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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_848_Библиотеки_им_академика_М_И_Перельмана
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CHAPTER
Chapter 1: Introduction
INTrOduCTION
STERILIZATION OF INSTRUMENTS
Sterilization is the process of destroying all microbes
causing infection while Disinfection refers to the process
of killing microbes except spores from inanimate objects
or substances.
DIFFERENT METHODS OF
STERILIZATION
Physical agents Chemical agents Halogens
Incineration (for
waste material)
Hot air oven
Boiling
Autoclave
Radiation
Phenol
Cresol
Chlorhexidine
Dettol
(Chloroxylenol)
Cetrimide
Savlon (Cetrimide +
Hibitane)
EUSOL (Edinburgh
University solution
of lime)
Iodophores (e.g.
povidone iodine)
Alcohol
Formaldehyde
Cidex (2%
Glutaraldehyde)
Hydrogen peroxide
1
SOME IMPORTANT METHODS
A. Autoclaving
Temperature: 120°–135
Pressure: 15 psi.
Sharp and plastic instruments cannot be sterilized
Bacillus thermophillus spores used as an indicator.
B. Boiling
For 30 min at 100°C
Usually used in OT between the surgeries.
C. Cidex (2% Glutaraldehyde)
Usually used for disinfection in between surgeries
Instruments dipped in solution for 4 hours to sterilize
them and for 15-20 minutes to disinfect them
Time required is 4 to 24 hours.
D. Formaldehyde
Used to disinfect operation theater
Fumigation: 500 ml of formalin with 1 liter water is
boiled to get formaldehyde vapor
Formalin tablets used in gas chambers specially for
ber optic instruments
°C for 20 min
3
ey Points
K
Most metallic instruments are sterilized by autoclaving except sharp instruments like scissors for which Cidex is preferred.
Ethylene oxide gas and gamma irradiation are generally used for industrial sterilization.
4
Section 1: Metallic Instruments
PARTS OF A SURGICAL INSTRUMENT
A typical long metallic surgical instrument has:
A. Finger bows: To grasp the instrument with the thumb and ring nger
B. Catch/Ratchet: To lock the instrument in the desired position
C. Shaft: Length from catch to joint
D. Joint/Shank: Point of junction of blade and shaft. Can be box type or pivot type
E. Blades: From joint to the tip of the instrument
F. Tip of the instrument: Terminal part of the blade which may be sharp or blunt.
EXAMINATION TIPS
HOW TO HOLD AN INSTRUMENT
A typical sugrical instrument
Chapter 1: Introduction
5
HOW TO DESCRIBE AN INSTRUMENT
Remember to include the following points in your
description:
Complete name of the instrument
Common use
Common surgery in which it is used
Other uses
Sterilization method.
Example
is is Spencer Wells medium sized curved artery forceps
used to achieve hemostasis in surgeries like Modied
Radical Mastectomy (MRM), Hernioplasty, etc. It may also
be used for ………… It is sterilized by autoclaving.
Instruments used at
Chapter
start of surgery
CHEATLE’S FORCEP
2
alient Features
S
Curved blades with large serrations
Without lock.
Usually dipped in antiseptic solutions like cidex/savlon in
operation theater.
ses
U
Pick sterilized and autoclaved articles like instruments,
drapes
Transfer sterilized articles from one tray to another.
Chapter 2: Instruments Used at Start of Surgery
RAMPLEY’S SPONGE HOLDING FORCEPS
alient Features
S
Tip of the blades are oval, fenestrated and with horizontal
serrations on its inner aspect
Long shaft and blades provided to prevent instrument
from touching the unsterile eld
Catch lock for rm grip of swab/sponge.
ey Points
K
To paint an operative eld, rst savlon (cetrimide solution)
followed by spirit and 2-3 coats of povidone-iodine is
used
For abdominal surgeries, area from mid-chest to mid-
thigh needs to be exposed and painted.
7
ses
U
To clean the operative area
For swabbing/packing cavities
To hold soft hollow organs like gallbladder fundus in cholecystectomy
Can hold cervix in a pregnant patient
Can be used in place of ovum forceps
Can be used in place of pile holding forceps during hemorrhoidectomy
Can be used as a tongue holding forceps.
8
Section 1: Metallic Instruments
TOWEL CLIPS
MAYO’S/DOYEN’S TOWEL CLIP
Small curved sharp blades which meet or cross each
other
Pincer like instrument (instrument opens up on pressing
the shaft)
Blade tips – sharply pointed for rm grasping.
ses
U
To x the drape properly to expose the operative site only
To x the suction tubes, diathermy cables, camera cables to the drape
To hold the ribs while elevating them in a stove-in-chest injury
Substitute for tongue holding forceps, umbilical cord holding forceps
To give external traction in fracture of small long bones.
