Storage of surgical instruments

Tools should be stored in a dry, heated room at a temperature of 15-20 ° C.Formaldehyde, iodine, chlorine lime, i.e.substances whose vapors cause corrosion of metals.

Tools for current use are laid out in cabinets by type and purpose. Scalpels are placed on supports, since their blades should be on weight.

For long-term storage and transport, tools made of carbon steel should be lubricated with neutral petrolatum or covered with paraffin.

The lubricant is immersed in molten petrolatum at a temperature of 60-70 ° C.The lubricated tools are wrapped in a thin waxed paper. Tools made of stainless steel, aluminum, brass, bronze are not subject to lubrication. Before lubrication, the tools are thoroughly degreased or boiled in water with soap and soda, washed with water, dried and inspected for lack of traces of rust. This work is carried out in gloves, as touching the tools with sweaty hands contributes to the appearance of rust. It is impossible to lubricate the greased tools with petroleum jelly, it is first necessary to remove the rust by polishing the tool.

Processing of tools received from the warehouse.

The tools received in the package in the winter, in order to avoid fogging, are kept for several hours without unpacking. After removing the waxed paper, clean the instruments with clean soft gauze napkins and disassemble each on a separate napkin, so as not to confuse parts from various tools when disassembling. The disassembled parts are washed with hot water, cleaned of vaseline residues and immersed for 1 hour in ethyl alcohol. Degreased parts are wiped dry with napkins and collected, after which the tool is ready for sterilization.

The sterile instruments are laid out by the sister depending on the type of operations.

An exemplary set of tools for the most typical operations.

1. The total kit required for any operation:

• the pins for strengthening the operating underwear - 8 pcs.;

• scalpels - 4 pieces;

• tweezers: surgical - 4 pcs., Anatomical - 2 pcs., Pawed - 2 pcs., Anatomical long - 1 pc.;

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

• Cooper shears - 3 pieces;

• Richter scissors - 1 piece;

• straight scissors - 1 piece;

• sharp three-tooth hooks - 2 pcs.;

• Farabefe hooks - 2 pcs.;

• Langenbeck hooks - 2 pieces;

• Blade Buyalsky - 2 pieces;

• Deshana needles - 2 pcs.;

• gutter probe - 1 unit;

• button probe - 1 pc.;

• spoon sharp Volkmann - 1 piece;

• lead straight and curved - 2 pcs.;

• Needle holders - 2 pcs.;

• round needles - 10 pcs.;

• syringes and needles for them of different sizes - 5 pcs.;

Tools required for abdominal and abdominal surgery.

Kit for cholecystectomy:

• general surgical set ;

• Fyodorov's clamp - 1 piece;

• Mikulich clamps - 10 pieces;

• retractors( abdominal mirrors) 2 pcs.

Set for resection of the stomach:

• a common set;

• abdominal mirrors - 4 pcs.;

• Mikulich clamps - 10 pieces;

• intestinal pulp - 4 pieces;

• Peara pulpwood - 2 pcs.(large and small).

When applying anastomoses on the esophagus, stomach and intestines, the use of machines for the mechanical seam is the most aseptic, since the lumen of the gut remains closed at the time of application of the anastomoses. In addition, there is no need to use suction and impose on the organ wall clamps that can lead to a violation of blood circulation in the operation area. The application of a mechanical seam ensures a reduction in the duration of the operation, its safety, allows expanding the amount of interventions on the gastrointestinal tract and producing them in weakened patients.

Set for operations but for hemorrhoids:

• a common set;

• rectal mirror - 1 piece;

• the final hemorrhoidal clamps - 5 pcs.; • Langenbeck hooks.

Instruments for urological operations.

The standard set includes urological instruments, which is associated with the release of urine into the wound during surgery. In this regard, often it is necessary to drain the cavities of the urinary organs or wounds, leaving them drainage tubes, sometimes for a long time. However, it is often necessary to bougie the ureter, the urethra, by various species of buzha.

• common set;

• catheters with an inflatable balloon - 2 pcs.;

• ureteral catheters - Janet syringe - 1 unit;

• metal curved bougies of different sizes;

• retractors for the bladder, kidney leads - 2 pcs.;

• spoon for extraction of stones from the bladder - 1 pc.;

• ureter holder - 1 piece;

• boomerang needle holder for suturing in the depth of the wound;- clip for the kidney foot - 2 pcs.

