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BLADES

deep knife- 7 handle with 15 blade; Used to

cut deep, delicate tissue

inside knife- 3 handle with 10 blade; Used

to cut superficial tissue.

skin knife-4 handle with 20 blade; Used to

cut skin.

SCISSORS

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, breast)

Metzenbaum scissors- Used to cut delicate tissue

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CLAMPING and OCCLUDING

Hemostat- used to clamp blood vessels or tag sutures.

Its jaws maybe straight or curved.

Other names: crile, snap or stat.

Hemostat, mosquito (left to right) – used to clamp

small blood vessels. Its jaws maybe straight or

curved.

Kelly, hemostat, mosquito (left to right) – used to

clamp larger vessels and tissue

Burlisher- used to clamp deep blood

vessels. It has two closed finger rings.

Burlishers with open finger rings are

called tonsil hemostats.

Other names: Schnidt tonsil forcep,

Adson forcep

Right Angle- 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

Hemoclip applier with hemoclips-

applies metal clips onto blood vessels

and ducts which will remain occluded.

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GRASPING and HOLDING

Allis- used to grasp tissue. It is available in

short and long sizes. A “Judd-Allis” holds

intestinal tissue; a “heavy allis” holds breast

tissue.

Babcock - used to grasp delicate tissue

(intestine, fallopian tube, ovary)

Kocher- used to grasp heavy tissue. May

also be used as clamp. The jaws may be

straight or curved.

Other names: Oschner

Foerster sponge stick - used to grasp

sponges.

Other names: sponge forcep

Dissector- used to hold a peanut

Backhaus towel clip- used to hold

towels and drapes in place.

Other names: towel clip

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Pick ups, thumb forceps, and tissue

forceps- are available in various lengths,

with or without teeth, and smooth or

serrated jaws.

Russian tissue forceps- used to grasp

tissue

Adson pick ups- are either smooth:

used to grasp delicate tissue; or with

teeth: used to grasp the skin

Other names: dura forceps

long smooth pick-ups are called dressingforceps. Short smooth pick-ups are used to

grasp delicate tissue

DeBakey forceps- used to grasp delicate

tissue, particularly in cardiovascular surgery.

Thumb forceps- used to grasp tough tissue

(fascia, breast). Forceps may either have

many teeth or a single tooth. Single tooth

forceps are called “rat tooth forceps.”

Mayo-Hegar needle holders- used to hold

needles when suturing. They may also be

places in the sewing catergory.

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Deaver retractor (manual) - used to retractdeep abdominal or chest incisions.

Richardson retractor- (manual) - used to

retract deep abdominal or chest incisions.

Army-navy retractor- used to retract

shallow or superficial incisions.

Other names: USA, US Army

Goulet (manual) - used to retract shallow

or superficial incsisions.

Malleable or Ribbon retractor (manual)

- used to retract deep wounds.

Weitlaner retractor (self-retaining) -

used to retract shallow incisions

Gelpi retractor (self-retaining) – used to

retract shallow incisions

Balfour with bladder blade- used to retract wound edges

during deep abdominal procedures.

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DUTIES of SCRUB NURSE

Before an operation

Ensures that the circulating nurse has checked the equipment

Ensures that the theater has been cleaned before the trolley is set

Prepares the instruments and equipment needed in the operation

Uses sterile technique for scrubbing, gowning and gloving Receives sterile equipment via circulating nurse using sterile technique

Performs initial sponges, instruments and needle count, checks with circulating nurse

When surgeon arrives after scrubbing

Perform assisted gowning and gloving to the surgeon and assistant surgeon as soon as

they enter the operation suite Assemble the drapes according to use. Start with towel, towel clips, draw sheet and then

lap sheet. Then, assist in draping the patient aseptically according to routine procedure

Place blade on the knife handle using needle holder, assemble suction tip and suctiontube Bring mayo stand and back table near the draped patient after draping is completed

Secure suction tube and cautery cord with towel clips or allis

Prepares sutures and needles according to use

During an operation

Maintain sterility throughout the procedure Awareness of the patient’s safety

Adhere to the policy regarding sponge/ instruments count/ surgical needles

Arrange the instrument on the mayo table and on the back table

Before the Incision Begins

Provide 2 sponges on the operative site prior to incision

Passes the 1st knife for the skin to the surgeon with blade facing downward and ahemostat to the assistant surgeon

