Chapter 11 Workbook

Dilator

graduated, smooth instrument that is used to increase the diameter of an anatomical opening in tissue

Scissoring

When the two tips of forceps cross over each other. A pin stop is set in the handle to prevent this.

Sizer

A trial, reusable replica of an implantable prosthesis

Tungston Carbide Insert

Found on shanks of scissors or needle holders.Prevents needle from slipping and rotating .Resistant to scratching, pitting and dulling.

Anodizing

Used in the manufacturing of lightweight aluminum instrument trays without this process, aluminum trays would easily scratch. The process allows the manufacturing of large instrument trays without the added weight of stainless steel.

One-piece Scalpel

Single Use cutting instrument.

Single -Action Rongeur

a heavy cutting instrument(bone) that has one spring loaded hinge

Double -Action Rongeur

A bone cutting instrument with two hinges in the middleCreates twice the leverage

Bevel

Found on a chisel were one side is straight and the other is beveled.

lPartial Occlusion or Traumatic Clamp or Vascular Clamp

Has locking ratchets, but the tips and shanks do not close tightly over the tissue. these clamps have enough pressure to slow or stop blood flow but do not bruise or crush the vessel

Jaws of a clamp

should be aligned with serrationscheck for irregularitiesmisalignment can cause snagging

Box lock

The hinge point of many surgical instruments. This is a single pin design that provides balance and reduces weight.Examine for cracks, pitting, play and tissue debris

Shank

The area of a surgical instrument between the box lock and the finger ring

Ratchet

locking portion of an instrument located near the finger ringsaligned they do not spring open unexpectedly

Finger Rings

used to grasp instrument and control jaw action; can be open/closed, round/oval

Scalpel (knife)

A. cutting

Hemostat

B. clamping and occluding

Ronguer

A. cutting

Tenaculum

C. grasping and holding

Osteotome

A. cutting

Caliper

F. measuring

Depth gauge

F. measuring

Bougie

E. dilating

Needle Holder

D. suturing

Thumb Forceps

C. grasping and holding

Speculum

H. speculum

Bone Clamp

C. grasping and holding

Elevator

A. cutting

Snare

A. cutting

#23 Blade

fits handle sizeD. #4 E. #4L

#10 Blade

fits handle sizeA. #3 C. #7 B. #3L F. #9

#11 Blade

fits handle sizeA. #3 C. #7B. #3L F. #9

#12 Blade

fits handle sizeA. #3 C. #7B. #3L F. #9

#15 Blade

fits handle sizeA. #3 C. #7B. #3L D. #9

#20 Blade

fits handle sizeD. #4E. #4L

#27 Blade

fits handle sizeD. #4E. #4L

#28 Blade

fits handle sizeD. #4E. #4L

#25 Blade

fits handle sizeD. #4E. #4L

Name several ways that injury to team members can be prevented as instruments are passed and handled during a surgical procedure.

1. while passing an instrument, it should be orientated in a way that facilitate its immediate use2. instruments should be passed purposefully and securely3. instruments should be passed by grasping them in the midsection4. power instruments or stapling instruments , are in safety mode when passed5. when there is no flat surface in the sterile field, a magnetic mat should be available to prevent instruments from sliding to the floor.

Adipose (fat)

tends to fragment when clamped, few blood vessels, slippy, lobular in structure, toothed instruments are used

Spleen and Liver

highly vascular, delicate, can break apart when injured, must be handled carefully

Bone

resilient, strong, manipulation is by traction

Muscle

occurs in fibers and bundles, slow to regain function when severed, usually moved aside rather than severed during surgery

Skin

very strong in healthy individuals, elastic, normally not cut with scissors during surgery

Serosa (fine membrane that covers organs of the body)

fine membrane, easily punctured, handled with smooth (not toothed) instruments only

Ligament

resilient and strong, fibrous, elastic

Tendon

slippery, strong, stringy, few blood vessels, handled with toothed instruments

Surgical- (premium) Grade Instruments

highest quality used for cutting instruments has the highest level of chromium

Floor-Grade Instruments*

contains lower percentage of chromium can bend and break easily. Fittings and joints are poorly constructed and fittings are poor quality

Satin Finish Instruments

reduces glare, prone to staining

Bright (or Mirror) Finished Instruments

instruments resist staining, highly reflective, produce glare, highly polished

Ebony (Black) Finished Instruments

used on laser surgery, instruments. absorbs light, and prevents reflection of laser energy into adjacent tissues

Elevator

a straight instrument with curved sharp of dull tip used to separate or lift tissue layers such as periosteum from bone

Gouge

v shaped bone chisel

Hemostat

a surgical clamp most often used to occlude a blood vessel and stop blood flow through a vessel It can be long or short, straight or curved

Rongeur

a hinged instrument with sharp, cup shaped tips that is used to extract pieces of bone or other connective tissue. it has a spring loaded hinge. the tips are cupped or beveled and the edges are sharp. may have a single hinge or two hinges.

