Please enable JavaScript.
Coggle requires JavaScript to display documents.
Surgical Instrumentation 1 (Laying out surgical instruments (For small,.…
Surgical Instrumentation 1
Commence cleaning as soon as possible after surgery and wear protective clothing
Remove sharps and waste and dispose of correctly
Separate delicate and very large instruments and process separately
Soak instruments in cold water
Scrub instruments under running water, paying special attention to moving parts
Clean instruments in ultrasonic cleaner if available
Rinse and dry instruments
Lubricate and check instruments for damage
Package instruments
Care of hinges and moving parts
Extra attention must be paid to the moving parts of instruments:
Clean the hinged areas thoroughly as they tend to harbour contamination
Open the hinged areas during cleaning and sterilisation so that working parts are fully exposed to the cleaning process
Ultrasonic cleaners are particularly useful for hinged instruments, as they clean the areas where brushing may not always reach
Following cleaning, ensure that hinged areas are completely dry as water can trap in there
Lubrication
Hinges and any area where metal moves against a metal must then be lubricated. Use a proprietary lubricant designed for surgical instruments and apply according to the manufacturer's instructions
Packing
Always check instruments thoroughly with moving parts thoroughly before you pack:
Check the hinges move smoothly, and there is no laxity in the joint
Check that the jaws of the instruments such as artery forceps and needle holders meet correctly, and that you can't see any light between them
Check the blades of scissors glide smoothly past eachother
The ideal surgical wrap should have the following qualities
Selective permeability ~ Steam or gas must be able to penetrate the wrapping for sterilisation to occur. It must easily be exhausted from the pack once the sterilisation process is complete. Once sterile the package must not be permeable; if it becomes permeable microorganisms can enter the package and the sterilisation is ineffective
Resistance ~ The material should be resistant to damage when handled. If rips, punctures or worn areas do occur the damage needs to be readily apparent
Flexibility ~ The material should follow the contours of the pack. All packs of equipment must be robust enough to withstand pressure and rough handling
With these requirements in mind, there are number of alternative methods of packing surgical kits
Textile wraps
Advantages: Resistant to rips and punctures, high degree of flexibility
Disadvantages: You need to double wrap, bulky, predetermined sizes, fabric must be purchased cut to size and hemmed, expensive and time consuming, threads can contaminate the surgical site, remains water permeable once sterilised
Textiles such as cotton used to make reusable wraps. While certain textiles are very steam permeable, they have the disadvantage that they remain water permeable once sterilised. 2 layers of wrapping is required
Paper wraps
Crepe paper drapes, usually supplied on large rolls can also be used. They tend to be more water repellant than fabric
Advantages: Relatively water repellent, can be reused several times (manufacturers do not advise this), can be cut to size, variety of materials available
Disadvantages: cost, time involved cutting into size, increase in waste, must be double wrapped
Self seal autoclave bags
Proprietary autoclave bags are available, usually with a paper bag and a clear plastic front. They are easy and quick to use, you can see what is inside, and there is often a sterilisation indicator on the pack
Advantages: quick to package, range of sizes, instruments visible for easy identification, indicator on back of bag
Disadvantages: expensive, paper backing can become wet or tear, not suitable for heavy instruments, delicate instruments will need protective cover
Bowie dick tape and autoclave film
Nylon film is available on a roll and can be used with bowie dick tape to make pouches. The nylon film is waterproof, and transparent, allowing you to view what is inside the package
Advantages: Cheaper than self seal bags, instruments are visible, can cut bag to desired size, reusable (small microscopic holes can appear though)
Disadvantages: not suitable for heavy instruments, delicate instruments will need a protective cover, bowie dick tape is not a good indication that sterilisation has taken place, plastic is relatively stiff and can be difficult to open in a sterile way, over time microscopic holes can appear in the plastic reducing sterility
Instrument trays
Autoclavable instrument trays can be used to hold large instrument sets. They provide good protection for instruments and are fully waterproof
Advantages: instruments can be laid out in order of use, instruments are protective (special inserts of delicate instruments), no damage during storage
Disadvantages: expensive, can't see instruments, space for storage
Boxes and drums
Autoclave boxes and drums come in a variety of sizes. They can be expensive to buy initially but are fully reusable
Advantages: ready made, reusable, less risk of damage during storage
Disadvantages: no drape to cover trolley, expensive, takes up storage space
Loading the autoclave, never: overload the autoclave, overload a packing bag or tray, roll drapes too tightly. Breaking any of these rules results in the flow of hot air/steam being restricted and consequently inadequate sterilisation
Laying out surgical instruments
For small,. non-complex operations it is common for the surgeon to lay out their own equipment. For complex surgery requiring an array of instruments, the theatre nurse may be required to lay out the equipment
All equipment must be laid out in a sterile way and in such a way that instruments can be quickly located
Equipment can be laid out by a non-scrubbed nurse using Cheatle forceps
The longer the period that instruments are exposed to the air, the greater the chances of contamination
Instruments should be laid out in a methodical way, and in the order of use. For example, instruments required for incising the skin should be laid out at one end of the trolley, and those required for later stages such as bone holding forceps, laid at the other end of the trolley
Where there are multiple instruments of the same type, such as artery forceps, lay them out together. Similar instruments such as scissors, should be placed in close proximity
Needle holders should be loaded, and diathermy and air equipment should be connected
A typical general surgical kit may comprise:
Scalpel handles x 2
Dissecting forceps - heavy/fine/toothed/plain x 1 of each
Mayo scissors x 1
Artery forceps x 10
Mosquito forceps x 5
Allis tissue forceps x 6
Kocher's artery forceps/ spencer wells x 6
Langenbeck retractors x 2
Gelpi retractors x 1
Suture scissors x 1
Backhaus towel holding forceps x 10
Probe x 1
Diathermy lead and probe x 1
Suction tubing and tip x 1
Sutre tray x 1