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Sx Skills - Basic Surgical Instruments & Handling

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drraythe's version from 2016-05-05 10:24

Instrumentation

Question Answer
7 anatomical parts of a ringed instrument?Tips
Jaws
Lock box+lock box pin (where the 2 parts come together)
Shank (long part past lock box)
Ring handle
Ratchet (part that you can click it together to hold it closed)
What is the appropriate way to hold a ringed instrument?Tripod grip (Thumb & ring finger in the rings, index stabilizing against the shanks)
What are the 4 hemostatic forceps we care about?A. Halstead
B. Kelly
C. Crile
(D. Oschner)
E. Rochester-Carmalt
What are Mosquito hemostatic forceps used for?For hemostasis of SMALL blood vessels
What are Halsted hemostatic forceps used for?For hemostasis of SMALL blood vessels
W/ a hemostat, which way do you want to curve pointing when you clamp the vessel?Down
What are Crile hemostatic forceps used for?Clamps larger vessels
What are Kelly hemostatic forceps used for?Clamps larger vessels (Kelly is half naked)
What are Rochester-Carmalt hemostatic forceps used for?Crush larger bundles of tissue (i.e. ovarian pedicles during OHE)
What are Bulldog-Satinsky hemostatic forceps used for?Exerts gentle compression on vessel w/o causing endothelial damage for the purpose of temporary hemostasis
What are Satinsky hemostatic forceps used for?Exerts gentle compression on vessel w/o causing endothelial damage for the purpose of temporary hemostasis
Application of thumb forceps?Used to stabilize tissue and/or expose tissue layers when suturing
Use for Brown-Adson thumb forceps?General tissue manipulation
Use for Adson (rat-tooth) thumb forceps?Stabilize & retract less delicate tissues (general tissue manipulation, Linea alba)
How should you hold thumb forceps??UNDERHANDED


Not overhanded!
Use for Allis tissue forceps?Enables a firm grasp of tissue (eg. grasp tissue that is being removed from the body) (can be quite harmful to tissues)
Use for Babcock tissue forceps?Enables gentler grasp of tissues like hollow organs/ intestines (no teeth on the tips, looks like you can grab a small cock w/ it)
Use of Doyen intestinal forceps?Non-crushing, occluding forceps used to temporarily occlude lumen of bowel
Use of Forester sponge forceps?Manipulate/handle sponges or sterile dressing materials
When do you use bone-holding forceps (she wont make us memorize the bone forceps names)Hold bones during fracture repair

What is the purpose of needle-holders? What are the 2 most commonly used types?Grasp & manipulate curved needles
Types:
Mayo-Hagar Needle Driver (holder)

Olsen-Hagar Needle Driver (holder) which has scissors built-in
Handling → THUMB-RING FINGER HOLD: When do you use this?High precision, Use when suturing delicate tissues
AKA: The Wide Base Grip
AKA: The Tripod Grip
Handling → PENCIL GRIP HOLD: When do you use this?Ideal for delicate suturing (vascular, ophthalmic Sx) (Use w/ Castroviejo needle holders)
Handling → PALM GRIP HOLD: When do you use this?For high driving force but low precision
Handling → THENAR EMINENCE GRIP HOLD: when do you use this?Allows for good mobility, Good for continuous patterns...thumb isnt in the ring, controlling w/ meat of thumb
Use of Mayo scissors?Cut more dense tissues, usually 5½ to 6¾ inches in length, curve of scissors always towards the PTx, point of scissors always away from Ptx
Use of Metezenbaum scissors?Used for sharp & blunt dissection of more delicate tissues (DONT cut sutures w/ these) usually 7 inches in length
Use of Doyen scissors?Cut suture material (during Sx)
Use of Lister scissors?Cut bandages (Bottom protects PTx from being cut/scratched/stabbed)
Use of Spencer scissors?Removal of sutures
**What part of the scalpel do you cut w/?BELLY of the blade (not the tip!)
What are the 2 sizes of scalpel handles & what size blades do they correspond to?(1) #3 handle - for blades #10-15
(2) #4 handle - for blades #20-25
Press cutting-when would you do this?Stab incisions - think of this as a bladder - you do this when there's nothing delicate in there, just pee
Finger bumper press cutting-when would you do this?Stab incisions - helps to control how deep blade goes into tissue...if getting into preg. uterus for C-section, want more control!!
Inverted blade press cutting-when would you do this?Flip the belly up, want a shallow incision-use this when dissecting the linea Alba
Slide cutting-when would you do this?Use belly to make nice long incisions (skin incision for a spay, for instance)
Scalpel blade handling → Fingertip grip-use when?Long incisions
Scalpel blade handling → Palm grip-use when?Used where more force is reqd to incise tissue
Scalpel blade handling → Pencil grip-use when?Short precise incisions
Scalpel blade handling → Inverted pencil grip-use when?For the stab incision into Linea Alba (Protects tissue underneath)
What is the application for retractors?Retracts tissue to facilitate exposure of the surgical field
Use of Balfour retractors?Retract the abdominal wall for exposure of the abdominal cavity (abdomen is where balf comes from)
Use of Finochietto retractors?Used during thoracotomies to keep ribs separated (some Italian dude that wants to break all your ribs)
What are these called? What are they use for?
Gelpi Retractors. Retracts tissue to facilitate exposure of the surgical field
What are these called? What are they use for?
Weitlaner Retractors. Retracts tissue to facilitate exposure of the surgical field
What is the use of Hand-held retractors?Retraction of skin & superficial muscle layers (Senn-Miller, Parker, Army,Navy)
What is the use of towel clamps?Secure drapes to PTx or surgical instrumentation to drapes (i.e. suction, electroscalpel) (Only need to know the Backhaus Towel Clamp for this class)
Backhaus Towel Clamp
Use of ovariohysterectomy hook? The 2 kinds are?Retrieval of uterine horn during OHE. There is a Snook (flat tip) & Covault (ball-tipped)
Snook

Covault
memorize