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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
martensitic (stainless steel)
- 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
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
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
instruments produced with 400 series: martensitic
- needle holders
instruments produced with 300 series: austenitic
- rib spreaders
- suction devices
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...
after forging is completed...
the instrumentt must be fround and milled
2 common types of forceps:
- hartman mosquito 3.5"
- halsted mosquito 5"
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
2 most common needleholder designs
- crile-wood is narrower than the mayo-hegar
primary function of tissue foreceps
- grasping and holding
- manipulate tissue
other names for tissue forceps:
- rat tooth
- brown forceps
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
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
common self retaining retractors
standard mayo scissors
has beveled blade--most popular
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
primary function of suction devices is to extract (suction) blood and fluids from
the surgical site
2 most common types of suction devices
- 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
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
the primary function of kerrison/laminectomy rongeur is
remove the lamina
nail nippers (bone cutter) primary function is to
cut toe and finger nails and occasionally, to trim small bone fragments
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
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
solutions that damage instruments
use of saline on instruments
- accelerates rusting and pitting of surgical instruments
- operating room personnel can help by removing instruments from saline ASAP
instrument sharpness testing:
scissors 4 1/2" and LARGER
red test material
instrument sharpness testing:
scissors 4" or SMALLER
yellow test material
0.9% sodium chloride
instrument sharpness testing:
bone cutter, kerrison rongeur, laminectomy(pituitary) rongeur, double action rongeur
instrument sharpness testing:
bone curette, chisels and osteotomes
plastic dowel rod
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
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
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
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
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
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
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
the interior path through a needle, tube, or surgical instrument
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?
power sources for surgical instruments, 3 types:
- pneumatic (air)
instruments powered by electricity require,
a cable that can be sterilized
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
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
electrical powered footswitch cleaning
- follow manufactorer's instructions
- avoid pulling on or stressing the power cord
use compressed gas (CO2) , require a hose that can be sterilized
stond-alone cylinder (tank) with a pressure regulator or "piped-in" through a wall- or column-
mounted regulator panel
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
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
- 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
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
popular powered surgical instruments
- sternal saw
- dental drills
- micro drills
- wire drivers, drills, and saws
- saws designed to perform specific cutting actions, such as reciprocating or oscillating
prevent fluid invasion
by insuring that handpieces are attached to the hose during cleaning to prevent solutions from entering the motor
scopes that have transformed how surgery is performed
fiber optic light carriers and camera systems that enable surgeons...
to see inner body spaces/surfaces are very sensitive to pressure and bending
flexible endoscopes need to be...
"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
the decision to sterilize or high-level disinfect a scope is based upton its use according to the...
spaulding classification system
the society of gastroenterology nurses and associates (SGNA):
- guidelines for use of high-level disinfectants and sterilants
- safe and effective handling of glutaraldehyde
- reprocessing flexible gastrointestinal endoscopes
reprocessing recommendations published by the
CDC and FDA
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
endoscope manufacturers provide manual reprocessing instruction for..
each endoscope model
- automatic endoscope reprocessor
- automated equipment designed to clean, disinfect, and rinse flexible endoscopes
preferred for processing flexible endoscopes...
3 solutions approved for endoscope high-level disinfection:
- glutaraldehyde (cidex)
- orthophthalaldehyde (OPA)
- peracetic acid solutions
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
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
term flexible and endo
- 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
the largest operating channel is the...
instrument (biopsy) channel
biospies are taken by...
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
6 basic steps are required to clean and reprocess endoscopes:
- leak testing
- high-level disinfecting/sterilizing
leak test (endoscope)
an endoscope processing procedure that ensures the device's flexible covering and internal channels are watertight
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
steps for cleaning endoscopes:
detach all removable parts
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
a scope that fails a leak test should be...
immediately shipped to a service technician or manufacturer for repair
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
before storing, the scope should be...
completely dry both internally and externally
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
consists of 2 distally-located cups or jaws that open or close when a control located at the proximal end is manaipulated
video cameras on scopes...
allow easier visualization and recording of the procedures as they are projected to a video monitor
the optical element for rigid endoscope systems is called a
- **this elemnt is the most expensive and fagile part of the system
lenses must never be placed in an
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
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
laparoscopic insulation is very suseptable to ...
- pin holes
- overall loosening
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
instruments or sets borrowed from a vendor for emergency or scheduled surgical procedures that will be returned to the vendor following use
loaner instruments should be considered...
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
inventorying the instruments and sets when they arrive is an important step.
comfirming that the correct irem and number of items are delivered, and that the equipment functions correctly
central service techs wearing proper protective attire ...
should check loaner instruments
decontamination--each manufacturer has specific instructions about the type of..
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
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
microgrind, or supercut scissors are usually identified with...
a black handle
place where 2 parts of a ring handled instrument meet and pivot is called the ..
during instrument manufacture the process of _______ helps build a protective _______ _____ layer on each instrument's surface.
- chromium oxide
after applying instrument identifiation tape, instruments should be..
autoclaved to help the tape bond to the instrument
instrument marking tape should be wrapped approximately ____ around the instrument.
1 to 1 1/2
what is not an acceptable form of instrument marking...
electric etching (engraving)
purpose of a suction stylet...
is to unclog the suction during surgery
kerrison laminectomy rongeurs should be tested using...
an index card
scissors with tungsten carbide cutting edges are usually identified by..
the first step to inspect the insulation of a laparoscopic instrument is to
check the collar at the distal tip
which of the following steps happens when processing flexible endoscopes
which of the following should be used to thoroughly rinse (remove) all traces of disinfectant from an endoscopes channels
the purpose of using decontamination battery or cord when cleaning powered surgical instruments is
to keep fluid from entering the unit
endoscopes are often processed in a mechanical unit called:
an automatic endoscope reprocessor
the endoscope that would be dispensed for a procedure that required visualization of the lower part of the large intestine would be a
loaner instruments should
be decontaminated before use
information regarding cleaning processes for endoscopes should be provided by
the instrument manufacturer
not all endoscopes can be processed in an
electronic testing of laparoscopic insulation should be done
in the clean assembly area prior to set assembly
loaner instrumentation poses...
storage and workload challenges
after use, loaner instrumentation must be...
deconaminated before it is shipped out