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General InformationCleaning InstructionsCare of InstrumentsGeneral Surgery InstrumentsCutting instruments (1) Scalpel blades (2) Electrocautery (3) Scissors Needle HoldersForceps ThumbTissueHemostaticMiscellaneous Towel ClampsRetractorsStaplersSpeculumsCannulasMiscellaneous Small Animal Surgery EquipmentOphthalmic InstrumentsBasic Orthopedic EquipmentThe student is expected to use independent study methods for most of the surgical instruments. Instructors will present one or two instruments in class each day, and each week a category of instruments will be assigned for self-study. Instruments for independent study purposes can be found in the two drawers labeled “Orthopedic Instruments” and “Surgical Instruments” on the left side of the surgery suite. There is a list of the color-coding on the cabinet above the instrument drawers. These instruments are what we have at VTI, not all encompassing from this listFor testing purposes: be able to identify (the complete name based on this guide, spelling within two letters) and describe each instrument (anatomy and purpose). Instruments for use in surgeries are in the beige rolling cart.Anything in this guide with an * is something that is included in the General Instrument Pack Reference: Companion Animal Dental and Surgical InstrumentISBN: 978-1-58326-154-5General InformationThe best instruments are made of stainless steel; metal instruments can be cleaned, sterilized, and re-used many time.Two different brands: Pakistan or Germany Germany is a better product, but more expensiveCheck engraving on the side of the instrument for the brandCleaning of Surgical InstrumentsCleaning= the removal of fluid, tissue, and other organic debris to reduce the number of microorganisms present.All instruments should be cleaned and dried immediately after use; then they are either sterilized or disinfected.The instruments intended use will decide which method is necessary.Example: dental prophylaxis instruments are usually disinfected, not sterilized; suture placement kits may be disinfected for minor wound repair, but would be sterilized for an abdominal surgeryCleaning process:1. Open box locks/ratchets and scrub in cold water immediately after surgery (soak if you cannot get to them immediately to keep debris moist)Scrub with a tooth brush or other nylon brush Use either enzymatic instrument cleaner or soapy water (must rinse well when using dish soap)Touch ALL parts of the instrument-not just the working ends!2. Place in ultrasonic cleaning machine for better cleaningMachine creates ultrasound waves that create tiny bubbles, which break up debris on the instrument; more efficient and detailed than manual cleaningMachine makes a high pitched noise must be placed away from animals We place in the laundry room at VTI. Place sign on door.STEPS:Mix a 1/2 ounce of instrument cleaner in 1/2 gallon of distilled waterPlace instruments w/ ratchets fully OPEN into solution and cover with lidSet time for 20 minutesRemove instruments immediately, drain solution after EVERY use and wipe the machine clean3. Inspect instruments for cleanliness, proper alignment, sharpness, the ratchet is working, etc.As a technician, you are responsible for testing the function of instruments- don’t give a veterinarian a “sprung” instrument (this is a ratcheted instrument that doesn’t close tightly) or a dull scissors 4. Place instruments fully OPEN on dry on a lint free towel5. Spray with instrument milkLubes hinges and prevents rust/corrosion Milk comes as a concentrate and must be diluted with distilled water; only good for 14 days (this varies with brand)1:6 dilution 6. Leave instruments out to dry completely before putting away in proper locationCare of InstrumentsClean properly EVERY time and dry thoroughly Use only for intended purpose- you can dull cutting edges or loosen box locks if used inappropriately Example: Don’t cut bandages with standard operating scissors!Avoid dropping/handle carefullySharpen blades as neededYou can sharpen in clinic, send instruments to a professional sharpening company, or have a company come to your clinicColor coding- instrument tape can be used to identify instruments