# Presentation: 524008

## Module 4

- Surgical
- Instrumentation

**Notes:**
Instructor Notes 
This module covers the types of instrumentation with which the SPD technician must become familiar. The intent is to provide an overview and establish a framework for the technician to build on as s/he gains experience and becomes more familiar with the various instrumentation.

Learning activities:
This module is dependent upon hands-on sessions. You will need a supply of instrumentation. If the local facility is conducive to it, you may want to conduct this module in the prep area so that examples of each device are readily available. While it is possible for technicians to learn characteristics from descriptions and pictures, true familiarity can only be achieved by repeated handling of the actual instruments.
It is recommended that each medical center construct a pictorial job aid for use in assembling surgical instrument sets. If these are available, they can be used to supplement the hands-on sessions. 

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
How much do surgical instruments cost?
Who is responsible for them?
Why are there so many different sets?
What is a loaner set?

## At the end of this module you should be able to ... 

Label basic instruments and identify their use.

Demonstrate proper placement of instruments for trays, sets, containers, and stringers.

Identify processing, handling, and testing procedures for basic surgical instruments.

**Label basic instruments and identify their use.**
**Demonstrate proper placement of instruments for trays, sets, containers, and stringers.**
**Identify processing, handling, and testing procedures for basic surgical instruments****.**

**Notes:**
Instructor Notes 
Review the instructional objectives
Mention the online course  (**insert URL) and that the objectives are the same.

## Surgical Instruments

**Highly specialized, finely crafted**
**Major investment for Medical Centers**
**Require special handling and care**
**SPD responsibility includes;**
**cleaning, testing, **
**checking for damage, assembling,**
**packaging, and sterilizing**

**Notes:**
Instructor Notes 
The emphasis for this slide (and this module) is the importance of the surgical instruments to patient care and the critical need to keep them in good shape, functioning properly, and free from germs.

Learning activities:
Information regarding cost and life expectancy of individual items can be useful for impressing the value of this work.
You might mention a specific item on a fictional hospital bill—and then trace it’s path to the O.R. suite—mentioning the steps in the process and the number of people who might have interacted with the device.
If the cost seems exorbitant, talk briefly about the cost of NOT having it or not having it in working order (infection and death can result).

Points for Discussion
Where does SPD responsibility end? (it doesn’t)
Why make such a big deal—isn’t this routine? I mean, it’s what we do?
Which step in the process is most critical or important?

## 3 COMMON TYPES

**Endoscopic**

**Powered**

**Handheld**

**Notes:**
Instructor Notes 
Introduce each of the types; Handheld, Endoscopic, and Powered—later slides will cover each type in detail.
Supplies may vary between medical centers, depending on the type of work/patient they have, but the basic categories are the same. The technician’s responsibility is to recognize the different types, be familiar with local requirements for processing, and know where to look/ask if he has to process something unfamiliar.

Learning activities:
Talk briefly about each type, then use the following slides to go into detail about how to handle each one.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.

## Handheld Instruments

**Hemostatic Forceps**

**Soft Tissue Ring Forceps**

**Soft Tissue Thumb Forceps**

**Notes:**
Instructor Notes 
Handheld is the largest and most common group. For each subset, discuss the functionality and use, guidelines for processing, what to look for when inspecting, and any cautions or special considerations.
Learning activities:
Assemble an assortment of each type. As you present them, hold them up and point out features. Pass them around for the students to handle and compare. If time and space allow, set up a lab (possibly over lunch or overnight).  Assemble a set of the instruments specified in the manual. Place tags on them with the name and function. Arrange them on tables with the tag face down. Allow students to try to identify them, checking their answers by consulting the tags. You may also let them work in pairs or small groups, quizzing each other.
If picture job aids are available, have students assemble a set using the picture guide. Review their work as a class, commenting on common errors (and adding any “hints” for telling specific instruments apart).
Demonstrate testing and inspection techniques.
Points for Discussion
Use the following questions to guide classroom discussion.
For each type ... What is this used for?
What do you need to check when cleaning it?
How would you process this?
How would you package it for sterilization?

## Handheld Instruments

**Needle Holders**

**Scissors**

**Retractors**

**Miscellaneous**

**Notes:**
Instructor Notes
See previous slide

Learning Activities
See previous slide

Points for Discussion
See previous slide

## Handheld Composition

**Components**

**Notes:**
Instructor Notes 
Recognizing the instrument components and knowing how they work and what to look for are critical to successful processing.

Learning activities:
Use individual instruments to compare and contrast. Illustrate how the box locks and spring handle work.
Again—this is a hands-on activity. The more students handle the instruments, the more familiar with them they will become.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
What is this called?
What is most likely to go wrong with this instrument?
How is this instrument different from the one we just discussed?

