ch 11/12 iahcsmm

surgical instruments used to cut, incise, and/or dissect tissue

chisel-like instruments used to cut or shave bone

wedge-shaped instruments used to cut or shape bone

surgical instruments used to cute or bite away at bone and tissue

surgical instruments used to grasp

• surgical instruments used to control flow of blood
• clamp and occlude

surgical instruments designed to drive suture needle to close or rejoin a wound or surgical site

• this metal is also known as 400 series stainless steel
• it is magnetic, and may be heat-hardened

surgical instruments primarily used to move tissues and organs to keep them exposed throughout surgery

• surgical instruments with a hollow barrel (or lumen) through their center.
• cannulas are often inserted for drainage

a retractor used to expose the chest

surgical instruments used to extract blood from a surgical site

• this metal is also known as 300 series stainless steal.
• it is non-magnetic, cannot be heat-hardened, and is more corrosion-resistant than martensitic stainless steel

parallel grooves in the jaws of surgical instruments

the part of a surgical instrument that "locks" the handles in place

a chemical process applied during instrument manufacture that provides a corrosion-resistant finish by forming a thin transparent oxide film

• scissors
• osteotomes
• chisels
• rongeurs
• forceps
• needle holders

• retractors
• cannulas
• rib spreaders
• suction devices

stainless steel

the instrumentt must be fround and milled

hemostat

kelly hemostat

• hartman mosquito 3.5"
• halsted mosquito 5"

jaws made of this metal are typically preferred because they are harder and last longer, they grip the needle more firmly, and they can be replaced

• mayo-hegar
• crile-wood
• crile-wood is narrower than the mayo-hegar

• grasping and holding
• manipulate tissue

• rat tooth
• brown forceps
• pickups

• they have serrations rather than teeth at the distal end.
• primary function: manipulate tissue and pack surgical site

• move tissue aside for exposure and visualization of the surgical site
• can be hand held, self retraining, or table mounted

• weitlaner
• gelpi
• beckman-adson

has beveled blade--most popular

• black rings visually identify these scissors from standard or gold-handled tungsten carbide scissors
• this design is to stimulate a tissue lancing/slicing action

the surgical site

• baron
• frazier
• use a metal stylet that us used during the surgical procedure to unclog the suction channel
• stylet is not to be used to clean the device

• cut or bite away at bone and tissue
• difference between a single action and double action rongeur is the design of how the jaws close

remove the lamina

cut toe and finger nails and occasionally, to trim small bone fragments

• expose the vaginal cavity
• a pederson blade is narrower than that on a graves speculum

• within 15 min to an hour of surgical procedure, blood can begin to dry on instrument
• blood and soil is not allowed to dry on instruments
• to prevent damage due to dried blood, separate the rings, and rachets for box lock exposure on applicable instruments, cover them with a towel moistened with water
• or spray enzymatic solution on the instruments to prevent blood from drying

• saline
• betadine
• peroxide

• accelerates rusting and pitting of surgical instruments
• operating room personnel can help by removing instruments from saline ASAP

red test material

yellow test material

saline

index card

plastic dowel rod

• use tape;
• clean fingers with alcohol to remove oils, grease, and any possible dirt
• wipe alcohol on the site of the instrument where the tape will be placed to remove any lubricant or moisture
• **the site should always be the shank of the instrument and never the rings
• **cut tape on angle to allow its edge to lay flat
• wrap the tape 1-one and 1/2 times around the device
• after the tape is applied , autoclave the instrument to allow heat to help bond tape

• acid base etching-uses a stencil, solutions, and electricity to mark stainless steel
• heat-fused nylon- color-coding referred to as "dipping", powder coating process that leaves a thin layer of color nylon on the instrument
• laser etching- process is permanent and costly
• **surg. instruments can also be marked with an electric etching process, but this marking method should not be used because it damages the surface of the instrument

• all surgical instruments are designed to be sharpened or restored
• sharpen all cutting instruments: all scissors must be on a sharpening schedule based upon how frequently they are used

