Surgical Materials

Classification by type of points All types of scissors can have blunt or sharp blades (A: Sharp:Sharp, B: Blunt:Blunt).

All types can have either straight or curved blades.

Mayo and Metzenbaum Mayo scissors (B) are used for cutting heavy fascia and sutures. Metzenbaum scissors (A) are more delicate than Mayo scissors. Metzenbaum scissors are used to cut delicate tissues. Metzenbaum scissors have a longer handle to blade ratio.

Forceps: consist of two tines held together at one end with a spring device that holds the tines open. Forceps can be either tissue or dressing forceps. Dressing forceps have smooth or smoothly serrated tips.

Tissue forceps have teeth to grip tissue. Many forceps bear the name of the originator of the design, such as Adson tissue forceps.

Rat Tooth: A Tissue Forceps Interdigitating teeth hold tissue without slipping. Used to hold skin/dense tissue.

Adson Tissue Forceps Small serrated teeth on edge of tips. The Adsons tissue forceps has delicate serrated tips designed for light, careful handling of tissue.

Intestinal Tissue Forceps: Hinged (locking) forceps used for grasping and holding tissue.

Allis: An Intestinal Tissue Forceps

Interdigitating short teeth to grasp and hold bowel or tissue. Slightly traumatic, use to hold intestine, fascia and skin.

Babcock: An Intestinal Tissue Forceps More delicate that Allis, less directly traumatic. Broad, flared ends with smooth tips. Used to atraumatically hold viscera (bowel and bladder).

Sponge Forceps Sponge forceps can be straight or curved. Sponge forceps can have smooth or serrated jaws. Used to atraumatically hold viscera (bowel and bladder).

Hemostatic forceps: Hinged (locking) Forceps. Many hemostatic forceps bear the name of the designer (Kelly, Holstead, Crile). They are used to clamp and hold blood vessels.

Classification by size and shape and size of tips

Hemostatic forceps and hemostats may be curved or straight.

Kelly Hemostatic Forceps and Mosquito Hemostats Both are transversely serrated. Mosquito hemostats (A) are more delicate than Kelly hemostatic forceps (B).

Comparison of Kelly and Mosquito tips Mosquito hemostats (A) have a smaller, finer tip.

Carmalt

Heavier than Kelly. Preferred for clamping of ovarian pedicals during an ovariohysterectomy surgery because the serrations run longitudinally.

Doyen Intestinal Forceps Doyen intestinal forceps are non-crushing intestinal occluding forceps with longitudinal serrations. Used to temporarily occlude lumen of bowel.

Payr Pylorus Clamps Payr pylorus clamp is a crushing intestinal instrument. Used to occlude the end of bowel to be resected.

Needle holder: Hinged (locking) instrument used to hold the needle while suturing tissue. Good quality is ensured with tungsten carbide inserts at the tip of the needle holder.

Mayo-Hegar Heavy, with mildly tapered jaws.

No cutting blades.

Olsen-Hegar Includes both needle holding jaw and scissors blades. The disadvantage to having blades within the needle holder is the suture material may be accidentally cut.

Senn Blades at each end. Blades can be blunt (delicate) or sharp (more traumatic, used for fascia).

Hohman

Levers tissue away from bone during orthopedic procedures.

Weitlaner Ends can be blunt or sharp. Has rake tips. Ratchet to hold tissue apart.

Gelpi Has single point tips.

Ratchet to hold tissue apart.

Handles #3 Handle #4 Handle

Handles and Blades Blades #10, 11, 12, 15 fit the #3 handle. Blades #22, #23 fit the #4 handle and are commonly used for large animals.

Disposable Scalpel

Towel clamps secure drapes to a patient's skin. They may also be used to hold tissue.

Backhaus Towel Clamp Locking forceps with curved, pointed tips.

Scissors and Hemostats: The thumb and ring finger are inserted into the rings of the scissors while the index and middle finger are used to guide the instrument. The instrument should remain at the tips of the fingers for maximum control.

This is the wrong way to hold the scissors. The ring finger should be inserted into the ring.

This is also the wrong way to hold the scissors. The tips of the scissors should be pointing upwards.

Thumb Forceps: Thumb forceps are held like a pencil.

Thumb Forceps are not called 'tweezers'. Thumb Forceps are not held like a knife.

Scalpels: The scalpel is held with thumb, middle and ring finger while the index finger is placed on the upper edge to help guide the scalpel. Long gentle cutting strokes are less traumatic to tissue than short chopping motions.

The scalpel should never be used in a "stabbing" motion.

Nurses role The Nurses role during the peri-operative period of surgery depends on their position/department they work in. For this current article we will look at the medical-surgical nurses role in the preoperative and the post-operative periods.

Pre-Operative Period The role of the nurse in the pre-operative period is two fold. First, to make sure that the patient has not eaten for the pre-determined amount of time set by the Surgeon. Also, conduct any patient teaching about the surgery, the hold room, the OR itself, and the PACU. Instuct the family about the Surgeons preferences regarding family communication post-op as well. Second, all appropriate paperwork must be complete. This depends on your facility, but this mainly includes operative consent forms and pre-operative assessments and nurses notes. Depending on the time frame, on-call medicines (usually antibiotics) are given or sent with patient. Make sure your patients chart is in order, and that the current medication administration records are in the chart. Also, depending on your facility, make sure an adaquate amount of patient stickers are available for the surgery nurses, as well as any transfer forms that need to be filled out.

Intra-Operative Period This refers to the period from when the patient enters the anaesthetic rooms in the operating suite, to the moment they are discharged from recovery. In nursing care terms, it therefore covers three different aspects of nursing; anaesthetic nursing, instrument and circulating nursing and recovery nursing. The role of the nurse in theatre tends to be a little different from those of the nurse on a ward. The primary focus of the theatre nurse is that of safety and sterility, and not of education and the patient relationship. The main principle of any operation is speed - the faster open and closed, the less chance of the patient becoming compromised post-surgically; the theatre nurse hastens this process. In addition, each of the three disciplines have their own remits: anaesthetic nurses are concerned with ensuring that drugs are drawn up and administered safely, that checking procedures are followed, that consent has been obtained, that the patient is readied appropriately (in terms of positioning) for their operation and the patient has emotional support; instrument and circulating nurses are concerned with keeping the sterile field sterile, keeping a tally of things that go in, and therefore out, of the body, and with assissting the surgeons as required; recovery nurses are concerned with ensuring that the patient returns to a "normal" post-operative state, that their pain is controlled, that they are not running fevers, and that there are no post-anaesthetic complications.

Post-Operative Period Surgery is complete, PACU has called you report. Now it is time to get the patients room ready for their arrival. Depending on the surgery, make sure any equipment that is need is redily available to you. This could be graduated cylinders, tape, NG canisters, flushes, saftey pins, fresh linens or gowns, IVF and lines, etc. Once patient is in room and comfortable, explain the pain scale to the patient and make sure you have addressed their pain level before continuing any assessment. Once this is done, conduct your initial assessment as well as a wound assessment. Depending on the facility, get your hourly vitals as needed. Review post-op orders with the patient, as pain medicine and diet most likely has changed. Once you get back to the nursing station, make sure all orders are noted and correct. This is the time to make sure you have the

orders you need. Most surgeries are very routine, and some doctors get too familiar with writing the post-op orders. Make sure you have all the orders you need, especially if this is a late case. Nothing is worse that the patient spiking a temp at 1 AM and not having a Tylenol Suppository order for an NPO patient. Continue to monitor this patient closely, as even