INSTRUMENTS

By:
Dr. Nikuraj Deka
Registrar
Dept. of Surgery
What is disinfection?

Disinfection is the process by which microorganisms are killed or

removed excepting the bacterial spores.

What is sterilization?

Sterilization is a process by which all microorganisms like bacteria,

fungi, viruses and the bacterial spores are killed.
 Sterilization of instruments
 Autoclaving: Sterilization using steam under high pressure.
Standard autoclaving: Sterilization at a temperature of 121°C at
15lb/sq inch pressure for 30 minutes for metallic instruments
and 15 minutes for rubber goods (Catheters,gloves, drains, etc.).

 Boiling: Boiling of the instruments for half an hour after water

achieves a temperature of 100°C.
This is not suitable for sharp instruments as there is loss of
sharpness due to boiling and there is formation of crust over the
instruments.
 Sterilization of instruments:
 Chemical sterilization: Chemicals (2% Glutaraldehyde solution
(Cidex) , Lysol, Alcohol, Peracetic acid )are used for sterilization
of instruments. Sharp instruments are particularly sterilized by
keeping them dipped in chemicals.
2% Glutaraldehyde solution (Cidex):
 For sterilization, the instruments are kept immersed in
glutaraldehyde solution for 4 hours.
 For disinfection of instruments, dipping for a period of 15–20
minutes is adequate.
Laparoscopic instruments and cystoscopes are sterilized by
keeping them in glutaraldehyde solution. In between cases a
period of 15–20 minutes of dipping is adequate for disinfection.
 Sterilization of instruments:
 Gas sterilization:
 Ethylene oxide gas
 Formaldehyde gas
 Gamma irradiation: useful for large scale industrial sterilization.
 Direct flaming: In case of urgency when an instrument has fallen
down from the operation table and is urgently required, it may
be sterilized by direct flaming.
 Hot air oven: Sterilization of glass syringes and test tubes
Sterilization of instruments:
 Metal instruments are sterilized by autoclaving for 30 minutes.
 Rubber articles like gloves and catheters are sterilized by
autoclaving for 15 minutes.
 Sharp instruments like scissors, needles, scalpel blades are kept
dipped in lysol or glutaraldehyde solution for sterilization.
 Boiling is not suitable for sharp instruments as there is loss of
sharpness.
 Laparoscopic instruments and cystoscopes are sterilized by
keeping them in glutaraldehyde solution.
 Parts of an instrument:
 Two finger bows for holding the instrument.
 A pair of shaft or body of the instrument.
 A catch or a ratchet - Once the ratchets are pressed the blades
are kept in a closed position.
 Blades—A pair of blades constitutes the terminal part of the
instrument.
 Joint—The two parts of the shaft and the blades are kept
attached by a joint. This joint may be either a box joint or a pivot
joint.
 In box joint there is a slot in one shaft and the other shaft is
passed through this slot
 In pivot joint the two shafts are attached at one point by a
screw
Parts of an instrument:
TOWEL CLIP ( DOYENS’ and BACKHAUS’ )
USES OF TOWEL CLIP:
 Fixing the draping sheets.
 Fixing the diathermy cables, suction tubes, laparoscopic camera
cables and fiberoptic light cables to the draping sheets.
RAMPLEY’S SWAB HOLDING FORCEPS
 RAMPLEY’S SWAB HOLDING FORCEPS
 This is a long instrument (average 9½" in length).
 The instrument is provided with f inger bows and a pair of long
shaft.
 The shaft has a rachet, a joint and a pair of blades.
 The blades are oval, fenestrated and provided with serrations
on the inner aspect.
 This instrument may be straight or curved.
USES OF SWAB HOLDING FORCEP:
 Cleansing the skin with swab dipped in antiseptic solution
during all operations.
 Used for holding a swab which is used to clean the blood during
dissection of Calot's triangle during cholecystectomy
 The swab held up in the forceps is used to strip off the
peritoneum from the fascia transversalis while approaching the
retrop eritoneum for kidney exp osure or during lum b ar
sympathectomy
 Used for removing the laminated membrane and daughter cysts
during operation of hyadit cyst.
DEAVER’S RETRACTOR
Uses of Deaver’s retractor:
 Used during cholecystectomy for retraction of right lobe of liver.
 Used during truncal vagotomy for retraction of left lobe of liver.
 Used during gastrectomy for retraction of liver.
