
 Incision – surgical cut made into a tissue of
organ
 Cannula – a tube that is inserted into a body
cavity for drainage of fluid

Surgical Instruments I
• Forceps: for compressing or grasping tissue. Thumb
forceps and hemostats are typical forceps. Hemostats
aid in compressing tissue, especially blood vessels, to
stop bleeding (hemostasis).
• Needle holders: hemostat-like devices that hold
needles used to suture wounds closed.
• Needles: permanently attached suture material =
swaged-on. Tip may be blunt, tapered, sharp, cutting,
or some other configuration
• Scalpel handle and blades: size 10 blade most
popular, 11 has a straight edge and a sharp point.15
has a very small cutting edge, used for fine, delicate
surgery(e.g. eye). 20 is similar to 10 but larger.

Surgical Instruments II
• Scissors: blunt-blunt, blunt-sharp, or sharp-sharp.
They may also be straight or curved. Some scissors
are serrated for cutting thick bandages or cartilage.
• Retractors: pull overlying tissue away from the
surgical site. Hand-held retractors and self-retaining
• Suture materials: thickest suture is given the
number 6.
• <6 = smaller diameter.
• Sutures having smaller diameter indicated by 0 (“aught”)
smallest suture is designated 12-0 (twelve-aught).
• Synthetic = nylon, or natural = silk or gut.
• Some absorbed by the body during the healing process, nylon
removed after wound heals, usually in 7–10 days.
• Gauze pads: sponges used for soaking up blood
and other fluids from the surgical site.

Scissors
 Four different types
 Utility
 Suture
 Surgical
 Dissecting
SCISSORS
TYPES- ACCORDING TO CURVATURE- straight, curved or angled
“ “ USE - Dressing, stitch removal, tissue
“ “ the Tip - sharp or blunt

 Utility
 Cut material that may dull the blade

 Suture
 Remove sutures
 Type of utility

 Operating
 Surgical
 Cut soft tissue
 Different sizes
 Blade can be straight, curved, blunt or pointed

 Dissecting
 Separate and differentiate tissues

Forceps
 Three Types
 Thumb forceps
 Clamping forceps
 Needle holders
 Look like tweezers

 Thumb forceps
 Used for
 Grasping
 Compressing
 Cutting
 Pulling tissue

 Clamping forceps
 Hemostats
 Control blood flow

 Needle holders
 Locking forceps
 Similar to hemostats
 Holds suture needles when installing stitches

Scalpels
 Very sharp knife
 Handle and blade are packaged separately
 Used to make surgical cuts called incisions
 Different sizes and styles
 Tenotome- dissecting scalpel used for fine
dissection and cutting or dividing tendons

KNIVES
Interchangeable handles and blades
No 3 handle for # 15 blade – for small incisions
And #11 blade – i& d of abscesses
N04 handle for #24 etc for larger incisions

Tubes
 Cannula
 Wound healing
 Different lengths
 Types
 Trocar
 Catheters

 Trocar
 Release fluid or gas build-ups
 Sharp stylet inside cannula

 Catheters
 Either metal or rubber
 Inserted into body structures

Scalpels
 Bard-Parker Small Handles:
 #3
Scalpels

Scalpels
 #7

Scalpels
 #9 (round)

Scalpels
 Bard-Parker Large Handles:
 #4

Scissors
 Mayo
 Curved:
 Straight:

Scissors
 Metzenbaum
 Curved:
 Straight:

Scissors
 Lister Bandage Scissors:

Thumb Forceps
 Adson-Brown:

Needle Holders
 Mayo-Hagar:

Needle Holders
 Olsen-Hagar:
 The ones with built-in scissors

Needle Holders
 Castroviejo:

Hemostatic Forceps
 Halsted Mosquito:
 We have the curved ones!