• manufacturer's recommendations
• lubricants are abailable in spray form
• the point of application should be the instrument's hinged area or any working component such as a moving sliding area

• heavy instruments placed on bottom of tray
• select tray that allows for adequate weight/space distribution
• all curved instruments should be facing same direction
• tissue & dressing forceps should be softly nested
• delicate instruments shouuld be kept in micro cases or small protective cases
• use of metal instrument holders called stringers assist in faster sterile field

• with non-reflective black coating (ebonised) should never have metal-to-metal contact that can damage, chip, and scratch the finish during decontamination or tray assembly
• a silicon nipple mat can prevent metal-to-metal contact as can a foam or lint-free towel

• gomco-are patented medical devices
• mogen- the gap should be measured each year to assure that it is between 1.5mm to 2.5 mm
• like gomco clamps, should never be repaired or sharpened because they do not have a cutting edge

the interior path through a needle, tube, or surgical instrument

fluid invasion

• electric
• pneumatic (air)
• battery

a cable that can be sterilized

• damage to electrical parts during sterilization
• condensation that enters the equipment when seals wear out
• electrical contacts become worn and affect equipment handiling

• do no immerse the equipment in any solution including water
• do not use solvents or lubricats unless specified by the equipment manufacturer
• use a nylon bristle brush to clean the distal tip
• dry the equipment with a lint-free towel

• follow manufactorer's instructions
• avoid pulling on or stressing the power cord

use compressed gas (CO2) , require a hose that can be sterilized

mounted regulator panel

• 2 gauges
• one gauge- measures the pressure to the handpiece
• second gauge- measures the amount of nitrogen remaining in the tank

• never immerse in any solution
• properly insert the cleaning brush into attachments and burr guards
• carefully wipe and rinse the outer case
• use a decontamination hose to protect inner components
• burr guards must be lubricated according to the manufacturer's instructions

• most common
• least cumbersome of the 3 available power systems
• is insterted into the instrument so the device is free to maneuver across sterile field
• freedom of movement: batteries require charging, and requires increased handling
• carefully follow manufacturer's recommendations for the flash sterilization of battery packs

• never immerse handpieces, attachments, or batteries, into any solution including water
• clean surgical debris from attachments and handpieces using nylon brush&mild detergent
• rinse under running water while assuring that the water does not enter the batter contact area
• used a decontamination battery to protect electrical components from moisture

• dermatome/dermabraiders
• cebatomes
• sternal saw
• dental drills
• micro drills
• wire drivers, drills, and saws
• saws designed to perform specific cutting actions, such as reciprocating or oscillating

by insuring that handpieces are attached to the hose during cleaning to prevent solutions from entering the motor

• flexible
• rigid
• semi-rigid

to see inner body spaces/surfaces are very sensitive to pressure and bending

"leak tested" before submersion to assure that internal electrical curcuitry can protect components from fluid damage

• used to view the body's internal organs
• through natural openings such as mouth, anus, or through small incisions

spaulding classification system

• guidelines for use of high-level disinfectants and sterilants
• safe and effective handling of glutaraldehyde
• reprocessing flexible gastrointestinal endoscopes

CDC and FDA

• classifies "critical items" - those that penetrate skin or mucouse membranes or enter an area of the body that is normally sterile
• "semi-critical items" - only touch mucous membranes; ex: colonoscopes and gi endoscopes--require high level disinfection at a minimum to destroy: mycobaterium, vegetative bacteria, and non-lipid and small viruses, fungi, and some bacterial spores

each endoscope model

• automatic endoscope reprocessor
• automated equipment designed to clean, disinfect, and rinse flexible endoscopes

• liquid enzymes
• detergents

• glutaraldehyde (cidex)
• orthophthalaldehyde (OPA)
• peracetic acid solutions

• not all endoscopes and their accessories can be reprocessed in an AER
• if not specifically indicated in the AER labeling, ask AER manufacturers wheather the endoscope being used has been tested with their system

with each new piece of equipment and with each change in the chemical or process that is employed

