Surgical instrument processing is an essential part of surgery.

1. General Surgical
Instrumentation (1 hrs)
By Ame Mehadi(BSc, MSc-EMCCN)
ECCN Lecturer
BEC and PoNT Trainer
School of Nursing & Midwifery
CHMS, HU

2. Outline
Introduction
Classification of surgical instruments
Care of surgical instruments
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3. Introduction
Historical prospective of surgical instruments
The history dates back to 2500 BC:
– Ancient Greece,
– Egyptians and instruments resemble today’s instrument
– Hindu
1st made of
– Animal teeth
– Wood
– Ivory
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4. Introduction cont’d……
In mid 1800’s (civil war in USA) made of:
– Kitchen Knife
– Carpenter saw
– Table pork
In the beginning of 20th century- delicate instrument
– seen more useful than heavy one and
– Replaces the handles of wood, ivory,
– so that instrument could resist repeat sterilization.
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5. Introduction cont’d……
Composition of Surgical Instruments
–manufactured from stainless steel of:
• Iron
• Carbon
• Chromium of varying qualities
–Types of Instrument Finishes are several
• Bright – called mirror finish.
• Satin (dull) – tend to eliminate reselections.
• Embodied finish – finish–black and the golden handle.
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6. Introduction cont’d……
Surgical instrumentation is critical to the surgical procedure.
The performance of the OR team is enhanced when team
members know each instrument by name, how each item is safely
handled, and how each is used.
Preparing the instrument for appropriate processing will prolong
its use in patient care and decreases the costs for repair and
replacement.
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7. Classification of Surgical Instruments
classified according to their function, and most fall into
one of four groups.
A. Cutting and Dissecting
B. Grasping and Clamping
C. Exposing and Retracting
D. Probing and Dilating
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8. A. Cutting and Dissecting
have sharp edges/points.
used to dissect, incise, separate, penetrate, or excise tissue.
should be kept separate from other instruments, and
the sharp edges should be protected during
– cleaning,
– sterilizing, and
– storing.
proper precautions should be taken during the handling and
disposing of all sharps, blades, or scalpels.
– To prevent injury to the handler and damage to the sharp edges.
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9. A. Cutting and Dissecting……
This group includes:
– scissors,
– knives,
– biopsy punches,
– scalpels (blades),
– saws,
– osteotomes,
– drills and curettes,
– needles,
– chisels, etc.
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Different size surgical
blades (scalpels)
Punch biopsy forceps
 To take biopsy from the cervix

10.  Scissors.
A. Tissue scissors.
– Blades may be straight or curved and either
pointed/blunt, pointed/pointed, or
blunt/blunt.
B. Suture scissors.
C. Wire cutters and scissors.
D. Dressing/bandage scissors.
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Straight mayo
scissors
Curved mayo
scissors Episiotomy
Scissors
UMBILICAL CORD
CUTTING SCISSORS

11. Cutting and dissecting instruments.
 A. Osteotomes.
 B. Rasps.
 C. 1-6 Tissue curates.
 D. Blunt dissectors,
periosteal elevators.
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12. B. Grasping and Clamping
A clamp is an instrument that clasps tissue between its jaws.
Clamps are available for use on nearly every type of body tissue,
from delicate eye muscle to heavy bone.
most common clamps are
– the hemostatic clamps, designed to grasp blood vessels,
– crushing clamps,
– noncrushing vascular clamps etc.
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13. B. Grasping and Clamping
Grasping instruments
– used to hold and manipulate structures.
– this category includes
• Needle holder,
• thumb forceps,
• tissue forceps,
• Alli’s forceps,
• bone holders,
• tenaculi (tenaculm, singular) etc.
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Different types of blade holders (scalpel handles)

14. Different types of thumb forceps
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Needle holders, (A)
serrated tips, (B)
nonserrated tips.
Toothed
To hold tough structures like
rectus sheath, vaginal flaps or
skin margins during suturing
Non toothed

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Different types of clamps
Sponge holding forceps
 To hold sponges or
cervical lips
Towel clip UMBILICAL CORD
CLAMP

16. Allis' Forceps
 for grasping tough
structures like Rectus
sheath or fascia in
LSCS or Hysterectomy
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Artery Forceps
 used as a hemostat for
clamping bleeding vessels.
 For grasping tissue
(Opening and closing
peritoneum) .
 to hold stay sutures.
Babcock's Forceps
 for grasping tubular
structures like fallopian
tube in tubectomy In
Pomeroy's operation,
ureter, appendix etc.