Gynecological operations:

• general surgical set;

• metal catheter;

• abdominal mirror of Pfannenstiel.

With a possible reinfusion of blood from the abdominal cavity, a measuring cup with a capacity of 1-2 liters and a scoop is required.

Instruments used for pulmonary surgery:

• General kit;

• fork bend for ligature bent - 1 pc.;

• dissector with a cremalier of different sizes - 1 set;

• dissector with blade - 1 piece;

• straight dissector without a cremator 21 cm - 1 pc.;

• Bronchial clamps - 1 set;

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

• clip for the kidney foot - 2 pcs.;

• a large heart mirror - 1 pc.;

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

• the needle for biopsy bias is curved;

• needles from pleuroascheria - 2 sets;

• Injection curved needles - 10 pcs.;

• tracheostomy tubes of different sizes - 4 pcs.;

• Kocher probe - 1 piece;

• Needle of Deschan - 1 piece;

• sterile tracheostomy cannula - 1 pc.;

• Mosquito clamps - 15-20 pieces;

• clamps of Kocher, Billroth - 20 pieces;

• thin rubber drainage - 2 pcs.;

• three-way valves from pleuroasciter - 2 sets;

• cutting pliers for I edge - 1 piece;

• universal cutting pliers - 1 pc.;

• Spoon for taking biopsy straight and curved - 1 set;

• spatula for dividing tissues - 1 piece;

• blunt scissors - 1 piece;

• a knife-raspator for removal of cartilage from the bronchus - 1 unit;

• surgical tweezers 25 cm - 2 pcs.;

• anatomical forceps 25 cm - 2 pcs.;

• lift for the blade - 1 piece;

• retractor for the thoracic cavity rake large - 1 pc.;

• Raspator for I edge - 1 piece;

• flexible turnstile - 1 piece;

• forceps for grasping the lungs straight - 3 pcs.;

• Forceps for capturing the lung curved -3 pcs.;

• pliers for gripping the pleura - 1 pc.

Set for tracheostomy:

• common set( without intestinal needles);

• tracheostomy tubes of different sizes - 4 pcs.;

• sharp single-toothed hooks - 2 pcs.;

• Trusso expander - 1 piece;

• thick rubber catheter - 1 pc.;

• Tracheal catheter - 1 piece;

• electric pump with sterile catheter.

Toolkit for Injured Hernias:

• Generic set;

• pulmonary intestinal elastics straight;

• intestinal cysts elastically curved - 4 pcs.;

• crush crumbs - 2 pcs.;

• retractors( abdominal mirrors) - 2 pcs.;

• intestinal needles - 6 pieces.

Set for amputation:

• common set( without intestinal needles);

• Rubber harness - 1 piece;

• Amputation knives - 2 pieces;

• Retractor - 1 piece;

• Straight straightener - 1 piece;

• curved bender - 1 pc.;

• Saw arc - 1 piece;

• Folkman spoon - 1 piece;

• Cutters of Sheeton - 1 piece;

• fixing tongs.

Set of tools for trepanation of the skull:

• a common set;

• Straight straightener - 1 piece;

• curved bender - 1 piece;

• straight bit - 1 piece;

• chisel - 1 piece;

• hammer - 1 piece;

• Cutters of Sheeton - 1 piece;

• Daggran nippers - 1 piece;

• with 1 set of milling cutters;

• cerebral spatula( elevator) - 1 piece;

• Sterile rubber cylinder( pear) 1 pc.

Instrument delivery to the surgeon.

Should be fast, timely and technically correct. Speed ​​is achieved by work experience and skill.

There are three ways to apply tools:

• in the hands of a surgeon;

• on the instrument table;

• combined.

1. Filing instruments in the hands of a surgeon is the most perfect method, since it completely frees the surgeon from unnecessary actions not related to work in the operation area. This method is good due to the fact that it is easier for the operating sister to keep order and cleanliness on the instrument table. However, the most difficult, because it requires great rapidity, a clear knowledge of the progress of the operation. A complete harmony with the surgeon and knowledge of all the details of the technique, which is notable for different surgeons, is necessary.

