ch 11/12 iahcsmm

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Author:
Jaimilyn
ID:
104262
Filename:
ch 11/12 iahcsmm
Updated:
2011-09-26 20:50:29
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surg tech
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Description:
sugical instruments and complex instruments
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  1. scissors
    surgical instruments used to cut, incise, and/or dissect tissue
  2. osteotomes
    chisel-like instruments used to cut or shave bone
  3. chisels
    wedge-shaped instruments used to cut or shape bone
  4. rangeurs
    surgical instruments used to cute or bite away at bone and tissue
  5. forceps
    surgical instruments used to grasp
  6. hemostatic forceps
    • surgical instruments used to control flow of blood
    • clamp and occlude
  7. needle holders
    surgical instruments designed to drive suture needle to close or rejoin a wound or surgical site
  8. martensitic (stainless steel)
    • this metal is also known as 400 series stainless steel
    • it is magnetic, and may be heat-hardened
  9. retractors
    surgical instruments primarily used to move tissues and organs to keep them exposed throughout surgery
  10. cannulas
    • surgical instruments with a hollow barrel (or lumen) through their center.
    • cannulas are often inserted for drainage
  11. rib spreaders
    a retractor used to expose the chest
  12. suction devices
    surgical instruments used to extract blood from a surgical site
  13. astenitic (stainless steel)
    • 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
  14. serrations
    parallel grooves in the jaws of surgical instruments
  15. rachet
    the part of a surgical instrument that "locks" the handles in place
  16. passivation
    a chemical process applied during instrument manufacture that provides a corrosion-resistant finish by forming a thin transparent oxide film
  17. instruments produced with 400 series: martensitic
    • scissors
    • osteotomes
    • chisels
    • rongeurs
    • forceps
    • needle holders
  18. instruments produced with 300 series: austenitic
    • retractors
    • cannulas
    • rib spreaders
    • suction devices
  19. first step in manufacturing a surgical instrument is to forge the material to create a stamp of its rough outline from a heated bar of...
    stainless steel
  20. after forging is completed...
    the instrumentt must be fround and milled
  21. full serrations
    hemostat
  22. partial serrations
    kelly hemostat
  23. 2 common types of forceps:
    • hartman mosquito 3.5"
    • halsted mosquito 5"
  24. tungsten carbide jaws
    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
  25. 2 most common needleholder designs
    • mayo-hegar
    • crile-wood
    • crile-wood is narrower than the mayo-hegar
  26. primary function of tissue foreceps
    • grasping and holding
    • manipulate tissue
  27. other names for tissue forceps:
    • rat tooth
    • brown forceps
    • pickups
  28. dressing forceps are identical tissue forceps except
    • they have serrations rather than teeth at the distal end.
    • primary function: manipulate tissue and pack surgical site
  29. primary function of retractors is to
    • move tissue aside for exposure and visualization of the surgical site
    • can be hand held, self retraining, or table mounted
  30. common self retaining retractors
    • weitlaner
    • gelpi
    • beckman-adson
  31. standard mayo scissors
    has beveled blade--most popular
  32. microgrind or supercut blades
    • black rings visually identify these scissors from standard or gold-handled tungsten carbide scissors
    • this design is to stimulate a tissue lancing/slicing action
  33. primary function of suction devices is to extract (suction) blood and fluids from
    the surgical site
  34. 2 most common types of suction devices
    • 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
  35. primary function of a rongeur
    • 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
  36. the primary function of kerrison/laminectomy rongeur is
    remove the lamina
  37. nail nippers (bone cutter) primary function is to
    cut toe and finger nails and occasionally, to trim small bone fragments
  38. the primary usage of graves and pederson vaginal speculums is to
    • expose the vaginal cavity
    • a pederson blade is narrower than that on a graves speculum
  39. post operative care of surgical instruments
    • 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
  40. solutions that damage instruments
    • saline
    • betadine
    • peroxide
  41. use of saline on instruments
    • accelerates rusting and pitting of surgical instruments
    • operating room personnel can help by removing instruments from saline ASAP
  42. instrument sharpness testing:
    scissors 4 1/2" and LARGER
    red test material
  43. instrument sharpness testing:
    scissors 4" or SMALLER
    yellow test material
  44. 0.9% sodium chloride
    irrigation, USP
    saline
  45. instrument sharpness testing:
    bone cutter, kerrison rongeur, laminectomy(pituitary) rongeur, double action rongeur
    index card
  46. instrument sharpness testing:
    bone curette, chisels and osteotomes
    plastic dowel rod
  47. marking instruments for identification can be done:
    • 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
  48. other ways to mark instruments...