Hand the retractor to the assistant surgeon

Watch the field/ procedure and anticipate the surgeon’s needs Pass the instrument in a decisive and positive manner 

Watch out for hand signals to ask for instruments and keep instrument as clean as

 possible by wiping instrument with moist sponge Always remove charred tissue from the cautery tip

 Notify circulating nurse if you need additional instruments as clear as possible Keep 2 sponges on the field

Save and care for tissue specimen according to the hospital policy Remove excess instrument from the sterile field

Adhere and maintain sterile technique and watch for any breaks

End of Operation

Undertake count of sponges and instruments with circulating nurse

Informs the surgeon of count result Clears away instrument and equipment

After operation: helps to apply dressing

Removes and siposes of drapes De-gown Prepares the patient for recovery room

Completes documentation

Hand patient over to recover room

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DUTIES of CIRCULATING NURSE

Before an operation

Checks all equipment for proper functioning such as cautery machine, suction machine,

OR light and OR table

Make sure theater is clean

Arrange furniture according to use Place a clean sheet, arm board (arm strap) and a pillow on the OR table

Provide a clean kick bucket and pail

Collect necessary stock and equipment Turn on aircon unit

Help scrub nurse with setting up the theater 

Assist with counts and records

During the Induction of Anesthesia

Turn on OR light Assist the anesthesiologist in positioning the patient Assist the patient in assuming the position for anesthesia

Anticipate the anesthesiologist’s needs

If spinal anesthesia is contemplated:

o Place the patient in quasi fetal position and provide pillow

o Perform lumbar preparation aseptically

o Anticipate anesthesiologist’s needs

After the patient is anesthetized

Reposition the patient per anesthesiologist’s instruction

Attached anesthesia screen and place the patient’s arm on the arm boards

Apply restraints on the patient Expose the area for skin preparation

Catheterize the patient as indicated by the anesthesiologist

Perform skin preparation

During Operation

Remain in theater throughout operation

Focus the OR light every now and then Connect diatherapy, suction, etc.

Position kick buckets on the operating side

Replenishes and records sponge/ sutures Ensure the theater door remain closed and patient’ s dignity is upheld

Watch out for any break in aseptic technique

End of Operation

Assist with final sponge and instruments count

Signs the theater register  Ensures specimen are properly labeled and signed

After an Operation

Hands dressing to the scrub nurse Helps remove and dispose of drapes

Helps to prepare the patient for the recovery room

Assist the scrub nurse, taking the instrumentations to the service (washroom) Ensures that the theater is ready for the next case

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EMBRYONIC PREGNANCY

Although the term may not be familiar to most people, a blighted ovum is actually a fairly common

 pregnancy complication. Also known as an embryonic pregnancy, a blighted ovum refers to the failure

of the fetus to develop despite the fact that normal conception, implantation and growth of the placentahaving taken place. Credited as causing 50% to 60% of all first trimester miscarriages, a blighted ovum

will always end in pregnancy loss within the first 12 weeks of pregnancy.

Signs of a Blighted Ovum

Symptoms of a blighted ovum pregnancy include spotting, cramps, vaginal bleeding as your hCG levels

 begin to fall, and/or failure to detect a fetal heartbeat by the 12th week of pregnancy. Additionally, an

ultrasound showing an empty gestational sac can confirm that you have a blighted ovum.

Treating a Blighted Ovum

Most health care providers agree that it is best to let your body deal with the blighted ovum naturally,

which it does most of the time. In some instances, the body may miscarry the pregnancy while in others

the body will simply reabsorb the fertilized egg. A reabsorbed egg will likely cause you to experience a

heavier than usual period or notice clots in your period. By allowing your body to handle the blighted

ovum itself, you can avoid potential scarring thereby ensuring your fertility health.

However, once a blighted ovum has been discovered, many women find it far too upsetting to just wait

for a miscarriage to occur. In these instances, as well as for women who may have an infection or are

experiencing heavy bleeding, it is possible to have either a suction curettage or dilation and curettage

(D&C) procedure done.

