Aseptic Laboratory/Suture and Instruments Flashcards
Asepsis
Prevent wound contamination by destroying organisms before they enter the wound
Antisepsis
killing bacteria after they have entered the wound
Disinfection
use of germicidal substances to kill most microorganisms
Sterilization
the process of destroying all microorganisms such as bacteria, fungi, and spores
What is the goal of aseptic surgical technique?
minimize contamination of surgical wounds
What is not sterile once surgery starts?
Your back neck shoulders axillae below waist
Physical sterilization
Thermal energy
Filtration
Radiation energy
Chemical sterilization
Plasma
Disinfectants
What is the most common method of sterilization?
Autoclave
What is the minimum standard for autoclaving?
250F
15 psi
13 min
What is the disadvantage of steam sterilization?
dulls sharp instruments
What is used for Chemical sterilization?
Ethylene Oxide
Gas Plasma
What does the effectiveness of Chemical Sterilization depend on?
Gas concentration
Temperature
Exposure time
Humidity (minimum of 35%)
What is disinfected with “Cold Disinfectants”?
Dental Instruments
Scopes
What is the shelf life of a sterile pack using Heat sealed paper/transparent plastic pouch?
1 years
What is the shelf life of a sterile pack using 2 layers of polyethylene + muslin?
9 months
What is the shelf life of a sterile pack using 2 layers of crepe paper + muslin?
10 weeks
What is the shelf life of a sterile pack using 2 layers of double wrap muslin?
8 weeks
What is the shelf life of a sterile pack using 1 layer of crepe paper?
3 weeks
Halsted’s Principles of Surgery
- Gentle Tissue Handling
- Accurate hemostasis
- Preservation of blood supply
- Strict aseptic technique
- Sutures tied without tension
- Accurate tissue apposition
- Obliteration of dead space
- Postoperative wound protection
Primary Hemorrhage
Bleeding during procedure
Intermediate delayed hemorrhage
within 24 hours of surgery
Secondary delayed hemorrhage
After 24 hours - usually the result of ineffective ligation
Gelform
Absorbable gelatin sponge Topical hemostatic agent derived from pig skin
Surgicel
Absorbable plant based cellulose topical hemostatic agent
Hemablock
microporous polysaccharide powder topical hemostatic agent
Types of Definitive Hemostasis
Electrocoagulation
Ligature
Vascular clips
Primary vascular repair
Electrocoagulation
Electric current delivered to the tissues
What are the advantages of Electrocoagulation?
Decreased blood loss and operative time
Improved visualization
What are the disadvantages of Electrocoagulation?
Less hemostatic security than ligation
Collateral tissue damage
3 scalpel handle
used in small animals
4 scalpel handle
used in large animals
What size blade goes with a Bard-Parker #3 scalpel handle?
#10 #11 #12 #15
What size blade goes with a #4 scalpel handle?
20s
Metzenbaum Scissors
Used for dissection and cutting delicate tissues such as subcutaneous tissues, intestine, or bladder
Mayo Scissors
Used for general dissection and cutting through tissues such as muscle fascia, tendon, the linea alba, or trimming skin
Vernon Cartilage and Wire Scissors
Good for cutting sutures and drape material
Brown Adson Tissue Forceps
Very common general use tissue forceps for general tissue handling but can crush tissue
Halstead Mosquito Forceps
Delicate hemostat used for ligating individual vessels
Rochester-Carmalt Hemostatic Forceps
Used to occlude large vascular structures such as the ovarian pedicle
Backhaus Towel Clamp
Used to secure the quarter drapes or Huck towels to the patient skin
Allis Tissue Forceps
Forceps used to grasp tissue facilitating retraction, positioning of suction tubing and electrocautery wire on patient drape
Snook Ovariohysterectomy Hook
Used to blindly exteriorization of uterine horn during ovariohysterectomy
What are the Crushing Tissue Forceps?
Babcock tissue forceps
Allis tissue forceps
What are the Non-crushing forceps?
Doyen Intestinal Forceps
What are the Hemostatic forceps?
Rochester Carmalt forceps
Kelly Hemostat forceps
Halsted mosquito forceps
How should you always place curved forceps?
tips should be always pointed out of the body cavity or away from the patient
Babcock Tissue Forceps
Forceps used for helping grasp and retract soft tissues such as the stomach or bladder
Straight Doyen Intestinal Tissue Forceps
Forceps used for intestinal lumen occlusion in enterotomies, resection and anastomosis
Straight and Curved Kelly Hemostatic Forceps
Forceps used for tip clamping of small to medium vessels
What are the Thumb Forceps?
