Preparing tools for the operation

The operating sister is obliged to know the functional purpose of surgical instruments, the rules for their selection and selection for a particular operation. At its disposal should be a sufficient number of tools - 2-3 sets.

Tools are made from stainless steel, less often from steel, coated with nickel or chromium, and also from titanium alloys.

By classification, almost all the tools can be divided into the following groups.

1. Tools disconnecting the fabric:

• scalpels;according to the shape of the blade: bellied and pointed;the length of the peritoneum is divided into large( 50 mm) and medium( 40 mm).Scalpels pointed are only of medium size;

• scissors are general surgical: according to the shape of the blades they can be straight, curved along the plane( Cooper), curved along the edge. In addition, the scissors can be pointed, blunt-ended and with one sharp end;

• knives-tenons: straight and curved, blunt-ended and with spear-shaped blades. Designed for operations on muscles and tendons;

• resection, amputation knives;

• saw, sheet, arc, saw Jigley. Apply for operations on the bones.

2. Exciting( clamping tools) - tools that serve to capture, clamp tissues or organs to temporarily stop bleeding, block the lumen of the hollow organs with a current of liquid contents in them, and also to grab and strengthen the operating linen, drainage tubes:

• Haemostatic clamps of the type: Coher with slicing, Billroth, Halstead( dentate), straight and curved with denticles, "mosquitoes", elastic vascular clamp;

• surgical, anatomical, labile tweezers for tissue capture and retention, as well as the Mikulich clamp for capturing the peritoneal wall of the peritoneum and fixing it with sterile underwear. B. Pommels: elastic( straight, curved) and crushing;Linen hoes and skirts of the warehouse;

• Leaders - curved and straight. In addition, there are a number of instruments used for individual operations: the hemorrhoidal terminal clamp( Luer's clamp), the fixing bone forceps Farabeuf Olie, the clamp of the Fedorov's kidney foot, the hepatic clip of Israel, and so on.

3. Tools designed to expand natural holes and dilute the edges of the wound, improve access and hold in a certain position. To this end, they apply:

• surgical hooks: cogged, wire, plate( two-tooth, three-tooth and four-tooth hooks).The size of the hooks is related to their purpose: miniature hooks are used for cosmetic operations, hooks of large size are used for cavity operations, hooks in the form of a double blade are hooks of Farabeuf and Langenbeck, as well as hepatic and renal hooks. Hooks with working parts of a saddle shape are called mirrors( mirror Fritsch, Duaena);

• retractors, by which the edges of the wound are retained without the help of the surgeon's hands;they are lock, ring, tracheotomy according to the Tissue, rack and pinion, and others;

• Expander, mirrors for widening the anus of Subbotina and Simsa.

4. Tools for protecting tissues from accidental damage - gaunt probe, Kocher probe, Buyalsky's spatula, Reverden's shoulder blade, bellied probe.

5. Tools for connecting fabrics:

• Needles: straight, semi-curved, curved( with a small curvature - 120 ° bend and a large curvature - 180 ° bend).Curved needles are convenient for sewing tissues in the depth of the wound, straight needles are used to sew soft tissues.

The needles are distinguished on the cross-section by:

a) round needles;produce straight and curved 180 °;

b) trihedral needles are only curved, can be gynecological( № 2-8);thick;surgical № 1-8( thin) and ocular( № 1-3);

c) flat needles - special needles for the liver, which in shape can be curved, semi-curved, straight.

By the shape of the eyelet, the needles can be mechanical, semi-automatic. Atraumatic needles do not have an ear. Ligature needles - needles, with which the ligature thread is carried under a blood vessel for the purpose of dressing;Cooper's needle, Deshana's needle, vascular needles for ligation of the lung's root, Bogush's probe-needle.

Needle holders for fixing needles: needle holder with curved handles Mathieu, vascular needle holder Geghar, needle holder of Troyanov. The connecting instruments include the Ilizarov apparatus, various rods and "nails" for fixing bones.

6. Apparatus for mechanical seam:

• apparatus for applying a vascular seam;

• blood vessel stitcher with a knife - designed for simultaneous suturing of vessels with their intersection;

• appliance for the application of pouch seams - for suturing the stump of the duodenum, small intestine and dome of the cecum;

• device for applying esophageal intestinal anastomosis serves for one-stage stitching with a round seam of the esophagus with a gut or stomach with simultaneous formation of an anastomosis;

• tissue and organ scraper is used for applying double-row and double-deck stitches during resection of the stomach, small and large intestine, lung tissue;

• sternum and rib stitching machine.