4. Scissors
• All types of scissors can
have blunt or sharp
blades
• (A: Sharp:Sharp, B:
Blunt:Blunt).
5. • 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.
6. • All types can have
either straight or curved
blades.
7. • 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.
8. • Rat Tooth: A Tissue
Forceps
• Interdigitating teeth
hold tissue without
slipping.
• Used to hold skin/dense
tissue.
9. • 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.
10. • 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.
11. • 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).
12. • 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).
13. • 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.
14. • Classification by size
and shape and size of
tips
• Hemostatic forceps and
hemostats may be
curved or straight.
15. • Kelly Hemostatic
Forceps and Mosquito
Hemostats
• Both are transversely
serrated.
• Mosquito hemostats (A)
are more delicate than
Kelly hemostatic forceps
(B).
16. • Comparison of Kelly
and Mosquito tips
• Mosquito hemostats (A)
have a smaller, finer tip.
17. • Carmalt
• Heavier than Kelly.
• Preferred for clamping
of ovarian pedicals
during an
ovariohysterectomy
surgery because the
serrations run
longitudinally.
18. • Doyen Intestinal Forceps
• Doyen intestinal forceps
are non-crushing
intestinal occluding
forceps with longitudinal
serrations.
• Used to temporarily
occlude lumen of bowel.
•
19. • Payr Pylorus Clamps
• Payr pylorus clamp is a
crushing intestinal
instrument.
• Used to occlude the
end of bowel to be
resected.
20. • 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.
21. • 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
22. • Senn
• Blades at each end.
• Blades can be blunt
(delicate) or sharp
(more traumatic, used
for fascia).
23. • Hohman
• Levers tissue away from
bone during orthopedic
procedures.
24. • Weitlaner
• Ends can be blunt or
sharp.
• Has rake tips.
• Ratchet to hold tissue
apart.
25. • Gelpi
• Has single point tips.
• Ratchet to hold tissue
apart.
31. • 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.
32. • This is the wrong way to
hold the scissors. The
ring finger should be
inserted into the ring.
33. • This is also the wrong
way to hold the
scissors. The tips of the
scissors should be
pointing upwards.
35. • Thumb Forceps are not
called 'tweezers'.
• Thumb Forceps are not
held like a knife.
36. • 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.
38. Autoclave
• An autoclave is a self
locking machine that
sterilizes with steam
under pressure.
• Sterilization is achieved
by the high temperature
that steam under
pressure can reach.
• The high pressure also
ensures saturation of
wrapped surgical packs.
39. Autoclave Temperature Pressure
Time (min)
Settings (F) (PSI)
General
Wrapped 250 20 30
Items
Bottled
250 20 30
Solutions
'Flashing' 270 30 4-7
40. Preparation for sterilization
• All instruments must be double wrapped in
linen or special paper or placed in a special
metal box equipped with a filter before
sterilization.
• 'Flashing' is when an instrument is autoclaved
unwrapped for a shorter period of time.
'Flashing' is often used when a critical
instrument is dropped.
41. • Color Change
Sterilization Indicators
• The white stripes on the
tape change to black
when the appropriate
conditions (temperature)
have been met.
• Indicators should be on
the inside and outside of
equipment pack.
• Expiration dates should
be printed on all
equipment packs.
42. • Biological sterilization indicators contain
spores that are supplied in closed containers
and are included with the instrument being
autoclaved. Inability to culture the spores
after autoclaving confirms adequate
sterilization. Biological indicators are the most
accurate sterilization indicators.
43. Ethylene Oxide Sterilization: ETO
Gas
• Large Two-Chamber EtO
Sterilizer
• Colorless gas, very toxic and
flammable.
• Requires special equipment
• Odor similar to ether.
• Used for heat sensitive
instruments: plastics, suture
material, lenses and finely
sharpened instruments.
• Materials must be well aerated
after sterilization.
• Materials/instruments must
be dry.
44. Cold (Chemical) Sterilization
• Instruments must be dry
before immersion.
• Glutaraldehyde (Cidex) is
the most common
disinfectant.
• 3 hours exposure time is
needed to destroy spores.
• Glutaraldehyde is
bactericidal, fungicidal,
viricidal, and sporicidal.
45. Radiation Sterilization
• High energy ionizing radiation destroys microorganisms
and is used to sterilize prepacked surgical equipment.
• Used for instruments that can't be sterilized by heat or
chemicals.
• Common sources of radiation include electron beam
and Cobalt-60
49. Autograft After surgery, site is
immobilized: 3-7 days
Burns of face & head Elevate head of bed
Circumferential burns of Elevate extremities above the
extremities level of the heart
Skin graft Elevate & immobilize graft site
Avoid weight bearing
50. Hypophysectomy Elevate the head
Thyroidectomy Place in Semi-Fowlers
Sandbags or pillows may
be used to support the
head or neck.
51. Mastectomy Head of bed elevated at
least 30 0 (Semi-Fowlers)
w/ affected arm elevated
on a pillow
Turn only to the back &
unaffected side.