Hemostatic Forceps
 Rochester-Carmalt:

Hemostatic Forceps
 Satinsky:
• cardiovascular
• allow occlusion of only
a portion of vessel

Hemostatic Forceps
 Oschner:

Tissue Forceps
 Doyen: Intestinal

Forceps
 Serrefine (Bulldog Clamp):
Used for temporary occlusion of medium sized vessels

Towel Clamps
 Backhaus:
Drape to skin

Towel Clamps
 Edna:
Nonpenetrating towel clamp
Attach drape to drape or instruments to
drapes (suction, cautery)

Hand-held Retractors
 Senn:

 Army-Navy:

 Ribbon (Malleable):

 Hohmann:

 Farabeuf:

 Meyerding:

Self-Retaining Retractors
 Gelpi:

 Weitlaner:

 Balfour: Abdominal retractor

 Finochietto: Rib retractor

 Meyerding:

Ovariohysterectomy Hooks
 Snook:

Bone-Holding Forceps
 Kern:

Bone-Holding Forceps
 Serrated Reduction:

Retracting and Exposing
Instruments
 A Deaver retractor (manual) is used to retract deep
abdominal or chest incisions. Available in various
widths.

EXPOSING & RETRACTING
•BALFOUR ABDOMINAL RETRACTOR
nursinglectures.blogspot.com

•ARMY NAVY
FARABEUF Retractor

•GELPI Perineal Retractor

•Weitlaner Retractor

•Senn Retractors

•Finochietto Retractor

 A Richardson retractor (manual) is used to retract
deep abdominal or chest incisions
Instruments

Instruments
 An Army-Navy retractor (manual) is used to retract
shallow or superficial incisions. Other names: USA,
US Army.

Instruments
 A goulet (manual) is used to retract shallow or
superficial incisions.

 A malleable or ribbon retractor (manual) is used to
retract deep wounds. May be bent to various
shapes.
Instruments

 A Weitlaner retractor (self-retaining) is used to
retract shallow incisions.
Instruments

 A Balfour with bladder blade (self-retaining) is used
to retract wound edges during deep abdominal
procedures.
Instruments

ELECTROSURGERY
•INITIAL Incision is
made by a SCALPEL
•Doubling the current
increases the heat
produced fourfold
•ARGON Enhanced
ESU Tip is held at 60
degree angle, causing
LESS Tissue Damage
•BUZZING – the
process of coagulating
the VESSELS
•BUZZ should not
exceed more than 3
SECONDS

Powered Surgical Instruments
DRILL
BURR
BLADE
REAMER
ABRADER
AIR-POWERED
ELECTRICALLY POWERED

VIEWING
•Speculums
•Endoscopes
•Hollow Endoscopes
•Lensed Endoscopes

LASER SURGERY
•Light amplification by stimulated emission of radiation (LASER)
•Types of LASES = ARGON, CARBON DIOXIDE, HOLMIUM,
KRYPTON, NEODYMIUM, PHOSPHATE, RUBY/XENON

Catheters
 Are used for evacuating or injecting fluids.

 Catheters are sized on a french scale according to the
diameter of the lumen .

Drains and tubes
Are devices used to
drain fluid from the body
when excessive drainage
is expected .

The Trocar Catheter
With a large trocar needle is
used for a closed thoracostomy .

B-2- P.E.G. (Percutaneous
Endoscopic Gastrostomy)

B-3- Nasogastric and
nasojejunal feeding tube

B-6- Blackemore Sengstaken
Tube

C- Genitourinary
Tubes &Catheter

-Rubber
-Plastic
-Silicone
2-ways foley
3-ways foley

2Way Foley Catheters
To drain the bladder
An inflatable balloon near the tip
which holds the catheter in place
2way Foley

3 Way Foley
Has an inlet for irrigation .

Robinson Catheter
Straight Drainage Of
The Bladder.

C-4- Nephrostomy Tubes
Malecot
Pigtail

D-5- BT (blood transfusion) set

D-6- Fogarty Catheter
Arterial embolectomy catheter is used to
remove blood clots from an artery .

Differentiate vascular tubes from;
-spinal needle or catheter
-peritoneal catheter

IMPORTANT TERMS
 Atraumatic
 Dilation
 Dissection
 Grasping
 Retraction
 Sharp
 Traumatic
 Trocar

CLASSIFICATION OF
INSTRUMENTS
 Cutting and
Dissecting
 Grasping and Holding
 Clamping and
Occluding
 Exposing and
Retracting
 Suturing and Stapling
 Viewing
 Suctioning and
Aspirating
 Dilating and Probing
 Measuring
 Accessory
Instruments
 Microinstrumentation

CUTTING AND DISSECTING
•SCALPELS
• Insert Blade using a HEAVY HEMOSTAT of KELLY CLAMP
•No.
•No. 11 Blade
•No. 12 Blade
•No. 15 Blade
•No. 23 Blade
•KNIVES
•SCISSORS
•BONE Cutters and Debulking Tools
•Biopsy Forceps and Punches
•Curettes
•Snares
•Blunt Dissectors

