Lecture 4 - Instruments & Tissue Handling Flashcards
What are Halsted’s Principles of Surgery?
- 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
Tissue damage is proportional to _____ and _____.
time, trauma
In which hand should you hold non-articulating instruments?
non-dominant hand
In which hand should you hold articulating instruments?
dominant hand
How can hand tremors be minimized?
by decreasing the fulcrum distance
What are the cutting instruments?
scalpel and scissors
What are the grasping instruments?
needle holders, tissue forceps, thumb forceps, towel clamps
Besides cutting and grasping, what are the other general types of instruments?
retracting, orthopedic, miscellaneous
What is the primary cutting instrument?
scalpel blade
Scalpel blades have the _____ amount of tissue trauma.
least
What are the sizes of each blade from left to right? Which one is most commonly used?
10, #11, #12, #15
#10 is the most common
What should you use to grip your scalpel blade to load it? On what surface should it be gripped?
Use needle holders to grip the non-cutting surface
What is the proper process of loading a scalpel blade onto the handle?
Align slot in handle with hole in the blade and advance the blade until it is locked
What should you use to remove the scalpel blade from the handle and how often?
ALWAYS use a needle holder
How should the scalpel blade/handle be pointed when unloading the blade?
down and away
What are the two grips that can be used to hold the scalpel blade?
Fingertup grip (overhand) and pencil grip
What does your non-dominant hand do when making an incision?
applies counter-traction
How should the blade be held in relation to the skin when making an incision?
Perpendicular to the skin (held by the dominant hand)
How should an incision be made, in general?
Full thickness with a single pass
What are the motions a scalpel blade can do?
Sliding, pressing, reverse pressing, press cut (stabbing), sawing, and scraping
What is an example of a time when you would use a sawing motion with your scalpel?
removing lung or liver lobe
When would you use a scraping motion with your scalpel?
for very specific reasons
What are the 2 types of tissue dissection?
blunt vs. sharp
What type of grip should be used to hold scissors?
tripod grip
What types of forces can be used with scissors?
Closing, shearing, torque forces
When should you use mayo scissors?
Fascia, linea alba, extending incision
When should you use metzenbaum scissors?
on more delicate tissues (blunt dissection)
When should you use operating (utility, sharp-blunt) scissors?
Cutting inanimate objects
When should operating (utility, sharp-blunt) scissors NOT be used?
On tissues
Cutting suture in the abdomen because of the sharp end
Identify this instrument.
Bandage scissors (Lister)
Identify this instrument.
Suture scissors (Spencer stitch)
What are the 3 types of tissue forceps?
- Crushing
- Non-crushing
- Hemostatic
What are needle holders used for?
Passage and retrieval of needle with suturing, instrument ties for knot tying
With which grip do you have the greatest control of the needle holders with max wrist motion?
palming
The needle should be passed on a _____ path.
circular
Where on the needle should the needle holders grasp it?
At a perpendicular angle between 1/3 to 1/2 the length of the needle from the swaged end
What should you grasp the needle with after you have pulled it through the skin?
needle holders NOT your hand
What are the 3 types of needle holders?
Mayo-Hegar, Olsen-Hegar, and Castroviejo
What is a Castroviejo needle holder used for?
Microsurgery (it is spring-loaded)
What should crushing tissue forceps be used on?
Only for tissues that are to be removed from the body
What are the 4 types of crushing tissue forceps?
- Allis
- Babcock
- Oschner-Kocher
- Right-angle
Identify this instrument.
Allis tissue forceps
Identify this instrument.
Babcock tisssue forceps
Identify this instrument.
Oschner-Kocher tissue forceps
Identify this instrument.
Right-angle tissue forceps
What are the non-crushing tissue forceps?
Doyen and Satinsky
What would you use Doyen tissue forceps for?
Bowel surgery; space in the middle is where the bowel would go
What would you use Satinsky tissue forceps for?
Vascular occlusion; should have on the table ready to go if doing a high risk surgery
Identify this instrument.
Doyen tissue forceps
Identify this instrument.
Satinsky tissue forceps
What are hemostatic forceps used for?
They are a type of crushing forceps used to achieve hemostasis by clamping a vessel.
What types of serrations can be found on hemostatic forceps?
Transverse (tip) and longitudinal (jaw)
What are the transverse serrations on hemostatic forceps used on?
smaller tissues
What are the longitudinal serrations on hemostatic forceps used on?
Larger, bulkier tissues
What are the 4 types of hemostatic forceps?
