MEDICAL INSTRUMENT

NABILA ZHAFIRAH IIA

Vaginal Speculum
• Used during
gynecological exam or
procedure
• Dilates the opening of the
vaginal cavity, allowing
for inspection of the
vagina and cervix
• Facilitates access for
observation and treatment
 Scalpel
Uses:
*Surgical knife used to incise
skin & SC tissue and also
divide major vascular pedicle
after ligation
 Drains
Vacuum Drain bottle (Redivac)

•Used to drain areas where fluid or

blood may collect or where the
surgery has left a cavity which is
closed by the suction from the
vacuum drain.

•This is an example of an active

closed drainage system.
 Q1: indications: ‫مهم‬
-Drainage of urine in
chronic retention e.g. :SEP
-Monitor urine outflow
-Hemostasis after
prostatectomy
-Peritoneal drainage in
biliary peritonitis

Q2: complications:
-False passage
Foley's catheter -Bleeding
-Infection
-Rupture urethra
-Obstruction of catheter
Rectal deflation tube
 Q1: Indications:
-Drain fluid & blood leakage
after perforation
-After laparotomy for
peritonitis

corrugated rubber Q2: Removal:

drainage After it stops drainage

No more used – highly Q3: Complications:

complicated -Infection
-Incisional hernia
It’s open cystic drain -Bleeding
Describe – uses -Pressure necrosis
-Loss it in drained cavity
 Indications:
for varicose vein
surgery

Vein stippler
 Allis forceps
Uses:
1- hold tough structures as fascia, sheath , tendon
2- hold duodenum for duodenal closure during gasterectomy

Can hold delicate structure (X)  hold fascia & aponeurosis

Toothed - locked - box - crushed
 Artery
Forceps
(mosquito
forceps)

Uses:
1- Hold peritoneum, viscous, soft tissue,
bleeding vessels
2- Facilitate tying of ligature
Babcock Uses:
Hold:
forceps 1-intestine during resection
2-thyroid gland
3-mesoappendix
4-uterine tube
5-ureter
6-C.B.D
Toothed Uses:
*Hold tough layer such
forceps as skin, fascia,
aponeurosis, fat &
muscles
*Give firm grip
Intestinal clamp Uses:
* Occlude intestinal lumen to
(non crushing prevent slippage of contents
&
clamp) Control bleeding during
intestinal anastomosis
Non crushing – Box * Occlude portal vein
– Locked – Non * Coapitation of intestine
toothed
Kocher’s forceps Uses:
*hold tough structures
*strap muscles
Curved –Toothed – screw- thyroidectomy
Crushing *crush base of appendix
*clamp vascular bands or
omentum
*dissect in tissue planes
Lahey's forceps (right angled clamp)
*Right angle – crushing – long – box
*Used to ligating major vascular pedicles example
superior thyroid pedicle - cystic artery – lumbar vein
(lumber sympathectomy)
Satinsky vena cava clamp (vascular clamp)
*Non crushing – box – locked
*Used to isolate part of wall of IVC to anastomose to
portal vein during portocaval anastomosis
Used to hold renal pedicle to control haemorrhage while
doing partial nephrectomy
Bulldog
Has spring handle
Occlude blood vessel temporary
Used during direct arterial surgery
example anastomosis & grafting
Needle Holder

• Used to hold and pass a suturing needle

through tissue
• Has groove to hold needle within jaws
Towel Clamp
• Adds weight to drapes
and towels to ensure
they stay in place
• Allow exposure of the
operative site
Skin Hook
• Flat end is a blunt
retractor
• Three-prong end may be
sharp to dull
• Used to retract small
incisions or secure a skin
edge for suturing
Iris Suture Scissors

• Used to remove
sutures
• Blade has beak or
hook to slide under
sutures
Sharp/Sharp Scissors

