Instruments

Dellon Durga
Oropharyngeal
airway/Geudel
useful in the unconscious patient

curved end
goes over the tongue
fits the contour of the pharynx
prevents post pharyngeal obstruction
ridge
serves as a bite block – (instead of pt
biting the ET tube, tongue or sides of
mouth)
prevents occlusion

How to insert OPA In pts. Mouth?

-suction mouth
-measure the distance from corner of
pts. Mouth to angle of mandible, to
get correct size
-with Non dominant hand lift the pts.
Chin and with Dominant hand Insert it
inverted until it reaches soft palate
&then Rotate 180^ (adults)
Endotracheal Tube
Parts
Connector –15mm standard size that
connects to the ventilator
Valve
Phlange- ease in handling?
Pilot balloon – inflate with air until
desired tension
Murphy‟s eye – hole for air to pass if
the tip is blocked
Beveled tip – beveled makes it pass
more easily through VC
Cuff – produces air tight seal and
prevents aspiration
Number – indicates distance from the
tip to cord
Internal Diameter-Adults 8cm+/-
1…males 8-9, females 7-8,
*Peds ETT not usually Cuffed,
Infant ID 3.5, , Premature 2.5
• *A south bound ETT is used for head
surgery,maxillofacial,ophthalmology
• *North bound for Thyroid surgery…
•
• Complications
While doing procedure
1. airway
– tooth damage or displacement/dislocation
– lip and tongue laceration
– dislocation of mandible- esp. if TMJ unstable
2. malposition
– eosophageal intubation
– endobronchial intubation –most commonly right bronchus (less acute
angle)
[Link] of physiologic reflexes
a. HTN
b. Tachycardia
c. Increased ICP
d. Increased intraocular pressure
• While tube is insitu
1. endobronchial intubation
2. unintentional extubation
3. obstruction
4. ignition – esp. laser surgery bcuz gases may explode
• Following extubation
1. laryngospasm
2. laryngitis
3. airway trauma
4. edema and stenosis
a. glottic
b. subglottic
c. tracheal
5. hoarseness
a. vocal cord paralysis
b. vocal cord granuloma
 • How to know if ETT is in place
1. direct vision
2. auscultation
a. bases of lung
b. apices of lung
c. epigastrium
3. CXR
4. end tidal carbon dioxide – on capnograph ( Best?)
5. Rise and Fall of chest
6. Condensation in tube
Care of ETT
1st ventilator check-note ETT position, record cm mark at lips..ensure tube is
secured
2nd check –Do Cxray to verify position, Perform oral care + suctioning of
pharynx using Fr. 14 catheter….reposition tube to other side of mouth, Retape
or resecure…Perform cuff care(pressure check - manometry)….
Special ETT
[Link]
[Link]
3. Double lumen-Caralin’s = for independent lung ventilation (varying
pressures) eg for pts with two different lung pathologies or wit a gd lung & a
bad one, also during Lung operations.
[Link] Evac – has a hole above cuff to facilitate suctioning of fluids…hence
preventing Aspiration
[Link] airway- allows you to manage the airway in conditions that r
unfavorable & cannot intubate…there is no need to visualize v cord
[Link] airway
Macgill’s Forceps
Indications
1. to remove
foreign bodies
2. assist in
placement of
a. NG tube
[Link]

To place pharyngeal packs

The handles are curved so
that the operator’s hand
does not obstruct the view
LMA
Is an alternative advanced
airway device to ETT and
does not require a high
degree of skill

Parts
1. connector – for oxygen
2. bite block
3. cuff
4. pilot balloon & line
5. check valve
6. bite plate

• Sits on top of the larynx and

therefore does not intubate
the trachea.
 Methods Of Insertion
• 1Deflated vs Inflated technique
• [Link] technique- like a pen
• [Link] technique
•
• *it is inserted blindly through the mouth and hypopharynx and silded down until it lies at the
entrance of the trachea covered with bulb
LMA VS ETT
Advantages of LMA
1. less invasive
2. useful in difficult intubations
3. neck mobility not required
4. less tooth and laryngeal trauma
5. decreased laryngospasm and bronchospasm
6. no risk of eosophageal or endobronchial intubation
7. does not require a high degree of skill for intubation
Disadvantages of LMA
1. improper placement
2. aspiration of reflux
use of LMA
1. short operations
2. Difficult intubation
Tracheostomy tube
it decreases the dead space by half
ABCD of TT
Assist to provide PEEP for long
periods >10 days and airway
protection
Bountiful relief of upper airway
obstruction
Comatose state
Disastrous accidents of mouth

