for the syllabus of 4th year clinical pharmacy of TU .

1. Presented by :Nabina Paudel
4th batch B.Pharma
Surgical and Medical Devices
9/8/20191

2. Introduction
 The items related to surgical processes and other items which
are medicine related items used for the patients care though
not drug, fall under the category of surgical and other items.
 Surgical instruments are specially degined tools or devices for
performing specific actions of carrying out desired effects
during surgery/operation.
9/8/20192

3. Surgical Supplies
 Forceps
 Scissors
 Scalpel
 Needles/syrings
 Catheters
 ETT
 Laryngoscope
 Endoscope
 Colonoscope
 IV Cannula
• Sutures and ligatures
•IV sets
•Blood transfusion sets
•Gloves
•Tongue depressors
•Surgical dressings
- cotton
- Gauge
- Bandages
- Adhesive tapes
9/8/20193

4. Other health accessories
 Contact lenses
 Pulse oxymeter
 Glucometer
 Ophthalmoscope
 Otoscope
 BP monitoring devices
 Thermometer
 ECG machine
 Echocardiography machine
 Defibrillator
 Wrist brace
• Lumbo sacral corset
•Cervical collar
•Headlight
•Naso gastric tube
•Hemodialysis machine
•X-ray machine
•CT scanning machine
•MRI machine
•TMT devices
•Nebulizer
•Oxygen cylinder
•USG machine
9/8/20194

5. Surgical forceps
 Forceps are hinged instruments utilized for
gripping or clasping objects.
 Those used in the medical field are manufactured
from quality carbon steel in order to withstand the
rigors of ongoing sterilization.
 There are many types of forceps, some are
discussed below:
9/8/20195

6. Hemostatic Forceps
9/8/20196

7.  Instrument type/name: Hemostatic Forceps
 Also termed as : Artery Forceps, Clamps and Snaps
 Raw material: Stainless steel
 Main function: To clamp and restrict arteries or tissue, to
control the flow of blood
 Where used mostly: General surgery
 Important product features: They have fine serrations of
varying lengths in the jaws.
 Other comments: Some patterns are available with sharp
teeth in the jaws.
9/8/20197

8. Dressing/Thumb Forceps
9/8/20198

9.  Instrument type/name: Dressing/Thumb Forceps
 Raw material: Stainless steel
 Main function: To grasp and handle dressing and
other material
 Where used mostly: General surgery
 Important product features: Tweezer-type forceps
are generally serrated, without teeth.
They come in many sizes and shapes.
9/8/20199

10. Kelly Forceps
Also termed : Rochester
forceps
Raw material: stainless
steel
Features: either curved or
straight
Use: for gripping and
holding tightly onto tissue,
including rupture blood
vessel 9/8/201910

11. Alligator forceps
Raw material: stainless steel
Use: with their long shaft, are
utilized for retrieving objects from
within and between cavities in the
patients body
Intresting features: the serrated
tips donot damage living tissue.
9/8/201911

12. Biopsy forceps
Raw materials: stainless steel
Features: straight or angled shaft
Uses : grip and hold living tissue
and are chosen when delicate and
precision word is to be performed.
9/8/201912

13. Obstetrical forceps
 It is also known as brain forceps, used to help in
fetal delivery for adjusting the position of the head
of the unborn child during delivery.
9/8/201913

14. Cheatles forceps
 It is used to remove the hot sterile surgical
instruments from the sterilizer and to place them
to the sterile pouches.
9/8/201914

15. Surgical scissors
9/8/201915

16.  They are used for cutting or dissecting the
tissues, cutting the sutures, bandages, etc.
Surgical scalpels
They are very sharp knives used in surgery
where extremely fine cutting is needed.
9/8/201916

17. Tongue depressor
 It is a device used to depress the tongue to allow
examination of mouth and throat.
9/8/201917

18. Surgical needles
•Needles are used for suturing the
tissues.
•Two types:- straight and curved.
•Straight : used while working on the
surface.
•Curved : used while working at the
depth.
•They are round, triangular, flat .
•The curvature may be half circle,
3/8th or 5/8th circle.
9/8/201918

19. Swab holder
 It is used to hold a Swab to cleanse the
operational field in the depth.
9/8/201919

20. Urinary catheter
 A urinary catheter is any tube system placed in the body
to drain and collect urine from the bladder. There are
three lengths:
 Female (20-26cm)
 Male or Standard: (40-45cm) and
 Paediatric (30-32cm).
 Types are:
9/8/201920

21. 9/8/201921
 Foleys catheters
•It is a soft plastic or rubber tube i.e. inserted into the bladder
to drain the urine.
•Complications of catheters use may include urinary tract or
kidney infections, blood infection, urethral injury, skin
breakdown, bladder stones and blood in the urine.