• Used to cut and dissect

tissue
• Both blade tips are sharp
Sharp/Blunt Scissors

• Used to cut and dissect

fascia and muscle
• One blunt tip and one
sharp tip
Nasal Speculum

• Used to spread
nostrils during
examination
Sponge Forceps

 Used to hold gauze

squares or sponge to
“mop up” the surgical site
 Jaws are serrated
Transfer Forceps

When sterile, transfer

forceps;
• arrange items on
sterile tray
• transfer items to
sterile field
 Airway Instruments
Endotracheal Tube
• Used to provide a definitive airway
for patients. This means a cuff is
inflated to prevent aspiration. Used
for long operations, (laparotomy) and
in cases of inhalation injury, (burns)

• Indications:
▫ Depressed consciousness
▫ Hypoxemia
▫ Airway Obstruction
 Airway Instruments
Endotracheal Tube
• Then check the tube is in the trachea by:
▫ Auscultating: ensure bilateral breath
sounds
▫ Auscultate over the stomach (epigastric
region) to ensure no gurgling (that would
indicate oesophageal intubation)
▫ Measure end tidal CO2 tension: since
CO2 is produced in the lung, you can
confirm that the tube is in the trachea by
measuring the end tidal CO2 tension. If the
tube is in the oesophagus, then the CO2
gas pattern would be absent.
▫ Do CXR and look for metallic mark
 Airway Instruments
Oropharyngeal / Guedel Airway
• This is essentially a rigid, curved
plastic tube. It is an airway
adjunct
• It is used to provide an airway for
a patient where there is an
impaired level of consciousness.
• It is sized by measuring the
distance from the angle of the
mandible to the patient’s
mouth.
• It is inserted upside down into the
mouth and rotated downwards
when it is past the tongue within
the oral cavity.
 Airway Instruments
Endotracheal Tube
• Complications:
▫ Broken Teeth, lacerations of the
tissues of the upper airway,
▫ Intubation of the Oesophagus
 Airway Instruments
Tracheostomy Tube
• Definitive airway
• Tracheostomy = surgical
opening into the trachea.
• Can be temporary or
permanent.
• It involves placing the
tracheostomy in between the
2 and 4th tracheal rings.
• Usually done in theatre
under GA.
 Airway Instruments
Tracheostomy Tube
• Indications
▫ Patients who require long term intubation
(>2 weeks) – better tolerated than ETT
▫ Severe maxillofacial injury (unable to
intubate)
▫ Post-laryngeal surgery (e.g. laryngectomy
for malignancy)
▫ Lung disease (e.g. COPD) to reduce dead
space and allow effective ventilation
▫ Obstructive sleep apnoea
▫ Upper airway obstruction
• Complications
▫ Tracheostomy stenosis,
▫ Infection
▫ Blocked tube,
▫ Tracheoesophageal fistula
▫ Surgical emphysema.
 Airway Instruments
Laryngoscope
• A laryngoscope has a handle and a
curved blade, usually fitted with a
light, it moves the tongue and
epiglottis aside in order to inspect
the larynx.

• It is used to aid insertion of an

endotracheal tube or for
examination.
 Surgical Instruments
Proctoscope (Gabriel)

• Used to visualise the anal canal

and lower rectum
• It is also used when injecting or
banding haemorrhoids.
• After explaining the procedure to
the patient, the patient is placed in
the left lateral position and a
digital rectal examination is
performed.
• The proctoscope is then attached
to a light source and lubricated
prior to its insertion into the
rectum.
 Surgical Instruments
Shouldered Syringe

• This a syringe used for the

injection of haemorrhoids
with 5% phenol in almond
oil.
• The injection is performed in
conjunction with a
proctoscope.
• The injection is performed
above the dentate line as it is
insensitive
 Surgical Instruments
Rigid Sigmoidoscope
• Used for the inspection of the rectum
and lower sigmoid colon.
• After explaining to the patient what
you are about to do, you must attach a
light source and a air pumping device.
• The patient is placed in the left lateral
position and a digital rectal
examination is performed.
• The sigmoidoscope is then lubricated
with jelly and inserted pointing
towards the umbilicus.
• Air is pumped into the rectum to allow
you see the direction of the rectal
lumen.
• Biopsies can also be taken of rectal
mucosa through the sigmoidoscope eg
in a case of ulcerative colitis
 Surgical Instruments
Trucut Biopsy Needle