In suction curettage, your doctor will gently vacuum out the products of conception. This may be done

under general or local anesthetic. For a D&C, you’re cervix is dilated and the sides of your uterus are

scraped down to ensure that all tissue has been removed. Again, anesthetic is usually used. These

 procedures are done to ensure that you do not suffer from an infection later on. Although both procedures

are safe, there is a risk of scarring, which may affect your fertility.

Layers of Uterus

The layers, from innermost to outermost, are as follows:

Endometrium 

The lining of the uterine cavity is called the "endometrium". It consists of the functional

endometrium and the basal endometrium from which the former arises. Damage to the basal

endometrium results in adhesion formation and/or fibrosis (Asherman's syndrome). In all

 placental mammals, including humans, the endometrium builds a lining periodically which is

shed or reabsorbed if no pregnancy occurs. Shedding of the functional endometrial lining is

responsible for menstrual bleeding (known colloquially as a "period" in humans with a cycle of 

about 28 days) throughout the fertile years of a female and for some time beyond. Depending on

the species, menstrual cycles may vary from a few days to six months, but can vary widely even

in the same individual, often stopping for several cycles before resuming. Marsupials and

monotremes do not have menstruation.

Myometrium 

The uterus mostly consists of smooth muscle, known as "myometrium." The innermost layer of 

myometrium is known as the junctional zone, which becomes thickened in adenomyosis.

Parametrium 

The loose connective tissue around the uterus.

Perimetrium 

The peritoneum covering of the fundus and ventral and dorsal aspects of the uterus.

Layers of Skin

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The layers of the skin are a lot like the layers of soil in a flowerbed. Each has its use and all the skin

layers (or soil) work together to provide nutrients and protection for the stuff growing in it.

Epidermis: This layer is made of skin cells at the end of their life-cycle. These cells provide protection

from injury and a barrier to keep infectious organisms at bay. Think of this layer as the mulch coveringthe flowerbed. The epidermis holds in fluid and protects raw nerve cells from too much stimulation.

Dermis: The top soil. This layer contains capillaries that feed the cells with nutrient-rich blood. Just like

top soil, most things grow here - including hair follicles, nerve cells, and sweat glands. If damaged, the

dermis will weep serous fluid and swell.

Subcutaneous: The subcutaneous layer is also known as the hypodermis, and it is technically not

officially skin, but rather attaches the skin to everything beneath. It also contains a layer of fat. Some of 

us have more fat than others, but this layer is always present in some form. In the flowerbed, this is the

layer of sandy foundation that allows for drainage. Indeed, blood vessels in the subcutaneous layer feed

and drain the capillaries of the dermis.

Layers of Abdomen

Skin is a soft outer covering of an animal, in particular a vertebrate. Other animal coverings such as the

arthropod exoskeleton or the seashell have different developmental origin, structure and chemical

composition. The adjective cutaneous means "of the skin" (from Latin cutis, skin). In mammals, the skin

is the largest organ of the integumentary system made up of multiple layers of ectodermal tissue, and

guards the underlying muscles, bones, ligaments and internal organs.

Fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that

surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together inmuch the same manner as plastic wrap can be used to hold the contents of sandwiches together. It

consists of several layers: a superficial fascia, a deep fascia, and a subserous (or visceral) fascia and

extends uninterrupted from the head to the tip of the toes.

Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ

cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell.

They are classified as skeletal, cardiac, or smooth muscles. Their function is to produce force and

cause motion. Muscles can cause either locomotion of the organism itself or movement of internal

organs. Cardiac and smooth muscle contraction occurs without conscious thought and is necessary for 

survival.

The transversalis fascia (or transverse fascia) is a thin aponeurotic membrane which lies between the

inner surface of the Transversus abdominis and the extraperitoneal fascia.

It forms part of the general layer of fascia lining the abdominal parietes, and is directly continuous with

the iliac and pelvic fasciae.

The peritoneum is the serous membrane that forms the lining of the abdominal cavity or the coelom — it

covers most of the intra-abdominal (or coelomic) organs — in higher vertebrates and some invertebrates

(annelids, for instance). It is composed of a layer of mesothelium supported by a thin layer of connective

tissue. The peritoneum both supports the abdominal organs and serves as a conduit for their blood and

lymph vessels and nerves.

FRACTIONAL D&C

a diagnostic technique in which each section of the uterus is examined and curetted to obtain specimens

of the endometrium from all parts of the organ. It is often performed in the diagnosis of endometrial

cancer.