 Used during pancreaticojejunostomy for retraction of stomach.
 Used during right or left hemicolectomy to retract the abdominal
wall while mobilizing the colon from the paracolic gutter.
 Used during kidney operation to retract the abdominal wall.
 Used during anterior resection of rectum or abdominoperineal
resection to retract the urinary bladder in male or uterus in
female during dissection in the pelvis.
MORRIS’ RETRACTOR
Uses of Morris’ retractor:
This is a big retractor which is useful for giving maximum
exposure in large incisions such as those used in the abdomen. It
can be used to improve visibility on one side of an incision (by
pulling firmly in that direction); so is valuable during the initial
phase of a laparotomy.
LANGENBACH’S RETRACTOR
Uses of Lagenbach’s retractor:
 Used during appendicectomy to retract the layers of the abdominal
wall while making the incision.
 Used while making and closing different abdominal incisions for ease
of working in deeper layers of the abdominal wall.
 Used during thyroidectomy to retract the strap muscles and the
sternomastoid for dissection and ligation of the thyroid vessels.
 Used during modif ied radical mastectomy for retraction of pectoralis
major muscle for better visualization during axillary dissection.
 Used during inguinal hernia operation for retraction of different layers
for proper visualization during repair of the posterior wall of the
inguinal canal.
 Used during radical neck dissection for retraction of skin f la ps,
sternocleidomastoid muscle for better visualization at depth.
DOYEN’S RETRACTOR
Uses of Doyen’s retractor:
 Used for retraction of abdominal wall during laparotomies.
 Used for retraction of bladder during CS and hysterectomies.
HEMOSTATIC/ARTERY FORCEPS
(CURVED & STRAIGHT)
 HEMOSTATIC/ARTERY FORCEPS
(CURVED & STRAIGHT)
Spencer Well’s hemostatic forceps are provided with finger bows,
rachet, a pair of shaft and a pair of blades. The blades are usually
half the length of the shaft. The full length of the blades are
provided with transverse serrations. The tips are conical and non
toothed. When the rachet is closed the blades are apposed.
Uses of Hemostatic Forceps:
 It is used during all operations. It is used to hold bleeding
vessels.
 While making abdominal incisions and during the closure of the
incision the hemostatic forceps is used to hold the cut margins
of the rectus sheath, linea alba, external oblique aponeurosis
and the surgical peritoneum.
 During appendicectomy it is used to split the internal oblique
and transversus abdominis muscle. May be used to crush the
base of appendix during appendicectomy.
 While doing intestinal resec tion and anastom osis, the
mesenteric vessels are held in between hemostatic forceps and
the desired line of mesentery is divided.
 It may be used to dissect the vein while doing venesection.
KOCHER’S HEMOSTATIC/ARTERY FORCEPS
( CURVRD & STRAIGHT)
KOCHER’S HEMOSTATIC/ARTERY FORCEPS
( CURVRD & STRAIGHT)
 The blades are slightly longer than in a Spencer Well's type of
hemostatic forceps.
 At the tip of the blades there is a tooth in one blade and a
groove in the other blade where the tooth f its when the rachet is
closed.
 This type of forceps is suitable for holding vessels in tough
structures like palm, soles and the scalp where the vessels tend
to retract in the deepfascia.
 The teeth at the tip of blades help to hold the retracting vessels
securely.
Uses of Kocher’s hemostatic forceps:
 Used during appendicectomy operation to crush the base of
appendix.
 Used to hold perforating vessels during mastectomy.
 During subtotal thyroidectomy a series of Kocher’s hemostatic
forceps are applied around the margin of thyroid gland lobe before
excision of the enlarged thyroid lobe.
 Used for holding vessels in the scalp while raising a skin f lap for
craniotomy.
 Used to hold bleeding vessels in palm and sole.
 Used in obstetrics for artificial rupture of membrane.
MOSQUITO HEMOSTATIC FORCEPS
(CURVED & STRAIGHT)
 MOSQUITO HEMOSTATIC FORCEPS
(CURVED & STRAIGHT)
 This instrument is very light, small and delicate.
 The blades are smaller in comparison to Spencer Well’s type of
hemostatic forceps and there are fine transverse serrations in
the blades.
 The tip of the blades are conical and are non-toothed.
 This instrument is used to hold the small bleeding vessels.
Uses of Mosquito forceps:
 Used as hemostatic forceps for operations in infants and
children where the vessels are delicate.
 Used to hold fine bleeding vessels during cleft lip operation.
 Used during circumcision. Three pairs of mosquito forceps are
applied one pair on either side of the preputial orifice and one at
the midline raphe where frenulum is attached. The prepuce is
then divided starting in the dorsal midline. The skin over the
shaft of the penis is retracted and the small vessels on the shaft
of the penis are held by mosquito forceps and ligated.
RIGHT ANGLED FORCEPS (LAHEY’S
FORCEPS)
 RIGHT ANGLED FORCEPS (LAHEY’S
FORCEPS)
 Like a hemostatic forceps this instrument has f inger bows, a
catch, a pair of shaft and a pair of blades.
 The terminal part of blades are bent at right angles to the shaft
of the instrument and there are transverse serrations in the
blade.
Uses of right angled forceps:
 Used to dissect pedicles of important organs and a ligature may
be passed around the dissected vessels. Also used as a
hemostatic forceps to hold a bleeding vessel at a depth.
 Used during cholecystectomy to dissect the cystic duct and the
artery and to pass a ligature around these structures.
 Used during gastrectomies to dissect and pass ligatures around
the left gastric artery, right gastric artery, gastroepiploic vessels
before their divisions.
 Used during vagotomy to dissect the anterior and posterior
vagus nerves and pass ligatures around these structures before
their division.
 Used during splenectomy to dissect the splenic artery and the
vein and to pass ligature around them.
ALLIS’ TISSUE FORCEPS
 ALLIS’ TISSUE FORCEPS
 This is a light instrument.
 The blades are longer and there is a gap between the blades
which can accommodate some amount of tissue.
 The tip of the blades are provided with sharp teeth with grooves
in between.
 When the ratchet is closed the teeth of the one blade fits in the
groove of the other blade and vice versa.
Uses of Allis tissue forceps:
 During laparotomy through midline incision, skin margins may
be retracted by applying Allis tissue forceps to the skin margin
while linea alba is incised. The linea alba may be lifted up by
applying Allis tissue forceps while incising the peritoneum.
 While closing the midline incision the linea alba may be held up
by Allis tissue forceps during suturing.
 Used to hold the skin m argins during incisional hernia
operations to raise the skin flaps.
 Used during thyroid operations, neck dissection to hold the
margins of the skin while raising skin flaps.
 Used to hold the skin f laps while excising a lipoma, sebaceous
cyst or lymph node.
BABCOCK’S TISSUE FORCEPS
 BABCOCK’S TISSUE FORCEPS
 The terminal part of the blades are curved and fenestrated.
 The tip is provided with a ridge in one blade and groove in the
other.
 When the rachet is closed the ridge of one blade f its into the
groove of the other blade.
 As there are no teeth this is a non-traumatic forceps.
 The fenestration in the blade allows some soft tissue to be
accommodated in the hollow while holding it.
Uses of Babcock’s tissue forcep:
 Used during appendicectomy. Usually three pairs of Babcock’s
forceps are required during appendicectomy. One pair holds the
appendix near its tip, one pair holds the body of the appendix
and the third pair holds the base of the appendix.
 Used during gastrectomy, gastrojejunostomy to hold the
margins of the stomach while applying an occlusion clamp.
 Used during small and large intestine resection anastomosis to
hold the margins of the gut before applying an intestinal
occlusion clamp. In open method of resection anastomosis,
intestinal occlusion clamps are not applied. The cut margins of
the gut are held up with Babcock‘s tissue forceps and sutured.
 Used during gastrostomy or jejunostomy to hold the gut while
applying suture.
NEEDLE HOLDERS
 Needle holders:
 The blades of the needle holder are smaller in comparison to the
shaft of the instrument.
 T here are criss cross serrat ions in t he blade and t here is a
longitudinal groove in the center of the criss cross serration which
allows f irm gripping of the needle. However, the groove maynot be
there in all needle holders
 The small sized needle holders are used for suturing on the surface.
 The long needle holders are used for suturing at the depth inside the
abdomen.

