Surgical instrumentation is critical to surgical procedure. The performance of OR team is enhance when team members know each instrument by name, know how each is safely handled and know how each is used. Preparing the instrument for appropriate processing will prolong its use in patient care and decrease the costs for repair and replacement.

1. Jamilah saad Alqahtani
CNS,MSN,NS,RGN,BSN, OR Specialist

2. 5/26/2018 jamilah saad Alqahtani 2

3. Outlines
1. Surgical instruments history & background
2. Comparison between past, present and the future of surgical
instruments
3. definition of Surgical instruments
4. Fabrication of Metal Instruments
5. Classifications of surgical instruments
6. principles of using surgical instruments
7. Passing the surgical instruments
8. powered instruments Handling, cleaning and sterilizing
9. key points in Handling instruments before, during and at the end of
procedure
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4. Introduction
•Surgical instrumentation is critical to surgical
procedure.
•The performance of OR team is enhance when team
members know each instrument by name, know
how each is safely handled and know how each is
used.
•Preparing the instrument for appropriate processing
will prolong its use in patient care and decrease the
costs for repair and replacement.
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5. Introduction
• Communication is key to extending instrument life and promoting
patient safety Of all the different kinds of medical instruments found
in a hospital setting, surgical instruments are among the most
sensitive and delicate.
• Patient safety depends on sterile, functional instrumentation.
• To prevent damage to the instruments and promote patient safety, it
is critical that OR nurses and technicians should be trained the best
care and precaution when handling, cleaning and sterilizing surgical
instruments.
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6. Historical Background
• Surgical instruments have been manufactured since the dawn of pre-
history. Rough trephines for performing round craniotomies were
discovered in neolithic sites in many places. It is believed that they
were used by shamans to release evil spirits and alleviate headaches
and head traumas caused by war-inflicted wounds.
 https://www.gettyimages.co.uk/detail/news-photo/trephine-is-a-crown-saw-used-for-perforating-
the-skull-and-news-photo/90766805
 https://www.surgicalholdings.co.uk/surgical/surgical_instruments.php?content=history5/26/2018 jamilah saad Alqahtani 6

7. Historical Background
• In the Antiquity, surgeons and physicians in Greece and Rome developed many
ingenious instruments manufactured from bronze, iron and silver, such as
scalpels, lancets, curettes, tweezers, specula, trephines, forceps, probes, dilators,
tubes, surgical knifes, etc. They are still very well preserved in several medical
museums around the world. Most of these instruments continued to be used in
Medieval times, albeit with a better manufacturing technique.
https://www.researchgate.net/publication/16158509_The_history_and_evolution_of_surgical_
instruments_II_Origins_Function_Carriage_Manufacture
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8. Historical Background
• In the Renaissance and post-Renaissance era, new instruments were
again invented and designed, in order to accompany the increased
audacity of surgeons. Amputation sets originated in this period, due
to the increased severity of war-inflicted wounds by shot, grapnel and
cannon.
https://hipertextual.com/2017/05/hombre-herido-diagramas5/26/2018 jamilah saad Alqahtani 8

9. BASIC SURGICAL TOOLS
PAST PRESENT FUTURE
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10. Definition
• Surgical instruments are
precisely designed and manufactured tools. for single (disposable) or multiple use (non-
disposable), must be resisted physical and chemical effects, body fluids, secretions,
cleaning agents and sterilization
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11. Fabrication of Metal Instruments
Stainless steel
Titanium
Vitallium
Other metals
Plated instruments
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12. Classification Of surgical Instruments
• Cutting and dissecting
• Grasping and holding
• Clamping and occluding
• Exposing and retracting
• Suturing stapling
• Viewing
• Suction and aspirating
• Dilating and probing
• Measuring
• Accessory instruments
• Microinstrumentation
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13. Classification Of Surgical Instruments
Cutting and dissecting
1. Scalpels
2. knives
3. Scissors
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14. Classification Of Surgical Instruments
4- Bone cutters and debulking tools
5- Other sharp dissectors
6- Blunt dissectors
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15. Classification Of Surgical Instruments
Grasping and holding
1. Tissue forceps
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16. Classification Of Surgical Instruments
2- Stone forceps
3- Tenaculums
4- Bone holders
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17. Classification Of Surgical Instruments
Clamping and occluding
1. Hemostatic forceps
2. Non crushing vascular clamps
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18. Classification Of Surgical Instruments
Exposing and retracting
1. Handheld retractors
2. Self retaining retractors
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19. Classification Of Surgical Instruments
Suturing or stapling
1. Needle holder
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20. Classification Of Surgical Instruments
2- Staplers
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21. Classification Of Surgical Instruments
Viewing
1. Speculums
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22. Classification Of Surgical Instruments
Viewing
2.endoscopes
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23. Classification Of Surgical Instruments
Suctioning and aspiration
1. Suction
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24. Classification Of Surgical Instruments
• Dilating and probing
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25. Classification Of Surgical Instruments
• Measuring
• Accessory instruments
• Microinstrumentation
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26. Basic Principles Of Handling Surgical
Instruments
• Safety
• Economy movement Relax
handling
• Avoid awkward movement
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27. Passing Surgical Instrument
• Tip is visible
• Hand is free
• Handle is placed directly into
waiting hand
• Avoid placing fingers in the rings
as the instruments is passed
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29. Power Sources Surgical Instruments
• Air-powered instruments
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30. Power Sources Surgical Instruments
• Electrical powered instruments
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31. Handling Powered Surgical Instruments
• Keys points in handling powered instruments including the following:
1. Set the instruments and attachments on small sterile table
2. Handle and store the air hose or electric cord with care
3. To prevent inadvertent activation assemble the appropriate
handpiece attachments (e.g. blades, drills, reamers) and power
source with safety mechanism in position. Always be certain that
attachments completely seated and locked in the handpiece.
4. Test the functionality of the instrument before surgeon use.
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32. Cleaning and sterilizing power instruments
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33. General guidelines apply to the cleaning of all
power instruments
• Clean and decontaminate the instruments
immediately after use to maintain optimal
function
• Lubricate the instrument as recommended by the
manufacturer
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34. Care Cycle For Surgical Instruments
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35. Handling Surgical Instruments
 Setting up the instruments table
 Handling Instruments during surgical
procedure
 passing surgical instrument
 Dismantling the Instruments Table at the of
procedure

