Anaesthesia and life support equipment, monitoring devices,
lights, the operating table and the operating room itself are
all essential to surgical care and need to be cared for and
maintained. Equipment should be kept strictly for use in the
operating room, treatment room or emergency department in order
to ensure that it will be available, in good repair and sterilized
or cleaned ready for use.
Equipment and instruments
Care and repair
Surgical instruments and equipment used in the operating room
should be dedicated to this use and should not be removed;
the surgeon, nurse and anaesthetist will expect them to be
available during the next case. It is essential that all personnel
check the medications and equipment they will be using prior
to beginning a case or procedure.
You must have resuscitation equipment, such as oxygen and suction
available wherever critically ill patients are cared for and
where medications which can cause apnoea (such as narcotics
and sedatives) are administered. The treatment room, emergency
department, case room and operating room are obvious examples
of such areas.
Medical equipment is expensive and can be quite delicate. Have
a regular plan of maintenance for equipment and plan in advance
for the repair and replacement of equipment. Create a list
(inventory) of the equipment you have, then work out when the
various items will need to be serviced and ultimately replaced.
Many types of surgical instruments are available. There are
broad groupings within this range:
and instruments for holding tissue
decision about which instrument to use sometimes has to
be made on the basis of what is available. When you have a
choice between instruments:
the shortest instrument that will comfortably reach
the operative site
cutting suture or other non-tissue material, avoid
using fine scissors that are designed to cut tissue
or dissect tissue planes; use larger and blunter scissors
for non-tissue materials
instruments in good repair; forceps that cross at the
tip, scissors that do not cut easily and needle drivers
that do not grip the needle securely can be frustrating
three-point control: have three points of contact
between your hand and the instrument to stabilize
the instruments and increase the precision of use
using instruments that open and close, extend your
index finger along the instrument to provide extra
control and stability
only the tips of your fingers and thumb through the
handles on instruments that open and close. In this
way, rotation of the instrument can come from your
wrist and forearm and provide a greater arc of control.
It is also quicker and less cumbersome to pick up and
put down the instrument.
The way in which the scalpel is held depends on its size and
the procedure being performed. Most procedures are performed
with a #3 handle and either a #10, 11 or 15 blade. Use a #10
blade for large incisions, #11 for stab incision and #15 for
fine precision work (Figure 2.2). If a larger #4 handle is
used, use a #20 or #22 blade.
When incising the skin or abdominal wall, use the larger scalpel
and blade. Hold the knife parallel to the surface with your
third to fifth finger, thumb and index finger; this provides
the three-point control. Your index finger will guide the blade
and determine the degree of pressure applied.
When using the scalpel for dissection, use a smaller knife
and hold the instrument like a pen with your thumb, third finger
and index finger holding the knife and your index finger controlling
the dissection (Figure 2.3).
Forceps are either toothed or non-toothed. Toothed forceps
are also referred to as “atraumatic” as they
are less likely to crush tissue. Hold these forceps
like the small scalpel or a pen.
Artery forceps come in many sizes and shapes. Place your thumb
and fingers through the handles just enough to sufficiently
control the instrument. Place your index finger on the shaft
of the instrument to provide three-point control. Hold curved
dissection scissors in the same way.
Using your left hand
Scissors are designed so that the blades come together when
used in the right hand. When right handed scissors are used
in the left hand, the motion of cutting actually separates
the tips of the scissors and widens the space between the blades;
this makes cutting difficult, if not impossible. In order to
use them with your left hand, it is necessary to hold them
and apply pressure in a way that brings the blades closer together.