    • 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
  49. repair vendors maintain instruments...
    • 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
  50. surgical instruments with moving parts must be lubricated after each use or in accordance with..
    • 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
  51. tray assembly tips
    • 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
  52. laser-finished instruments (tray assembly)
    • 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
  53. gomco and mogen circumcision clamps
    • 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
  54. lumen
    the interior path through a needle, tube, or surgical instrument
  55. powdered surgical instruments contain several working components and will be damaged if fluid is allowed to penetrate into the interior of the instrument, this is called?
    fluid invasion
  56. power sources for surgical instruments, 3 types:
    • electric
    • pneumatic (air)
    • battery
  57. instruments powered by electricity require,
    a cable that can be sterilized
  58. common problems associated with electric power equipment
    • damage to electrical parts during sterilization
    • condensation that enters the equipment when seals wear out
    • electrical contacts become worn and affect equipment handiling
  59. to care and handle electric-powered equipment include
    • 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
  60. electrical powered footswitch cleaning
    • follow manufactorer's instructions
    • avoid pulling on or stressing the power cord
  61. pneumatic-powered (air-powered)
    use compressed gas (CO2) , require a hose that can be sterilized
  62. stond-alone cylinder (tank) with a pressure regulator or "piped-in" through a wall- or column-
    mounted regulator panel
  63. nitrogen can also be used for pneumatic power, and tanks of this gas contain a regulator with..
    • 2 gauges
    • one gauge- measures the pressure to the handpiece
    • second gauge- measures the amount of nitrogen remaining in the tank
  64. care and handle air equipment
    • 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
  65. battery-powered
    • 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
  66. care and handle of battery-powered instruments
    • 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
  67. popular powered surgical instruments
    • 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
  68. prevent fluid invasion
    by insuring that handpieces are attached to the hose during cleaning to prevent solutions from entering the motor
  69. scopes that have transformed how surgery is performed
    • flexible
    • rigid
    • semi-rigid
  70. fiber optic light carriers and camera systems that enable surgeons...
    to see inner body spaces/surfaces are very sensitive to pressure and bending
  71. flexible endoscopes need to be...
    "leak tested" before submersion to assure that internal electrical curcuitry can protect components from fluid damage
  72. endoscopes
    • used to view the body's internal organs
    • through natural openings such as mouth, anus, or through small incisions
  73. the decision to sterilize or high-level disinfect a scope is based upton its use according to the...
    spaulding classification system
  74. the society of gastroenterology nurses and associates (SGNA):
    guideline topics
    • guidelines for use of high-level disinfectants and sterilants
    • safe and effective handling of glutaraldehyde
    • reprocessing flexible gastrointestinal endoscopes
  75. reprocessing recommendations published by the
    CDC and FDA
  76. endoscopes and the spaulding classification system
    • 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
  77. endoscope manufacturers provide manual reprocessing instruction for..
    each endoscope model
  78. (AER)
    • automatic endoscope reprocessor
    • automated equipment designed to clean, disinfect, and rinse flexible endoscopes
  79. preferred for processing flexible endoscopes...
    • liquid enzymes
    • detergents
  80. 3 solutions approved for endoscope high-level disinfection:
    • glutaraldehyde (cidex)
    • orthophthalaldehyde (OPA)
    • peracetic acid solutions
  81. when can an AER be used
    • 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
  82. staff education:
    department-wide education is key to effective infection control in endoscopy, and should be updated....
    with each new piece of equipment and with each change in the chemical or process that is employed
  83. term flexible and endo
    • flexible-to bend
    • endo- inside
  84. scope components
    • 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
  85. the largest operating channel is the...
    instrument (biopsy) channel
  86. endoscope channels:
    • instrument
    • optical
    • suction
    • air/water
  87. biospies are taken by...