Brown-Adson forceps
Adson forceps
DeBakey forceps
Bishop-Harmon forceps
Adson Tissue Forceps
Forceps that result in less crush injury than with Brown-Adson tissue forceps but have poor grip on fat or other friable tissues
DeBakey Tissue Forceps
Most frequently used thumb forceps in soft tissue surgery that are less traumatic than Brown-Adson thumb forceps
Bishop-Harmon Forceps
Used to grasp tissue in ophthalmic surgery
What blades are used with the Beaver Blade Scalpel Handle?
#64 #67
Describe a #10 Blade use
Long flat blade for sharp penetration of hollow organs or for precision
Describe a #11 Blade use
Sharp penetration of hollow organs or for precision cutting
Describe a #12 Blade use
Used for Onychectomy in cats
Describe a #15 Blade use
Used for subcutaneous or fascial incisions
When would you use a Beaver Blade Scalpel Handles and blades?
Incise the limbus for intraocular surgery
Used by some orthopedic surgeons for incision of intra-articular structures
What are the different types of surgical scissors?
Mayo scissors Metzenbaum scissors Stevens tenotomy scissors Spencer stitch scissors Vernon cartilage and wire scissors
Stevens Tenotomy Scissors
Used for precision cutting such as ophthalmic and urologic surgery
What is an important feature of the Spencer Stitch Scissors?
Hooked tip used to entrap suture for cutting
Spencer Stitch Scissors
Used for post-op suture removal
Vernon Cartilage and Wire Scissors
Used to incise thick, tough tissue and orthopedic wire
What are the Needle Holders?
Mayo-Hegar needle holders
Olsen-Hegar needle holders
Castroviejo needle holders
Derf needle holders
Describe the Mayo-Hegar Needle Holders
Textured tungsten carbide jaw inserts provide intermediate needle holding security over smooth jaws or jaws with teeth
Describe Olsen-Hegar needle holders
Combined needle driver/scissors
Same jaw as the Mayo-Hegar needle holders
Derf Needle Holders
Ophthalmic needle drivers
small size useful for suturing smaller structures such as the eyelid or conjunctiva
Castroviejo needle holders
Microsurgery needle driver
Used for ophthalmic and vascular surgery
Spring loaded handle
Self-Retaining Retractors
Balfour retractor
Finochietto retractor
Gelpi retractor
Weitlaner retracter
Hand Held Retractors
Army-Navy retractor Malleable retractor Hohmann retractor Senn retractor Snook hook/ Spay hook
Balfour Retractor
Blunt blades used to retract abdominal wall laterally
Central “bladder blade” can be used to retract rib cage cranially
Finochietto Retractor
Adjustable rib retractor
Used for retraction of chest wall during intercostal thoractomy and median sternotomy
Flat retractor blades are perpendicular to instrument
Gelpi Retractor
Ring retractor with self-retaining ratchet
Used for retraction of soft tissues (especially useful for retraction of muscle bellies during orthopedic or spinal surgery)
Weitlaner Retractor
Ringed Retractor with self-retaining
Multiple pointed prongs on each arm
Useful for retraction of soft tissue in a small, superficial incision
Army-Navy Retractor
Double ended blunt retractor
Hand held retractor typically used by assistant
Used for both soft tissue and orthopedic surgery
Malleable Retractor
Double ended blunt retractor
used for retracting viscera in abdominal and thoracic surgery
Hohmann Retractor
Used to lever muscle and soft tissues away from surgical field and bone during orthopedic surgeries
Senn Retractor
Double ended retractor with a blunt or sharp fork on one end and right angle blade on other end
Used in soft tissue and orthopedic surgery for retraction of tissues in small working spaces
Orthopedic Instruments
Speed lock bone holding forceps Kern bone holding forceps Jacob's chuck Mallet Osteotome Periosteal elevator Lampert Rongeur
Kern Bone Holding Forceps
Used to grip and manipulate bone during fracture reduction and repair
Speed Lock Bone Holding Forceps
Used to grip and manipulate bone during fracture reduction and repair
Jacob’s chuck
Used to drive IM pins and K-wires during orthopedic surgery
Key used to tighten or release pin grip
Mallet
used in orthopedic surgery to advance an osteotome for making precise osteotomies
Osteotome
two sided beveled instrument used to create osteotomy in numerous orthopedic procedure
Chisel
one sided beveled instrument used to create osteotomy in numerous orthopedic procedures
Periosteal Elevator
Used to reflect muscle and soft tissue from bone
Free Periosteal Elevator
Double ended periosteal elevator
Lampert Rongeur
Forceps with cupped jaws and blunted or tapered tips