Uses:
To hold the needle for suturing.
MAYO’S SCISSORS
Uses of Mayo’s scissors:
 Used for cutting sutures.
 May be used to cut dressings.
 May be used to cut a corrugated rubber sheet drain.
 Used during appendicectomy to split the internal oblique and
transversus abdominis muscle.
MCINDOE SCISSORS
 MCINDOE SCISSORS
 These are fine scissors.
 The blades are delicate and smaller than in Mayo’s scissors and
are used for tissue dissection and cutting delicate structures.
 In Metzenbaum scissors the blades are long in comparison to
the shaft.
Uses of Mcindoe Scissors:
 Used during appendicectomy to cut the external oblique aponeurosis
and peritoneum. The mesoappendix is cut after being ligated.
 Used during herniorrhaphy to cut the external oblique aponeurosis to
expose the inguinal canal.
 Used during mastectomy and incisional hernia operation to raise the
skin flap by sharp dissection.
 Used during radical neck dissection to raise skin f la ps by sharp
dissection.
 Used during splenectomy, nephrectomy to cut the pedicles after
ligature.
 Used during cholecystectomy to cut the cystic duct and the artery
after they are ligated.
METZENBAUM SCISSORS
Uses of Metzenbaum scissors:
The Metzenbaum scissors are used for dissection at the depth.
May be used in above situations as an alternative to McIndoe
scissors.
 Used during vagotomy to divide the nerves after ligature.
 Used during cholecystectomy to divide the cystic duct and
artery after ligature
PLAIN DISSECTING FORCEPS
 PLAIN DISSECTING FORCEPS
 There are grooves on the shaft of the instrument which allows
easy gripping.
 The two limbs of the shaft are so designed that it provides a
spring action and the blades are kept apart.
 Pressing the two limbs of the shaft of the instruments brings
the two blades closer and helps in gripping the tissues.
 There are transverse serrations at the tip of the blades which
helps in lifting the tissues and the needle during suturing.
 There are no tooth at the tip.
Uses of Plain dissecting forceps:
 Used during almost all operations to hold delicate structures like
peritoneum, vessels, nerves and muscles during dissection and
suturing.
 Used during appendicectomy to bring out the cecum and to
deliver the appendix when it is held by the Babcock’s tissue
forceps.
 Used during gastrojejunostomy, gut resection anastomosis to
hold the gut margin during suturing.
 Used to hold blood vessels, nerves during dissection.
TOOTHED DISSECTING FORCEPS
 TOOTHED DISSECTING FORCEPS
 The design is same as the plain dissecting forceps but there is
a tooth at the tip of one blade and a groove at the tip of the
other blade.
 When the blades are approximated the toothed tip f its into the
groove.
 Because of the presence of the tooth, the tissues may be better
gripped and there is less chance of slipping.
Uses of toothed dissecting forceps:
 Used during almost all operations to hold tough structures like
skin, fascia and aponeurosis.
 Used to hold the cut skin margins during suturing.
 Used to hold the linea alba or the rectus sheath during closure of
abdominal incision.
 Used to hold the scalp during closure of scalp incision.
CORD HOLDING FORCEPS
 Cord holding forceps:
In addition to f inger bows and shaft there are two semicircular
blades and when the rachet is closed the blades are apposed and
makes a circular opening in the blade.

