Storage of surgical instruments

August 12, 2017 17:50 | Paramedic

Tools should be stored in a dry, heated room at a temperature of 15-20 ° C..Should not be stored next to formalin, iodine, bleach, iesubstances which corrode metals pair.

Tools display in current use cases by type and destinations.Scalpels are placed on supports, as they must be on the edge weight.

For prolonged storage and transportation of tools made of carbon steel, must be lubricated or coated with vaseline neutral paraffin.

lubricated by immersion in molten petrolatum at a temperature of 60-70 ° C.Wobbly tools wrapped in waxed paper thin.Tools made of stainless steel, aluminum, brass, bronze, lubrication can not be.Prior tools lubricated thoroughly degreased or boiled in water with soap and soda, washed with water, dried and inspected for rust traces.This work is carried out in gloves, as touching the instruments sweaty hands contributes to the appearance of rust.Rusty tools lubricated with petroleum jelly can not, you must first remove the rust by polishing tool.

Processing tools derived from

the warehouse.

Tools received the package in the winter, in order to prevent fogging is maintained for several hours without unpacking.After removing the waxed paper instruments wipe clean with a soft gauze and dismantled each on a separate napkin to when disassembling not to mix items from different instruments.Dismantled parts are washed with hot water, purified from petrolatum residues and immersed for 1 hour in ethanol.Nonfat parts wiped dry with napkins and collected, then the tool is ready for sterilization.

Sterile tools sister lays out depending on the type of operations.

exemplary set of tools for the most common operations.

1. A common set of required for any operation:

• hoe to enhance surgical linen - 8 pcs .;

• scalpels - 4 pcs .;

• tweezers: Surgical - 4 pcs, anatomical - 2 pc, web-footed - 2 pcs, anatomical long - 1 pcs .;...

• clamps Hemostatic threaded (curved and straight) Kocher, Billroth - 15 pcs .;

• Scissors Cooper - 3 pcs .;

• Richter curved scissors - 1 pc .;

• Scissors straight - 1 pc .;

• drills sharp hooks - 2 pcs .;

• farabeuf hooks - 2 pcs .;

• Langenbeck hooks - 2 pcs .;

• blade Buyalsky - 2 pcs .;

• Deschamps needles - 2 pcs .;

• fluted tube - 1 pc .;

• bellied probe - 1 pc .;

• sharp Volkmann spoon - 1 pc .;

• forceps straight and curved - 2 pcs .;

• needle holders - 2 pcs .;

• circular needles - 10 pcs .;

• syringes and needles to them in different sizes - 5 pcs .;

tools required for operations on the abdominal organs and the abdominal wall.

Set for cholecystectomy:

common surgical kit ;

• Clip Fedorov - 1 pc .;

• clamps Mikulic - 10 pcs .;

• retractors (abdominal mirror) 2 pcs.

kit gastrectomy:

• a common set;

• abdominal mirror - 4 pcs .;

• clamps Mikulic - 10 pcs .;

• intestinal zhomy - 4 pcs .;

• zhomy Payr - 2 pcs.(Large and small).

When anastomosis in the esophagus, stomach and intestines most use of aseptic machines for mechanical seam, as at the time of the bowel lumen anastomosis remains closed.Furthermore, there is no need to use and apply suction to the wall body clamps which can lead to poor circulation in the zone of operation.Imposition of a mechanical seam provides a reduction in the duration of the operation, its safety, allows to expand the volume of operations on the gastro-intestinal tract and produce them in debilitated patients.

set for operations but about hemorrhoids:

• a common set;

• rectal Mirror - 1 pc .;

• fenestrated hemorrhoidal clamps - 5 pcs .;

• Langenbeck hooks.

Tools for urological operations.

The standard set includes urological instruments, due to the release of urine into the wound during surgery.Therefore often necessary to drain the urinary organs or cavity wounds, leaving them in the drainage tubes, sometimes for extended periods.However, there is often a need for bougienage ureter, urethra, various kinds of bougies.

• a common set;

• catheter with an inflatable balloon - 2 pcs .;

• ureteral catheters - Janet syringe - 1 pc .;

• curved metal bougies of different sizes;

• retractors for bladder, kidney exhaust - 2 pcs .;

• spoon to extract stones from the bladder - 1 pc .;

• ureter Holder - 1 pc .;

• bumerangovy needle holder for suturing wounds in depth;- Clip renal legs - 2 pcs ..