Perineal & Place on lithotomy post
vaginal
procedures
52. Hemorrhoidectomy Assist to a lateral (side-
lying) post
Gastroesophageal reflux Reverse Trendelenburg’s
post may be prescribed
53. Liver biopsy DURING:
Supine, w/ right side of upper
abd exposed
Right arm is raised &
extended over the left shoulder
behind the head
AFTER:
Assist to a lateral (side-lying) post
Place a small pillow or folded
towel under he puncture site for at
least 3 0 to provide pressure to the
site & prevent bleeding
54. Bronchoscopy Place in Semi-Fowlers post (to
postop prevent choking or aspiration
resulting from impaired ability
to swallow)
Laryngectomy Place in Semi-Fowlers or
(radical neck Fowler’s post (to maintain a
dissection) patent airway & minimize
edema)
1.Sengstaken- Maintain elevation of the head
Blakemore (3 of bed
lumen) &
Minnesota tubes
( 4 lumen)
55. Thoracentesis sitting on the edge of the bed
& leaning fwd over the
bedside table, w/ feet
supported on a stool, or lying
in bed on the unaffected side
w/ head of the bed elevated
about 45 0 Fowler’s post
Thoracotomy Lateral, unaffected side
56. Abd aneurysm After surgery, limit elevation of the
resection head to 45 0 Fowler’s post (to avoid
flexion of the graft)
May be turn from side to side
Amputation of 1st 24 0 after amputation, elevate foot of
lower extremity the bed
Consult physician & put in prone post
2x/day for a 20-3o min period
Arterial vascular Bed rest is maintained for 24 0,&
grafting of an affected extremity is kept straight.
extremity Limit movt & avoid flexion of the hip &
knee
57. Cardiac If femoral artery was used, maintain
catherization on bed rest for 3-4 0; client may turn
from side to side
Affected extremity is kept straight &
head is elevated no > 30 0 until
hemostasis is adequately achieved.
1. CHF & pulmonary Post upright, preferably w/ legs dangling
edema over the side of the bed
58. Peripheral arterial disease Obtain physicians order for positioning
Because swelling can prevent arterial blood flow,
advise to elevate feet at rest, but not raise legs
above the level of the heart (extreme elevation
slows blood flow), some are advised to maintain a
slightly dependent post (to promote perfusion)
DVT If extremity is red, edematous & painful &
traditional heparin therapy is initiated, bed rest w/
leg elevation may be prescribed
If receiving low-molecular-weight heparin,
usually can be out-of-bed after 24 0 if pain level
permits.
Varicose veins Leg elevation above heart level; minimized prolonged
sitting or standing during daily activities
59. 1. Cataract surgery Post-op: elevate head of bed
(Semi-Fowlers or Fowler’s) post
on the back or the non-operative
side (to prevent the devt of edema
at the operative site)
60. 1. Retinal If detachment is large, bedrest &
detachment/ bilateral eye patching may be
prescribed (to minimize eye movt &
prevent extension of the detachment)
Restrictions in activity & post ff a
repair of detachments depends on
the physician’s preference &
surgical procedure performed
If gas bubble has been injected to
flatten the retina & reinforce
repair, post so that the gas rises in
the eye & presses against the repair
(usually face down or angled toward
the unoperative site)
61. 1. Autonomic dysreflexia Elevate head of bed to High
Fowler’s post (to adequate
ventilation & assist in the
prevention of HPN stroke)
1. Cerebral aneurysm Bed rest is maintained w/ the
head of the bed elevated 30-45
0 Semi-Fowlers or Fowler’s
post (to prevent pressure on
the aneurysm site)
1. Cerebral angiography Maintain bed rest for
12-24 0 as prescribed
The extremity into w/c
the contrast medium is
injected is kept straight
& immobilized for 8 0
62. 1. CVA W/ hemorrhagic stroke, head of bed is
elevated to 30 0 (to reduce ICP & facilitate
venous drainage)
W/ ischemic stroke, head of bed is kept flat
Maintain head in midline, neutral post (to
facilitate venous drainage from the head)
Avoid extreme hip & neck flexion (extreme
hip flexion may increase intrathoracic
pressure; extreme neck flexion prohibits
venous drainage from the brain)
1. Craniotomy Don’t post on the operated site, esp if the bone
flap has been removed (because the brain has
no bony covering on the affected site)
Elevate head of bed to 30-45 0 Semi-Fowlers
or Fowler’s post & maintain head in midline,
neutral post (to facilitate venous drainage
from the head)
Avoid extreme hip & neck flexion
63. 1. Laminectomy Logroll the client
- surgical cutting When out of bed, back is kept straight
into the (placed in straight-backed chair) w/
backbone to feet resting comfortably on the floor
obtain access
into the spinal
cord.
1. ICP Elevate head of bed to 30-45 0 Semi-
Fowlers or Fowler’s post & maintain
head in midline, neutral post (to
facilitate venous drainage from the
head)
Avoid extreme hip & neck flexion
64. 1. Lumbar puncture DURING:
Assist to a lateral (side-lying) post,
w/ back bowed at the edge of the
examining table, knees flexed upto
abd, & head bent so that chin is
resting on the chest.
AFTER:
Place in supine post for 4-12 0 as
prescribed
1. Myelogram postop If water soluble dye is used, head of
bed is elevated to 30-60 0 for 12 0 (to
keep the dye from irritating the
cerebral meninges)
If oil-based dye is used, a supine post
for several hours after the dye has
been removed (to prevent leakage of
CSF)
65. Spinal cord injury/ Immobilize on spinal
backboard, w/ head in
neutral post (to
prevent complete
injury from becoming
complete)
Prevent head flexion,
rotation or extension;
head is immobilized
w/ a firm, padded
cervical collar.
Logroll the client; no
part of the body
should be twisted or
66. Total hip Post depends on surgical technique
replacement used, method of implantation &
prosthesis
Avoid extreme internal & external
rotation
Avoid adduction
Maintain abduction when in supine
post on the unoperative side
Check physician’s order re
elevation of head of bed; flexion is
usually limited: 60 0 : 1st post-op
week
90 0 : 2-3 mos thereafter
