Chapter 13 Instrumentation Flashcards
3 – accepts blades #10, 11, 12, 15
Scalpel
Blades
Made of _____steel or _____steel
Handles
Produce less tissue trauma than do scissor incisions due to the sharpness of the cutting edge.
3 – accepts blades #10, 11, 12, 15
Scalpel
Blades
Made of carbon steel or stainless steel
Handles
Produce less tissue trauma than do scissor incisions due to the sharpness of the cutting edge.
Scissors
Point type
Sharp-sharp
Sharp-blunt
Blunt-blunt
Blade shape
Straight or curved
Cutting edge type
Plain
Serrated – prevent slippage, particularly on lax (eyelid) or dense (cartilage) tissue.
Scissors with straight tips have a greater mechanical advantage
Scissors with curved tips have a greater mechanical advantage
Curved tips have greater versatility and enable improved visibility particularlydeeper in wounds
Metzenbaum scissors have thin delicate blades that are approximately ¼ of the overall instrument length.Used on delicate tissues.
Mayo scissors have thick blades that are approximately 1/3 of the length.Used in denser tissues (fascia)
Utility of operating scissors often have straight blades with sharp-blunt tips and are reserved for us on inanimate objects ((suture material)
Martin cartilage scissors – have coarser blades with serrated edges for cutting denser tissues (during otic procedures)
Potts-Smith scissors – for cardiovascular procedures
Tenotomy scissors
Stevens – ring handled
Wescott – spring-handled for ophthalmic procedures
Wire scissors have short, notched serrated blades and are used to cut stainless steel wire
Rongeurs
Forceps with cupped jaws and blunted or tapered tips used to remove pieces of bone to expose underlying structures to prepare bone for grafting or to recontour bone ends.
Stille-Luer, Ruskin, Lempert (finer more delicate jaws), Kerrison (has a cutting blade)
Periosteal elevators – reflecting muscle and other soft tissue from bone.
Freer and Sayre, ASIF, and Langenbeck
Bone cutting instruments
Chisel – beveled on one side
Osteotome – double beveled
Gouges
Manual saws – include hobby saw and the Gigli wire saw
Power oscillating saws are used commonly for various orthopedic(TPLO or FHO) and soft tissue (median sternotomy)
Bone cutting forceps come in various sizes and weight, and similar to rongeurs are available as single or double action.They have paired chisel-like tips for cutting bone
Currettes – used to remove bone or soft tissue particularly from restricted sites (cancellous bone harvesting, bulla osteotomy).
Trephines have t-handles, a cylindrical cutting blade and often a central stylet for removing bone from the shaft used to gain entry into bony cavities and obtain sample of bone for biopsy.
_________Instruments – used on inanimate objects except for towel clamps which can also be used to assist in closure of an incision under tension
Needle holders
Cross hatching jaw design is intended to limit twisting and rotation of the needle allowing the surgeon to accurately control passage of the needle through tissue.
Textured turngsten carbide needle-holder jaw inserts have advantages over both smooth jaw inserts and those with teeth.They provide intermediate needle-holding security between smooth needle holder jaws and those with teeth while minimizing the potential for suture material damage and weakening during knot tying.
Mayo-Hegar
Olsen-Hegar (with scissor)
Castroviejo (spring handled ophthalmic needle holders)
Tissue forceps – for tissue grasping and dissection
Crile forceps – cross-serrations are designed to be used in a tip-clampin gashion
Rochester-Carmalt forceps – longitudinal serration are used in a jaw-clamping fashion
Crushing tissue forceps – have apposing tips and are hinged in the middle frequently with a ratchet lock at the handle
Right-angle forceps – lacking a ratchet lock and are used most often to dissect tissue especially when isolating vessels ex: patent ductus arteriosus
Babcock tissue forceps – grasp tissue at right angles to the direction of tension application.
Allis tissue forceps - grasp tissue at right angles to the direction of tension application.
Ochsner-kocher forceps – large intermeshing teeth at the tip ends.
Non-crushing tissue forceps
Doyen intestinal forceps – fine longitudinally oriented grooves of various lengths
Peripheral vascular clamps – bulldog clamps and patent ductus clamps, DeBakey and Cooley forceps
Partial occlusion forceps – Stainsky are used when incising large vessels such as the caudal vena cava or aorta.They restrict blood flow in only a portion of the vessel during application.
Hemostatic forceps
Halstead mosquito - transversely oriented serrations designed for tip clamping
Kelly – transversely oriented serrations designed for tip clamping half way along the length
Crile - transversely oriented serrations designed for tip clamping
Rochester-carmalt forceps – longitudinally oriented serrations and cross-hatched tips for jaw clamping (pedicle clamping during ovariohysterectomy)
Thumb forceps
Brown-Adson forceps – contain very fine teeth in two parallel row
Debakey
Dressing
Adson forceps
Towel clamps
Pointed tips used to hold towels or quarter drapes securely to the skin of the patient.
Penetrating (Backhaus towel clamps)
Non penetrating (Edna Lorna towel clamps)
Bone holding forceps
Maniupulate bone fragments or to grip bone during fracture reduction and fixation
Kern
Lane
Verbugge
Reduction forceps with or without speed locks or ratchets and having tips with serrations or points
Grasping Instruments – used on inanimate objects except for towel clamps which can also be used to assist in closure of an incision under tension
Needle holders
Cross hatching jaw design is intended to limit twisting and rotation of the needle allowing the surgeon to accurately control passage of the needle through tissue.