## Handheld Composition

**Materials**
** ****Stainless steel**
** ****Titanium Alloy**
** ****Copper**
** ****Brass**
**Finishes**
** ****Mirror**
** ****Satin**
** ****Matte**
** ****Ebonized**
**Electroplating**

**Notes:**
Instructor Notes 
Instruments come in a variety of types, materials, colors, and finishes. The same instrument by two different manufacturer’s may have different appearances.

Learning activities:
Show examples of each type and discuss the pros and cons of each.
Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
What is the advantage of a patina?
What are ebonized instruments used for? Why is this important?
Can you repair a damaged electroplated finish?

## Handheld Composition

**Floor Grade**
**O.R. Grade**

**Notes:**
Instructor Notes 
Emphasize the cost factor involved in the selection of instruments.

Learning activities:
Display both types. Pass them around for examination by the students.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
Why can’t floor grade and O.R. grade be processed together?
How can you tell them apart?

## Cleaning and Decontamination

-  Safe transport
-  Cleaning and
-   Decontamination
-  Inspection
-  Repair or Replacement
-  Assembly
-  Packaging
-  Sterilization
-  Storage

**Notes:**
Instructor Notes
This slide summarizes the associated sections in the manual.
Talk about the requirements for each stage.
Emphasize how to handle instruments and DOs and DON’Ts

Learning activities
Hold up individual instruments and ask students what to look for when inspecting them and how to clean them.
This section is intended as an overview of the decontamination, packaging and sterilization process, they are covered in detail in Modules 3, 5, and 6.
Demonstrate the method for testing needle holders and scissors.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
How is instrument repair handled in this facility?
How are repairs tracked? Why is this important?
How are decisions made about the contents of instrument sets?
If something needs to change in a set, how is it accomplished?

## Staining and Corrosion

**Causes of deterioration :**
- Blood
- Saline
- Mercury bichloride
- Phenol
- Mercury salts
- Potassium thiocyanate
- Ferrous chloride
- Hydrochloric acid
- Iodine
- Aluminum chloride
- Barium chloride
- Calcium chloride
- Blood
- Carbolic acid
- Chlorinated lime
- Dakin's solution

- Types of stains and possible causes:
- Rust colored
- Bluish gray
- Purple-black
- Corrosion/rust
- Pitting

**Notes:**
Instructor Notes
Review the different types of staining and corrosion.

Learning activities
If possible, show examples.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
Why do you need to know what caused staining or corrosion?

## Endoscopic Equipment

- Rigid
*gastroscope, cystoscopes, resectoscopes, laparoscopes, and arthroscopes*
- Flexible
*esophogusgastroduodenum (EGD) scopes, bronchoscopes, sigmoidoscopes, and colonoscopes*

**Notes:**
Instructor Notes
Endoscopes are some of the most complex and most costly equipment that technicians must process, and doctors depend upon them to guide patient care decisions, so there is no room for error in their processing.

Learning activities
Bring in an example of a rigid and a flexible endoscope, preferably in its case or container. Walk through the cleaning and decontamination process, highlighting difficult to clean areas and common errors.

The online course contains a printable job aid for cleaning endoscopic equipment. You may want to print it out or refer them to the URL.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
What does it mean if you see black spots through the light channel?
What if you see a crescent or half moon?What should you do about it?
What should you do if you have to clean a scope that you have not dealt with before?
How do you learn about new equipment in this facility? Are there in-services?
Where are the manuals stored?
What is the EtO cap for?
Why is it important to thoroughly dry the scopes?

## Endoscopic Equipment

- Always follow the manufacturer's recommendations
- DO NOT
- autoclave telescopes or resectoscopes.
- bend, drop, or pile instruments on top
- use ultrasonic cleaning (it tends to loosen optical cement from the lens)
- forget to lubricate stopcocks or moving parts with silicone lubricant
- use alcohol often, it may cause the glass to appear scratched.

**Notes:**
Instructor Notes
It is critical that students develop a respect for the complexity and value of these instruments.

Learning activities
Bring in a few manuals or manufacturer’s instructions. Go over some of the cautions and discuss their meaning and rationale.
Talk about each “DON’T” and why it is important.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
Why do you have to use care with solutions around Endoscopic equipment?
What should you do if pieces appear missing or damaged?
How often should equipment be lubricated?

## Endoscopic Equipment

- Check for clear vision
- Inspect the cover glass for cracks or chips
- Dry thoroughly before EtO sterilization
- Coordinate with O.R. staff to ensure adequate equipment is available for scheduled procedures

**Notes:**
Instructor Notes
While you can’t take the time to go over the procedure for every scope that the medical center owns, you can walk through general steps and precautions. It helps if you can use actual equipment to reinforce your points.

Learning activities
Talk about what to do.
Discuss the difficulties inherent in maintaining expensive, complex equipment that is in high demand.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
What should you do if a particular piece of equipment is constantly being requested and there isn’t time to process it?
Why is drying important?
What should you do if the glass or filament seems damaged?

