Veterinary Surgical Nursing

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Veterinary Surgical Nursing

• Surgical Instruments

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Relevant Learning Outcomes

• Commonly used instruments
• Identify
• Describe usage
• Maintain

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Whats in a name? - Mayo

• Mayo Family- Americandoctors of early 1900s
• founded renownedMayo Clinic in Rochester,
  Minnesota, USA.
• Today 500 doctors at this clinic

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Metals

• Surgical Stainless steel
• Ideal metal for most instruments
• Tungsten carbide
• Used for inserts where strength and durability
  important
• Chrome plated carbon steel
• Cheap, but blisters and corrodes easily

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Needle Holder
TipsJaws Box lock Shank Ratchet Ring handle
e.g. Mayo-Hegar
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Needle Holder Functions

• Hold needle
• Tie knots

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Needle Holder Features

• Optionally
• Scissors
• For cutting sutures
• But can accidentally cut suture!
• Ratchet
• For more secure grip
• But can get ratchet caught in gloves

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Needle Holder Types

• 4 types

Gillies Olsen-Hegar
Mathieu/McPhails Mayo-Hegar
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Needle Holder Types

• 2 kinds of Hegars
• not Hägars!

Olsen Mayo
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Needle Holders

• What does your practice have?
• What would you prefer?

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Scissor Uses

• Heavy dissection
• Fine dissection
• Sutures
• Bandages

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Scissor Features

• Blades
• Straight
• Curved
• Tips
• Round only (Blunt)
• Sharp only
• Combination of Round Sharp
• Edges
• Plain
• Serrated

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Scissor Types

• Heavy dissection (Mayo)
• Fine dissection (Metzenbaum)
• Suture removal
• Dressing

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Mayo

• Heavy dissection

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Metzenbaum

• Fine dissection

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Suture removal
Sharp-Blunt
Notched
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Dressing scissors
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Forceps

• Thumb (tweezers)
• Tissue
• Haemostatic
• Intestinal clamps
• Bone holding
• Sponge-holding
• Syringe-holding

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Thumb Forceps (tweezers)

• Plain
• Delicate tissues (e.g. viscera)
• Dressings
• Toothed
• Skin Connective tissue
• Single row of teeth (dissection)
• Pad of teeth (wound closure)
• Long Mesh of teeth (holding vessels)
• Curved row of teeth (holding needles)

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Thumb Forceps Plain
Dressing
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Thumb Forceps Rat-tooth
Rats Teeth?
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Thumb Forceps Tooth
Rat tooth - fine(Adson)
Rat tooth - heavy
Long Mesh of teeth(DeBakey)
Pad of teeth(Brown-Adson)
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Thumb Forceps Tooth
Russian
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Tissue Forceps

• Have Ratchet grips

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Tissue Forceps

• 2 kinds
• Toothed type (Allis)
• Bar type (Babcock)

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Tissue Forceps
Allis
Babcock
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Tissue Forceps

• Always cause some trauma
• But OK on tough tissues (fascia)

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Haemostatic Forceps

• Used to compress blood vessels
• If curved
• point curved tips up to pass ligatures

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Haemostatic Forceps

• Transverse grooves
• Small (Mosquito)
• Large (Crile, Kelly, Rochester-Pean)
• Plus rats teeth (Rochester-Ochsner)
• Longitudinal grooves
• Large (Rochester-Carmalt)
• Less likely to slip on large bundles
• Recommended for ovarian pedicles (spays)

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Haemostatic Forceps

• Mosquito
• small

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Haemostatic Forceps

• Crile
• Fully grooved jaws

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Haemostatic Forceps

• Kelly
• Partly grooved jaws

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Haemostatic Forceps

• Rochester-Carmalt
• Longitudinally grooved
• For strong but soft gripon large pedicles(spays)

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Haemostatic Forceps

• Angiotribe
• Longitudinally slotted
• For strong gripon large pedicles(large animals)

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Haemostatic Forceps

• Rochester-Ochsner
• Extra grip on tips

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Intestinal forceps

• Doyen clamps
• Used to stop leaks fromcut ends of intestines
• Not as good as an assist-ants fingers !