Gynecological surgery:

• obshchehirurgicheskogo set;

• metallic catheter;

• bryushnostenochnoe mirror Pfannenstiel.

When possible reinfusion of blood from the abdominal cavity required measuring cup with a capacity of 1 to 2 liters and a ladle.

tools used in operations on the lungs:

• a common set;

• plug for deflating ligatures curved - 1 pc .;

• dissectors with ratchet different sizes - 1 set;

• dissector with a shovel - 1 pc .;

• straight dissector without racks 21 cm - 1 pc .;

• clamps to the bronchi - 1 set;

• clamp for wedge resection of the lung (the line) - 2 pcs .;

• clamp renal pedicle - 2 pcs .;

• large mirror for the heart - 1 pc .;

• probe needle Bogush (for intrathoracic anesthesia) - 1 pc .;

• curved needle for taking a biopsy;

• needle from plevroaspiragora - 2 sets;

• inject curved needle - 10 pcs .;

• tracheostomy tube in different sizes - 4 pcs .;

• Kocher probe - 1 pc .;

• needle Deschamps - 1 pc .;

• sterile tracheostomy tube - 1 pc .;

• «Mosquito» clips - 15-20 pcs .;

• Kocher clamps, Billroth - 20 pcs .;

• thin rubber drainage - 2 pcs .;

• Three-way valves on plevroaspiratora - 2 sets;

• Clippers ribs I - 1 pc .;

• Universal pliers, rib - 1 pc .;

• spoon biopsy straight and curved - 1 set;

• spatula to separate tissues - 1 pc .;

• blunt scissors - 1 pc .;

•-rasp knife to remove cartilage from the bronchus - 1 pc .;

• surgical tweezers 25 cm - 2 pcs .;

• anatomical tweezers 25 cm - 2 pcs .;

• lift the blade - 1 pc .;

• retractor to thoracic cavity rack big - 1 pc .;

• rasp for I rib - 1 pc .;

• Flexible turnstile - 1 pc .;

• tongs for gripping light straight - 3 pcs .;

• easy to grip pliers curved -3 pcs .;

• pliers for grasping the pleura - 1 pc.

kit tracheostomy:

• a common set (without intestinal needles);

• tracheostomy tube in different sizes - 4 pcs .;

• unidentate sharp hooks - 2 pcs .;

• extender Trousseau - 1 pc .;

• thick rubber catheter - 1 pc .;

• metallic tracheal catheter - 1 pc .;

• electric pump with a sterile catheter.

Toolbox about strangulated hernia:

• a common set;

• zhomy intestinal elastic lines;

• zhomy intestinal elastic curved - 4 pcs .;

• zhomy crush - 2 pcs .;

• retractors (abdominal mirror) - 2 pcs .;

• intestinal needles - 6 pieces.

kit for amputation:

• a common set (without intestinal needles);

• rubber band - 1 pc .;

• amputation knives - 2 pcs .;

• Retractor - 1 pc .;

• straight rasp - 1 pc .;

• curved rasp - 1 pc .;

• Saw the arc - 1 pc .;

• Volkmann spoon - 1 pc .;

• Clippers Liston - 1 pc .;

• fixation forceps.

Toolkit for craniotomy:

• a common set;

• straight rasp - 1 pc .;

• curved rasp - 1 pc .;

• Direct bit - 1 pc .;

• fluted chisels - 1 pcs .;

• hammer - 1 pc .;

• Clippers Liston - 1 pc .;

• Clippers Dahlgren - 1 pc .;

• drill with a set of cutters - 1 pc .;

• brain spatula (elevator) - 1 pc .;

• sterile rubber balloon (pear) 1 pc.

tool supply surgeon.

must be fast, timely and technically correct.The speed achieved experience and skill.

There are three ways to supply tools:

• in the surgeon's hands;

• on the instrument table;

• combined.