USES:
Used during hernia operation to hold the spermatic cord so that
the cord can be retracted during repair of the posterior wall of the
inguinal canal.
GASTRIC OCCLUSION CLAMPS
 GASTRIC OCCLUSION CLAMPS
 This is a long instrument with f inger bows, a rachet and a pair
of long shaft provided with a pair of long stout blades.
 There are transverse serrations in the blade with a linear
fenestration along the center of each blade extending near the
tip of the blade.
 The fenestration makes the blade lighter and prevents crushing
of tissues.
 This instrument may be curved.
Uses of Gastric occlusion clamp:
 Used during gastrojejunostomy to clamp the stomach side for
gastrojejunal anastomosis
 Used during gastrectomy. The line of resection is decided. Two
pairs of gastric occlusion clamps are applied along the proximal
line of resection and the tomach is divided in between the two
gastric occlusion clamps. Two pairs of intestinal occlusion
clamps are applied toward the duodenal end and the stomach is
divided inbetween.
INTESTINAL OCCLUSION CLAMPS
 INTESTINAL OCCLUSION CLAMPS
 This instrument has f inger bows, a pair of shaft with a pair of
long blades.
 The blades are lighter and there are vertical serrations in the
blade.
 There is a rachet, which when closed bring the blades in
apposition.
 This instrument may be curved.
Uses of Intestinal occlusion clamp:
Used for gut resection and anastomosis
DESJARDIN’S CHOLEDOCHOLITHOTOMY
FORCEPS
DESJARDIN’S CHOLEDOCHOLITHOTOMY
FORCEPS
 This is a long and slender instrument.
 There are finger bows but no catch.
 The shafts are curved, in some it is a gentle curve and in other
varieties there are different degrees of curvature.
 The blades are small and fenestrated centrally.
 There are no serrations in the blade.
Uses of Desjardin’s forceps:
 Used during choledocholithotomy: The Desjardin’s forceps is
introduced into the bile duct and the stones are removed by
holding the stones in the fenestrated blades.
 During laparoscopic cholecystectomy: While extracting the
gallbladder through the epigastric port, it usually gets stuck if
there are large stones in the gallbladder or there are multiple
small stones in the gallbladder. The gallbladder is opened and
the stone removed from the gallbladder by the Desjardin’s
choledocholithotomy forceps.
SUPRAPUBIC CYSTOLITHOTOMY
FORCEPS
 SUPRAPUBIC CYSTOLITHOTOMY
FORCEPS
 This forceps consists of f inger bows—a pair of shaft and a pair
of blades.
 The blades are longer and the inner surface of the blades are
provided with f ine knobs which helps in better gripping of the
stones.
 There are no rachet in this instrument.
Uses of Cystolithotomy forceps:
Used for suprapubic cystolithotomy. After the bladder is opened
by a suprapubic cystotomy the instrument is inserted into the
bladder and the stone is removed.
PYELOLITHOTOMY FORCEPS
 PYELOLITHOTOMY FORCEPS
 This is a long instrument, consists of f inger bows, a pair of
shaft and a pair of blades.
 The blades are small and oval with transverse serration on the
inner side of the blades with a central groove.
 There is no rachet in the shaft.
Uses of pyelolithotomy forceps:
Used to hold the stone during nephrolithotomy, pyelolithotomy or
ureterolithotomy.
 CLUTTON’S METALLIC
BOUGIE/URETHRAL DILATOR
 CLUTTON’S METALLIC
BOUGIE/URETHRAL DILATOR
 This is a solid, cylindrical metallic instrument.
 The handle is violin shaped with a long shaft and the terminal
end has a smooth curve with a blunt tip.
 The number written on the handle has a difference of 4.
 The denominator number denotes the circumference in mm at
the base and the numerator denotes the circumference in mm at
the tip.
 This is available in a set of 12 and the different numbers are
6/10, 8/12, 10/14, 12/16 ........... 28/32.
LISTER’S METALLIC BOUGIE/URTHRAL
DILATOR
 LISTER’S METALLIC BOUGIE/URTHRAL
DILATOR
 This is identical to a Clutton’s metallic bougie.
 The differences are:
• The handle is rounded and the tip is olive pointed.
• The number written has a difference of 3.
• This is also available in a set of 12.
Uses of Urethral Dilator/ Metallic Bougie:
 Used for dilatation of urethra in urethral stricture
 Used for dilatation of urethra prior to introduction of cystoscope
 Used during repair of rupture urethra by rail road technique.
 Used during choledocholithotomy. This is used as a sound to
ascertain presence of bile ductstones. This may be passed
through the ampulla of vater to ascertain the patency of ampulla.
LISTER’S SINUS FORCEPS
 Lister’s sinus forceps:
This is a long slender instrument with a pair of small blades with
transverse serrations. There is no ratchet in the handle.