## Powered Equipment

- Power sources:
- Electrical
- line current or battery
- Pneumatic or air powered
- compressed medical gasses such as carbon dioxide, nitrogen, or compressed air
- NEVER immerse
- Clean according to manufacturer’s directions
- Older instruments may require lubrication

**Notes:**
Instructor Notes
Equipment types and models may vary among medical centers. Familiarize yourself with the power equipment that is available in this facility.
It may include reamers, drills, screwdrivers, and saws.
Craniotomes, drills, and perforators are used by neurosurgeons. Dermatomes are used by plastic and general surgeons to take skin grafts, and sternal saws are used by thoracic surgeons to cut the sternum.

Learning activities
Stress safety issues like removing the power source and handling bits and blades with care.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
What types of power equipment are you familiar with?
How do you test them?
How do you keep all the accessories together?

## Powered Equipment

- Attachments
- May be processed like stainless steel surgical instruments
- Always remove before processing
- Include
- chucks
- chuck keys
- burr guards
- hudson and trinkle adapters
- wrenches

**Notes:**
Instructor Notes
The tool without the proper bits or blades, is useless. SPD has a responsibility to manage and track equipment accessories.
Containers or cases can be helpful for this purpose.

Learning activities
Discuss the local procedure for ensuring that attachments stay with the original equipment and the difficulties associated with cleaning these items.

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
What should you do if a bit or blade is missing?
What should you do if an attachment is damaged?
What if it won’t release from the tool?

## New Technology

**Rapidly changing**
**Difficult and expensive for medical centers to keep up with**
**Often instrumentation is loaned by manufacturer**

**Notes:**
Instructor Notes
Discuss the rapid change in technology over the past few years.
Determine the local policies on loaner equipment.

Learning activities
Review the requirements for processing loaner equipment

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.
How does a loaner program benefit both the medical center and the supplier?
What do you do differently for loaner equipment?
Who is responsible for making sure all pieces are returned?
What do you do if loaner equipment seems to be non-functional?

## Summary

**Surgical Instrumentation**
**Varied and complex**
**Expensive and requires special handling**
**Requires communication with O.R. staff **
**SPD responsible for all processing**
**Continuously changing **
**Requires ongoing training**

**Notes:**
Instructor Notes
The biggest challenge to learners in this module is the variety and complexity of the equipment they are asked to be familiar with. Recognition and proper procedures must be built over time. Encourage the medical center to hold in-service sessions to review processing requirements and to introduce new equipment.

Learning activities
Briefly review the important points of this module.
Ask if there are any questions.
Ask students to share their challenges or what they found most difficult about learning all the different instrumentation. Encourage more experienced students to share tips that they found useful.

Points for Discussion
Is some material better than others? 
What determines what you use?

## What type of instrument is each of these?

**Needle Holder**

**Soft Tissue**
** ****Thumb Forceps**

**Retractor**

**Retractor**

**Notes:**
Instructor Notes 
The slides are designed to display the question first and then fly in the answer on mouse click. You may want to keep track of students questions that recur in order to reinforce them in the next session.

Learning activities:
You can decide how you want to use the review questions:
 Assign them as homework
 Break the class into small groups and have them answer together (or to save time give each group a subset of the questions)
 Project them and solicit verbal answers from volunteers
Strongly recommend that the learners make notes regarding the correct answers (the questions are tied directly to the learning objectives and therefore to the certification test).

Points for Discussion
Use the questions to review and reinforce module content and correct any misconceptions.

## Match the picture to the name.

**Needle Holder**

**Hemostatic**
** ****Forceps**

**Soft Tissue**
** ****Ring Forceps**

**Soft tissue**
**Thumb Forceps**

**Notes:**
Instructor Notes 
The slides are designed to display the question first and then fly in the answer on mouse click. You may want to keep track of students questions that recur in order to reinforce them in the next session.

Learning activities:
You can decide how you want to use the review questions:
 Assign them as homework
 Break the class into small groups and have them answer together (or to save time give each group a subset of the questions)
 Project them and solicit verbal answers from volunteers
Strongly recommend that the learners make notes regarding the correct answers (the questions are tied directly to the learning objectives and therefore to the certification test).

Points for Discussion
Use the questions to review and reinforce module content and correct any misconceptions.

## JAWS

**JAWS**

**FINGER RING**

**RACHET**

**SHANK**

**SCREW**

**BOX LOCK**

**Notes:**
Instructor Notes 
The slides are designed to display the question first and then fly in the answer on mouse click. You may want to keep track of students questions that recur in order to reinforce them in the next session.