• flexible-to bend
• endo- inside

• are assembled within an impervious material covering to produce an instrument that can bend gently to maneuver inside the body
• **care must be taken to avoid breaking any fibers by bending the endoscope at sharp angles or by dropping it

instrument (biopsy) channel

• instrument
• optical
• suction
• air/water

threading a flexible biopsy instrument through the biopsy channel to obtain a tissue specimen

• direct visualization of the tracheobronchial tree, and involves:
• diagnosis to secure uncontaminated secretion for culture, to take a biopsy, or to find the cause of a cough or hemoptysis(spitting up bone)

flexible cystoscope is used to visualize the urethra and bladder

used to perform gastroscopy and involves the visual inspection of the upper digestive tract with aspiration of contents and biopsy, if necessary

• colonoscopy involves the visual inspection of the entire large intestine with a colonoscope
• sigmoidoscopy involves the visual inspection of the lower part of the large intestine with a sigmoidscope

• pre-cleaning
• leak testing
• cleaning
• high-level disinfecting/sterilizing
• drying
• storing

an endoscope processing procedure that ensures the device's flexible covering and internal channels are watertight

• remove all valves
• attach the leak tester to the EtO venting connector
• the most common area for leaks is bending rubber at the distal tip of the insertion tube; always check this area first
• visually inspect scope for tears,hole,and joints that may leak
• completely submerge scope under water
• observe the control knobs
• observe for holes in the scope's internal channels

detach all removable parts

• immerse endoscope in disinfectant which is in a basin large enough for the endoscope. do not coil it too tightly
• use the cleaning adapters to fill all channels with disinfectant until no bubbles are seen exiting the channels
• place all valves and removable parts in the disinfectant
• cover with a tight lid
• check the disinfectants label instructions to determine the correct immersion time, and set a timer for that time
• when immersion is complete, purge the endoscopes channels with air to remove the disinfectant

immediately shipped to a service technician or manufacturer for repair

help prepare it for storage by minimizing the moisture necessary for bacterial growth

completely dry both internally and externally

• with the insertion tube hanging vertically (not coiled)
• with the weight of the control body supported and angulation locks off
• in a dry, dust-free cabinet with good ventilation

consists of 2 distally-located cups or jaws that open or close when a control located at the proximal end is manaipulated

allow easier visualization and recording of the procedures as they are projected to a video monitor

• telescope
• **this elemnt is the most expensive and fagile part of the system

ultrasonic cleaner

• avoid touching the ocular or the objective lenses
• examine non-video scope for optical clarity
• inspect optical fibers surrounding the lens train at the tip of the scope
• check the eyepiece seal for any visible signs of damage

• used to perform surgeries with several small holes versus large incisions
• some units conduct electricity to the working distal tip, and are typically insulated with a black material
• non electric units do not have the black insulation coating

• pin holes
• cracks
• tears
• overall loosening

• the insulation should fit tightly against the collar, and this union should be tight and snug with no spaces visible
• electronic testing devices can detect microscopic holes in the shaft of a laparoscopic instrument

instruments or sets borrowed from a vendor for emergency or scheduled surgical procedures that will be returned to the vendor following use

contaminated

every device is cleaned, disinfected, and sterilized according to the manufactorer's written instructions

comfirming that the correct irem and number of items are delivered, and that the equipment functions correctly

should check loaner instruments

enzymatic detergent, temperature, and mechanical cleaning method to be used

virus-like infectious agents that cause a variety of neurodegenerative diseases in humans and animals including scrapie in sheep and goats, bovine spongiform encephalopathy (BSE) and creutzfeldt-jakob disease (CJD) in humans

moved to a department area with low traffic flow and away from the direct airflow of cooling vents

a black handle

box lock

• passivation
• chromium oxide

autoclaved to help the tape bond to the instrument

1 to 1 1/2

electric etching (engraving)

is to unclog the suction during surgery

an index card

gold handles

check the collar at the distal tip

leak testing

filtered water

to keep fluid from entering the unit

an automatic endoscope reprocessor

sigmoidoscope

be decontaminated before use

the instrument manufacturer

AER

in the clean assembly area prior to set assembly

storage and workload challenges

deconaminated before it is shipped out