Unit 3: surgical equipment and instruments

Question 1

What are the SVMA practice standards for surgical suites

Answer 1

Must have a separate room for surgery in all clinics built or remodelled after 2004
If there is not a separate single purpose surgery room, a written protocol describing how asepsis is maintained must be presented
A recovery area must also be provided where a patient may be frequently observed following anesthesia (but need not be separate from animal compartments)

Question 2

What should the ideal surgical suite include

Answer 2

A surgical facility should strive to create the safest enviro for the patient
The american animal hospital association (AAHA) recommends three distinct and separate areas for a surgical facility
The preparation area
The scrub area
The surgery room

Question 3

What is the prep area used for

Answer 3

Should be adjacent to the surgery room
Used for patient preparation (e.g., clipping and initial scrub) and the storage of surgical supplies
Ideal to have a separate anaesthesia machine for the prep room
To prevent cross contamination from occurring when the machine is moved from one room to another
Procedures that are considered clean but not sterile or that are classified as dirty should be performed in this area

Question 4

What is the scrub area and what is it used for

Answer 4

Large enough to hold a scrub sink
Room to put on gown and gloves
May also be where the autoclave is located

Question 5

What is a surgical suite

Answer 5

Separate dedicated room used only for aseptic surgical procedures
Should be easy to clean
Large enough that personnel can easily move around the surgery table without contaminating the surgical field or the surgeon

Question 6

What are some characteristics of a surgical suite

Answer 6

Large enough that personnel can easily move around the surgery table without contaminating the surgical field or the surgeon
Should be free of clutter
Only required surgical equipment should be kept in the surgery suite
Cabinets should be made of non porous material with doors
Protects sterile supplies from dust, debris, and other contaminants
Should have a door into room that can be closed
Air pressure should be greater in the surgery room than rest of veterinary facility
Higher air pressure pushing air out of the surgical suite → this will reduce the ability of the airborne bacteria to move into the surgical room from the other areas of the clinic

Question 7

What is permanent equipement

Answer 7

Equipment that is attached to the floor, wall or ceiling in the surgical room

Question 8

What are some examples of permanent equipment

Answer 8

Surgical lights
Surgery table
Radiographic view box/computer
Anesthetic machine
- Although they should not leave the surgery room, in many facilities they are required to serve a dual purpose and are moved to other areas of the hospital

Question 9

What should you do with movable equipment for the surgical suite

Answer 9

These items must be cleaned and disinfected thoroughly before being returned to the surgery room

Question 10

Movable equipment items include

Answer 10

Monitoring equipment
Heating pads
IV drip stand
Instrument table, mayo stand
Suction
Cautery unit
Kick bucket

Question 11

How do you clean surgical equipment

Answer 11

The surgery room should never be dry dusted this may aerosolized the dust and bacteria
All equipment should be wiped daily before surgery with the appropriate cleaning or disinfecting solution
Important to follow the manufacturer’s instruction
This information should include the equipments compatibility with chemical germicides
Whether it can be immersed for cleaning
How it should be decontaminated

Question 12

What is perioperative equipment

Answer 12

Many pieces of equipment besides surgical instruments are critical to the success of a surgical procedure
Whether related to providing patient comfort, assisting the surgeon, or monitoring anaesthesia, each item is an integral part of the process

Question 13

What is perioperative equipment

Answer 13

Patient warming devices
Surgery lights
Surgery table
Electrosurgery
Suction machines
Surgical instruments

Question 14

What should you do before placing an animal on a heating pad

Answer 14

Unless otherwise indicated in the instruction manual – ALWAYS place a towel between your patient and the warming device to prevent thermal burns!

Question 15

Circulating warm-water blankets are commonly used for surgical patients why

Answer 15

The heated surface helps prevent the loss of body heat to a cold metal surface
Diminishes hypothermia

Question 16

What are hard heating pads and what are the advantages

Answer 16

Made of acrylic plastic glass, (plexiglass) connects to many currently available circulating water pumps
The main advantage to the is style of heating system is that the plexiglass is puncture proof

Question 17

What is a hot dog warming blanket

Answer 17

Uses electricity to warm the pad but does not pose the same threat for thermal burns as traditional heating pads
Has a sensor in the pad to regulate the what generated
Not puncture proof but are not harmed if punctured

Question 18

What is a forced air warmer

Answer 18

(ie bair hugger)
The pad is placed around the patient, then inflated with warm air
The constant flow of warm air is very effective at maintaining or increasing patients body temp
Not puncture proof, but there is less risk of puncture because the pad is not placed near the animal until the patient is anesthetized