• Used to take histological

specimens from lesions
▫ eg breast lumps or liver.
• The procedure can be
performed under local
anaesthetic
 Surgical Instruments
Sutures

• Sutures
• Used to hold a wound together in
good apposition until such a time as
the natural healing process is
sufficiently well established to make
the support from the suture
material unnecessary and
redundant

• Alternatives:
• Staples
• Steristrips – self adhesive tape,
useful for superficial lacerations,
useful if there is potential tension on
a wound
• Tissue adhesive – based on
cyanoacrylate manometer, wounds
need to be clean and tension free
 Surgical Instruments
Suture material
• Absorbable
• Non-Absorbable
Synthetic
 Polyglycolic Acid (Dexon)
– Natural
• Silk
 Polyglactin (Vicryl)
 Polydioxone (PDS) • Linen
 Polyglyconate (Maxon) • Stainless Steel Wire
– Synthetic
– Polyamide (Nylon)
– Polyester (Dacron)
– Polypropylene (Prolene)
 Surgical Instruments
Needle Holder

• These are special forceps

• Designed to hold the needle to allow

the surgeon to suture accurately
 Surgical Instruments
Laparoscopic Port

• Used during laparoscopic

procedures eg Lap Chole

• Ports allow the surgeon to insert

telescopes/Cameras/instruments
 Surgical Instruments
Dever’s retractor

• Used in open abdominal

surgery
• Allows the surgeon to
operate with more space
 Surgical Instruments
Self Retaining retractor

• Used to hold wounds open

• Eg Hernia
repair/appendectomy
 Fluids
Hartmanns Solution
• Used in Surgery,
especially nil by mouth
patients
 Fluids
Dextrose
• Dextrose is a solution
made of sugar and water
 Fluids
Saline
Crystalloids are an electrolyte solution in
water. It can pass through a semi-
permeable membrane (cell wall).
NaCl saline 0.9% solution is an isotonic
fluid as it has similar Na+ levels to the
extracellular fluid in the body. Saline
distributes throughout the ECF (not the
ICF like dextrose does). The ECF consists
of plasma, interstitial fluid and
transcellular fluid (note colloids stay in
the plasma). Saline is a good
maintenance fluid.
 Fluids

Dextrose Dextrose Dextrose

Saline Saline Saline
1000ml 1000ml 1000ml
40g 40g 40g
Dextrose Dextrose Dextrose
Na 30mM Na 30mM Na 30mM
K 20mM K 20mM K 20mM
OR

Normal 5% 5%
Saline Dextrose Dextrose
1000ml 1000ml 1000ml
50g Dextrose 50g Dextrose
Na 150mM
K 20mM K 20mM K 20mM
 Fluids
Gelofusine
This is a colloid. Used in cases of volume
loss: eg trauma, molecules cannot pass
through semi permeable membrane.
Remains in the intravascular space.
Useful in increasing Blood Pressure.
Use is controversial.

Natural colloids: albumin

Synthetic colloids: Gelofusine and

Haemaccel (gelatine based infusions)
 Lines
Cannulas

This is a an IV cannula. It is used to give IV

fluids and IV drugs.
If you wish to give the fluid quickly, the
cannula must be short and large bore
(Poiseuille’s law – flow is proportional to the
fourth power of the internal radius of the
tube and inversely proportional to the
length).