Serosa

The visceral peritoneum.The outermost layer of the organs .

Tenaculum

a grasping instrument with sharp pointed tips, generally used to manipulate or grasp tissue such as the thyroid or cervix. has one or more needle sharp teeth in jaws that can be delicate or heavy. This instrument penetrates the tissue on both sides of the jaws, in a pincer hold.

Titanium Anodizing

method that imparts color and hardness to the surface of titanium. performed by passing an electric current through the surface metal, resulting in oxidation. different colors are achieved by adjusting the oxide level of the coating. this process is commonly used in the manufacture of orthopedic implants such as plates and screws. color coding allows easy matching of implant components and specialized tools. titanium is extremely hard and resistant to corrosion and pitting, a quality that is essential in orthopedics

Gold Dip or Black Finish (on the finger rings)

the working tip or edge of the instrument has tungsten carbide inserts that are highly resistant to scratching, pitting, and dulling.

Overall Length

short instruments are used on surface tissues, those that are not deep inside the body. long instruments are needed for use deep in body cavities or in very deep bodied patients.

Weight and Thickness

the heavier an instrument is, the less precise the instrument will be at the working end. lightweight instruments are used for the most delicate tissue so that the surgeon has immediate tactile feedback. even long instruments used in minimally invasive surgery must have delicate tips. the shank portion of the instrument must also be somewhat delicate in order to provide the tactile feedback needed for precision surgery. surgical scissors with moderately heavy blades are generally used on fibrous tissue, whereas those with short delicate blades are intended for dissection of delicate tissues.

Points or Teeth

toothed or sharp pointed instruments are used to grip fibrous tissue that would otherwise slip through the instruments jaws. tissue forceps or pickups with one or more teeth are used only on connective tissues such as ligament, fascia, or skin, but never on delicate tissue. vascular forceps contain one or two smooth ridges along the tips. these can grasp delicate tissue without tearing it retractors with sharp teeth are placed only in tissue that is avascular, such as adipose and fascia.

Shape

the overall shape of the instrument is a clue to its specific use. long shanks are necessary for instruments used deep in the body. the bayonet shaped instruments are almost always used in nasal or neurosurgery. shorter instruments are used on superficial tissues. few instruments are perfectly straight, because of contours and bends of anatomy require instruments that can reach around and under structures.

Clamp

any instrument that closes over tissue to hold or occlude it

Biting Clamp

has teeth or sharp serrations in the jaws that penetrate the tissue to hold it securely. mainly used on tissue that will be removed as part of the surgical procedure or on tissue that is extremely tough and resilient, such as fascia or ligament

Thumb Forceps

non locking instrument used for grasping tissue and suture needles during suturing and for general tissue manipulation. often called pickups

Toothed Forceps

have one or more teeth in the jaws and are described by the number and type of teeth that mesh with slots on the opposite tine. used on skin, fascia, and other connective tissue

.Smooth Forceps

no teeth and used on delicate tissue such as serosa, bowel, blood vessels, or ducts.

Iris Scissors

small sharp tipped scissors are used for extremely fine dissection in plastic surgery

Metzenbaum Scissors

round tipped light dissecting scissors used extensively on delicate tissue in general surgery. These are the most commonly used scissors in surgery

Shears

large cutting instruments used to sever bone tissue. most common use is during thoracic surgery when one or more ribs must be cut for access to the chest cavity. some are designed so that the cutting edge is left or right of the hinge. these are called side cutting

Castroviejo scissors

commonly used in microsurgery

Metal Alloy

A combination of several different kinds of metals. Used in the manufacture of stainless steel.

Curved Mayo Scissors

fibrous connective tissue requires heavier scissors. never used for cutting suture because it dulls them quickly

Straight Mayo Scissors

used for cutting sutures

Curette

small cup with a sharpened, serrated, or smooth rim at the end of the handle. used in many specialties for scooping out tissue, including bone and soft tissue. fine ones are used in ear, para nasal, and spinal surgery. larger heavier ones are used in orthopedic procedures. soft tissue ones are used in gynecological surgery for endometrial curettage.

Wire Cutting Scissors

used for stainless steel and other metal suture materials