that are commonly used in the same packExample: if your clinic has 4 “Spay Packs”, all of the instruments that makeup one pack can be labeled as red, the second pack can be labeled as yellow, etc.This makes it easy when cleaning multiple packs used throughout the dayDo not place the instrument tape on the working endsTape is safe to use in all sterilization methodsGeneral Surgical InstrumentsCutting instruments:Scalpel blades –primary cutting tool of surgeon incisions proven to heal wellScalpel blades can come detached from the handles and individually sterilized in foil packets or as disposable, pre-sterilized blades (blade and handle all in one)Come in various sizes for small and large animals#10, #11, #12, #15 (these fit the Bard-Parker no. 3 handle)#20, #21, #22 (these fit the Bard-Parker no. 4 handle)USES: Incise tissue (#10), lance abscesses (#12), declaws, feline/rat neuter (#15-small precise), lance abscesses, incising vessels (#11), skin scrapes (used and re-sterilized, size depends on sample size)*Scalpel handles – used to hold scalpel blade to safely cut tissuesTwo common sizesCan be plastic or stainless steelBard Parker no. 3 – fit blades #10, #11, #12, #15Bard Parker no. 4 – fit blades #20, #21, #22 (large animal surgeons)HOLD: Scalpel blade is held with thumb, middle and ring finer; index finger is placed on upper edge and used as a guide*Should never be used in a stabbing motion – only long, gentle strokesElectrocautery – allows surgeon to cut, or cut while simultaneously providing coagulation minimizes bleedingElectrical current passes through a hand piece to the tissue and is grounded to the ground plate under the patient.Ground plate - keeps patient from being burned (gel or towel in between) Required for MONOPOLAR cauteryNot required for BIPOLOR cauteryWith bipolar cautery, current passes out one tip, through patient, and then travels back into the other tipHand piece is controlled by surgeon via a foot pedalThis item must be sterilized!Tips- come in many different shapes and sizesThese must be sterilized as they will be secured onto the hand piece by the surgeon.Machine operation: Power level and switching from cautery to cautery/coagulation is adjusted by tech, or non-sterile assistant Scissors – one of the most common surgical instruments usedavailable in MANY widths, lengths, and shapesClassified by: shape of tips and character of their pointsShape = curved or straightCharacter = blunt-blunt, sharp-sharp, or blunt-sharpMay ONLY be used for their intended purposePARTS: points, two blades, two handles/shanks, box lock and finger ringsUSES: Incising tissue, transecting tissue, separating tissue (ex. Fascia from muscle), cutting suture, drape, bandages…HOLD: thumb and ring finger are inserted into the rings; index and middle fingers are used as guidesTYPES:*Standard operating scissors- used to cut drape and suture materialFull name depends on shape and character Example: Curved sharp/sharp standard operating scissors*Mayo dissecting scissors – sturdy; cut ligaments and tendons*Metzenbaum dissecting scissors – cutting delicate tissues (fat, muscle, organs)Very long shanks; short bladesLittauer suture removal scissors - removing skin sutures from patientLower blade has a hook-shaped pointWide, round bladesNot used to cut wire sutureSpencer suture removal scissors – removing skin sutures from patientLower blade has a hook-shaped pointThin bladesNot used to cut wire sutureWire cutting scissors – used to cut wire (ex. stainless steel suture, cerclage wire, OR small diameter IM pins)Bandage cutting scissors – used to remove or fit bandage materialflat, blunt nodule on the lower tip, prevents cutting the patient’s skinTYPES:Utility scissors- heavy duty; angled blades with serrationsLarge plastic handlesLister bandage scissors – stainless steel; angled, wide, blunt bladesKnowles bandage scissors – stainless steel; straight, pointed, thinner blades*Needle Holders – also known as “needle drivers”; may OR may not cutUSE: to grasp needle and pass suture material through tissue; tying knotsPARTS: rounded tips, jaws w/ longitudinal groove in the center, box lock, shank, finger rings and RACHETOptional: carbide jaw inserts to extend life of instrument (gold finger rings)TYPES: Mayo-Hegar – no scissors; can only hold suture needleRemember: “you can’t cut mayo”Olsen-Hegar – jaws are flat and finely serratedHas suture scissors below the jaws = efficient suturing Downside- may cut suture accidentallyRemember: “TWO functions, like the Olsen twins”Grasping/Holding Instruments: Thumb Forceps- form a V-shape; work by spring action with a joint at the end of two handlesPARTS: tines/tips, jaws, handles, spring hingeAre opposed by manually compressing the two handles togetherCome in varied sizes and grasping surfacesThe more intermeshed teeth = more gentle ex. Bed of nails vs. 1 nailUSES: manipulation of delicate tissues (usually in non-dominant hand)Example: hold the skin around an incision you are suturing HOLD: like a pencil; hand sits under the instrument (not over the instrument)TYPES:Adson thumb forceps – One jaw has two teeth, interlock with the one tooth on the other jaw; bowed handlesThe “Adson” handle is specific to any Adson instrumentAdson dressing forceps – flat jaws; no teeth *Brown-Adson thumb/tissue forceps – each tip has two rows of intermeshed teeth (fit together)Most commonly used!Rat-tooth forceps – used for tougher tissues; much narrower handles than Adson’s; varying amount of teeth that always interlockExample: 1x2 or 2x3Debakey thoracic tissue forceps – the most slender and delicateTwo long rows of microscopic teeth on each jawMost atraumatic; used when you want delicate tissue to stay in tactUsed for handling blood vessels Russian thumb forceps – two broad, spoon shaped tips with serrated edges strong gripGreat for extracting tissue you want removedBayonet thumb forceps – most used in ear and nose proceduresEasily grasp objects through the speculum of an otoscopeSurgeons fingers are not in the line of anatomical site when using these Tissue Forceps- locking instrumentsPARTS: jaws, box lock, shank, finger rings and ratcheted locking deviceCome in various tooth patterns and sizesUSES: Grip tissue (with more strength than thumb forceps); can be left in place while surgeon continues elsewhereTYPES:*Allis tissue forceps – traumatic; applied to tissue being excisedTip has inward facing, interlocking teeth that can vary in numberBabcock intestinal forceps – used on bowel, bladder (viscera)Less traumatic; wide grasping surface; tips are rounded and hollow with longitudinal striationsDoyen intestinal forceps – non-crushing; used to temporarily occlude the lumen of the bowel Longitudinal striations along entire jawsJaws are very long and don’t completely close when ratcheted all the wayExample procedure: intestinal resection and anastomosisD. Hemostatic forceps- these tissue forceps are a category all their ownHemostatic Forceps – also known as hemostats; a type of tissue forceps but there are many of them so they get their own categoryUSE: to stop bleeding, by crushing tissues and vesselsClassified by: size, pattern of jaw striations, and shape of tipsSize = their length, measured in inchesShape of tips = straight or curved (all types can come in either)Jaw pattern- transverse or longitudinalMost have transverse striations along jaws (NOT ALL)HOLD: thumb and ring finer are inserted into rings; index and middle fingers are used as a guideCurve is pointed upwards when in use on the patientCurve is down when tech is handing this instrument to surgeon (that way it will be pointing up when surgeon applies it to tissue)TYPES:*Halsted mosquito hemostats – crushing small vessels3.5 or 5 inches longTransverse striations on entire length of inner jaws*Kelly hemostatic forceps – occluding larger vessels and tissues 5.5 inches longTransverse striations on jaws that go from tip to half way downCrile hemostatic forceps - occluding larger vessels and tissues5.5 inches longTransverse striations along entire length of inner jawsRochester-Pean hemostats – grasping larger vessels and hollow organ tissue (pedicles and stumps)Transverse striations along the entire inner jawsLarger than criles; come in many lengths*Rochester- Carmalt hemostats - grasping larger vessels and hollow organ tissue (pedicles and stumps) before ligating Example: OHEOpposing longitudinal grooves along entire bladesCross hatching at the tip = aggressive crushing powerRochester-Ochsner hemostats – grasping larger vessels and tissues very well; identical to Peans, except these have teethTransverse striations along entire inner jawsTeeth on the tip- one on one tip and two on the other tip (1x2)Ferguson angiotribe – heavy duty; arresting and preventing hemorrhage Deep, longitudinal grooves with total cross hatching Towel Clamps- used to secure sterile towels/drapes to the patient; a type of forcepsMust actually penetrate skin when securing item to patient!TYPES: *Backhaus towel clamp – tear drop shaped, curved blades; ends in sharp pointsRing handles and a ratchet Jones towel clamp – spring action, yet self-retaining due to locking mechanismHas a joint at the end of two handles ; ends in sharp pointsRoeder towel clamp – Backhaus towel clamp + ball stopsMiscellaneous forceps A. Alligator forceps – very long shank which sits at a 45° angle to the ring handlesSerrated jaws at the end for graspingNo ratchetUSES: grasping small objects; removing items from the body; probing fistulasB. Foerster sponge holding forceps – box lock, shank, ring handles and ratchetJaws are oval loops; can be serrated or flatCan be straight or curvedInstrument comes in varying lengthsUSES: holding gauze/lap pad to swab surgical siteTo dry site; soak up fluidsC. Young tongue holding forceps – box lock, shank, ring handles and ratchetUSES: Manipulating the tongueJaws are oval loops with a rubber insert Blades are slightly shorter and wider than Foresters Retractors- exposing instruments; may be hand held or self-retainingUSES: to atraumatically improve field of vision; give surgeon more room for viewing wounds/incisionsTYPES:Hand held:*Snook hook (ovariohysterectomy hook) – looks like a shepherd’s hookSpecifically for grabbing uterine horns during OHEVolkmann Retractor – looks like a curved forkNumber of prongs can varyArmy-Navy retractor – flat, blunt blade that is bent on each endThe projection on one end is longer than the other projectionHole in the center of bladeCommonly used to retract muscles from bonesSenn retractor – curved 3-prong claw at one end; bent, flat blade on the other end (pointing opposite directions)Malleable retractor – thin metal that is bent to desired shapeSelf-retaining:Balfour abdominal retractor – 3 adjustable curved loops, mounted on a barMiddle portion rests on xiphoid; lateral loops open the incision laterallyComes in pediatric size tooUSE: Retract abdominal wall for access to peritoneal cavityFinochietto rib spreader – two broad, outward facing blades mounted on a ratcheted bar = 6-12” spreadHandle to adjust distance by turningUSE: gaining access to thoracic cavity during thoracotomy holds ribs apartGelpi retractor – points, blades, finger rings, ratcheted hingeVery sharp points that separate as the hinge is closedPoints face away from each otherCan buy stops to put on the pointsUSE: opening deep woundsWeitlaner retractor– claws, blades, finger rings, ratcheted hingeClaws open as hinge is closed (opposite of scissors)Prongs point away from each other3 x 4 interdigitating teeth Stapling Devices – fast and easy application compared to suturing; can be internal OR external depending on which stapler is usedUSES: primary wound closure; vessel ligation; anastomosis Good for patients with suture reactionsCan be plastic with pre-loaded staples (one patient use) or stainless steel with clips that you order and re-load (reusable)But really we reuse everything in veterinary medicine…TYPES: Surgical skin stapler – primarily closing skin incisions; staples are stainless steel; plastic; “one time use”Faster than suturing Few allergic reactionsAlso used for securing catheters, nasal cannulas, feeding tubes, etc with the use of butterfly wingsSurgical clip applicator – closing visceral wounds/incisions; ligating vessels (internal)Example: Ligaclip Stapler – quickly ligating vessels; fires one staple at a time when handles are squeezed Example: Hemoclip Applicator – ligate vessels after taking organ biopsiesStaples are permanent Stapler must be sterilized before/after use Skin staple remover- required to remove skin staplesDilating Instruments: Speculums- may be plastic or steelUSES: to open up a narrow passagewayTYPES: NasalVaginalOralCannulas- hollow tubesUSES: for delivery of fluids, or removing blockagesTYPES:Lacrimal cannula – to flush the lacrimal ductAluminum hub; small as 30 gaugeCurved or straight Can also be used for anal sac duct flushingMiscellaneous Surgical Equipment:Suction Tips- tip attached to a long, sterile polyethylene tube, which is attached to a vacuum (suction machine) and plugged inUSES: clearing blood/fluid from surgical site, lavaging wounds, dentals Ex. GI surgery w/ gastric lavageTYPES:Poole suction tip – plastic; made of two tubes within each other; taken apart for cleaningCan be curved or straight Outer tube is like a sleeve with holes throughout it:Avoids clogging of tipDistributes suctioning power USES: suctioning large volumes of fluids from surgical field Commonly in abdominal or thoracic cavitiesYankauer suction tip – stainless steel or plastic; hollow tube with a curve and a bulbous head; only one hole for suctioningUSES: removing secretions during oral surgery, suctioning fluidFraizer suction tip – small and slender; various diameters (measures in Fr)Small hole on the handle to regulate degree of suction USES: remove very small amount of fluid (in place of gauze)Mayo Instrument Stand – metal device with two wheels on the same side, and flat projections on the other sideUSES: to hold instruments during surgeryCovered with a sterile huck towel or a drape before instruments are placedAdjustable heightCan also be attached to the surgical table and have a swivelSurgical Table – used for holding the patient during surgeryCan usually move up and down to fit surgeon’s heightCan sometimes form a “V” shape by lifting both sidesMay or may not be heated (VTI has a heated table!)Groove directors – used to guide scalpel bladeStab incision made in skin, inserted in (above the muscle), keeps surgeon from accidentally cutting deeper layersMost surgeons just use thumb forceps to hold the superficial layers up and out of the way Thoracic positioner – “V-trough”; used to stabilize patient/position for surgery Can be plastic or foamNot needed if your surgical table forms a V Instrument tip protectors – to protect tips of instruments when not in use (in the drawers or sterilized in the pack)Instrument tape – used to label instruments by color coding (expensive)Can be sterilized with this tape onLight handle- plastic handle that attaches to a surgical lamp in order for the sterile surgeon to direct the light source as they see fitCan usually be autoclavedOphthalmic Instruments: Used for procedures involving the eyeOphthalmic scissors TYPES: A. Iris scissors – small, delicate scissors; usually sharp/sharp; curved or straightUSE: Dissecting or cutting tissue during ocular surgery B. Stevens tenotomy scissors- small, delicate, precision scissors with very narrow blades and sharp points; curved or straight USE: dissecting or cutting tissues during ocular surgery Ophthalmic needle holdersTYPES:Castroviejo needle holders – delicate needle holders; with or without lock; straight or curvedLong handles, spring action, delicate jawsCatch and release in the middle USE: corneal surgeries (laceration, cataract), third eyelid gland prolapse repair Derf needle holders – smaller version of Mayo-hegar needle holders (less than 5 inches)Can have carbide jaw inserts USE: suturing eyelid lacerations, tarsorrhaphy, entropion, extropion, enucleations, etc Ophthalmic forceps- gently grasp, hold, and manipulate tissues and remove foreign bodies TYPES: A. Castroviejo forceps - delicate thumb forceps; straight or angled, sharp pointed tips; sping-action hinge USE: grasping tissues during ocular surgeries B. Chalazion forceps – thumb forceps with a flattened plate at the grasping end of one shank, and an opposing ring on the other one; spring-action hinge; screw locking mechanism USE: to stabilize the eyelid and arrest bleeding Ex. Great for eyelid tumor removal and laceration repairs Ophthalmic retractors – retracting the eye lid open and facilitate access to the globe, cornea, and conjunctiva TYPES:Cook eye speculum – two curved, outward facing blades attached to a barScrew for adjusting the size self-retaining Each blade gently retracts one eyelid away from the other eyelidBarraquer