Used to remove small fragments of bone, to recontour bone, or to prepare bone for grafting
Has finer tipped jaws and are used in more restricted areas (bulla osteotomy)
List the Ophthalmic Instruments
Castroviejo needle holders Derf needle holders Bishop-Harmon tissue forceps Barraquer eyelid speculum Jaeger eyelid plate Stevens tenotomy scissors Beaver blade and handle
Barraquer Eyelid Speculum
Wire self retaining instrument used hold eyelids open during enucleations and surgery of the cornea and third eyelid
Jaeger Eyelid Plate
Used to protect globe when making incisions into the eyelid
Poole suction tip
Used to suction large amounts of fluid from body cavity
Blunt tip prevents trauma to organs
Inner cannula unscrews and can be used as a modified Frazier suction tip
Frazier Suction Tip
Fine tipped suction tip for removal of small amounts of fluid from surgical field
Used for mostly orthopedic and neurologic surgery
List Dental Instruments
Wind tipped dental elevator Wedge tipped dental elevator Curette Scaler Extraction forceps Calculus removal forceps Dental explorer Periodontal probe
Wing Tipped Dental Elevator
used to sever the periodontal ligament by rotating the instrument around the tooth
Wedge tipped Dental Elevator
used to weaken the periodontal ligament and luxate the tooth for extraction
Curette
used for subgingival cleansing, root planing, and curettage
Scaler
Removes dental deposits from above gumline
Extraction forceps
used to grasp loose/luxated teeth for extraction
Calculus removal forceps
uneven tipped instrument useful in removing large pieces of calculi prior to scaling
Dental explorer
increased tactile sensation for detecting areas of enamel decay
Periodontal probe
Used to measure pocket depths around a tooth
What are the Absorbable Suture materials?
Chromic gut Polyglactin 910 Polyglycolic acid Glycomer 631 Caprolactone Poliglecaprone 25 Polydiaxonone
What are the nonabsorbable sutures?
Nylon Silk Polypropylene Polymerized caprolactam Stainless steel wire
When would you use Polyglactin 910?
Dental Surgery
When would you use Polyglycolic acid?
Dental Surgery
When would you use Glycomer 631?
Closure of entertomies, cystotomies, body wall closure, fascia closure
When would you use Caprolactone?
Closure of cystotomies (non-infected bladders), subcutaneous tissues
When would you use Poliglecaprone 25?
Closure of cystotomies (non-infected bladder), subcutaneous tissues
When would you use Polidioxanone?
Closure of entertomies, cystotomies, body wall closure, fascia closure
When would you use Silk?
Cardiovascular surgery
When would you use Nylon?
Skin closure, orthopedic repair (lateral tibiofabellar suture)
When would you use Polypropylene?
Tendon, ligament, fascial, and joint capsule closures
When would you use Polymerized caprolactam?
Skin sutures
When would you use Stainless Steel Suture?
Orthopedic applications (closure of sternotomy)
What is a disadvantage of Chromic Gut?
Knot security decreases when wet
What is a disadvantage of Nylon?
Susceptible to degradation
Hydration may lead to disruption of hydrogen bonds leading to loss of tensile strength
What is a disadvantage of Polymerized caprolactam?
Sinus formation when implanted in tissues
What are the properties of ideal suture material?
Minimal tissue reaction Gental passage through tissues High knot safety and security No Capillarity Maximum tensile strength/high breaking strength Consistent performance Good and predictable absorption Comfortable handling
Capillarity
Process by which fluid and bacteria are wicked along multifilament fibers
3/8 circle needle shape
more easily manipulated through superficial tissue
1/4 circle needle shape
used for ophthalmic procedures
5/8 circle needle shape
Useful in confined locations or deep tissues
Taperpoint needle
Sharp tip that pierces and spreads tissue without cutting
When would you use a Taperpoint needle?
Intestine
Sucutaneous tissue
fasica
Tapercut
combination of reverse cutting and taperpoint
When would you use a Tapercut needle?
Heavy thick fascia, tendon, vascular grafts
Cutting needle
Cutting edge on concave portion of needle. Tends to cut out of tissue
Reverse cutting needle
Cutting edge on convex surface reducing risk of tissue cut out
When would you use a Reverse cutting needle?
Skin
Spatula point needle
Flat on top and bottom
When would you use a Spatula point needle?
Ophthalmic procedures
Blunt point needle
Blunt point that dissects through friable tissue without cutting
When would you use a Blunt point needle?
Soft parenchymal organs (liver or kidneys)