Tracheostomy
This may be:
emergency or elective
percutaneous or open.
Indications for tracheostomy
[Link] to provide PEEP for long periods >10 days and airway protection
[Link] relief of upper airway obstruction eg..
Supralaryngeal obstruction
• Ludwig's angina
• Severe facial fractures
• Glandular fever
• Laryngeal obstruction
• Epiglottitis
• Laryngeal tumour
• Bilateral vocal cord palsy
•
[Link] state to Prevent pulmonary Aspiration
• Coma
• Myasthenia gravis
• Bulbar or pseudobulbar palsy
•
[Link] accidents of mouth
[Link] support
• Injury to the chest wall
• Seriously ill or injured patients (ARDS)
[Link] endotracheal intubation
[Link] endotracheal intubation
Advantages
[Link] blind tracheal intub
[Link] visualization of cord not needed
• Contraindications
• [Link] body in airway
• [Link] or mandibular f#
• [Link] of reactive airway dz.
• [Link] stomach or retained gastric contents
Nasopharyngeal Airway
Flared end remains outside
The beveled end goes inside
Better tolerated than the
oropharyngeal airway

Indications
[Link] oropharynx
risk of the procedure
[Link] to mucosa of nasal
turbinates or conchae causing
epistaxis
contraindications
[Link] patients
[Link] skull fractures
Laryngoscope
Types
Magill (straight blade)
Macintosh (curved blade)
Mc Coys (flexible tip)
Used to move epiglottis

Technique – produce intubation

under direct vision to prevent
eosophageal intubation thus
filling stomach with air
Place patient in the sniffing
position
Insert blade in the right side of the
mouth
Sweep the tongue from right to
leftPlace the tip of the blade in the
vallecula
Visualize vocal cords
Place ETT through vocal cords
INDICATIONS FOR LARYNGOSCOPY
[Link] n view Glottis
[Link] during Intubation under GA
[Link] ENT –Etiolgy of throat(strictures) / ear pain
[Link] Obstructive masses in airway
Laryngoscope sizes = Men 4, women 3, child 2, toddler 1
Mallampati Score
1. All of v cord visualized
2. 0Most of v c „‟
3. Posterior part “”
4. Nothing at all “”
• *for score of 4 do fiberoptic laryngoscopy or use LMA
Ambu bag
Transparent mask
1. see vomit/ secretions
2. see condensation of
breathing
oxygen reservoir
self refilling bag

Indication
1. to provide Positive
pressure ventilation
PEEP to a patient that is
not adequately
breathing
Face Mask
Transparent face mask
[Link] vomit and secretions
[Link] the condensation
caused by respiration

Indications
[Link] facilitate manual delivery
of oxygen or anesthetic gas
from the breathing circuit by
creating an air tight seal
Yankauer Suction
 Fluids
• Crystalloids
1. hypertonic
a. 3% NS
b. 5% D in half NS
c. 5% D in NS
d. 10% D
2. isotonic
a. NS
b. RL
3. hypotonic
a. D5W ????????????
b. ½ NS

Indications
[Link]
a. Hypoosmolar states
2. isotonic
a. acute fluid loss ( vomit , blood , diarrhea)
3. hypotonic
a. hyperosmolar state ( dehydration, insensible loss)
 • D5W
1. 100mls = 5g dextrose therefore 500mls 5%
= 25g=
• 100kcal . the caloric value is minimal
1. used for –
a. DM pre op
b. Ongoing losses
c. Fever
2. contraindicated in
a. head trauma
i. worsens brain edema
 Colloids
1. Synthetic
a. Gelfusine
b. Dextran
c. Albumin
d. pentastarch
2. natural
a. whole blood
b. packed cells
c. plasma
d. platlets
e. Cryoprecipitate
Indications
1. fluid resuscitation in patients with severe IV fluid or blood deficit ( often used with crystalloids when
the fluid deficit exceeds 3-4litres)
2. Third space loss
3. low protein states
colloids are retained IV for 3-6 hrs
crystalloids retained for 20-30 mins
GI Instruments
 Drains
Closed
1. Active
• Hemovac
• Jackson - Pratt
• Chest tube on suction
2. Passive
• NG Tube
• Foley urethral catheter
• Chest tube not on suction
Open
1. Active
• SUMP drain
[Link]
• Penrose drain
• Cigarette drain
• Corrugated drain
• T – tube
• Closed active drains
Indications
• Thyroidectomy
• Neck surgery
• Breast surgery
• Lymphatic surgery
• Groin surgery
NG Tube
Indications
Diagnostic
Examine the nature of the stomach
contents Color and consistency
Monitor fluid volume from stomach
Determine the quality of the gastric
contents
Facilitate pentogastrin MAO/BAO
test