17. SINGLE TOOTHED VULSELLUM
 To hold the cervix after
opening the vault of vagina
 To hold new cervical stump
after amputation of the cervix
and fothrergill’s operation
after subtotal hysterectomy
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WRIGLEY'S FORCEPS
Obstetric forceps for out let forceps
delivery.
Parts of the forceps are blades (which has
windows or fenestrate for firm grip of the
head), Shank, Lock(English lock for Wriglys
forceps), Handle.
MULTIPLE TOOTHED VULSELLUM
 used for grasping the cervix
(Usually anterior lip of the
cervix is grasped)
 in procedures like Insertion of
IUCD, Cx Biopsy D&C, First
trimester MTP with Suction
Evacuation. Cx Biopsy
 Posterior lip of the cervix is
grasped for post. colpotomy

18. C. Exposing and Retracting
 Soft tissues, muscles, and other structures should be pulled aside for exposure of the
surgical site.
 Exposing and retracting instruments are those that hold tissue or organs away from the
area where the surgeon is working.
 are available for use in all parts of the body.
 They may be very shallow, as for skin retraction, or very deep, as for the retraction of
abdominal contents.
 Retractors can be handheld or self-retaining.
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19. C. Exposing and Retracting
Handheld Retractors
– have a blade on their handle
– the blades vary in width and length to
correspond to the size and depth of the
incision.
– the blades may be dull or sharp
– some retractors have blades at both ends
rather than a handle on one end
– are usually used in pairs, and
– they are held by the first or second assistant.
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Different types of handheld retractors

20. C. Exposing and Retracting
Malleable Retractor
– is a flat length of low-carbon stainless steel, silver, or silver-plated copper which may
be bent to the desired angle and depth for retraction.
Hooks.
– Single, double, or multiple very fine hooks with sharp points are used to retract
delicate structures.
– commonly used to retract skin edges during a wide-flap dissection such as a face lift
or mastectomy.
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21. C. Exposing and Retracting
Self-Retaining Retractors
– Holding devices with two or more blades
can be inserted to spread the edges of
an incision and hold them apart.
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Different types of self-retaining retractors

22.  CUSCO’S SPECULUM
– Self retaining speculum.
– Used in OPD for routine
examination.
– procedures like taking of Pap
smear, insertion and removal of
Copper T can be done
Sims' Speculum
– It retracts posterior vaginal wall.
– for inspection of vagina and
cervix in OPD.
– Taking Pap Smear, Insertion and
removal of Copper T, Taking
swabs, D&C, Cervix Biopsy,
Vaginal Hysterectomy,
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Sims' Anterior Vaginal
Wall Retractor

23. Right Angle
Retractor
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Doyen's
Retractor Deaver's Retractor
 for retraction of
deep structures

24. D. Probing and Dilating
Probes
– used to explore a
structure or to locate an
obstruction.
– used to explore the depth
of a wound or to trace the
path of a fistula.
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Round probes Grooved probes

25. D. Probing and Dilating
Dilators
–used to increase/enlarge the
diameter of a lumen, such as
the urethra, uterine cervix, or
esophagus.
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Hegar uterine dilators

26. 26
Sterilize
Chemical
High-pressure steam
Dry heat
Decontaminate
Clean
Dry/Cool and Store
High-Level Disinfect
Boil
Steam
Chemical
Key steps in instrument Processing

27. 27
Key Steps in Processing Instruments and Other Items

28. Care of Instruments
 Staff involved in the cleaning and packing process of instruments must use standard
blood and body substance isolation precautions.
 Proper selection requires a general understanding of surgical procedures and a
knowledge of anatomy.
 In order to prevent damage,
– instruments must only be used for the purpose they were designed for.
– delicate instruments should be
• handled with care and
• separated from other instruments.
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29. Care of Instruments
 In order to prevent corrosions or damage,
– instruments must not be immersed in saline, hypochlorite, & chemical disinfectants.
 Specialized instruments should be regularly checked by appropriately trained person.
 Specialist equipment should be made available to check the integrity of diathermy cables
and instruments.
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30. Care of Instruments
 The method of cleaning,
 selection of packing material and
 method of sterilization
 defective Instruments must be removed, labeled and sent for repair or replacement in
accordance with local policy.
 OR staff should be aware of the implications of reprocessing surgical instruments.
 all staff involved in instrument processing have full instruction and understanding of the
techniques involved.
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of surgical instruments and other items
should be undertaken according to the
physical properties of the item and the
manufacturer’s instructions.

31. Care of Instruments
 Most operating rooms use trays of instruments which are prepared, checked, and packed by
personnel in central supply units.
 Each tray of instruments should contain an instrument checklist, which incorporates the
information necessary for a recorded program of use.
 Regular inspection of all instruments should be made by an appropriately qualified person.
 The scrub person should ensure that instruments are handled in such a manner as to avoid
personal injury, and injury to the patient or to other members of the surgical team.
 Special care should be taken with sharp instruments (e.g., scalpels and loaded needle holders).
 all sharp instruments are transferred between staff in a receiver.
 Instruments must not be allowed to rest directly on the patient, which could cause injury to the
patient and damage to the drapes.
 Instruments that have been taken directly from an autoclave into the operating room must be
allowed to cool naturally before use.
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32. Storage of Instruments
 The storage area should be clean, dry, and free of dust.
 All storage surfaces should be smooth, nonporous, and be easily cleanable.
 Sterile items should be protected from direct sunlight.
 The temperature of the storage areas should range between 22 oC and 24 oC with a
relative humidity of 35% to 68%.
 Perioperative personnel should have the knowledge and skills related to the handling
of sterile items.
 Sterile items should be transferred to and from storage areas on clean, specifically
designated trolleys.
 All sterile items should have an event-related shelf life.
 The length of time an item can be considered sterile is referred to as the shelf life.
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33. Review Questions
1. Identify the different types of surgical instruments.
2. Describe cutting instruments and give two examples.
3. Explain the use of grasping instruments.
4. How do you classify retracting instruments?
5. What is the use of dilators?
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