22. Fig: Foleys catheter 9/8/201922

23. Suprapubic catheters
 It is an indewlling catheter i.e. placed directly into the
bladder through abdomen.
 The catheter is inserted above the pubic bone.
9/8/201923

24. Fig: suprapubic catheter
9/8/201924

25. Long term (indwelling catheters)
 A catheter that is left in place for a period may be attached to a drainage
bag to collect the urine. There are 2 types of drainage bags.
 One type is a leg bag, which is a smaller drainage device that attaches
by elastic bands to the leg. Used in day time.
 The other type of drainage bag is a larger drainage device that may be
used during the night.
 The drainage device must be emptied at least every 8 hrs, or when the
device is full.
Potentials complications
 Urine with a strong smells or becomes thick or cloudy.
 Fever, chills.
 Urethral swelling around the catheters.
 Bleeding into or around the catheters.
 Catheter draining little or no urine despite adequate fluid intake.
 Leakage of large amounts of urine around the catheters.
9/8/201925

26. Fig: indwelling catheter
9/8/201926

27. Endotracheal tube
 It is a specific type of tracheal tube that is nearly
always inserted through the mouth (orotracheal) or
nose (nasotracheal).
 It is used to deliver oxygen in higher concentrations
than found in air, or to administer other gases such
as helium, nitric oxide, xenon, or certain volatile
anesthetic agents such as desflurane, isoflurane or
sevoflurane.
9/8/201927

28. Fig: Endotracheal tube
9/8/201928

29. Iv sets
 Infusion set is used for the infusion of I.V fluids
and fluid- derivatives
9/8/201929

30. Blood transfusion set
 The set is for administring blood or blood
products.
9/8/201930

31. Syringes
 They are instrument meant for injection of parenteral
preparation into the body cavity.
 Syringes are devices used to propel drugs into the
body by various routes.
Types
 Reusable luer, glass:
This syringes can be used both for injection and
aspiration. It is made up brosilicate glass & available
with glass or stainless steel nozzle and has to be
sterilized before use.
- Available in 2,3,5,ten and 20 ml capacity. 9/8/201931

32.  Disposable luer:
This syringe is made of medical grade polypropylene.
It consists of two parts & available in a sterile form
with the luer nozzle. They come in sizes 3,5,ten 20
and 50 ml capacity.
 Tuberculin disposable syringes
It is useful for the administration of small dosage of
drugs & available in 0.5 & one ml capacity.
9/8/201932

33. Fig:
Disposable
Fig:
Tuberculine
Fig: resuable 9/8/201933

34. IV cannula
 A cannula or IV cannula is a tube that can be
inserted into the body, often for the delivery or
removal of fluids.
 Iv cannula is inserted into a vein, primarily for the
administration of intravenous fluids, for obtaining
blood samples & for administrating medicines.
 The average cannula size is fourteen to 26 gauge.
 Fourteen = large
 26= small
9/8/201934

35. Fig: IV cannula
9/8/201935

36. Otoscope
 An otoscope or auriscope is a medical device which
is used to look into the ears.
 Diseases which may be diagnosed by an otoscope
include otitis media and otitis externa, infection of
the middle and outer parts of the ear, respectively.
9/8/201936

37. Fig: otoscope
9/8/201937

38. Opthalmoscope
 Opthalmoscopy is a test that allows a health
professional to see inside the fundus of the eye
and other structures using Opthalmoscope or
funduscope.
 It is used to detect & evaluate symptoms of retinal
detachment or eye disease such as glaucoma.
9/8/201938

39. Fig:
Opthalmoscope
9/8/201939

40. Colostomy kit
 A colostomy is a surgical procedure where the
colon is by passed and the intestine is re- routed
to an opening on the abdominal wall ( called a
stoma).
 A plastic bag is attached to the stoma that
collects feces passing through the intestine as
waste.
9/8/201940

