13 Principles of Sterile Technique

1. 2. 3. 4. Only sterile items are used within the sterile field. Sterile persons are gowned and gloved. Tables are sterile only at table level. Sterile persons touch only sterile items or areas. Unsterile persons touch only unsterile items or areas. 5. Unsterile persons avoid reaching over sterile field. Sterile persons avoid leaning over unsterile areas. 6. Edges of anything that encloses sterile content are considered unsterile. 7. Unsterile persons avoid sterile areas. 8. Sterile field is created as close as possible to the time of use. 9. Sterile areas are continuously kept in view. 10. Sterile persons keep well within sterile area. 11. Sterile persons keep contact with sterile areas to a minimum. 12. Microorganisms must be kept to irreducible minimum. 13. Destruction of integrity of microbial barriers results in contamination.

SURGICAL INSTRUMENTS FOR MAJOR AND MINOR SURGERY

Surgical instruments exist in vast numbers and varieties. The following are examples of the basic instruments that should learned by every beginning surgeon.

SCISSORS
Classification by type of points All types of scissors can have blunt or sharp blades (A: Sharp:Sharp, B: Blunt:Blunt).

All types can have either straight or curved blades.

Mayo and Metzenbaum Mayo scissors (B) are used for cutting heavy fascia and sutures. Metzenbaum scissors (A) are more delicate than Mayo scissors. Metzenbaum scissors are used to cut delicate tissues. Metzenbaum scissors have a longer handle to blade ratio.

FORCEPS
DRESSING AND TISSUE FORCEPS Forceps: consist of two tines held together at one end with a spring device that holds the tines open. Forceps can be either tissue or dressing forceps. Dressing forceps have smooth or smoothly serrated tips. Tissue forceps have teeth to grip tissue. Many forceps bear the name of the originator of the design, such as Adson tissue forceps. Rat Tooth: A Tissue Forceps Interdigitating teeth hold tissue without slipping. Used to hold skin/dense tissue.

Adson Tissue Forceps Small serrated teeth on edge of tips. The Adsons tissue forceps has delicate serrated tips designed for light, careful handling of tissue.

Intestinal Tissue Forceps: Hinged (locking) forceps used for grasping and holding tissue. Allis: An Intestinal Tissue Forceps Interdigitating short teeth to grasp and hold bowel or tissue. Slightly traumatic, use to hold intestine, fascia and skin.

Babcock: An Intestinal Tissue Forceps More delicate that Allis, less directly traumatic. Broad, flared ends with smooth tips. Used to atraumatically hold viscera (bowel and bladder).

Sponge Forceps Sponge forceps can be straight or curved. Sponge forceps can have smooth or serrated jaws. Used to atraumatically hold viscera (bowel and bladder).

HEMOSTATS Hemostatic forceps: Hinged (locking) Forceps. Many hemostatic forceps bear the name of the designer (Kelly, Holstead, Crile). They are used to clamp and hold blood vessels. Classification by size and shape and size of tips Hemostatic forceps and hemostats may be curved or straight.

Kelly Hemostatic Forceps and Mosquito Hemostats Both are transversely serrated. Mosquito hemostats (A) are more delicate than Kelly hemostatic forceps (B).

Comparison of Kelly and Mosquito tips Mosquito hemostats (A) have a smaller, finer tip.

Carmalt Heavier than Kelly. Preferred for clamping of ovarian pedicals during an ovariohysterectomy surgery because the serrations run longitudinally.

INTESTINAL FORCEPS Doyen Intestinal Forceps Doyen intestinal forceps are non-crushing intestinal occluding forceps with longitudinal serrations. Used to temporarily occlude lumen of bowel.

Payr Pylorus Clamps Payr pylorus clamp is a crushing intestinal instrument. Used to occlude the end of bowel to be resected.

NEEDLE HOLDER
Needle holder: Hinged (locking) instrument used to hold the needle while suturing tissue. Good quality is ensured with tungsten carbide inserts at the tip of the needle holder. Mayo-Hegar Heavy, with mildly tapered jaws. No cutting blades.

Olsen-Hegar Includes both needle holding jaw and scissors blades. The disadvantage to having blades within the needle holder is the suture material may be accidentally cut.

RETRACTORS
HAND HELD RETRACTORS Senn Blades at each end. Blades can be blunt (delicate) or sharp (more traumatic, used for fascia).

Hohman Levers tissue away from bone during orthopedic procedures.

SELF RETAINING RETRACTORS Weitlaner Ends can be blunt or sharp. Has rake tips. Ratchet to hold tissue apart.

Gelpi Has single point tips. Ratchet to hold tissue apart

SCAPELS AND BLADES

Handles #3 Handle #4 Handle

Handles and Blades Blades #10, 11, 12, 15 fit the #3 handle. Blades #22, #23 fit the #4 handle and are commonly used for large animals.

Disposable Scalpel

TOWEL CLAMP
Towel clamps secure drapes to a patient's skin. They may also be used to hold tissue. Backhaus Towel Clamp

Locking forceps with curved, pointed tips

INSTRUMENT HANDLING
Scissors and Hemostats: The thumb and ring finger are inserted into the rings of the scissors while the index and middle finger are used to guide the instrument. The instrument should remain at the tips of the fingers for maximum control.

This is the wrong way to hold the scissors. The ring finger should be inserted into the ring.

This is also the wrong way to hold the scissors. The tips of the scissors should be pointing upwards.

Thumb Forceps: Thumb forceps are held like a pencil.

Thumb Forceps are not called 'tweezers'. Thumb Forceps are not held like a knife.

Scalpels: The scalpel is held with thumb, middle and ring finger while the index finger is placed on the upper edge to help guide the scalpel. Long gentle cutting strokes are less traumatic to tissue than short chopping motions. The scalpel should never be used in a "stabbing" motion.

REQUIREMENT in NCM 102.1

SUBMITTED BY:

Romatho, Rainida Catherine B. LEVEL II MMnn4

SUBMITTED BY:

Clinical Instructor

January 12, 2011