Learning activities:
You can decide how you want to use the review questions:
 Assign them as homework
 Break the class into small groups and have them answer together (or to save time give each group a subset of the questions)
 Project them and solicit verbal answers from volunteers
Strongly recommend that the learners make notes regarding the correct answers (the questions are tied directly to the learning objectives and therefore to the certification test).

Points for Discussion
Use the questions to review and reinforce module content and correct any misconceptions.

## The advantage of a mirror finish is:
It does not spot or discolor easily
It is easier to clean a matte finish
Mirror finishes are less expensive to produce
Mirror finish helps illuminate the work area

- It does not spot or discolor easily
- It is easier to clean a matte finish
- Mirror finishes are less expensive to produce
- Mirror finish helps illuminate the work area

**Notes:**
Instructor Notes 
The slides are designed to display the question first and then fly in the answer on mouse click. You may want to keep track of students questions that recur in order to reinforce them in the next session.

Learning activities:
You can decide how you want to use the review questions:
 Assign them as homework
 Break the class into small groups and have them answer together (or to save time give each group a subset of the questions)
 Project them and solicit verbal answers from volunteers
Strongly recommend that the learners make notes regarding the correct answers (the questions are tied directly to the learning objectives and therefore to the certification test).

Points for Discussion
Use the questions to review and reinforce module content and correct any misconceptions.

## An ebonized finish is a non-glare surface primarily used for: 

Microsurgery
Neurosurgery
Laser Surgery
General Surgery

- Microsurgery
- Neurosurgery
- Laser Surgery
- General Surgery

**Notes:**
Instructor Notes 
The slides are designed to display the question first and then fly in the answer on mouse click. You may want to keep track of students questions that recur in order to reinforce them in the next session.

Learning activities:
You can decide how you want to use the review questions:
 Assign them as homework
 Break the class into small groups and have them answer together (or to save time give each group a subset of the questions)
 Project them and solicit verbal answers from volunteers
Strongly recommend that the learners make notes regarding the correct answers (the questions are tied directly to the learning objectives and therefore to the certification test).

Points for Discussion
Use the questions to review and reinforce module content and correct any misconceptions.

## What is the recommended pH level of detergent for cleaning handheld instruments?

**pH of 6 - 8**

**Notes:**
Instructor Notes 
The slides are designed to display the question first and then fly in the answer on mouse click. You may want to keep track of students questions that recur in order to reinforce them in the next session.

Learning activities:
You can decide how you want to use the review questions:
 Assign them as homework
 Break the class into small groups and have them answer together (or to save time give each group a subset of the questions)
 Project them and solicit verbal answers from volunteers
Strongly recommend that the learners make notes regarding the correct answers (the questions are tied directly to the learning objectives and therefore to the certification test).

Points for Discussion
Use the questions to review and reinforce module content and correct any misconceptions.

## What should you do when inspecting a soft tissue forceps?

- Check for proper jaw alignment, proper tension, freely moving box locks.

**Notes:**
Instructor Notes 
The slides are designed to display the question first and then fly in the answer on mouse click. You may want to keep track of students questions that recur in order to reinforce them in the next session.

Learning activities:
You can decide how you want to use the review questions:
 Assign them as homework
 Break the class into small groups and have them answer together (or to save time give each group a subset of the questions)
 Project them and solicit verbal answers from volunteers
Strongly recommend that the learners make notes regarding the correct answers (the questions are tied directly to the learning objectives and therefore to the certification test).

Points for Discussion
Use the questions to review and reinforce module content and correct any misconceptions.

## How do you test a needle holder?

- Place a piece of suture (2-0 silk) in the tip and close it to the first ratchet. Lift the suture. The needle holder should remain securely attached.

## When arranging an instrument set to be wrapped and sterilized, what is the proper order?

-  Large items on bottom
-  Stringed instruments on top
-  Ring handled open

**Notes:**
Instructor Notes 
Click for next slide to display the answer.

Learning activities:

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.

## Gastrointestinal scopes	
Colonoscopes 	
Laparascope
Hysteroscope
Sigmoidoscopes 
Arthroscopes	
Resectoscopes

**Colonoscopes ****	**
**Laparascope**
**Hysteroscope**
**Sigmoidoscopes **
**Arthroscopes****	**
**Resectoscopes**

- Which of the following are
-  flexible endoscopes?

**Notes:**
Instructor Notes 

Learning activities:

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.

## Gastrointestinal scopes	
Colonoscopes 	
Laparascope
Hysteroscope
Sigmoidoscopes 
Arthroscopes	
Resectoscopes

**Colonoscopes ****	**
**Laparascope**
**Hysteroscope**
**Sigmoidoscopes **
**Arthroscopes****	**
**Resectoscopes**

- Which of the following are rigid endoscopes?

**Notes:**
Instructor Notes 

Learning activities:

Points for Discussion
Use the following questions to guide classroom discussion during the presentation of the module.