USES:

 For incision and drainage of abscess by Hilton’s method.

 May be used to hold a gauge swab to clean the abscess cavity.
ANAL SPECULUM
 ANAL SPECULUM
 The instrument is about 3 inches long.
 There is a hollow outer sheath where a handle is attached.
 The terminal end of the sheath is either round or obliquely cut.
 The inner rod is called the obturator and its terminal part is
smooth and rounded and fits well with the outer sheath.
 In some instrument, there is arrangement for attachment of a
light.
Uses of Anal speculum:
 Diagnostic uses:
By proctoscopic examination, it is possible to diagnose following
conditions: piles, an anal or a rectal polyp, carcinoma of anal
canal or rectum

 Therapeutic uses:
 Used during injection sclerotherapy of piles
 Used during polypectomy
 Used while taking a biopsy from a rectal or an anal growth.
Two way Foley’s balloon catheter
Three way Foley’s balloon catheter
 Foley’s Catheter
This is a variety of self retaining catheter:
 In two ways Foley’s balloon catheter, the side channel is used to
inflate the balloon so that it is kept indwelling. There is a valve in
the side channel. The main channel is for drainage of urine. The
catheter number and the balloon capacity is mentioned on the
main or side channel.
 In three ways Foley’s balloon catheter, there is an additional third
channel for either irrigation or drainage.
Uses of Foleys catheter:
 For relief of retention of urine by urethral catheterization.
 May be used for suprapubic cystostomy
 May be used for tube nephrostomy
 May be used for gastrostomy or jejunostomy
 May be used for urethral catheterization following open
prostatectomy for drainage of bladder. The three way catheter is
favored as there is a side channel for irrigation of bladder
KEHR’S T-TUBE
 Kehr’s T tube:
 Composed of PVC (polyvinyl chloride).
 There is a short horizontal limb which is inserted into the bile
duct and a long vertical limb which is brought outside.

USES:

 Following choledochotomy, the bile duct is closed over a T-tube,

as primary closure of bile duct is associated with higher
incidence of leakage.
 Used to drain the bile duct following repair of bile duct injury.
The T-tube acts as a stent and is usually kept for about 4–6
weeks.
How T-tube is inserted?
The short limb is cut to a desired length. The limb passing toward
the lower end of the bile duct is kept about 3–4 cm and the limb
passing toward the hepatic duct is kept about 2–3 cm. A slit is
made in the short limb so that the two openings are connected by
the slit and a rim of tube is cut away along the slit made. The
short limb is then inserted into the bile duct. The choledochotomy
is then closed with interrupted sutures so that the T-tube f it s
snugly in the bile duct taking care not to take any bite of the
suture in the T-tube. The long verical limb of the T-tube is brought
out through a stab wound in the skin in lateral abdominal wall and
is fixed to the skin by a stitch.
How will you take care of T-tube?
 The T-tube is connected to a closed system of drain into a
urobag.
 The bile is collected in the urobag, measured and evacuated
every morning.
 A T-tube cholangiogram is done on 10th-14th postoperative day.
 If T-tube cholangiogram is normal, the T-tube is clamped
overnight and if patient has noproblem, on next morning the T-
tube is removed by a smart pull. There may be slight leakage of
bile for 1–2 days and the tract closes spontaneously.
 SUTURES
Most of the sutures are supplied in a sterilized pack. In
examination, mention the following points:
 No. of suture—1/0, 2/0, ....
 Natural or synthetic
 Absorbable or non-absorbable
 Type of suture - catgut, polyglycolic acid, polyglactin .....
 Whether provided with a needle or not - If there is a needle,
description of the needle - length, curvature, round bodied or
cutting needle
 Length of the suture - 45 cm, 70 cm, 90 cm ..............
 TYPES OF SUTURES:
 ABSORBABLE
 NATURAL: Catgut
 SYNTHETIC: Polyglactin Sutures (Vicryl), Polyglactin Rapide (Vicryl
Rapide) Suture, Polyglecaprone (Monocryl Suture), Polydioxanone
Suture (PDS·II)

 NONABSORBABLE
 NATURAL: Silk
 SYNTHETIC: Polypropylene Suture, Polyamide Sutures, Nylon Sutures,