•Bone Curette

•Mayo Scissors
•Metzenbaum Scissors

•Suture Scissors
(Blunt /Blunt)

GRASPING & HOLDING
•Tissue Forceps
•Smooth Forceps
•Toothed Forceps
•Allis Forceps
•Babcock Forceps
•Stone Forceps
•Tenaculums
•Bone Holders

GRASPING & HOLDING
•Rat-Toothed Tissue Forceps

GRASPING & HOLDING
•Allis Tissue Forceps

GRASPING & HOLDING
•Babcock Intestinal Forceps

GRASPING & HOLDING
•Backhaus Towel Clamps

CLAMPING & OCCLUDING
•Hemostatic Forceps
•Hemostats
•Crushing Clamps
•Noncrushing Vascular Clampsnursinglectures.blogspot.com

•Hemostatic Forceps
•Hemostats
•Crushing Clamps
•Noncrushing Vascular Clamps- used to occlude peripheral or
major blood vessels

•Pean Intestinal forceps

•Spay Hook

•Ribbon Retractor

SUTURING & STAPLING
•Needle Holders
•Tungsten Carbide Jaws
•Crosshatched Serrations
•Smooth Jaws
•Staplers

SUTURING & STAPLING
•Terminal End Staplers
•Internal Anastomosis Staplers
•End-to-End Circular Staplers

VIEWING
•Speculums
•Endoscopes
•Hollow Endoscopes
•Lensed Endoscopes nursinglectures.blogspot.com

SUCTIONING & ASPIRATING
•Suction
•Poole Abdominal Tip
•Frazier Tip
•Yankeur Tip
•Autotransfusion

SUCTIONING & ASPIRATING
•Suction
•Poole Abdominal Tip
•Frazier Tip
•Yankeur Tip
•Trocar

DILATING & PROBING

MEASURING

ACCESSORY INSTRUMENTS

MICROINSTRUMENTATION

HANDLING INSTRUMENTS
•Standardized BASIC
sets
•Scrub Person
counts ALL
instruments, sharp
and sponges with
the CIRCULATOR
•Handle Loose
Instruments
SEPARATELY
•Sort by
CLASSIFICATION nursinglectures.blogspot.com

Handling INSTRUMENTS during
SURGERY
• Know the NAME and USE
• Handle INDIVIDUALLY
• Use for the INTENDED purpose
• Use of HAND SIGNALS
• Short INSTRUMENTS = Superficial
Work
• LONG Instruments = DEEP
• PASS instruments DECISIVELY
• FREE-HAND TECHNIQUE
• Watch the sterile field for
LOOSE instruments
• With a MOIST, SPONGE wipe
blood and organic debris from
instruments using a
DEMINERALIZED STERILE,
DISTILLED H20

PATIENT SAFETY in LASERS
 Eyes and Eyelids
should be adequately
protected (aluminum
foil, moist pads)
 Antiseptics must be
NONFlammable
 Rectum should be
packed with a
MOISTENED sponge
to prevent escape of
METHANE gas
 Anesthetic Agents
should be
NONCombustible
 Flexible metallic or
insulated silicone
endotracheal tubes
 Wear high filtration
MASKS for CO2 laser
ablation such as
condylomata
(Venereal warts)

Advantages of LASERS
 Precise CONTROL =
ACCURATE incision
 Access to HARD to
REACH areas
(endoscopes, rhodium
reflector mirrors)
 Unobstructed view of
the surgical site
 Minimal TRAUMA to
tissues
 DRY, Bloodless
SURGICAL Field
 Minimal THERMAL
effect
 Reduced RISK for
INFECTION
 Prompt Healing
 Reduced
OPERATING Time

THANK YOU
Free Nursing Lectures
http://nursinglectures.blogspot.com

BASIC SURGICAL
INSTRUMENTS
Fundamentals of Primary Health Care
B

BASIC SURGICAL
INSTRUMENTS
 Basic laparotomy instruments are essential to
accomplish most types of general surgery. Each
instrument can be placed into one of the four
following basic categories:
 Retracting and Occluding Instruments
 Cutting and Dissecting Instruments
 Clamping and Occluding Instruments
 Grasping and Holding Instruments

Instruments
 used to hold back or retract organs or tissue to gain
exposure to the operative site. They are either "self-
retaining" (stay open on their own) or "manual" (held by
hand). When identifying retractors, look at the blade, not
the handle.

