Surg 101--Chapter 22 Flashcards
The knowledge base for instrumentation includes the _____ of instruments.
classification
The knowledge base for instrumentation includes the relationship between the _____ of an instrument and the instrument’s use in the _____.
design, body
The knowledge base for instrumentation includes the _____ of instruments.
care
The knowledge base for instrumentation includes the ability to recognize _____ instruments.
high quality
_____ (as it applies to the ST) means applying knowledge of an instrument’s capabilities, structure, design, size, and type to the surgical task at hand.
Critical thinking
The ST must plan the set up and arrangement of instruments so that as the surgery progresses, needed instruments are immediately available on the _____.
instrument (Mayo) stand
_____ are assembled according to the particular surgical specialty.
Instrument trays
There are two different grades of instruments–_____ and _____.
floor grade and surgical grade
_____ instruments are made from inferior metals and are imprecisely constructed.
Floor-grade
_____ instruments tend to bend and break easily.
Floor-grade
_____ instruments often show pitting and staining within the first few sterilization processes.
Floor-grade
_____ instruments are intended for use in less critical applications (such as suture and suture removal kits in the ER).
Floor-grade
_____ instruments are often classified as single-use items.
Floor-grade
_____ instruments are constructed of high quality stainless steel and other metal alloys (such as carbon and chromium).
Surgical-grade
_____ instruments resist bending, pitting, scratching, and dulling.
Surgical-grade
_____ is the most common metal used in surgical instruments but is also subject to corrosion.
Stainless steel
The three types of finishes used on metal instruments are _____, _____, and _____.
bright, satin, and ebony
A _____ (or mirror) finish is highly polished, reflects light, and may cause glare in the surgical field, affecting the surgeon’s vision.
bright
A _____ finish reduces glare and light reflection which can lead to eye fatigue.
satin
_____ finish instruments tend to stain more easily from the effects of detergents and low water quality.
Satin
_____ is a black chromium finish used for laser surgery.
Ebony
The dull black finish of ebony prevents _____ from reflecting or bouncing off of instruments.
laser beams
Many instruments have expensive _____ inserts to maintain a sharp edge in scissors and gripping ability in needle holders.
tungsten carbide
Instruments with tungsten carbide inserts usually are manufactured with _____ or _____ handles.
gold-plated or black
Tungsten carbide instruments are very _____.
expensive
The distribution of weight between the handle (finger rings) and the _____ is measured and tested for optimum performance.
fulcrum
Instruments are designed to match their use and the type of _____ on which they are used.
tissue
Blood vessels are never handled with an instrument that might _____ or ______ the tissue.
puncture or bruise
Fibrous tissue is very resilient and requires _____ instruments to maintain grasp.
toothed
A _____ (also called a box lock) has one or more ratchets that remain closed after they are set.
locking box lock clamp
Microsurgical instruments use a _____, which is used in the design of needle holders.
spring lock mechanism
Thumb forceps are used for _____, usually during suturing or handling tissue during surgery.
grasping
Thumb forceps are often called _____.
“pickups”
Toothed forceps have one or more _____ in the _____.
teeth, jaws
Thumb forceps are used to grasp _____ or other _____.
skin, connective tissue
Examples of toothed forceps include _____, _____, _____, and _____.
Adson forceps with teeth, thumb tissue forceps with teeth, Bonney tissue forceps, and Cushing forceps
_____ are used on delicate tissue such as serosa, bowel, blood vessels, or ducts.
Smooth forceps (no teeth)
Examples of smooth forceps include _____, _____, _____, _____.
smooth thumb forceps, smooth Adson forceps, DeBakey forceps, and smooth Cushing forceps
A _____ has teeth or sharp serrations in the jaws.
biting clamp
An example of a biting clamp is the _____ clamp.
Kocher
A _____ is used on avascular fibrous tissue, bone, or on tissue that will be removed as part of the procedure.
biting clamp
A _____ has one or more teeth in jaws that can be delicate or heavy.
tenaculum
A _____ penetrates the tissue rather than just holding it with pressure on the outside surface.
tenaculum
A tenaculum is used in _____, such as the cervix.
fibrous tissue
An _____ usually has locking ratchets, but the tips do not close tightly over the tissue.
atraumatic clamp
An _____ is used on delicate tissue that is highly vascular or easily injured.
atraumatic clamp
An example of an atraumatic clamp is the _____.
Duval lung clamp
The _____ is an atraumatic, non-crushing clamp usually used on the bowel or fallopian tube.
