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Intro to Surgery > Lecture 4 - Instruments & Tissue Handling > Flashcards

Lecture 4 - Instruments & Tissue Handling Flashcards

1
Q

What are Halsted’s Principles of Surgery?

A
  1. Gentle tissue handling 2. Meticulous hemostasis 3. Strict aseptic technique 4. Preservation of blood supply 5. Elimination of dead space 6. Minimize tension 7. Careful approximation of tissues 8. Minimize foreign material 9. Sharp anatomic dissection
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2
Q

Tissue damage is proportional to _____ and _____.

A

time, trauma

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3
Q

In which hand should you hold non-articulating instruments?

A

non-dominant hand

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4
Q

In which hand should you hold articulating instruments?

A

dominant hand

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5
Q

How can hand tremors be minimized?

A

by decreasing the fulcrum distance

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6
Q

What are the cutting instruments?

A

scalpel and scissors

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7
Q

What are the grasping instruments?

A

needle holders, tissue forceps, thumb forceps, towel clamps

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8
Q

Besides cutting and grasping, what are the other general types of instruments?

A

retracting, orthopedic, miscellaneous

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9
Q

What is the primary cutting instrument?

A

scalpel blade

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10
Q

Scalpel blades have the _____ amount of tissue trauma.

A

least

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11
Q

What are the sizes of each blade from left to right? Which one is most commonly used?

A

10, #11, #12, #15

#10 is the most common

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12
Q

What should you use to grip your scalpel blade to load it? On what surface should it be gripped?

A

Use needle holders to grip the non-cutting surface

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13
Q

What is the proper process of loading a scalpel blade onto the handle?

A

Align slot in handle with hole in the blade and advance the blade until it is locked

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14
Q

What should you use to remove the scalpel blade from the handle and how often?

A

ALWAYS use a needle holder

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15
Q

How should the scalpel blade/handle be pointed when unloading the blade?

A

down and away

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16
Q

What are the two grips that can be used to hold the scalpel blade?

A

Fingertup grip (overhand) and pencil grip

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17
Q

What does your non-dominant hand do when making an incision?

A

applies counter-traction

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18
Q

How should the blade be held in relation to the skin when making an incision?

A

Perpendicular to the skin (held by the dominant hand)

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19
Q

How should an incision be made, in general?

A

Full thickness with a single pass

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20
Q

What are the motions a scalpel blade can do?

A

Sliding, pressing, reverse pressing, press cut (stabbing), sawing, and scraping

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21
Q

What is an example of a time when you would use a sawing motion with your scalpel?

A

removing lung or liver lobe

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22
Q

When would you use a scraping motion with your scalpel?

A

for very specific reasons

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23
Q

What are the 2 types of tissue dissection?

A

blunt vs. sharp

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24
Q

What type of grip should be used to hold scissors?

A

tripod grip

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25
Q

What types of forces can be used with scissors?

A

Closing, shearing, torque forces

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26
Q

When should you use mayo scissors?

A

Fascia, linea alba, extending incision

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27
Q

When should you use metzenbaum scissors?

A

on more delicate tissues (blunt dissection)

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28
Q

When should you use operating (utility, sharp-blunt) scissors?

A

Cutting inanimate objects

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29
Q

When should operating (utility, sharp-blunt) scissors NOT be used?

A

On tissues

Cutting suture in the abdomen because of the sharp end

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30
Q

Identify this instrument.

A

Bandage scissors (Lister)

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31
Q

Identify this instrument.

A

Suture scissors (Spencer stitch)

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32
Q

What are the 3 types of tissue forceps?

A
  1. Crushing
  2. Non-crushing
  3. Hemostatic
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33
Q

What are needle holders used for?

A

Passage and retrieval of needle with suturing, instrument ties for knot tying

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34
Q

With which grip do you have the greatest control of the needle holders with max wrist motion?

A

palming

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35
Q

The needle should be passed on a _____ path.

A

circular

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36
Q

Where on the needle should the needle holders grasp it?

A

At a perpendicular angle between 1/3 to 1/2 the length of the needle from the swaged end

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37
Q

What should you grasp the needle with after you have pulled it through the skin?

A

needle holders NOT your hand

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38
Q

What are the 3 types of needle holders?

A

Mayo-Hegar, Olsen-Hegar, and Castroviejo

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39
Q

What is a Castroviejo needle holder used for?

A

Microsurgery (it is spring-loaded)

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40
Q

What should crushing tissue forceps be used on?

A

Only for tissues that are to be removed from the body

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41
Q

What are the 4 types of crushing tissue forceps?

A
  1. Allis
  2. Babcock
  3. Oschner-Kocher
  4. Right-angle
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42
Q

Identify this instrument.

A

Allis tissue forceps

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43
Q

Identify this instrument.

A

Babcock tisssue forceps

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44
Q

Identify this instrument.

A

Oschner-Kocher tissue forceps

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45
Q

Identify this instrument.

A

Right-angle tissue forceps

46
Q

What are the non-crushing tissue forceps?

A

Doyen and Satinsky

47
Q

What would you use Doyen tissue forceps for?

A

Bowel surgery; space in the middle is where the bowel would go

48
Q

What would you use Satinsky tissue forceps for?

A

Vascular occlusion; should have on the table ready to go if doing a high risk surgery

49
Q

Identify this instrument.

A

Doyen tissue forceps

50
Q

Identify this instrument.

A

Satinsky tissue forceps

51
Q

What are hemostatic forceps used for?

A

They are a type of crushing forceps used to achieve hemostasis by clamping a vessel.

52
Q

What types of serrations can be found on hemostatic forceps?

A

Transverse (tip) and longitudinal (jaw)

53
Q

What are the transverse serrations on hemostatic forceps used on?