- Mosquito
- Kelly
- Crile
- Rochester-Carmalt
What is different about the serrations on Kelly hemostats vs. the other types?
They only go halfway down
“Kelly is a good girl so she only goes halfway”
Identify this instrument.
Mosquito hemostats
Identify this instrument.
Kelly hemostats
Identify this instrument.
Crile hemostats
Identify this instrument.
Rochester-Carmalt hemostats
What is the difference between Rochester vs. Bainbridge hemostats?
Bainbridge are very narrow, Rochester are wider/thicker
Identify these instruments.
Left = Rochester-Carmalt
Right = Bainbridge forceps
What are thumb forceps used for?
To grasp and hold tissues for manupulation;
To stabilize tissue or expose tissue layers when suturing
Thumb forceps with fine teeth should be used on _____ tissues.
more delicate
What are the two grips used for grasping thumb forceps and when is each one used?
Pencil grip = in use
Palmed = not in use
What are Debakey thumb forceps used on?
Soft tissue and vessels; they have fine teeth
What are Brown-Adson and Rat-tooth forceps used on and why?
Thicker and more robuse tissues; they have larger teeth
What are towel clamps used for?
Securing towels and drapes to one another and to the patient.
On what type of tissues should traction be placed with towel clamps?
On tissues to be excised or counteract tension on skin closure
Identify this instrument.
Backhaus towel clamp
Identify this instrument.
Roeder towel clamp
Identify this instrument.
Lorna-Edna towel clamp
What is characteristic of Roeder towel clamps?
They have balls designed to prevent slippage thru the drapes
What are the roles of retractors?
Deflect tissues and improve visualization
Maintain exposure of the operative field
Why should you be careful when using retractors?
They can cause trauma to tossues during placement and/or from ischemia.
What should you use to protect underlying tissues from retractors?
Moist laparotomy sponges
What are the 6 types of handheld retractors?
- Malleable
- Hohman
- Spay hook
- Army Navy
- Parker
- Senn (sharp and blunt)
What do hand-held retractors require?
Surgical assistant to hold them in place
What are the 5 self-retaining retractors?
- Gelpi
- Wetilaner
- Beckman
- Balfour (+/- bladder blade)
- Finochietto
What is the Balfour retractor used for?
Retract edges of abdominal wall for laparotomy; can have a bladder blade
*Need to be careful not to trap bowel underneath…can cause ischemia*
What is the Finochietto retractor used for?
Separates ribs for thoracotomy or sternum for median sternotomy
What are the 3 types of suction tips?
- Poole
- Yankauer
- Frazier
Identify this instrument.
Malleable/ribbon retractor
Identify this instrument.
Hohman retractors
Identify this instrument.
Spay hook
Identify this instrument.
Top to bottom: Army Navy, Parker, Sharp Senn, Blunt Senn
Identify this instrument.
Gelpi retractor
Identify this instrument.
Weitlaner retractor
Identify this instrument.
Beckman retractor
Identify this instrument.
Balfour retractor (without bladder blade)
Identify this instrument.
Bladder blade
Identify this instrument.
Finochietto retractor
Identify this instrument.
Poole suction tip
Identify this instrument.
Yankauer suction tip
Identify this instrument.
Frazier suction tip
What should small basins be used for?
Sharps
What should large basins be used for?
Sterile saline
What are light handles used for?
They allow sterile personnel to move lights throughout surgery; fit your specific light
How should you use gauze sponges/laparotomy pads with hemorrhage?
Dab not wipe
What are some purposes of gauze sponges and laparotomy pads?
Keep tissues protected and moist, isolate organs of interest and aid in gentle retraction
What is significant about the blue straps of laparotomy pads?
They are radiopaque and will show up in an xray
*Always count sponges/pads if used inside a body cavity!*
A common surgical error is: _____ scalpel strokes.
multiple
A common surgical error is: _____ or _____ dissection.
excessive, “blind”
A common surgical error is: Unnecessary _____ manipulation or _____ motion.
tissue, hand
A common surgical error is: _____ instead of _____ with gauze.
wiping, dabbing
A common surgical error is: Grasping _____ of tissue.
large amounts
A common surgical error is: Inappropriate _____ choice or handling.
instrument
A common surgical error is: Inappropriate _____ size or _____ choice.
suture, needle
A common surgical error is: Knots not _____ or _____.
tight, square
A common surgical error is: Not accounting for _____.
gauze
