Surgical Instruments

Medical and Surgical Instruments for Nursing

Surgical Instruments

Definition

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.

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:

cutting, grinding, and dissecting

clamping
grasping and holding
probing
dilating or enlarging
retracting
suctioning

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.