Beruflich Dokumente
Kultur Dokumente
LEARNING OBJECTIVES:
After the site is prepared, tibial and femoral trials to cement, meticulous inspection of all surfaces References
are used before implanting the components to of each instrument for residual bioburden is Primary Cruciate-Retaining & Cruciate-
ensure adequate resection and to confirm that imperative. All trials must also be carefully Substituting Procedures. DePuy Orthopedics.
the implants are properly sized. The tibial tray is inspected because surgeons may try several 2000.
assembled to the tibial impactor and inserted into sizes to determine that which is best. Femoral
Inspecting Surgical Instruments: An Illustrated
the prepared proximal end of the tibia using a and tibial trials, femoral impactors, and large
Guide. Spectrum Surgical Instruments. 2006.
mallet. The femoral component is inserted into drill bit ends are examples of instruments that
the prepared distal end of the femur with a are difficult to visually inspect. Central Service Instrumentation Resource Course: Identification,
femoral impactor and mallet. If it will be employees should use a lighted magnifying Handling and Processing of Surgical Instruments.
cemented, the patella component is held in place glass to view these items, and they may request International Association of Healthcare Central
by a patella clamp. The final step before closure is that a co-worker provide a “double-check” for Service Materiel Management. 2006.
to insert the tibial insert. The new joint comprised the most challenging instruments. All Knee Joint Replacement. MedlinePlus. 2005.
of the femoral, tibial, and patellar components instruments with cutting edges must be checked M. Swank. Orthopedic Personnel Roles in
functions the same as cartilage in a healthy knee to ensure sharpness. Curettes and osteotomes the OR for Computer-Assisted Total Knee
to prevent the bones from rubbing together at are tested with a plastic dowel rod, rongeurs are Arthroplasty. AORN Journal. 2005.
the joint. tested with an index card, and scissors should
Central Service Technical Manual. Seventh
be tested with the appropriate testing material.
Instruments used for TKA procedures present Edition. International Association of Healthcare
significant processing challenges for Central Service A successful system for reprocessing T K A Central Service Materiel Management. 2007.
personnel, and it is critical that they always follow instruments includes written departmental Special thanks to Tom Andresen. DePuy
the manufacturers’ instructions when processing procedures that address several important issues: Orthopedics
them. Many instruments require manual cleaning
because bone, tissue and, in some cases, cement • The need for on-going open communication
can become so embedded in the instruments they between Central Service, operating room,
must be cleaned with brushes before automatic and vendor personnel
washing. Drill bits and guides, cutting blocks, and CIS Self-Study Lesson Plans
• Packaging requirements
the tibial keel punch and drill are among the
instruments that may retain bone and tissue. Some • Manufacturers’ written instructions for
instruments have knurled (crosshatch-designed) cleaning and sterilization Lesson Authors
handles to help surgeons grip them. However, this
Paula Vandiver, CRCST, CIS
feature retains bone, blood, and cement and • Instrumentation inspection
Orthopedic Specialist CS Technician
presents a cleaning challenge.
• Tray assembly Anderson Hospital
Central Service staff must also be aware of the Maryville, IL
detergents used in mechanical washers because • Continuing education
Lisa Huber, CRCST, ACE, FCS
they may not be compatible with the metals used
TKA instrumentation provides special sterilization Sterile Processing Director
to manufacture the TKA instruments and
challenges because of the size, weight, and Anderson Hospital
sterilization containers. Central Service technicians
number of required trays, and the multiple layers Maryville, IL
should consult the manufacturers’ instructions to
of instruments within the trays. Many vendors
learn about detergents that are compatible with
require extended sterilization cycle times for TKA Technical Editor
the instruments and instrument trays. Also, many
instruments. Since there are no standardized Carla McDermott, RN, ACE
TKA instrument trays are designed with multiple
instructions, it is necessary to obtain detailed and Education Specialist
layers. Central Service technicians must ensure
specific processing information from each vendor Morton Plant Mease Healthcare
that tray lids are removed, that instruments are
providing loaner instrumentation. Dunedin, FL.
disassembled, and that layers are separated to
provide full contact between the spray action of Careful inspection, cleaning, and sterilization of
Series Writer/Editor
the washer and instruments during cleaning. TKA instrumentation according to the
Jack D. Ninemeier, Ph.D.
manufacturers’ requirements and written
TKA instrumentation also poses special Michigan State University
Central Service Department procedures can help
inspection challenges. Since instruments are East Lansing, MI.
prevent surgery delays, and they are essential
placed directly upon bone and may be exposed
elements to a quality patient outcome.
CIS Self-Study Lesson Plan Quiz
(Instrument Continuing Education-ICE)
CIS
Instruments for Total Knee Arthroplasty
Questions (circle correct answer):
1. A rongeur may be used to 7. Proximal refers to 13. The term, “resection,” refers to
a) ensure accurate placement of trials a) nearer to a point of reference a) the surgical removal of body tissue
b) remove bone and tissue or attachment b) surgical reconstruction or replacement
c) resect the femur b) the farthest point from the point of a joint
CRCST of origin
d) accommodate the prosthesis c) cartilage preventing bones from
c) an alignment technique rubbing together at the joint
d) removal of tissue d) assurance of accurate cuts made by
2. Three examples of retractors are the surgeon
a) Chandler, Osteotome, and Bennett
b) Hohmann, Chandler, and Curette 8. The femur is the
c) Chandler, Bennett, and Hohmann a) thigh bone 14. Which instruments are used for the
b) kneecap accurate resurfacing of the patella?
d) Chandler, Hohmann, and Keel
c) shin bone a) patella clamp and patella cutting guide
d) hip bone b) patella cutting guide and caliper
c) patella clamp and caliper
3. The cutting edge of curettes and
d) patella cutting guide and stylus
osteotomes should be tested for
sharpness with a (an) 9. The tibia is the
a) plastic dowel rod a) thigh bone
b) tongue depressor b) kneecap 15. The femoral component is
c) index card c) shin bone inserted using a
d) huck towel d) hip bone a) femoral impactor and mallet
b) femoral locating device and mallet
c) femoral cutting block and mallet
10. Cutting edges of rongeurs should be d) femoral trial and mallet
4. The patella is also called the
a) thigh bone tested for sharpness with a (an)
b) kneecap a) plastic dowel rod
c) shin bone b) tongue depressor
d) hip bone c) index card
d) huck towel
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