1. Submission tool in the hands of the surgeon - the most perfect way, since completely frees the surgeon from unnecessary actions, not related to work in the area of ​​operations.This method is due to the fact that the operating sister easier to keep order and cleanliness in the tool table.However, the most difficult, because it requires a lot of speed, a clear knowledge of travel operations.Need full harmony with the surgeon and the knowledge of all the details of the art, is markedly different in different surgeons.

supply scalpel: scalpel handle serves the surgeon, nurse holds his neck and the blade with a small cloth, the blunt edge of a scalpel turned to her palm.

Feed scissors, clamps, hooks carried out in the form of a closed ring by yourself.

supply needle holder.Needle Holder is supplied so that the surgeon can this same hand to capture the long end of the thread or the long end of the thread sister holding forceps in the air, so it is not overwhelmed around needle holder.Submission of a suture: thread without needles supplied tweezers.Touching hands thread should be as small as possible in order to avoid infection.Its length is determined by the joint views: continuous seam take a thread length of 40 -45 cm, for surface nodal joints - 18-20 cm for seams, imposed in wound depth - 25-30 cm thread of the same length is used for the purse-string suture..Catgut is necessary to take a little longer than the silk thread as it slides when tying.

Silk number 1-2 is used for intestinal suture, number 0 - seam vessels and nerves, number 4-6 - for the fascia, skin sewing silk number 3-4.Muscles tend to sew catgut.

Before serving, you need to check the strength of the filaments to break.

Selection of needles but curvature and thickness:

• on the wall surface (parenteral leaf peritoneum) joint applied using a circular (intestinal) curved needle;

• intestinal or stomach wall - direct circular needle;

• for vascular suture used atraumatic needles disposable;

• for stitching muscles and aponeuroses serves cutting (triangular) curved needle;

• for suturing in deep water, in a confined space, use a needle with a large curved and long ligature.

2. Submission tools on the tool table.

Operating sister puts on the table the necessary tool

set of tools and materials, the surgeon during the operation picks up the tools.Sister maintain order on the table, takes the ligatures vdevaet thread in the needle.This method is useful for a septic operations, so as not to contaminate a large tool table.

3. Combined method combines the above two methods.

In less difficult moment Surgeon tools takes himself (lie close at hand).Tools that require preparation (syringes, needle holders), delivers a sister.Care should be taken so that each tool is used and already unnecessary at this time was again placed on the instrument table.Do not allow the cluster tools on the sheets around the surgical wound.Each instrument must be returned immediately rubbed with gauze, or on the surface of the blood-stained bacteria can settle out of the air, the blood dries and it will be difficult to remove.For a single-use tool shed or immediately after application, or it being imposed on the fabric it remains until the end of the operation.Repeatedly use the tools that are needed throughout the operation - scalpels, scissors, some types of clamps.

sister should follow not only the purity of the return instruments, but also for their serviceability.Pay particular attention must be checked for the presence of the needle hub of the needle.

Possible errors when filing tools.

1. Incorrect filing ligatures seam:

• If the thread is too long, it gets confused and prevents the surgeon to tie;In short - it makes it difficult to engage;

• threading thick thread a thin needle.The needle in this case can get stuck in the tissue, ripping it, and if the thin thread threaded into a thick needle, the sewing thread may slip out of the eye;

• feeding fragile ligatures that when tying breaks.Therefore, every ligature, especially when dressing container, you need to check the strength of the gap;

• ligatures threading the needle eye from the end of one length.In this case, that one end was short, it is necessary to stretch the thread, causing it razvoloknitsya and may break when sewing or tying.

2. Improper filing tool.

• feeding a cutting needle instead of a round at the suture on the intestinal or stomach wall;

• supply of surgical tweezers instead anatomy.The surgeon, without realizing it, can damage the body, such as the intestine.

3. Brute mistake is to use small beads and napkins for abdominal operations.

4. Dangerous operating error sister is a lack of information on the number of instruments, napkins, tampons on the table before the operation. This is necessary so as not to leave any foreign objects in the wound (especially during operations on the abdominal and thoracic cavity organs).There should be a rule: before suturing cavities sister, calculating instruments, swabs, wipes, report to the surgeon that the calculation is made, the number of them before and after the matches.In order not to leave a foreign body, such as in the abdominal cavity, apply a variety of devices - from the most basic (attach pad to clamp the sheet) to the most complex - special devices-holders.Whichever method is used, it is an important rule - strict control.