speculum – wire; no screw adjustmentSelf-retaining; blades can be solid or fenestrated Jaeger eyelid plate- flat and smooth; must be held while in use Protects the cornea and globe during eyelid procedures Desmarres lid retractor- retracting EITHER the upper or lower eyelid; must be held while in useLong, thin handle with a blade that folds back on itself Graefe eyelid speculum- has a screw adjustment/locking mechanism Self-retaining; blades can be solid or fenestrated Orthopedic Instruments: Used for procedures involving the prevention and correction of muscles, bones, joints, tendons, and ligaments Ex. FHO, amputations, fx repair, cruciate ligament repair, etc… Periosteal elevators – has a blade like structure at one or both endsUSES: to pry off periosteum or muscle from bone surfaceTYPE:Freer elevator Bone holding forceps USES: to hold bone fragments in line while positioning/placing orthopedic implants; available in various sizes TYPES:Kern bone holding forceps- four pointed prongs on the jaws; may or may not have a locking mechanism Clam shell bone holding forceps- jaws look like a clamshellRuskin Rongeurs – hand held; sharp, heavy, cupped jaws with rounded tipsUSES: to cut/remove small pieces of dense tissue (bone, cartilage, or fibrous tissue)Double-action mechanism; can be straight or curved; various jaw sizes Liston bone cutting forceps- used to cut bone; single action w/ angled blades Heavy duty, sturdy box lockWith or without a spring locking mechanismBone curette – look like an ice cream scoop, but with a sharp cutting edgeAvailable in many sizesUSES: to scrape hard tissue (bone, cartilage, or fibrous tissue)Osteotome/Chisel – difference is osteotome has a double beveled sharp edge; chisel has a single beveled edgeUSES: to cut through or shape bone; must be used in conjunction with a mallet Lucae mallet- drives cutting tip of instrument into the bone; provides the forceThis is one type of mallet…there are manySee Picture Guide for what this mallet looks like Putti bone rasp and Foman bone rasp – used to file bone smooth rough edgesCan be single or double endedCome in various lengths & widths; can be fine or coarse Can be flat or convexPutti- larger, pointed endsFoman- smaller, oval/blunted endsGigli wire – comes in various gaugesUSES: to cut bone; must be used in conjunction with T-shaped handlesWraps around bone and used in a saw like fashion Ex: at the zoo we used gigli wire to trim elephant tusks and goat hornsHohmann retractor – single blade and handle; sometimes has holes on bottom of handle Flat blade with a small, sharp beak at the tipUSE: mostly used in joint surgeries; can be used to retract tissue away from bone11. Michele trephine—heavy duty, T-shaped boring tool with graduated diameter shafts that end in circular, sharp edgesThe top of the “T” is the handleAvailable in various sizes from 5-8 mmUSE: obtain samples of cortical or cancellous bone (biopsy) Orthopedic Implants and Tools: Steinmann pins – also called intramedullary pins (IM pins) Vary in length, diameter, type of pointStainless steel pin inserted into IM cavityCan be smooth or threadedUsually come in large packs with multiple widths and lengthsUSES: fracture fixationJacob’s Hand Chuck – required to insert IM pin into boneTightens down around the IM pin with the use of a keyMust have the key to be operational! Don’t forget to sterilize this too!Pin cutter – necessary to cut IM pins to the proper lengthOrthopedic wire – stainless steel wire on a spoolComes in many gauges (18-22 most common)Applied with a wire twister Ex. Cerclage wire USE: to secure orthopedic implants in place; sometimes to oppose rotational forcesWire twister – has two holes in which wire is insertedOnce wire is circling the bone, it is twisted like a twist tieUSES: bone stabilization in conjunction with plates and pinsBone screws – come in many lengths and diameters Required to be drilled in place into the boneBone plates- named by the number of screw holes and the screw diameter sizeExample= 4 hole 3.0 mm plateRequires- drill, bits, guides, depth gauges, screws, plate bendersPlate benders – bend bone plates to fit patient’s anatomy ................
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