Emergencies (265ml/min)

Generally insert a 18G (green) or higher

when giving drugs. Emergency should be
brown (14G) which has a flow rate of about
265ml/min. Use antecubital fossae in
emergencies. If you cannot get it, use
femorals.
 Lines
Cannulas
Blue 22G

Pink 20G

Green 18G

White 17G

Grey 16G

Brown
14G
 Lines
Triple lumen Central Venous Pressure Catheter

• Inserted into either the

right subclavian vein or
internal jugular vein.
• Used for Central Venous
Pressure monitoring and
to administer drugs
(chemotherapy drugs),
taking blood, not good
for fluids.
• Single or triple lumen
 Lines
Triple lumen Central Venous Pressure Catheter
• Inserted using Seldinger technique.:
• Lie patient flat. Infiltrate skin with LA 5ml of lignocaine
• Assemble the catheter and flush all the lumina
• Introduce needle and syringe 1cm below the junction of the
middle and medial thirds of the clavicle. Aim the needle to the
sternal notch and advance. Aspirate as you advance the needle.
• Once blood enters the syringe, remove the syringe keeping the
needle still in its position.
• Insert the guide wire, remove the needle, feed the dilator over
the guide wire, remove dilator, insert central line, remove guide
wire
• Stitch in place, Order CXR to check position and exclude
pneumotharax
 Lines
Triple lumen Central Venous Pressure Catheter
• Complications of a central line insertion:
•
• Immediate: pneumothorax, haemothorax, damage to
adjacent vessels e.g. carotid arteries, primary haemorrhage
•
• Early: infection (skin commensals), secondary
haemorrhage, haematoma formation
•
• Late: thrombosis, catheter blockage.
 Lines
Nasogastric Tube
• This is a feeding NG tube. It is used for
enteral nutrition in patients.

• It has a fine bore and is soft (comfortable

for patients), unlike the Ryle’s NG tube
which is wide bore. Note the end has a cap
(not present in Ryle’s NG tube). It is made
from silastic, which tends to block less
often.

• Another indication is oesophageal

obstruction.

• DO NOT use is patients with basal skull

fractures, facial trauma or if patient
refuses it.
 Lines
Hickmann Line
• This is a Hickman line. It is a modified central line
that is tunnelled under the skin to make it more
secure. It is used as a long term central vascular
access device. It is usually inserted into the right
subclavian vein.

• The Hickmann line is a central line as it is inserted

into a central vein (therefore making it a central
venous access device). It is used mainly for long
term access to the central line. This can be for
providing patient with TPN or for taking blood or
administering drugs long term.

• The line is tunnelled under the skin, therefore you

will see subcutaneous swelling under the skin along
the path of the catheter (CVP catheters are not
tunnelled and they are used for short term only).
 Lines
Peripherally Inserted Central Catheter (PICC)

These lines are inserted into a

peripheral vein, usually the cephalic
vein in the antecubital fossa and
'unwound' upwards into the
subclavian vein/superior vena cava.
They are firmly secured with tape or
sutures.
They tend to be used for relatively
short-term venous access, e.g. a
prolonged course of antibiotics, but
can be used for periods of up to
several months.
 Lines
Swan-Ganz Catheter
Inserted into
pulmonary artery,
this is a diagnostic
catheter used to
detect heart failure,
sepsis, monitor
pressures in right
atrium, right
ventricle and
pulmonary artery
 Lines
Tesio Line

For Renal Dialysis

 Drains

• A surgical drain is a tube used to • Types of drainage systems

remove pus, blood or other fluids
from a wound.
▫Closed
•Broadly classified as: ▫Open
▫ Tube Drains
▫ Corrugated Drains
▫Passive
▫Active
 Drains
Chest Drain Bottle
•Bottle to which the chest drain is attached.
• There is a line called prime level which is
filled with sterile water.
• The chest drain tubing is connected to a tube
which is under the sterile water and therefore
acts as a water seal.
•After a chest drain has been inserted you can
see bubbling in the water as the air leaves the
pleural space.
•The chest drain bottle can be used to collect
air, blood, fluid and pus from the pleural
space.
•The system can be driven by attaching suction
to the top of the bottle making it an example of
a active closed drainage system
 Drains
Yates Tissue Drain

• Row of tubes
• For big cavity drains
• It is an open drainage system