 A Gelpi retractor (self-retaining) is used to retract
shallow incisions.
Instruments

Cutting and Dissecting
Instruments
 are sharp and are used to cut body tissue or surgical
supplies.
Knife Handle, Scissors
(left to right)

Instruments
 7 handle with 15 blade (deep knife) - Used to cut
deep, delicate tissue.
 3 handle with 10 blade (inside knife) – Used to cut
superficial tissue.
 4 handle with 20 blade (skin knife) - Used to cut
skin.
#7, #3, #4
(left to right)

 Straight Mayo scissors - Used to cut suture and
supplies. Also known as: Suture scissors.
EX: Straight Mayo scissors being used to cut suture.
Instruments

 Curved Mayo scissors - Used to cut heavy tissue
(fascia, muscle, uterus, breast). Available in regular
and long sizes.
Instruments

 Metzenbaum scissors - Used to cut delicate
tissue. Available in regular and long sizes.
Instruments

 are used to compress blood vessels or hollow organs
for hemostasis or to prevent spillage of contents.
Clamping and Occluding
Instruments

 A hemostat is used to clamp blood vessels or tag
sutures. Its jaws may be straight or curved. Other
names: crile, snap or stat.
Instruments

Instruments
 A mosquito is used to clamp small blood
vessels. Its jaws may be straight or curved.
hemostat, mosquito (left to right)

 A Kelly is used to clamp larger vessels and
tissue. Available in short and long sizes. Other
names: Rochester Pean.
Kelly, hemostat, mosquito (left to right)
Instruments

 A burlisher is used to clamp deep blood
vessels. Burlishers have two closed finger
rings. Burlishers with an open finger ring are called
tonsil hemostats. Other names: Schnidt tonsil forcep,
Adson forcep.
Instruments

 A right angle is used to clamp hard-to-reach vessels
and to place sutures behind or around a vessel. A
right angle with a suture attached is called a "tie on a
passer." Other names: Mixter.
Instruments

 A hemoclip applier with hemoclips applies metal
clips onto blood vessels and ducts which will remain
occluded.
hemoclip applier with hemoclips
Instruments

Grasping and Holding
Instruments
 are used to hold tissue, drapes or sponges.

 An Allis is used to grasp tissue. Available in short
and long sizes. A "Judd-Allis" holds intestinal tissue;
a "heavy allis" holds breast tissue.
Instruments

Instruments
 A Babcock is used to grasp delicate tissue (intestine,
fallopian tube, ovary). Available in short and long
sizes.

 A Kocher is used to grasp heavy tissue. May also
be used as a clamp. The jaws may be straight or
curved. Other names: Ochsner.
Instruments

 A Foerster sponge stick is used to grasp
sponges. Other names: sponge forcep.
Foerster sponge stick EX: Sponge sticks holding a 4 X 4
and probang.
Instruments

 A dissector is used to hold a peanut.
Instruments
dissector
EX: Dissector holding a peanut.

 A Backhaus towel clip is used to hold towels and
drapes in place. Other name: towel clip.
Backhaus towel clip Large & small towel clips
Instruments

 Pick ups, thumb forceps and tissue forceps are
available in various lengths, with or without teeth, and
smooth or serrated jaws.
Instruments

 Russian tissue forceps are used to grasp tissue.
Instruments

 Adson pick ups are either smooth: used to grasp
delicate tissue; or with teeth: used to grasp the
skin. Other names: Dura forceps.
Instruments

Instruments
 Long smooth pick-ups are called dressing
forceps. Short smooth pick-ups are used to grasp
delicate tissue.

 DeBakey forceps are used to grasp delicate tissue,
particularly in cardiovascular surgery.
Instruments

Instruments
 Thumb forceps are used to grasp tough tissue
(fascia, breast). Forceps may either have many
teeth or a single tooth. Single tooth forceps are also
called "rat tooth forceps."
single tooth forceps, many teeth forceps
(top to bottom)

 Mayo-Hegar needle holders are used to hold
needles when suturing. They may also be placed in
the sewing category.
Instruments
short, medium & long
(top to bottom)
EX: Needle holder with suture.

2.1. surgical instruments

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2.1. surgical instruments