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Sponge-Holding Forceps

• i.e. swab forceps

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Syringe-Holding Forceps
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Towel Clips

• 2 mechanisms
• Ratchet
• Backhaus
• Roeder
• Cross-action spring
• Grays
• Schaedel

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Towel Clamps
Ratchet(Backhaus)
Cross-action(Grays)
Ratchet(Roeder)
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Scalpels

• Small animal
• Flat handle 3
• Blades 10, 11, 15
• Large animal
• Flat handle 4
• Blades 20, 21
• Eye surgery
• Round handle (Beaver)

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Scalpels Many Types
10
11
15
21
20
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Scalpels Commonly Used
Large Animal
Small Animal
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Scalpel Handles

• Large flat handle
• Bard-Parker 4
• Small flat handle
• Bard-Parker 3
• Round handle
• Beaver

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Retractors

• Hand held
• Senn
• Army-navy
• Volkmann
• Malleable
• Hohmann
• Self retaining
• Gelpi
• Weitlaner
• Balfour
• Gossett
• Finochietto

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Hand held Retractors

• Senn

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Hand held Retractors

• Army-Navy

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Hand held Retractors

• Volkmann

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Hand held Retractors

• Malleable
• bend to shape

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Hand held Retractors

• Hohmann
• Orthopaedics
• (cruciates, hips)
• Also known asbone levers

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Self retaining Retractors

• Gelpi
• muscle joint
• (i.e. orthopaedics)

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Self retaining Retractors

• Weitlaner
• fascial

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Self retaining Retractors

• Balfour
• abdominal

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Self retaining Retractors

• Gossett
• abdominal

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Self retaining Retractors

• Finochietto
• Chest

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Periosteal Elevators

• Used to strip soft tissue (i.e. periosteum) from
  bone
• Handles
• many variations
• Working ends
• a rounded side
• a flatter side with a sharp edge

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Periosteal Elevators
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Bone Curettes

• Used to scrape (debride) tissue
• Infected bone
• Infected tooth sockets

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Bone Curettes
Examples
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Bone Cutting Instruments

• Bone Shears
• Bone Chisels Osteotomes
• Bone Saws
• Wire (Gigli)
• Trephines
• Rongeurs

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Bone shears
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Osteotome or Chisel?
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Osteotome Chisel
osteotome
chisel
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Guarded osteotome
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Rongeurs

• Used to nibble away bone or cartilage
• Various actions
• 1 hinge gt Single action rongeurs
• multiple hinges gt Double action rongeurs
• Double action provide greater leverage

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Rongeurs

• Examples

single action
double action
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Bone Graft Collection

• Methods
• Osteotome
• Curette
• Rongeurs

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Orthopaedic mallet
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Bone holders Kern
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Bone holders Kern
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Bone holders Reduction Forceps

• These are not towelclamps!

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Bone holders Reduction Forceps
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Bone holders Verbrugge

• Bone to plateholders

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Bone holders Lowman
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Drilling

1. Air drill
2. Electric drill
3. Hand drill
4. Jacobs chuck

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Air Drill

• Autoclavable

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Electric Drill

• Not autoclavable
• Requires protective sheath

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Hand Drill

• Autoclavable

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Jacobs Chuck

• Autoclavable
• For inserting Pins

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Wire instruments

• Wire passers
• Wire twisters
• Wire cutters

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Wire passers
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Wire twisters

• These look like needle holders
• But shouldnt use needle holders for
  wire-twisting!

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Wire cutters
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Probes
Grooved probe for anal sac removal
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Spay Hooks

• 2 different tips (flat or knob)

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Trephines

• Bone biopsies
• Bone tunnels

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Orthopaedic Wire

• Cerclage wire
• Various gauges
• Supplied on spools
• 22, 20 and 18 gauges commonly used
• Cutting (Gigli wire)

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Bone Pins

• Large pins gt Steinmann pins
• ¼ to 1/16 inch
• Trocar points only
• Also called Intramedullary Pins
• Small pins gt K wires Arthrodesis wires
• 0.9-2.0 mm
• Trocar or Chisel points
• Often used as Crossed Pins orPin Tension
  Band
• External fixator pins

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Steinmann Pins

• Placed inside bone marrow cavities for fracture
  repair

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Measuring diameters
Pins K-wire Drill bits Screws
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External fixator

• Pins
• Rods
• Clamps

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Bone Screws

• Thread type
• Cortical
• Cancellous
• Thread extent
• Full length thread
• Partial length thread
• Thread Raised above smooth shaft ( profile)
• Thread Cut out into smooth shaft (- profile)

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Bone Screws

• Diameters (mm)
• 1.5
• 2.0
• 2.7 small animals
• 3.5
• 4
• 4.5
• 5.5 large animals
• 6.5

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Bone Screws

• Thread extent
• Full length thread
• Partial length thread
• Heads
• Hex
• Cross

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Kick Bucket

• Try not to kick it too soon !

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The End
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