Therapeutic
Pre/intra op
Decompression / empty stomach
Treat bowel obstruction
Acute gastric dilatation
Cholecystitis
Secondary to burns

Treatment of post op paralytic illeus

Enteral feeding
Lavage – poisons
Medications
Contraindications
1. Maxillofacial fractures
2. Basilar skull fractures
To avoid perforation of the cribiform plate Use an orogastric tube instead
3. Osophageal anastomosis

Equipment required is:

non-sterile gloves
nasogastric tube size 10 (small) to 16 (large)
catheter drainage bag
lubricant
glass of water.

Technique
Estimate the length of the tube needed
Distance from mouth to tragus then to xiphisternal joint
Lubricate the NG tube
Have suction available and ready
Place the head in neutral position?
Advance the tube into one nostril directly posterior toward the occiput
Ask the patient to swallow, while the tube is being passed
*If the patient has a poor gag reflex then sometimes a laryngoscope and a Magill's forceps can be used to direct
the tube into the oesophagus

*DO Cxray to confirm position, Auscultate, Bubbles

• Suction Under Minimal Pressure (SUMP)
drain
Indications
• To drain intra abdominal collections in the
peritoneal cavity
• To drain abscesses and close off the space to
prevent recollection post drainage.
• Open passive drains

Types
• Penrose
• Cigarette = Penrose with a piece of gauze in
the lumen
• Corrugated penrose (has a radio-opaque line to
confirm location
 Jackson Pratt Drain
used to drain surgical wounds and keep
bacteria/blood from building up
usually attached to suction bulb
if you are asked to "strip" these tubes - it
means you need to pull along the length of
Penrose the clear tube filled with blood [this
prevents clotting]
T Tube
Indications
1. Drainage and decompression of the
billary tree ( post CBD exploration
and cholecystectomy
2. enables cholangiogram intra op and
on the tenth post day when the
fibrous tract is formed
3. used with choledoscope to remove
retained stones
4. provides splint for reparing a CBD
stricture
5. used for irrigation with Normal
Saline if retained CBD stone, to
encourage it’s passage
6. occasionally, used to form an
external billary fistula in CBD
obstruction not amendable to internal
bypass
Indications for removal
1. Usually after 2 weeks
2. when bilirubin level does not
increase
3. no symptoms or signs of cholangitis
after clamping
4. normal T-tube cholangiogram
 Genitourinray
Urethral catheters
 Non self retaining
Jakes
Indication – to enter the bladder only
 Self retaining
2 way foley catheter
 one end for syringe
 one end for drainage bag
3 way foleys catheter
 one end for syringe (to inflate)
one end for drainage bag
 one end for irrigation
Other self retaining catheters
Malecot
Depezzer (mushroom)
Indications
Suprapubic cystostomy
Gastrostomy
Drain the pelvis
Foley’s Catheter
Indications
Diagnostic
Monitor urine output
Adult = .5-1.0 cc/kg/hr
Child >/= 1.0cc/kg/hr
To facilitate urethrogram, cystogram
Measure post void residual volume (
usually 0 in a normal healthy adult
Obtain urine for culture and sensitivity