41. 9/8/201941

42. Laryngoscope
 It is an instrument used to obtain a view of the
vocal fold and glottis.
9/8/201942

43. Contact Lens
 Contact lenses are small , lightweight plastic
devices worn on the eye that correct refractive
errors in vision.
 A lens is corrective , cosmetic, or therapeutic lens
usually placed on the cornea of the eye. It is also
known as contact.
 Many commercial lens are tinted a faint blue to
make them more visible when immersed in
cleaning and storage solution.
9/8/201943

44. 9/8/201944

45. Complication
 Complication due to contact lens arise roughly in 4 % of contact lens.
 Problems associated with contact lens wear may affect the eyelid the
cunjuctiva , the various level of cornea and even the tear film that
covers the outer surface of eye.
Insertion
Contact lens are typically inserted into the eye by placing them on the
index finger with the concave side upward and rising the to touch the
cornea.
Removal
A soft lens may be removed by holding the eyelids open and grasping
the lens with opposing digits.
Care
While daily disposal lens require no cleaning other types requires
regular cleaning and disinfecting in order to retain clear vision and
prevent discomfort and infection.
9/8/201945

46. Nebulizers
 A nebulizer is a device that uses compressed air
to deliver medication to people in forms of a liquid
mist to the airway. It is commonly used in treating
cystic fibrosis, asthma and other respiratory
disease.
 They are also called atomizers, they pump air or
oxygen through a liquid medicine to turn into
vapor, which is inhaled by the patient
9/8/201946

47. 9/8/201947

48.  Parts
Nebulizer have three main parts : a cup that holds
the medication, a mouthpiece or mask attached to a
“T” shaped part, and a thin , plastic tube that
connects the mouthpiece to the compressor.
9/8/201948

49. Medical and surgical gloves
 Until late in the nineteen century, most surgeons
used to operate with their bare hands.
 A few doctors tried cotton or silk gloves but they
proved impractical and impossible to sterilize.
Today, sterile disposable gloves are in common
use by medical personnel.
9/8/201949

50. 9/8/201950

51. Nasogastric (NG) tube (Ryle’s
tube)
 It is an agent used for nanogastric intubation, a
medical process involving the insertion of a
plastic tube (nasogastric tube/NG tube) through
the nose, past the throat, and down into the
stomach.
 It is used for nasogastric introduction for drugs
and other oral agents and aspiration of intestional
secreation or drugs and for minimal quantities of
liquids. A syring is used for injection into the tube.
9/8/201951

52. 9/8/201952

53. 9/8/201953

54. 54
Surgical dressings & Sutures.

55. Surgical Dressings
55
Natural Fibres used for the preparation of Surgical
Dressings obtained from
Plants
Animals
Minerals
Synthetic & other Fibres.

56. Surgical dressings
Bandage
Surgical sutures
Ligatures
56

57. Surgical dressings :
 Material used alone or in
combination to cover
wound
 Protects the wound and
favours its proper healing
 Material which holds the
dressing in desired
position………BANDAGE
 Made up of fibres.
57

58. Functions
 Reduce or prevent
infection
 Mechanical support to
the tissues
 Protection to healing
wound
58

59. 59
Fig: bandages

60. Pharmacopoeial requirements
60
 Sterilized before use
 Stored in dry, well-ventilated place below 25 C
 Permitted antiseptics in prescribed concentrations be
used
 Adhesive products not allowed to freeze
 No loose threads, fiber ends
o

61. Types of recognised surgical dressings
PH103.8261
1 Fibres & related materials : Viscose, wool, cellulose
wadding
2 Carded products : Absorbent cotton, viscose wadding.
3 Non-extensible, non-adhesive woven products :
Absorbent muslin, Domette bandage
4 Non-extensible adhesive woven products : Belladonna
adhesive plaster, zinc oxide adhesive plaster.

62. PH103.8262
5 Extensible non-adhesive products : Cotton bandage, Elastic
web bandage.
6 Extensible adhesive woven products : Elastic adhesive
bandage,
Extension plaster
7 Non-woven products : Impermeable plastic surgical
adhesive tape, Permeable plastic
surgical adhesive tape.

