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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
What types of forces can be used with scissors?
Closing, shearing, torque forces
26
When should you use mayo scissors?
Fascia, linea alba, extending incision
27
When should you use metzenbaum scissors?
on more delicate tissues (blunt dissection)
28
When should you use operating (utility, sharp-blunt) scissors?
Cutting inanimate objects
29
When should operating (utility, sharp-blunt) scissors NOT be used?
On tissues Cutting suture in the abdomen because of the sharp end
30
Identify this instrument.
Bandage scissors (Lister)
31
Identify this instrument.
Suture scissors (Spencer stitch)
32
What are the 3 types of tissue forceps?
1. Crushing 2. Non-crushing 3. Hemostatic
33
What are needle holders used for?
Passage and retrieval of needle with suturing, instrument ties for knot tying
34
With which grip do you have the greatest control of the needle holders with max wrist motion?
palming
35
The needle should be passed on a _____ path.
circular
36
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
37
What should you grasp the needle with after you have pulled it through the skin?
needle holders NOT your hand
38
What are the 3 types of needle holders?
Mayo-Hegar, Olsen-Hegar, and Castroviejo
39
What is a Castroviejo needle holder used for?
Microsurgery (it is spring-loaded)
40
What should crushing tissue forceps be used on?
Only for tissues that are to be removed from the body
41
What are the 4 types of crushing tissue forceps?
1. Allis 2. Babcock 3. Oschner-Kocher 4. Right-angle
42
Identify this instrument.
Allis tissue forceps
43
Identify this instrument.
Babcock tisssue forceps
44
Identify this instrument.
Oschner-Kocher tissue forceps
45
Identify this instrument.
Right-angle tissue forceps
46
What are the non-crushing tissue forceps?
Doyen and Satinsky
47
What would you use Doyen tissue forceps for?
Bowel surgery; space in the middle is where the bowel would go
48
What would you use Satinsky tissue forceps for?
Vascular occlusion; should have on the table ready to go if doing a high risk surgery
49
Identify this instrument.
Doyen tissue forceps
50
Identify this instrument.
Satinsky tissue forceps
51
What are hemostatic forceps used for?
They are a type of crushing forceps used to achieve hemostasis by clamping a vessel.
52
What types of serrations can be found on hemostatic forceps?
Transverse (tip) and longitudinal (jaw)
53
What are the transverse serrations on hemostatic forceps used on?
smaller tissues
54
What are the longitudinal serrations on hemostatic forceps used on?
Larger, bulkier tissues
55
What are the 4 types of hemostatic forceps?
1. Mosquito 2. Kelly 3. Crile 4. Rochester-Carmalt
56
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"
57
Identify this instrument.
Mosquito hemostats
58
Identify this instrument.
Kelly hemostats
59
Identify this instrument.
Crile hemostats
60
Identify this instrument.
Rochester-Carmalt hemostats
61
What is the difference between Rochester vs. Bainbridge hemostats?
Bainbridge are very narrow, Rochester are wider/thicker
62
Identify these instruments.
Left = Rochester-Carmalt Right = Bainbridge forceps
63
What are thumb forceps used for?
To grasp and hold tissues for manupulation; To stabilize tissue or expose tissue layers when suturing
64
Thumb forceps with fine teeth should be used on _____ tissues.
more delicate
65
What are the two grips used for grasping thumb forceps and when is each one used?
Pencil grip = in use Palmed = not in use
66
What are Debakey thumb forceps used on?
Soft tissue and vessels; they have fine teeth
67
What are Brown-Adson and Rat-tooth forceps used on and why?
Thicker and more robuse tissues; they have larger teeth
68
What are towel clamps used for?
Securing towels and drapes to one another and to the patient.
69
On what type of tissues should traction be placed with towel clamps?
On tissues to be excised or counteract tension on skin closure
70
Identify this instrument.
Backhaus towel clamp
71
Identify this instrument.
Roeder towel clamp
72
Identify this instrument.
Lorna-Edna towel clamp
73
What is characteristic of Roeder towel clamps?
They have balls designed to prevent slippage thru the drapes
74
What are the roles of retractors?
Deflect tissues and improve visualization Maintain exposure of the operative field
75
Why should you be careful when using retractors?
They can cause trauma to tossues during placement and/or from ischemia.
76
What should you use to protect underlying tissues from retractors?
Moist laparotomy sponges
77
What are the 6 types of handheld retractors?
1. Malleable 2. Hohman 3. Spay hook 4. Army Navy 5. Parker 6. Senn (sharp and blunt)
78
What do hand-held retractors require?
Surgical assistant to hold them in place
79
What are the 5 self-retaining retractors?
1. Gelpi 2. Wetilaner 3. Beckman 4. Balfour (+/- bladder blade) 5. Finochietto
80
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\*
81
What is the Finochietto retractor used for?
Separates ribs for thoracotomy or sternum for median sternotomy
82
What are the 3 types of suction tips?
1. Poole 2. Yankauer 3. Frazier
83
Identify this instrument.
Malleable/ribbon retractor
84
Identify this instrument.
Hohman retractors
85
Identify this instrument.
Spay hook
86
Identify this instrument.
Top to bottom: Army Navy, Parker, Sharp Senn, Blunt Senn
87
Identify this instrument.
Gelpi retractor
88
Identify this instrument.
Weitlaner retractor
89
Identify this instrument.
Beckman retractor
90
Identify this instrument.
Balfour retractor (without bladder blade)
91
Identify this instrument.
Bladder blade
92
Identify this instrument.
Finochietto retractor
93
Identify this instrument.
Poole suction tip
94
Identify this instrument.
Yankauer suction tip
95
Identify this instrument.
Frazier suction tip
96
What should small basins be used for?
Sharps
97
What should large basins be used for?
Sterile saline
98
What are light handles used for?
They allow sterile personnel to move lights throughout surgery; fit your specific light
99
How should you use gauze sponges/laparotomy pads with hemorrhage?
Dab not wipe
100
What are some purposes of gauze sponges and laparotomy pads?
Keep tissues protected and moist, isolate organs of interest and aid in gentle retraction
101
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!\*
102
A common surgical error is: _____ scalpel strokes.
multiple
103
A common surgical error is: _____ or _____ dissection.
excessive, "blind"
104
A common surgical error is: Unnecessary _____ manipulation or _____ motion.
tissue, hand
105
A common surgical error is: _____ instead of _____ with gauze.
wiping, dabbing
106
A common surgical error is: Grasping _____ of tissue.
large amounts
107
A common surgical error is: Inappropriate _____ choice or handling.
instrument
108
A common surgical error is: Inappropriate _____ size or _____ choice.
suture, needle
109
A common surgical error is: Knots not _____ or \_\_\_\_\_.
tight, square
110
A common surgical error is: Not accounting for \_\_\_\_\_.
gauze

Intro to Surgery (36 decks)

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