 STAINLESS STEEL WIRE

Natural Absorbable Suture (Catgut):
 Derived from the submucosa of sheep's intestine or serosa of
cattle's intestine.
 Absorbed by a process of enzymatic digestion by proteolytic
enzymes.
 The chromic catgut loses 50% tensile strength in 7 days and loses
all its tensile strength in 28 days.
USES:
 Catgut is used to tie small subcutaneous vessels.
 Used to approximate subcutaneous tissues during closure of an
incision.
 Used during circumcision to suture the cut margins of the prepuce.
 Used during appendicectomy.
SYNTHETIC ABSORBABLE SUTURES:
 These may be monof il ament (monocryl, polydioxanone/PDS) or
polyfilament (vicryl and vicryl rapide)
 They can be of natural color or can be colored green (dexon) or
violet (vicryl)
 They are absorbed by a simple process of hydrolysis and evoke
minimal tissue reaction.
 These are sterilized by ethylene oxide.
 Vicryl maintains tensile strength in the tissues for about 28–30
days and get absorbed in 80–90 days.
 Complete absorption of PDS occurs in about 180–210 days.
SYNTHETIC ABSORBABLE SUTURES:
Uses of Vicryl:
 Indicated in all situations where catgut are used
 Used in biliary-enteric and pancreaticojejunal anastomosis.
 In small gut resection and large gut resection anastomosis.

Uses of PDS:
Closure of paramedian or midline and other abdominal incisions.
NATURAL NONABSORBABLE SUTURES:
SILK
 The silk is derived from the cocoon of silk worm larvae.
 Handling property is best and it knots securely.
 This is sterilized by gamma irradiation.
 The silk for surgical use is dyed black.
 Tensile strength: Silk maintains tensile strength for a longer time
and the tensile strength is lost in 2 years time.
Uses of Silk:
 Used during cholecystectomy to ligate the cystic duct and cystic
artery.
 Used during small and large gut resection to ligate the
mesenteric vessels.
 U se d to l i g a t e t he p e d i c l e s d uri ng ne p hre c to m y a nd
splenectomy.
 Used during truncal vagotomy to ligate the anterior and
posterior vagus nerve before their division.
 Used for anterior and posterior seromuscular sutures in small
gut anastomosis and in gastrojejunostomy.
SYNTHETIC NONABSORBABLE SUTURES
Uses of Polypropylene:
 Used for herniorrhaphy for repair of the posterior wall of inguinal
canal.
 Used for closure of midline abdominal incision
 Used for repair of incisional hernia
 Used for repair of tendon injuries
 Finer sutures 4-0, 5-0 are used for vascular anastomosis and for
repair of nerve injury.

Uses of Polyamide (Ethilon):

For closure of skin incision
RYLES TUBE
Procedure of Ryles Tube insertion:
 Explain the procedure and obtain consent.
 Sit the patient in a semi-upright position with the head supported with pillows
 Examine the nostrils for deformity or obstructions before insertion.
 Measure the tubing from the bridge of the nose to the earlobe, then to the point
halfway between the lower end of the sternum and the navel.
 Mark the measured length with a marker or note the distance.
 Lubricate 2-4 inches of tube with lubricant (eg, 2% Xylocaine).
 Pass the tube via either nostril, past the pharynx, into the oesophagus and then
into the stomach.
 Instruct the patient to swallow and advance the tube as the patient swallows.
 Stop immediately and withdraw the tube if the patient becomes distressed, starts
gasping or coughing, becomes cyanosed or if the tube coils in the mouth.
 Advance the tube until the mark is reached.
 Check the tube's position. Secure the tube with tape.
Checking tube position:
 Testing pH of aspirate: gastric placement is indicated by a pH
of less than 4, but may increase to between pH 4-6 if the patient
is receiving acid-inhibiting drugs. Blue litmus paper is used to
check the acidity of aspirate
 X-rays: In the absence of a positive aspirate test, where pH
readings are more than 5.5, or in a patient who is unconscious
or on a ventilator, an X-ray must be obtained to conf irm the
initial position of the nasogastric tube.
 Introducing a small quantity of air into the stomach and
checking for a bubbling sound over the epigastrium is unreliable.
Indications of Ryles tube:

 to drain gastric contents and decompress the stomach

 to treat gastric immobility and bowel obstruction
 lavage in drug over dosage or poisoning
 assessment of GI bleeding
 to aid in the prevention of vomiting and aspiration
 used for enteral feeding

Contraindications for Ryles tube insertion:

 Severe midface trauma

 Recent nasal surgery
 Esophageal varices
IV CANNULA
IV CANNULA