    threading a flexible biopsy instrument through the biopsy channel to obtain a tissue specimen
  88. bronchoscope
    • 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)
  89. cystoscope/ureteroscope
    flexible cystoscope is used to visualize the urethra and bladder
  90. gastroscope/esophagoscope
    used to perform gastroscopy and involves the visual inspection of the upper digestive tract with aspiration of contents and biopsy, if necessary
  91. colonoscope/sigmoidscope
    • 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
  92. 6 basic steps are required to clean and reprocess endoscopes:
    • pre-cleaning
    • leak testing
    • cleaning
    • high-level disinfecting/sterilizing
    • drying
    • storing
  93. leak test (endoscope)
    an endoscope processing procedure that ensures the device's flexible covering and internal channels are watertight
  94. basic steps for leak testing a scope
    • 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
  95. steps for cleaning endoscopes:
    detach all removable parts
  96. high-level disinfection and liquid chemical sterilization
    • 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
  97. a scope that fails a leak test should be...
    immediately shipped to a service technician or manufacturer for repair
  98. drying the exterior of the endoscope, and purging the remaining water from the channels ...
    help prepare it for storage by minimizing the moisture necessary for bacterial growth
  99. before storing, the scope should be...
    completely dry both internally and externally
  100. endoscopes should be stored...
    • 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
  101. biopsy forceps
    consists of 2 distally-located cups or jaws that open or close when a control located at the proximal end is manaipulated
  102. video cameras on scopes...
    allow easier visualization and recording of the procedures as they are projected to a video monitor
  103. the optical element for rigid endoscope systems is called a
    • telescope
    • **this elemnt is the most expensive and fagile part of the system
  104. lenses must never be placed in an
    ultrasonic cleaner
  105. lens inspection of a telescope
    • 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
  106. laparoscopic instruments (used in abdomin)
    • 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
  107. laparoscopic insulation is very suseptable to ...
    • pin holes
    • cracks
    • tears
    • overall loosening
  108. to inspect the laproscopic insulation ...
    • 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
  109. loaner instrumentation
    instruments or sets borrowed from a vendor for emergency or scheduled surgical procedures that will be returned to the vendor following use
  110. loaner instruments should be considered...
    contaminated
  111. from the time instruments are received, facitity staff accep responsibitly for them and must ensure that...
    every device is cleaned, disinfected, and sterilized according to the manufactorer's written instructions
  112. inventorying the instruments and sets when they arrive is an important step.
    procedures include:
    comfirming that the correct irem and number of items are delivered, and that the equipment functions correctly
  113. central service techs wearing proper protective attire ...
    should check loaner instruments
  114. decontamination--each manufacturer has specific instructions about the type of..
    enzymatic detergent, temperature, and mechanical cleaning method to be used
  115. prion
    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
  116. after the loaner instruments have been sterilized they should be...
    moved to a department area with low traffic flow and away from the direct airflow of cooling vents
  117. microgrind, or supercut scissors are usually identified with...
    a black handle
  118. place where 2 parts of a ring handled instrument meet and pivot is called the ..
    box lock
  119. during instrument manufacture the process of _______ helps build a protective _______ _____ layer on each instrument's surface.
    • passivation
    • chromium oxide
  120. after applying instrument identifiation tape, instruments should be..
    autoclaved to help the tape bond to the instrument
  121. instrument marking tape should be wrapped approximately ____ around the instrument.
    1 to 1 1/2
  122. what is not an acceptable form of instrument marking...
    electric etching (engraving)
  123. purpose of a suction stylet...
    is to unclog the suction during surgery
  124. kerrison laminectomy rongeurs should be tested using...
    an index card
  125. scissors with tungsten carbide cutting edges are usually identified by..
    gold handles
  126. the first step to inspect the insulation of a laparoscopic instrument is to
    check the collar at the distal tip
  127. which of the following steps happens when processing flexible endoscopes
    leak testing
  128. which of the following should be used to thoroughly rinse (remove) all traces of disinfectant from an endoscopes channels
    filtered water
  129. the purpose of using decontamination battery or cord when cleaning powered surgical instruments is
    to keep fluid from entering the unit
  130. endoscopes are often processed in a mechanical unit called:
    an automatic endoscope reprocessor
  131. the endoscope that would be dispensed for a procedure that required visualization of the lower part of the large intestine would be a
    sigmoidoscope
  132. loaner instruments should
    be decontaminated before use
  133. information regarding cleaning processes for endoscopes should be provided by
    the instrument manufacturer
  134. not all endoscopes can be processed in an
    AER
  135. electronic testing of laparoscopic insulation should be done
    in the clean assembly area prior to set assembly
  136. loaner instrumentation poses...
    storage and workload challenges
  137. after use, loaner instrumentation must be...
    deconaminated before it is shipped out

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