BACKHAUS TOWEL (CORNER) CLIP
Same as Doyen’s towel clip but without a pincer like
action
Has shafts, nger bows and catch lock
Curved sharp ends approximate but do not cross each
other.
BARD PARKER KNIFE HANDLE
alient Features
S
Also called as “Surgeon’s knife”
Shaft with grooves or serrations for better grip
Slot for attaching scalpel blade
Most common sizes – 3, 4
¾ (Blade No. 11, 15 for BP Handle No. 3)
¾ (Blade No. 22, 23, 24 for BP Handle No. 4).
Common types of blades
ses
U
To give skin incisions in surgeries
To do sharp dissection to raise skin aps in surgeries like
MRM, thyroidectomy, incisional hernia, etc.
Chapter 2: Instruments Used at Start of Surgery
ey Points
K
Dinner knife position Pen position
Stab position Fiddle bow position
Dinner knife position: Used to avoid tailing at the end of incision
Pen position: For ne dissection
Stab position: To give a stab incision in drainage of abscess
Fiddle bow position: Gentle incision over skin.
9
KIDNEY TRAY
alient Features
S
Has a kidney shaped structure.
ses
U
To store saline to wet the mops
To wash blood tinged mops intraoperatively
To collect stones from surgeries like cholelithiasis,
cystolithotomy, etc.
To mix warm and cold saline to wash peritoneal cavity
To collect uid from hydrocele surgery.
Forceps
ALLIS TISSUE FORCEPS
Chapter
3
alient Features
S
Blades are straight along the long axis with gap to
accommodate the tissue in between
Sharp teeth at the tip which interlock on closing with
minimal crushing of tissues
Catch lock mechanism present.
ses
U
To hold thin but tough structures, e.g. skin, deep fascia,
rectus sheath, etc.
To hold the brous capsule of a structure for dissection
To hold tough galea while raising skin aps during
craniotomy
To hold skin margins while raising skin aps in surgeries
like thyroidectomy, radical neck dissection, MRM (as an
alternative to skin hooks)
Can be used in place of towel clips.
BABCOCK TISSUE FORCEPS
Chapter 3: Forceps
11
alient Features
S
Non-traumatic type
Curved and fenestrated blades allow a bulky amount of
tissue to be held in between
Blade tips have transverse serrations
Fenestration in the blades makes the instrument light.
KOCHER’S HEMOSTATIC FORCEPS
alient Features
S
Toothed variety - Has a single sharp tooth at the tip of
one blade and groove at the tip of other blade
Blades are conical and blunt with transverse serrations on
inner margins
May be curved or straight
Catch lock present.
ses
U
To hold delicate and soft tissues like appendix, fallopian
tube, ureter, etc.
To hold gut during colostomy, gastrostomy, etc.
To hold cut margins of bladder in transvesical
prostatectomy and cystolithotomy.
ses
U
To hold spermatic cord at deep ring before cutting and
ligating it during high inguinal orchidectomy
To hold Mackenrodt’s ligament along with uterine vessels
before cutting and ligating it in hysterectomy
To hold the pedicles with major vessels during surgeries
like splenectomy, nephrectomy, etc.
To hold gauze pellets (peanut swabs) for blunt dissection
To hold supercial thyroid vessels and margins of the lobe
of the thyroid gland during thyroidectomy
To hold rib during rib resection
To hold tough brous fascia of palms and soles
To cause articial rupture of gestational membranes.
12
Section 1: Metallic Instruments
HEMOSTATIC ARTERY FORCEPS
Curved artery forceps
Straight artery forceps
TYPES
A. Halsted’s Mosquito Forceps
Very small in size
Pointed tips
Hold small pointed bleeding sites
To separate glans penis from inner surface of prepuce
in circumcision.
B. Spencer Wells Artery Forceps
May be small/medium/long
Long artery forceps used for drain insertion in peritoneal
cavity and holding deeper tissues in surgeries like open
cholecystectomy.
ses
U
Used as a haemostat
To hold the cut edges of fascia, aponeurosis, peritoneum
To open up abscess cavity
To hold free ends of tension sutures
To crush the base of appendix
To hold gauze pellets for blunt dissection (peanut)
To dissect vein while doing venesection.
alient Features
S
Blades have transverse serrations, well apposed with no
gap in between
Blades are usually half the length of the shaft
May be straight or curved
Catch lock mechanism present.
ey Points
K
Mosquito forceps are named so because:
¾ It is so small that it can hold proboscis of a mosquito
¾ Its bite on skin resembles a mosquito bite.
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