Introduction to instruments

Introduction

When undertaking a scrub role for the first time, a tray of surgical instruments can be a daunting vision for the scrub practitioner. This article aims to introduce instrument types, their uses, care, and general points to consider.

Instrument trays

Most operating departments are supplied with sterile trays and supplementary instruments from a central sterilisation unit. These are usually named according to their intended use and surgical speciality, such as a basic laparotomy set or minor orthopaedic set.

Instrument trays are provided in a variety of ways:

Edinburgh pre-set tray system

modified pre-set tray system

separate drape and instrument sets.

The pre-set systems contain instruments, drapes, swabs, gallipots and receivers. This approach saves time for the scrub and circulating practitioner, as everything is to hand from the one tray.

Separate instrument trays and drapes are used frequently where disposable or re-usable drapes are delivered sterile, directly from companies.

Instrument types and uses

Instruments can be divided into six broad categories:

sharps/ cutting instruments

haemostatic forceps (artery forceps)

clamps

grasping/ holding

retractors

accessory instruments.

The sharps category includes scalpels used to incise and dissect. Most scalpel handles require attachment of a disposable prepacked sterile blade. Scissors are used for dissection and cutting of surgical materials such as sutures. Scalpel blades and scissors are available in a wide variety of sizes, dependent on their intended use; for instance, long handled Nelson scissors may be used during a laparotomy or long Bard Parker handle scalpels for clearing the acetabulum in joint replacement surgery.

Haemostatic (artery) forceps are used to achieve haemostasis. They have serrated jaws, are ring handled with a ratchet lock to allow varying degrees of pressure to be applied, with either a curved or straight tip. The names and sizes of the instrument, depend on the type of tissue they should be used for and the depth of surgery being undertaken. Artery forceps are also commonly used for blunt dissection, and tagging of sutures or swabs in large body cavities. Examples of artery forceps commonly used are Mosquitos, Spencer-Wells and Roberts.

Clamps are used in a variety of surgical specialities, each type specifically designed for...