A

smaller tissues

54
Q

What are the longitudinal serrations on hemostatic forceps used on?

A

Larger, bulkier tissues

55
Q

What are the 4 types of hemostatic forceps?

A
  1. Mosquito
  2. Kelly
  3. Crile
  4. Rochester-Carmalt
56
Q

What is different about the serrations on Kelly hemostats vs. the other types?

A

They only go halfway down

“Kelly is a good girl so she only goes halfway”

57
Q

Identify this instrument.

A

Mosquito hemostats

58
Q

Identify this instrument.

A

Kelly hemostats

59
Q

Identify this instrument.

A

Crile hemostats

60
Q

Identify this instrument.

A

Rochester-Carmalt hemostats

61
Q

What is the difference between Rochester vs. Bainbridge hemostats?

A

Bainbridge are very narrow, Rochester are wider/thicker

62
Q

Identify these instruments.

A

Left = Rochester-Carmalt

Right = Bainbridge forceps

63
Q

What are thumb forceps used for?

A

To grasp and hold tissues for manupulation;

To stabilize tissue or expose tissue layers when suturing

64
Q

Thumb forceps with fine teeth should be used on _____ tissues.

A

more delicate

65
Q

What are the two grips used for grasping thumb forceps and when is each one used?

A

Pencil grip = in use

Palmed = not in use

66
Q

What are Debakey thumb forceps used on?

A

Soft tissue and vessels; they have fine teeth

67
Q

What are Brown-Adson and Rat-tooth forceps used on and why?

A

Thicker and more robuse tissues; they have larger teeth

68
Q

What are towel clamps used for?

A

Securing towels and drapes to one another and to the patient.

69
Q

On what type of tissues should traction be placed with towel clamps?

A

On tissues to be excised or counteract tension on skin closure

70
Q

Identify this instrument.

A

Backhaus towel clamp

71
Q

Identify this instrument.

A

Roeder towel clamp

72
Q

Identify this instrument.

A

Lorna-Edna towel clamp

73
Q

What is characteristic of Roeder towel clamps?

A

They have balls designed to prevent slippage thru the drapes

74
Q

What are the roles of retractors?

A

Deflect tissues and improve visualization

Maintain exposure of the operative field

75
Q

Why should you be careful when using retractors?

A

They can cause trauma to tossues during placement and/or from ischemia.

76
Q

What should you use to protect underlying tissues from retractors?

A

Moist laparotomy sponges

77
Q

What are the 6 types of handheld retractors?

A
  1. Malleable
  2. Hohman
  3. Spay hook
  4. Army Navy
  5. Parker
  6. Senn (sharp and blunt)
78
Q

What do hand-held retractors require?

A

Surgical assistant to hold them in place

79
Q

What are the 5 self-retaining retractors?

A
  1. Gelpi
  2. Wetilaner
  3. Beckman
  4. Balfour (+/- bladder blade)
  5. Finochietto
80
Q

What is the Balfour retractor used for?

A

Retract edges of abdominal wall for laparotomy; can have a bladder blade

*Need to be careful not to trap bowel underneath…can cause ischemia*

81
Q

What is the Finochietto retractor used for?

A

Separates ribs for thoracotomy or sternum for median sternotomy

82
Q

What are the 3 types of suction tips?

A
  1. Poole
  2. Yankauer
  3. Frazier
83
Q

Identify this instrument.

A

Malleable/ribbon retractor

84
Q

Identify this instrument.

A

Hohman retractors

85
Q

Identify this instrument.

A

Spay hook

86
Q

Identify this instrument.

A

Top to bottom: Army Navy, Parker, Sharp Senn, Blunt Senn

87
Q

Identify this instrument.

A

Gelpi retractor

88
Q

Identify this instrument.

A

Weitlaner retractor

89
Q

Identify this instrument.

A

Beckman retractor

90
Q

Identify this instrument.

A

Balfour retractor (without bladder blade)

91
Q

Identify this instrument.

A

Bladder blade

92
Q

Identify this instrument.

A

Finochietto retractor

93
Q

Identify this instrument.

A

Poole suction tip

94
Q

Identify this instrument.

A

Yankauer suction tip

95
Q

Identify this instrument.

A

Frazier suction tip

96
Q

What should small basins be used for?

A

Sharps

97
Q

What should large basins be used for?

A

Sterile saline

98
Q

What are light handles used for?

A

They allow sterile personnel to move lights throughout surgery; fit your specific light

99
Q

How should you use gauze sponges/laparotomy pads with hemorrhage?

A

Dab not wipe

100
Q

What are some purposes of gauze sponges and laparotomy pads?

A

Keep tissues protected and moist, isolate organs of interest and aid in gentle retraction

101
Q

What is significant about the blue straps of laparotomy pads?

A

They are radiopaque and will show up in an xray

*Always count sponges/pads if used inside a body cavity!*

102
Q

A common surgical error is: _____ scalpel strokes.

A

multiple

103
Q

A common surgical error is: _____ or _____ dissection.

A

excessive, “blind”

104
Q

A common surgical error is: Unnecessary _____ manipulation or _____ motion.

A

tissue, hand

105
Q

A common surgical error is: _____ instead of _____ with gauze.

A

wiping, dabbing

106
Q

A common surgical error is: Grasping _____ of tissue.

A

large amounts

107
Q

A common surgical error is: Inappropriate _____ choice or handling.

A

instrument

108
Q

A common surgical error is: Inappropriate _____ size or _____ choice.

A

suture, needle

109
Q

A common surgical error is: Knots not _____ or _____.

A

tight, square

110
Q

A common surgical error is: Not accounting for _____.

A

gauze

Intro to Surgery (36 decks)

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