Surgical Instruments A Deaver retractor (manual) is used to retract deep abdominal or chest incisions. Available in various widths.

. A Richardson retractor (manual) is used to retract deep abdominal or chest incisions An Army-Navy retractor (manual) is used to retract shallow or superficial incisions. Other names: USA, US Army. A malleable or ribbon retractor (manual) is used to retract deep wounds. May be bent to various shapes.

Cutting and Dissecting Instruments Straight Mayo scissors - Used to cut suture and supplies. Also known as: Suture scissors. Curved Mayo scissors - Used to cut heavy tissue (fascia, muscle, uterus, and breast). Available in regular and long sizes. Metzenbaum scissors (A) - Used to cut delicate tissue. regular and long sizes. Available in

Clamping and Occluding Instruments A hemostat is used to clamp blood vessels or tag sutures. Its jaws may be straight or curved. Other names: crile, snap or stat. A mosquito is used to clamp small blood vessels. straight or curved. A Kelly is used to clamp larger vessels and tissue. and long sizes. Other names: Rochester Pean. Available in short Its jaws may be

 A burlisher is used to clamp deep blood vessels. closed finger rings.

Burlishers have two

Burlishers with an open finger ring are called

tonsil hemostats. Other names: Schnidt tonsil forcep, Adson forcep. A right angle is used to clamp hard-to-reach vessels and to place sutures behind or around a vessel. A right angle with a suture attached is called a "tie on a passer." Other names: Mixter. A hemoclip applier with hemoclips applies metal clips onto blood vessels and ducts which will remain occluded.

Grasping and Holding Instruments (Are used to hold tissue, drapes or sponges.)

An Allis is used to grasp tissue. Available in short and long sizes. A "Judd-Allis" holds intestinal tissue; a "heavy allis" holds breast tissue. A Babcock is used to grasp delicate tissue (intestine, fallopian tube, ovary). Available in short and long sizes. A Kocher is used to grasp heavy tissue. May also be used as a

clamp. The jaws may be straight or curved. Other names: Ochsner. A Foerster sponge stick is used to grasp sponges. sponge forcep. A dissector is used to hold a peanut. A Backhaus towel clip is used to hold towels and drapes in place. Other name: towel clip. Pick ups, thumb forceps and tissue forceps are available in various lengths, with or without teeth, and smooth or serrated jaws. Other names:

 Russian tissue forceps are used to grasp tissue. DeBakey forceps are used to grasp delicate tissue, particularly in cardiovascular surgery. Adson pick ups are either smooth: used to grasp delicate tissue; or with teeth: used to grasp the skin. Other names: Dura forceps. Bone file- smoothing bone Parkes rasp-cutting bone Mini-Liston bone cutting forceps- cutting bone

Tasks and Responsibilities of the Nurse: SCRUB NURSE Pre-operative Responsibilities 1. Assist with the preparation of the room for the designated surgical procedure, including gathering supplies for the procedure. 2. Scrub, dry hands, gown, and glove. R. To promote sterility. 3. Assist person scrubbed in first position with: Setting up back table, mayo, and basins Arrangement of instruments Preparation of suture and needles Preparation and counting sponges Arrangement and preparation of other necessary items Gowning and gloving surgeon and assistants Assist with draping Arrangement of sterile field

Intra-operative Responsibilities 1. During the procedure, progress from double-scrubbed position. Train self to keep eyes on field, and learn steps of procedure. 2. Begin developing methods of anticipating needs of surgeon and assistant. After closing the skin: Assist with care of instruments and counts if necessary Care of specimen Assist with dressing of wound Post-operative Responsibilities 1. After the completion of the Procedure: Assist with the gathering of all materials used during the procedure Discard items as necessary being careful to discard sharp items in designated places Return all items to respective area Assist with cleaning of room Clean the materials used properly and arrange them after drying 2. Perform any duties which will speed up the surgical procedure to following in that room.

CIRCULATING NURSE Pre-operative Responsibilities 1. Care for the patient before surgery by: Greeting patient and assist nurse with identification Checking patient's chart, preparation, etc. 2. Prepare the room by: Obtaining instruments, supplies, and equipment for the designated operative procedure Opening unsterile supplies Assisting in gowning Observing breaks in sterile technique Assisting anesthesiologist as necesssary Assisting with skin preparation and positioning Assisting with forming of the sterile field Count the instruments, sharps and sponges before the procedure and confirm with scrub nurse. Intra-operative Responsibilities 1. During the Procedure: Remain in room and dispense materials as necessary Observe procedure as closely as possible Begin establishing method of anticipating needs of surgical team Care of specimen as indicated Care of operative records as indicated Before the closing of the organ or peritoneum, count all instruments, sharps and sponges and confirm with scrub nurse. Inform the surgeon and assistant surgeon of a report of the instruments.

Post-operative Responsibilities 1. Properly document all the necessary information on the patients chart. 2. Assist in the cleaning of the Operation Room as necessary.

Prior to operation:

A careful history and physical examination are performed to exclude the possibility of other gastrointestinal diseases that may mimic biliary colic, such as peptic ulcer disease or reflux esophagitis. When the diagnosis of acute cholecystitis is suspected the patient should receive nothing by mouth; however, nasogastric suction usually can be reserved for patients who are vomiting or have ileus and abdominal distention. Intravenous fluids are given to correct volume depletion and any electrolyte imbalances are measured and corrected. Monitor and regulate IVFs The nurse instructs the patient about the need to avoid smoking to enhance pulmonary recovery postoperatively and avoid respiratory complications. It is also important to instruct the patient to avoid the use of aspirin and other agents that can alter coagulation and other biochemical process One of the most important responsibility of the nurse is to let the patient sign an informed consent regarding the surgery. The patient is given an aesthesia prior to surgery and the patient is under NPO.

During the operation:

Monitoring responsibilities

the

vital

signs

of

the

patient

is

one

of

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of the nurse during the surgery. Assisting the anesthesia care provider during induction of general anesthesia Ensuring adequate oxygenation and hydration

After the operation

After recovery, the nurse places the patient in the low fowlers position. IV fluids may be given and nasogastric suction may be given to relieve abdominal distention. Water and other fluids are given in about 24hours, and soft diet is started when bowel sounds returned. Placing warm blankets on the patient to enhance comfort and preserve the patient's body temperature Assessing the patient's vital signs, oxygen saturation level, level of consciousness, circulation, pain, IV site, fluid rate, and hydration status, as well as the status of the surgical site and dressing and all related monitoring equipment The nurse helps in relieving the pain by instructing the patient regarding proper positioning.

The nurse helps in improving the respiratory status by instructing the patient regarding deep breathing exercises. The nurse also provides skin care like cleaning the incision part and providing clean dressing following a strict aseptic technique The nurse instructs the patient about the medications that are prescribed by the physician Discussing physician and the surgeon recommended follow-up management with the