Scalpel delivery: the scalpel is handed to the surgeon by the handle, the nurse holds it by the neck and blade with a small napkin, with the blunt edge of the scalpel facing toward her palm.

The supply of scissors, clamps, hooks is carried out in closed form by rings from itself.

Needle holder feed. The needle holder is fed so that the surgeon can with the same hand grab the long end of the thread or the long end of the thread the sister keeps tweezers on the weight so that it does not swirl around the needle holder. Suture feed: threads without needles are fed with tweezers. Touch the thread with your hands as little as possible to avoid infection. Its length is determined by the type of the seam: for a continuous seam, take a thread 40-45 cm long, for surface nodal seams - 18-20 cm, for seams applied in the depth of the wound - 25-30 cm. A thread of the same length is used for the sutured suture. Catgut should be taken a little longer than a silk thread, as it slips when tying.

Silk No. 1-2 is used for the intestinal suture, No. 0 for the seam of vessels and nerves, No. 4-6 for the aponeurosis, the skin is sewn with silk No. 3-4.Muscles, as a rule, sew catgut.

Before feeding, the tensile strength of the yarns must be checked.

Selection of needles with curvature and thickness:

• on the parietal( parenteral peritoneal leaf), the seam is applied using a round( intestinal) curved needle;

• on the intestinal wall or stomach - a straight round needle;

• single-use atraumatic needles are used for the vascular suture;

• for sewing muscles and aponeuroses give cutting( trihedral) curved needles;

• For seaming at great depth, in a tight space, use a needle with a large curvature and a long ligature.

2. Feeding tools to the instrument table.

The operating sister places the required

tool and material set on the instrument table, the surgeon takes the necessary tools from the table during the operation. The nurse maintains order on the table, serves ligatures, threads the needles into needles. This method is more appropriate to use in purulent operations, so as not to pollute the large instrument table.

3. The combined method combines the two methods described above.

In less difficult time, the surgeon takes the tools himself( lie at hand).Tools that require training( syringes, needle holders) are filed by the sister. It is necessary to ensure that each used instrument and already unnecessary at the moment is again placed on the instrument table. Do not allow the accumulation of tools on the sheets, near the operating wound. Each returned instrument must be immediately rubbed with gauze, otherwise bacteria can be left on the bloody surface from the air, the blood will wither and it will be difficult to remove it. In case of a single use, the instrument is either immediately discarded after application, or it, after being applied to the tissue, remains until the end of the operation. Repeatedly use those tools that are needed throughout the operation - scalpels, scissors, some types of clips.

The nurse must monitor not only the cleanliness of the returned tools, but also their serviceability. The needle holder should be checked carefully for needle presence.

Possible errors when feeding tools.

1. Incorrect ligation for the joint:

• if the thread is too long, it becomes entangled and prevents the surgeon from tying;if short - makes it difficult to tie it;

• inserting a thick thread into a thin needle. The needle may become stuck in the tissue, tear it, and if the thin thread is threaded into a thick needle, then the thread may slip from the eyelet when sewing;

• supply of loose ligature, which breaks when tied. Therefore, each ligature, especially when dressing the vessel, should be checked for strength, rupture;

• Insertion of the ligature into the eye of the needle with the ends of the same length. In this case, to make one end short, you have to stretch the thread, as a result of which it will be broken and can break when sewing or tying.

2. Incorrect tool feed.

• feeding the cutting needle instead of the round needle when applying a seam to the intestinal or gastric wall;

• supply surgical tweezers instead of anatomical. The surgeon, without noticing this, can damage the organ, for example, the gut.

3. A gross mistake is the use of small balls and napkins in cavitary operations.

4. A dangerous mistake of the operating sister is the lack of information about the number of instruments, napkins, tampons on the table before surgery. This is necessary in order not to leave foreign objects in the wound( especially, in operations on the organs of the abdominal and thoracic cavity).The rule should be observed: before sewing the cavities, the sister counts the instruments, tampons, napkins, reports to the surgeon that the count is made, the number of them before the operation and after it coincides. In order not to leave a foreign body, for example, in the abdominal cavity, a number of adaptations are used-from the simplest ones( attaching a tampon clip to the sheet) to the most complicated ones-special holding devices. Whichever method is used, the important is the rule - strict accounting.