Surgical instruments are tools or devices that perform such functions as cutting, dissecting, grasping, holding, retracting, or suturing. Most surgical instruments are made from stainless steel. Other metals, such as titanium, chromium, vanadium, and molybdenum, are also used.
Purpose
Surgical instruments facilitate a variety of procedures and operations. Specialized surgical packs contain the most common instruments needed for particular surgeries.
In the United States, surgical instruments are used in all hospitals, outpatient facilities, and most professional offices. Instrument users include surgeons, dentists, physicians, and many other health care providers. Millions of new and replacement instruments are sold each year. Many surgical instruments now have electronic or computerized components.
Description
Basic categories of surgical instruments include specialized implements for the following functions:
Scissors are an example of cutting instruments. Dissecting instruments are used to cut or separate tissue. Dissectors may be sharp or blunt. One example of a sharp dissector is a scalpel. Examples of blunt dissectors include the back of a knife handle, curettes, and elevators. Clamps, tenacula, and forceps are grasping and holding instruments. Probing instruments are used to enter natural openings, such as the common bile duct, or fistulas. Dilating instruments expand the size of an opening, such as the urethra or cervical os. Retractors assist in the visualization of the operative field while preventing trauma to other tissues. Suction devices remove blood and other fluids from a surgical or dental operative field.
Sharps and related items should be counted four times: prior to the start of the procedure; before closure of a cavity within a cavity; before wound closure begins; and at skin closure or the end of the procedure. In addition, a count should be taken any time surgical personnel are replaced before, during, or after a procedure. Instruments, sharps, and sponges should be counted during all procedures in which there is a possibility of leaving an item inside a patient.
The misuse of surgical instruments frequently causes alignment problems. Instruments should always be inspected before, during, and after surgical or dental procedures. Inspection is an ongoing process that must be carried out by all members of a surgical team.
Scissors must be sharp and smooth, and must cut easily. Their edges must be inspected for chips, nicks, or dents.
After a procedure, staff members responsible for cleaning and disinfecting the instruments should also inspect them. The instruments should be inspected again after cleaning and during packaging. Any instrument that is not in good working order should be sent for repair. Depending on use, surgical instruments can last for up to 10 years given proper care.
Preparation
Instruction in the use and care of surgical instruments may range from the medical training required by physicians and dentists to on-the-job training for orderlies and aides.
Surgical instruments are prepared for use according to strict institutional and professional protocols. Instruments are maintained and sterilized prior to use.
Surgical instruments must be kept clean during a procedure. This is accomplished by carefully wiping them with a moist sponge and rinsing them frequently in sterile water. Periodic cleaning during the procedure prevents blood and other tissues from hardening and becoming trapped on the surface of an instrument.
Instruments must be promptly rinsed and thoroughly cleaned and sterilized after a procedure. Ultrasonic cleaning and automatic washing often follow the manual cleaning of instruments. Instruments may also be placed in an autoclave after manual cleaning. The manufacturer's instructions must be followed for each type of machine. Staff members responsible for cleaning instruments should wear protective gloves, waterproof aprons, and face shields to protect themselves and maintain instrument sterility.
Aftercare
Observation of the patient after surgical or dental procedures provides the best indication that correct instrument handling and aseptic technique was followed during surgery. After an operation or dental procedure, individuals should show no evidence of the following:
retained instruments or sponges
infection at the site of the incision or operation
Risks
Risks associated with surgical instruments include improper use or technique by an operator, leaving an instrument inside a person after an operation, and transmitting infection or disease due to improper cleaning and sterilization techniques. Improperly cleaned or sterilized instruments may contribute to postoperative infections or mortality. Improper use of surgical instruments may contribute to postoperative complications.
Bland, K.I., W.G. Cioffi, and M.G. Sarr. Practice of GeneralSurgery. Philadelphia: Saunders, 2001.
Burke, K.M., P. Lemone and E. Mohen-Brown. UnderstandingMedical Surgical Nursing. Upper Saddle River, NJ: Prentice Hall, 2002.
Caruthers, B.L., and P. Price. Surgical Technology for the Surgical Technologist. Albany, NY: Delmar, 2001.
Grace, P.A., A. Cuschieri, D. Rowley, N. Borley, and A. Darzi. Clinical Surgery, 2nd ed. Londin, 2003.
Schwartz, S.I., J.E. Fischer, F. C. Spencer, G.T. Shires, and J.M. Daly. Principles of Surgery, 7th ed. New York: McGraw-Hill, 1998.
Townsend, C., K.L. Mattox, R.D. Beauchamp, B.M. Evers, and D.C. Sabiston. Sabiston's Review of Surgery, 3rd ed. Philadelphia: Saunders, 2001.
PERIODICALS
Beesley, J. "Creutzfeldt-Jakob Disease—The Perioperative Connection." British Journal of Perioperative Nursing 13, no.1 (2003): 21-3.
Guyton, S.W. "Robotic Surgery: The Computer-Enhanced Control of Surgical Instruments." Otolaryngology Clinics of North America 35, no.6 (2002): 1303-16.
Pisal, N., M. Sindos, and G. Henson. Risk Factors for Retained Instruments and Sponges after Surgery." New England Journal of Medicine 348, no.7 (2003): 1724-5.
Vrancich, A. "Instrumental Care. Creating Longevity through Proper Maintenance." Materials Management in Health Care 12, no.3 (2003): 22-5.
Williams, D. "Public Confidence in Medical Technology." Medical Device Technology 13, no.10 (2002): 11-13.
ORGANIZATIONS
American Board of Surgery. 1617 John F. Kennedy Boulevard, Suite 860, Philadelphia, PA 19103. (215)568-4000, fax: (215) 563-5718. <http://www.absurgery.org>
American College of Surgeons. 633 North St. Clair Street, Chicago, IL 60611-32311. (312) 202-5000. Fax: (312) 202-5001. E-mail: <postmaster@facs.org>. <http://www.facs.org>.
Association of Perioperative Registered Nurses, Inc. 2170 South Parker Road, Suite 300, Denver, CO 80231-5711. (800) 755-2676. <http://www.aorn.org>
Association of Surgical Technologists. 7108-C South Alton Way, Suite 100, Englewood, CO 80112-2106. (800) 637-7433.
OTHER
Surgical 911. [cited May 6, 2003] <http://www.surgical911.com>.