36. Setting up the instruments table
Key points in handling instruments before the surgical procedure
include:
1. Handle loose instruments separately to prevent inter-lacking or
crushing.
2. Inspect instruments such as scissors and forceps for alignment,
imperfections, cleanliness and working condition
3. Sort instruments nearly by classifications
4. Keep ring handled instruments together with curvatures and angles
pointed in the same direction
5. Leave retractors and heavy instruments in a tray or container or lay
them out on a flat surface of the table
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38. Handling Instruments during
surgical procedure
What are the most important things needed for effective and efficient role of the
scrub nurse in this time ?
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39. Handling Instruments during surgical procedure
1. Know the name and appropriate use of each instruments. Using the
fine instruments for heavy tissue damages the instrument
2. Handle instruments individually. Tangled instruments are hard to
separate in an emergency
3. Hand the surgeon or assistant the correct instrument for each
particular task
4. Pass instruments decisively and firmly when surgeon extends her/his
hand the instrument should be slapped or placed firmly into his/her
palm in the proper position for use.in general when passing curved
instrument, the curve of the instrument aligns with the direction of
the curve of the surgeon’s hand.
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40. Handling Instruments during surgical procedure
5. Watch the sterile field for loose instruments. After use remove them
to the mayo stand or instrument table
6. With moist sponge wipe the blood and organic debris from
instruments a promptly after each use
7. Flush the suction tip and tubing with sterile distal water periodically
to keep the lumen patent
8. Remove debris from electrosurgical tips to ensure electrical contact.
9. Place used instruments that will not be needed again in to a tray or
basin during or at the end of surgery
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41. Passing An Instrument To The Surgeon
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42. Points to remember when passing an
instrument to the surgeon
 If the surgeon is on the opposite side of the operating bed, pass across
right hand to right hand and for lifted handed surgeon by left hand
 If the surgeon in the same side of the operating bed and to the right
pass with your left hand
 Hemostatic forceps are held near the box lock by the scrub person and
passed by rotating the clockwise to place the handle directly into the
surgeon’s waiting hand
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43. Points to remember when passing an
instrument to the surgeon
 clip appliers are held between the fingers by the hinged joint during
loading and passing. Placing fingers in the ring may cause the clip to
be dischange unintentionally. The loaded applier is passed so the
rings automatically pass over the surgeon’s fingers in position of
function for rapid use.
 Sharp delicate instruments may be placed on a flat surface for the
surgeon to pick up
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44. Dismantling the Instrument Table
1. Check the drapes, towels, and table covers to be sure that
instruments do not go to the laundry or into the trash. A final
quick count is a safeguard.
2. Collect instruments from the mayo stand and any other small table
3. separate delicate, small instruments with those that may have
sharp or semi sharp edges for special handling
4. Disassemble all instruments with removable parts to expose all
surfaces for cleaning
5. Open all hinged instruments to expose box lacks and serrations
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45. Dismantling the Instrument Table
6. Separate instruments of dissimilar metals. Instruments of each type of
metal should be cleaned separately to prevent electrolytic deposition of
other metals.
7. Flush cold, distilled water through hollow instruments or channels such as
suction tips or endoscopes, to prevent organic debris from drying.
8. Rinse off blood and debris with demineralized distilled water or an
enzymatic detergent solution.
9. Follow the procedures for preparing each instrument for decontamination
or terminal sterilization.
10. Wrap the instrument for sterilization
11. Sterilize the instrument in steam unless contraindicated by manufacturer.
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46. Summary
 Surgical instruments background
 Compare the different between past, present and the future of
surgical instruments
 definition of Surgical instruments,
 Fabrication of Metal Instruments ,
 Classifications of the surgical instruments
 Basic principles of using surgical instruments,
 principles of Passing surgical instruments
 powered instruments and proper Handling of powered
instruments and cleaning and sterilizing of them
 key points in Handling instruments before during operation and
dismantling of instruments at the end of procedure5/26/2018 jamilah saad Alqahtani 46

47. References
1. Fairchild SS. Perioperative nursing: Principles and practice: Little, Brown; 1996.
2. Berry K, Kohn M. Operating room technique. New York: Mosby. 2004:345-62.
3. http://medical.tpub.com/14275/css/Handpiece-And-Bur-Exchange-118.htm
4. http://catalog.hospitime.com/hospitime-surgicalinstruments-care-cycle/
5. file:///C:/Users/jamilah/Downloads/handlingofsurgicalinstruments-
141127210405-conversion-gate01.pdf
6. https://www.slideshare.net/ahmadfsulong/handling-of-surgical-
instruments/17
7. https://www.surgicalholdings.co.uk/surgical/surgical_instruments.php?content
=history
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49. Have a nice
day
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