63. Properties
PH103.8263
• Absorbing wound exudates from the site
• Prevent or combat infection
• Physical protection to wound
• Mechanical support to the surrounding tissues
• Should not adhere to the granulating surface
• Easy to handle at all stages
• Durable
• Free from loose threads, ends or fibres
• Easily sterilised

64. Surgical dressing consists of
PH103.8264
1 Wound facing layer :
Inner layer Closest to the wound containing antiseptics
and healing agents
2 Absorbent layer :
Middle layer absorbs blood or pus or any exudate from
wound
3 Outer layer :
outer layer supports the inner layers

65. Special dressings : Pyroxillin, Acrylic polymer
PH103.8265
Absorbable Haemostats :
Human fibrin foam
Absorbable gelatin sponge
Oxidised cellulose
Calcium alginate

66. Sutures & Ligatures
PH103.8266
 Sterile threads or strings specially prepared for use in
surgery.
 Sutures used for sewing or stitching together tissues like
skin, muscle or tendon by using Needle.
 Ligatures used to tie & constrict
blood vessel vein or artery and no needle is used.

67. 9/8/201967

68. Properties
PH103.8268
• Sterility
• Adequate mechanical strength
• Non-irritant
• Fine gauze
• Time of absorption if absorbable

69. Classification
Absorbable sutures :
Absorbed & digested in the
tissues of the body
e.g. surgical catgut,
kangaroo tendon
synthetic absorbable
polymers
Non-absorbable sutures :
Not absorbed, remain in the
body, to be removed after
wound healing.
e.g. Silk cotton nylon
synthetic polyesters
stainless steel
69

70. Absorbable sutures :
70
Surgical catgut :
Sterile strand prepared from collagen healthy
animals like sheep and cattle
Kangaroo tendon :
Prepared from tails of kangaroo
Synthetic polyesters :
Condensed cyclic derivatives of glycolic
acid with cyclic derivatives of lactic acid
high tensile strength degraded by hydrolysis
and absorbed by the tissues

71. Non-absorbable sutures…
71
……..must be removed after wound healing
 Silk sutures :
Spinned or twisted fibres into a single strand
smooth and strong
 Cotton sutures:
Uniform in size used in critical parts where
strength of suture required for long time
 Nylon sutures:
Microfilaments braided into strands strong
water resistant used in skin plastic surgery

72. ………Non-absorbable sutures
72
 Linen suture :
Cheap, very strong
no uniformity in diameter
 Metallic sutures :
Silver & stainless steel used as surgical aid
monofilaments, twists and braids

73. Sterilisation of sutures
73
Chemical method :
Sterilisation by Iodine solution long time and tedious
Sterilisation by heat :
Boilable method :
Heating in high B.P. liquid like Tolune or Xylene in
glass tube which was sterilised in Autoclave requires
high temperature for drying,suture becomes stiff
need soaking in sterilised water before use

74. Non- boilable method
74
Suture in foil pack or plastic packet in alcohol with little
water heated temperature should not be very high as it
affects its quality.
Irradiation method :
Exposing the suture in finally sealed
container to electron
particles / gamma rays from cobalt 60
sterilisation dose 2.5 mega rads.

75. SUMMARY
75
In this class we learnt about
Surgical dressings :
Properties
Types
Functions
Surgical sutures & ligatures
Types
Properties
Uses
Sterilisation methods

76. Quiz
PH103.8276
 Any material that covers, protects and aids in healing
of wound
a) surgical fibre
b) surgical dressing
c) bandage
d) suture
 Material that holds and keeps dressing in position
a) surgical dressing
b) bandage
c) suture
d) ligature

77. …..QUIZ
PH103.8277
 Sterile threads used for sewing skin and tissues with a
needle
a) dressing
b) bandage
c) suture
d) ligature
 Most effective method of sterilisation of surgical
catgut
a) heating with iodine solution
b) autoclaving
c) irradiation
d) hot air oven

78. Questions
PH103.8278
1. Define surgical dressings and classify them with
examples.
2. Classify surgical sutures and ligatures with examples.
3. Define surgical suture and what are the properties of
an ideal suture ?
4. Differentiate the absorbable sutures and non-
absorbable sutures.