Babcock clamp
The Bainbridge intestinal clamp and the Doyen intestinal clamp have jaws with _____ that occlude but do not crush the tissue.
flexible blades
Whenever a long clamp (such as a vascular clamp) is placed across a tissue structure, at an approximated right angel, this is called _____.
cross clamping
Cross clamping is frequently used in _____ surgery and in _____ surgery.
vascular, intestinal
A _____ blocks the flow of blood.
hemostat
The _____, _____, and _____hemostats are used to completely occlude a blood vessel while it is tied or sealed with the ESU.
Kelly, Crile, and mosquito
A _____ is capable of varying low levels of compression between its jaws.
semi-occluding vascular clamp
Semi-occluding vascular clamps are _____ to allow access to blood vessels.
angled
Examples of vascular clamps include _____, _____, _____, _____, and _____.
bulldog, Satinsky, Fogarty, Crafoord, and Cooley clamps
The _____ is used whenever razor-sharp cutting is required for tissue dissections.
common surgical scalpel
A _____ is detachable from the knife handle.
scalpel blade
Scalpel blades are numbered consistently among manufacturers, and the number indicates the _____ and _____.
shape and size
Scalpel handles: 3, 3L, 7, 9
Blades: 10, 11, 12, 15
Scalpel handles: 4, 4L
Blades: 18 to 25
The _____ blade handle is used in surgery of the eye and ear.
beaver blade handle
_____ are among the most frequently used and important instruments in surgery.
scissors
Tissue scissors are used to sever _____ and should never be used on other materials or surgical supplies, including suture material.
tissue
Small, sharp-tipped scissors, such as _____ scissors, are used for extremely fine dissection in plastic surgery.
tenotomy
- Castroviejo scissors are commonly used in _____.
microsurgery
Round-tipped, light dissecting scissors, such as _____ scissors, are used extensively on delicate tissue in general surgery.
Metzenbaum
Fibrous connective tissue requires heavier scissors, such as the _____ scissors.
curved Mayo
Dissecting scissors are often used to _____ tissue.
undermine
_____ scissors are used for cutting suture.
Straight Mayo
Scissors designed to cut tissue should never be used to cut _____, because this dulls the blades.
suture
A _____ is used to cut and extract tissue.
rongeur
The rongeur tips are _____, and the edges of the cups are _____.
cupped, sharp
A rongeur with a single hinge is called a _____.
single-action rongeur
A rongeur with two hinges is called a _____.
double-action rongeur
A double-action rongeur creates _____ the leverage as a single-action rongeur.
twice
Shears are large cutting instruments used to cut _____.
bone
Some shears are designed so that the cutting edge is left or right of the _____.
hinge
The basic design of the _____ is a small cup with a sharpened, serrated, or smooth rim at the end of a long handle.
curette
The curette is used in many specialties for scooping out _____.
tissue
Very fine curettes are used in _____, _____, and _____ surgery.
ear, paranasal, and spinal
Larger, heavier curettes are used in _____ procedures.
orthopedic
Soft tissue curettes are used in _____ surgery for curettage of the endometrium.
gynecological
A _____ is an orthopedic cutting instrument that is used with a mallet.
chisel
A _____ is often used to remove bone from the _____ for use as a graft elsewhere in the body.
large osteotome, iliac crest
A _____ is V-shaped bone chisel, its cut looks like a small trough.
gouge
An _____ is used to separate or “elevate” tissue.
elevator
The heavy, round cutting elevator, such as the _____ elevator, slices tissue as it elevates.
Lambotte
Very finely balanced elevators, such as the _____ and _____ elevators are used in soft tissue surgery.
Penfield and Freer
In vascular surgery, Penfield and Freer elevators are used to separate atherosclerotic plaque from the inside of a _____.
blood vessels
The _____ is a very commonly used elevator.
Joker
The Joker’s short handle and strong tip make it ideal for separating _____ planes without causing bleeding.
connective tissue
A _____ is used to remodel bone.
rasp
As the surgical wound is deepened, tissue layers and other structures such as _____, _____, _____, and other tissue must be moved away from the focal point of the operation.
blood vessels, nerves, organs
The _____ retractor is generally used only for connective tissue.
rake
Self-retaining retractors hold tissue against the walls of the surgical wound by _____.
mechanical action
Examples of self-retaining are the _____ self-retaining, _____, and _____ retractor.
Thompson, Bookwalter, and Balfour
The _____ self-retaining retractor is used in cardiothoracic surgery.