Question 19

What deos surgical lights include

Answer 19

Adequate lighting is imperative
Ceiling- or wall-mounted lights are much better than the standing floor models
Removable light handles that can be autoclaved
The surgeon or surgical assistant can then place the handles on the lights, allowing either person to adjust the lights directly

Question 20

What are the types of surgical tables

Answer 20

A tabletop can be solid surface or can be designed in a split surface style

Question 21

What is the advantage of a solid surface surgical table

Answer 21

The solid top model is generally less expensive and can be more difficult to work with because fluids pool on the tabletop and can soil the patient

Question 22

What are the advantages of a split surgical table

Answer 22

A tray under the space in the table to collect any fluid that may run off the surgical field
The ability to be adjusted to help maintain the patient (especially large, deep chested dogs) in dorsal recumbency

Question 23

What should a surgical table be able to do

Answer 23

Surgery should also have the capability to be raised and lowered and to tilt in one direction
Hydraulics or electric power can be employed to accomplish variation in height
Manual effort is generally required to tilt the table

Question 24

What is electrosurgery

Answer 24

The use of electricity, transmitted through a special hand piece, to cut or coagulate vessels
Signal use or reusable cautery hand pieces
Charred material may be build up on the tip of the hand piece, impeding the flow of current
It may be cleaned by scrapping with a scalpel blade (away front eh sterile field) or by using a commercially available scratch pad

Question 25

What is Monopolar electrosurgery

Answer 25

A ground plate must be placed under the patient A water or saline saturated sponge should be placed on the ground plate between the patient and the plate Alcohol is never used to saturate the sponge because it may lead to patient burns or even fire Can be used to make the surgical incision An incision created with an electrosurgery unit takes longer to heal because of the charring of the tissues

Question 26

What is Bipolar electrosurgery

Answer 26

Utilizes a hand piece that resembles a thumb tissue forceps No round plate is needed As the hand piece is activated, the current passes from one tip to another

Question 27

Monopolar electrosurgery can be used how

Answer 27

The handpiece can be activated, and the tip of the hand piece can directly touch the tissue or vessel that needs cauterising A hemostat can be placed on the tissue or vessel that needs to be cauterised - The hemostat is then elevated off the surgical field so that the only metal touching the patient is the tip of the hemostat - The cautery handpiece tip can then be touched to the hemostat as the hand piece is activated

Question 28

What is suction

Answer 28

Defined as the ability to remove fluid or air from an area by a manual or a mechanical device

Question 29

What can you use for suction

Answer 29

Can be performed with a syringe, a bulb syringe, or a mechanical pump Mechanical pump is commonly used in surgery Suction can be used when working in body cavities to remove excess fluid

Question 30

When do you use suction in orhtopedic surgeries

Answer 30

Lavaging a joint Flushing a septic site Removing bone dust created while drilling screw holes for a fracture repair

Question 31

Why do you have to be careful with suction levels

Answer 31

Care must be taken to use appropriate levels of vacuum A sufficiently strong vacuum that meets the needs of the surgical procedure without being excessive is the goal Inappropriately low vacuum settings will not adequately suction the fluid and debris on the field and will prove to the frustrating In abdominal procedures, if the vacuum level is too high, omentum may become entrapped in the suction tip and may be damaged

Question 32

What is the elcrtical suction machine

Answer 32

Electric power: uses a motor to generate the vacuum or a central vacuum system may be used

Question 33

What deos electrical suction machiens need

Answer 33

Both require some sort of bottle or receptacle for the collected fluid Usually, the cover of the bottle has some type of float or safety drive that will not allow fluid into the working mechanism of the suction machine of the bottle becomes too full Different designs of suction tips Suction tubing is available in 6- and 10-foot lengths

Question 34

What should you do with suction tubing

Answer 34

The tubing is usually prepackaged and sterilized for single-time use After the package is opened onto the sterile field, one ended o the tubing is attached tot the suction tip and the other end is dropped off the field to be connected to the nonsterile suction unit Because of the length of the tubing and the difficulty in cleaning it appropriately, the tubing should be discarded after surgery If for some reason the tubing is not used after being opened, it can be resterilized Ethylene oxide sterilization must be used because this vinyl tubing will not withstand steam sterilization

Question 35

What is important to knwo about basic surgical isntruments

Answer 35

Are a major investment: important that instruments must be sued for their designed purpose Improper use can damage or destroy instruments Instruments are generally made of stainless tell, although some disposable models may be made of plastic