Textured turngsten carbide needle-holder jaw inserts have advantages over both smooth jaw inserts and those with teeth.They provide intermediate needle-holding security between smooth needle holder jaws and those with teeth while minimizing the potential for suture material damage and weakening during knot tying.
Mayo-Hegar
Olsen-Hegar (with scissor)
Castroviejo (spring handled ophthalmic needle holders)
Tissue forceps – for tissue grasping and dissection
Crile forceps – cross-serrations are designed to be used in a tip-clampin gashion
Rochester-Carmalt forceps – longitudinal serration are used in a jaw-clamping fashion
Crushing tissue forceps – have apposing tips and are hinged in the middle frequently with a ratchet lock at the handle
Right-angle forceps – lacking a ratchet lock and are used most often to dissect tissue especially when isolating vessels ex: patent ductus arteriosus
Babcock tissue forceps – grasp tissue at right angles to the direction of tension application.
Allis tissue forceps - grasp tissue at right angles to the direction of tension application.
Ochsner-kocher forceps – large intermeshing teeth at the tip ends.
Non-crushing tissue forceps
Doyen intestinal forceps – fine longitudinally oriented grooves of various lengths
Peripheral vascular clamps – bulldog clamps and patent ductus clamps, DeBakey and Cooley forceps
Partial occlusion forceps – Stainsky are used when incising large vessels such as the caudal vena cava or aorta.They restrict blood flow in only a portion of the vessel during application.
Hemostatic forceps
Halstead mosquito - transversely oriented serrations designed for tip clamping
Kelly – transversely oriented serrations designed for tip clamping half way along the length
Crile - transversely oriented serrations designed for tip clamping
Rochester-carmalt forceps – longitudinally oriented serrations and cross-hatched tips for jaw clamping (pedicle clamping during ovariohysterectomy)
Thumb forceps
Brown-Adson forceps – contain very fine teeth in two parallel row
Debakey
Dressing
Adson forceps
Towel clamps
Pointed tips used to hold towels or quarter drapes securely to the skin of the patient.
Penetrating (Backhaus towel clamps)
Non penetrating (Edna Lorna towel clamps)
Bone holding forceps
Maniupulate bone fragments or to grip bone during fracture reduction and fixation
Kern
Lane
Verbugge
Reduction forceps with or without speed locks or ratchets and having tips with serrations or points
__________
_______-held retractors
Senn –double ended
Army navy –double ended
Green – single ended retractors with a relatively broad U-shaped end
Malleable – thin and flexible and are available in various widths
Spay hook
Hohman
Meyerding – sharp-toothed blade at one end and a thumb grip at the other end
Retractors
Hand-held retractors
Senn –double ended
Army navy –double ended
Green – single ended retractors with a relatively broad U-shaped end
Malleable – thin and flexible and are available in various widths
Spay hook
Hohman
Meyerding – sharp-toothed blade at one end and a thumb grip at the other end
______________retractors – provide enhanced access during surgical procedures and do not require a surgical assistant
Balfour – can have an attached bladder blade
Finochietto
Gelp
Wietlaner
Ring retractors
Self-retaining retractors – provide enhanced access during surgical procedures and do not require a surgical assistant
Balfour – can have an attached bladder blade
Finochietto
Gelp
Wietlaner
Ring retractors
Suction tips
Poole- central pin point suction with an outer fenestrated tube.
Frazier – pin-point suctioning
Yankauer
Miscellaneous instruments
Lister bandage scissors
Suture removal scissors (Spencer)
Alligator forceps (Noyes)
Jacob hand chuck and key for placement of pins or wires in bone
Reused drill bits accounted for the largest proportion of instrument breakage in one study of orthopeid procedures in humans with an overall breakage rate of 0.18%
Reused drill bits accounted for the largest proportion of instrument breakage in one study of orthopeid procedures in humans with an overall breakage rate of ____%
Reused drill bits accounted for the largest proportion of instrument breakage in one study of orthopeid procedures in humans with an overall breakage rate of 0.18%
Microsurgical instruments
3 characterisits
Microsurgical instruments
3 characterisits
Satin finish to prevent glare
Sufficient length to be held comfortably using a pencil grip
Sufficiently gentle closing tension for spring-loaded instruments
5 Groups of microsurgical instruments
5 Groups
Microsurgical forceps – nontoothed and have precisely aligned tips and even spring tension to achieve a graded, smooth closure.Jeweler’s forceps, vessel dilators, dissecting forceps, and tying forceps
Microsurgical needle holders – flat or round grips and tips that are straight, curved, or angled.Spring-loaded microsurgical needle holders with both locking and nonlocking designs are available.
Microsurgical vessel clamps – used to approximate tubular structures by providing temporary, precise, tension-free occlusion without damaging the vessel.
Microsurgical scissors
Microsurgical retractors - example Alm retractor with a threaded handle for easy precise opening.
__________autoclaving should be avoided for microsurgical or ophthalmic instruments as the higher temperature used are detrimental to the fine points and cutting surfaces of such instruments
Flash autoclaving should be avoided for microsurgical or ophthalmic instruments as the higher temperature used are detrimental to the fine points and cutting surfaces of such instruments