Finochietto
The potential for bruising, nerve and vessel damage, and even serious injury, exists for any _____ used on living tissue.
mechanical device
The retractor is placed carefully and may be cushioned using _____ so that the bare blades do not press against the tissue.
laparotomy sponges
The selection of a retractor is based on the _____ and _____ of the incision.
length and depth
The _____ of the retractor blade is determined by the size of the incision and the tissue to be retracted.
width
_____ are rounded tubular or tube-like instruments used to widen or stretch the inside diameter of a lumen.
Dilators
The _____ is inserted into the cervix to measure the depth of the uterus from the cervix to the fundus.
uterine sound
Orthopedic calipers are used to prepare the bone for a _____.
joint implant
A _____ is used in orthopedic surgery to determine the length of screws to be implanted into bone.
depth gauge
A _____ is a trial, reusable replica of an implantable prosthesis.
sizer
A _____ is used to grasp a curved needle during suturing.
needle holder
The length, weight, and type of tip (for needle holders) must be matched to the _____ and _____.
suture and tissue
Very fine sutures require fine _____.
needle holders
If the needle holder is too heavy, the surgeon will lose the _____ of the needle.
“feel”
A needle holder that is too delicate for the needle will cause the needle to _____ during use.
twist
Most needle holders are _____ or _____ locked.
ratchet or spring
Always test the _____ before the needle holder is used.
ratchets
_____ is needed during a surgical procedure to clear blood, fluids, and small bits of tissue debris from the surgical site and provide an unobstructed view of the anatomy.
Suction
Suction is provided using _____, which attaches to a suction tip at one end and a closed suction canister at the other.
sterile plastic tubing
The selection of a particular surgical instrument is based on the _____, the depth of the _____, the technical requirements of the instrument, and the surgeon’s preference.
tissue type, surgical wound
_____ differ in texture, strength, elasticity, water, fat content, and permeability.
Normal tissues
The viscera, or organs of the body, are each covered by a fine membrane called the _____.
serosa
The _____ is easily punctured and the underlying tissue layers can bleed profusely.
serosa
_____ instruments are needed when handling the serosa.
Nontraumatic
Non-penetrating forceps, wide retractors which do not cut into the tissue and suction tips which have a guard to decrease the aspirating pressure are used on _____.
serosa
Tissue that is _____ is very delicate, tends to bleed profusely, tears easily, and has little or no resilience.
friable
_____ or _____ can cause normally strong tissue to become friable.
Infection or advanced age
Tissues such as the _____, _____, and _____ normally are friable.
liver, spleen, and lung
Friable tissue must be handled by hand or with _____ instruments.
Nontraumatic
_____ used on friable tissue must be nonoccluding and _____ nontoothed.
Clamps, forceps
Many anatomical structures with a _____ must be protected from puncture.
lumen
Structures with a lumen are usually handled with smooth, _____ instruments.
Nontraumatic
_____ used to temporarily occlude the intestine, fallopian tube, vas deferns, ureters, large blood vessels, and other ducts are only partly occlusive.
Clamps
_____ is resilient and able to withstand a limited amount of stretching without injury.
Elastic tissue
The _____ lining of body cavities, although elastic, can tear with extreme or repeated pressure.
peritoneal
The _____ and some glandular tissue, such as the tonsils, are elastic.
vaginal vault
Tissue is described as _____ when it is heavy with fluid, inflamed, or diseased.
boggy
Infected or edematous tissue is _____ and difficult to clamp and suture.
boggy
Boggy tissue is usually handled manually and non-occlusive clamps such as the _____ are used.
Babcock
Semi-solid tissue has a high _____ content.
fat
_____ does not compress well and tends to fragment into small pieces when clamped.
Fatty tissue
Adipose tissue has few _____ compared with other types of tissue.
blood vessels
Adipose tissue may require a penetrating retractor such as a _____.
sharp rake
The _____, which has fine serration at the tip, often is used to clamp or grasp adipose tissue.
Allis clamp
_____ are required for suturing fatty tissue.
Forceps with teeth
_____ is resilient and somewhat springy when healthy.
Bone tissue
Large bones usually are manipulated with _____ or _____ rather than direct pulling pressure.
traction or leverage
Other types of connective tissues, such as _____ and _____, are extremely strong and resilient.
cartilage and tendon
Most joint surfaces are exposed to _____, which has an oily consistency.
synovial fluid
Fascia is often grasped with _____, which have one or two teeth at the tip.
Kocher clamps
Used on mucous membrane organ tissue and on any tissue that bleeds easily.
Smooth forceps
Used on connective tissue, including the skin.
Toothed forceps
Specially designed with a scored insert at the working tip; this prevents puncturing of the blood vessels but provides sufficient friction to hold.
Vascular forceps