Question 36

What is the jaw or tip of a surgical isntrument

Answer 36

Can be traumatic or atraumatic Can be straight or curved Can have serrations Horizontal, vertical, or a combination Teeth or arrangement of the teeth can be 1x2, 2x3, and so on Can also be arranged in rows The tulips or jaws can easily become damaged Teeth and serrations of the tips of jaws should be thoroughly evaluated after each use to observe any defects that may have resulted from use Blades are available on most types of scissors as curves or straight Blades can have sharp or blunt tips

Question 37

What is the box lock of a surgical isntrument

Answer 37

where the hinge is) Present only on instruments with ring handles Is the joint or hinge of the instrument Absorbs great stress when the instrument is in use Must be inspected carefully to detect any cracks or evidence of degradation Most difficult part of the surgical instrument to clean

Question 38

What is the shank of a surgical instrument

Answer 38

(or shaft) The body of the instrument Runs from box lock to finger rings Is usually the longest area The longer the shank, the greater the closing force on the jaws

Question 39

What is the ratchet of the surgical isntrument

Answer 39

Found only on instruments with ring handles A device with interlocking teeth that will lock an instrument jaw in a closed position Degradation of this part of the instrument is usually seen as the inability of the ratchet to remain locked Difficult part of surgical instrument to clean

Question 40

What are the ring handles of the surgical instruments

Answer 40

Serve as the means for using and controlling the instrument Proper handling of an instrument with ring handles is achieved by placing the thumb and ring finger in the rings Neither ring should advance beyond the first knuckle of the thumb or finger The index finger can rest on the shank to help stabilise the instrument

Question 41

What is a groove director

Answer 41

Designed to aid the surgeon in making incisions on the linea alba Provides a channel that the scalpel can follow to avoid accidental incising of the abdominal viscera

Question 42

When is a bowl in an instrument pack

Answer 42

Some instrument packs include a sterile bowl The bowls can be used for holding saline for lavage or for storing sharps during the procedure to help keep the instrument table safe and clean

Question 43

What are intestinal clamps and when are they used

Answer 43

The types used in a procedure depends on the intended outcome of the tissue being clamped Tissue that is not viable or that is being removed can be clamped with a more traumatic clamp Tissue that merely needs to be manipulated but will remain in the patient needs to be handled with care

Question 44

What is a needle punch biopsy

Answer 44

Equipped with either a cutting or a core biopsy needles Available as manual and automatic devices Take a small piece of tissue (approximately the size of pencil lead) for microscopic evaluation Ultrasound guided biopsies of internal organs, including liver, speel, kidney and prostate, are often performed with theses instruments

Question 45

What are bone holders

Answer 45

Clamps designed to hold bone fragments together until permanent fixation can be achieved Cen have pointed, toothed or serrated tips

Question 46

What are periosteal elevators

Answer 46

Used to prepare the fractured bone for permanent fixation Used to elevate the periosteum form the bone so that the implants can be placed Used for making gingival flaps in dentistry

Question 47

What are bone rongeurs

Answer 47

Used to break up bits and pieces of bone for grafting purposes Pieces of bone too small to reattach to the animal are broken down into small pieces and packed around the fracture lines to encourage new osteoblast formation and promote whaling

Question 48

What are bone curettes used for

Answer 48

Used to harvest bone graft material or to shape and scrape bony surfaces

Question 49

What are hand chuck for orthopaedic surgeries

Answer 49

A hand chuck is designed to hold and drive intramedullary pins for repair of a fracture of for other orthopedic procedures requiring the use of pins The hand chuck is a manual drill

Question 50

What are some internal fixation implants for fractures

Answer 50

Intramedullary pins Pin cutter Orthopedic wire Bone plates and screws Depth gauge Prethreding tap Screwdriver Drill and tap sleeves Countersinks Plate benders

Question 51

What are some ways surgical power tools can get power

Answer 51

Pneumatic - Compressed nitrogen or air via power cord or hose Electric - Via wall plug– hose doesn't detach from hand piece Battery - Rechargeable battery pack inserted into hand piece – no hoses or cords Handpieces are never immersed in liquid

Question 52

When are power drills used

Answer 52

Fracture repair requires the use of a power drill to place implants

Question 53

What are some specialised drills

Answer 53

Neurosurgery requires the use of a specialized drill to remove the vertebral bony body Power saws

Question 54

Ophthalmic surgery instruments

Answer 54

These instruments are extremely delicate and expensive and should be handled with great care Because of the nature of the tissue for which these instruments are routinely used, the tips are very fine, the shafts tend to be shot, and the mechanism of use may be box lock or squeeze handle