Therapeutic
Relieve acute or chronic urinary
retention
Bladder irrigation
Instillation of drugs
Protect the suture line of the bladder
post op
Prevent urethral cross-prevent
adhesions an strictures
Maintain empty bladder during pelvic
surgery and long surgical procedures
Contraindications
Suspected or confirmed urethral injuries
1. severe pelvic fracture
2. blood at external urethral meatus
3. high riding prostate on rectal exam
4. scrotal or perineal injury/echymosis
Urinary catheters are usually made of either latex or silicone rubber. Silicone is less
irritant and should be used if the catheter is to be left indwelling for some days or
weeks.
A Foley catheter is self-retaining because of an inflatable balloon (Fig. and is usually
but not invariably made of latex.
Three-way catheters are used for irrigation of the bladder, e.g. after prostatectomy.
Size
• 8-10 F: children and adults with tight urethral stricture
• 12-14 F: normal urethra or in the presence of mild prostatic hypertrophy
• 16-18 F: moderate prostatic hypertrophy
• 20-24 F: after prostatectomy for free drainage and in other circumstances where
bladder irrigation is required with the use of a three-way catheter.
• The smallest size feasible should always be used.
Urethral Bougie
Designed for use by urologist only
Base numbers of 26/30 indicates 26
french diameter at tip and 30 french
diameter at base

Indications
1. Dilation of urethral stricture
usually following venereal disease
and trauma.
2. urethral calibration
Contraindications
1. Urethral rupture
2. urinary stasis
3. active urethritis/infection
4. urinary retention due to suspected
stricture
Cystoscope (flexible and
rigid)
Indications
Diagnostic
1. bladder biopsy
2. investigate a patient with
unexplained hematuria
3. retrograde pyelograms
4. positive urinary cytology
5. investigate lower urinary
tract symptoms (LUTS)

Therapeutic
1. stent placement ( to relieve
ureteric obstruction)
2. chemotherapy for bladder
cancer
3. retrieval of bladder
calculus
Rigid sigmoidoscope
• Used to look at the rectal and rectosigmoid regions
Proctoscope
• Flexible
• Rigid
Lower GI endoscopy
• Rectum 13- 15cm length
• Anus 4cm length
• Rigid sigmoidoscope 20 cm
• Flexible sigmoidoscope up to 65cm
• Colonoscope 160 -165cm
•
Rectosigmoid junction is 12-15cm from the anal canal and it
may be difficult to negotiate
 Rigid Sigmoidoscopy
Indications
• Diagnostic
1. visualize the lower GI tract
2. facilitates biopsy of lesions in the rectum and sigmoid
therapeutic
1. reduces volvulus
• technique
1. sedation
2. place patient in left lateral position
3. DRE
4. lubricate sigmoidoscope and introduce scope
5.
6. attach air source
a. to distend the bowel – allow better visualization
7. sigmoidoscope should be passed with adequate light and visualization
8. the mucosa is inspected for the color, inflammation, blood, lesions
• complications
1. bleeding
2. perforation
3. damage to surrounding structures
• NB the core biopsy needle is a tru -cut needle
Orthopedic Instruments
 Intra-Medullary Nails
1st generation nails
a. K nails
i. require an open fracture site. Nail inserted under direct vision
ii. Used without C arm.
[Link]
1. Infection
2. Non union
2nd and 3rd generation nails
a. Locked nails
i. can be used for both open and closed fractures.
ii. In closed nailing – C arm is needed.
[Link] the operation time and complication rate
 K Nail
Locking the nail to the bone both proximally and distally maintains length and rotational control
parts
Rectangular opening at the proximal end
aids in the removal when the fracture site unites via a hook placement.

3 point fixation
• Stability when in contact with bone
• Shape prevents rotation
Width
Depends on the narrowest point of shaft ( mid point)

Description
The length used depends on the length of the femur
It only provides rotational stability when used for mid shaft femoral #

Indications
Internal fixation of transverse or oblique # of the mid shaft of the femur

Contraindications
tibial #
# of the proximal and distal 3rd of the femur
It does not provide rotational control of these sites
Spiral or cominuted # of the femur
Upper limb fracture

Technique
Missing
1cm of K nail is left proximally in the piriform fossa
The # is then reduced and the nail advanced across the # site into the distal fragment
Insert the k nail in retrograde
Kuntscher Nail

Cloverleaf end

Used for transverse # of mid

third of femur, 7 cm below
lesser trochanter and 13 cm
above knee

Locked proximally and distally

Other intramedullary nailing ,

the IM rods are used
K wire [kirschner]
Indications
stabilize # of small parts of the
body fingers
Toes
metacarplas/tarsals

Mini fragments plates can also

be used for metacarpal and
metatarsal #

K wire looks like a long slim

steinman pin +/- 2 pointed
ends
Austin Moore Prosthesis
[partial hip prosthesis]
Parts
Head – reduced into acetabulum
Neck – rests on calcat (part of femoral
shaft with the strongest cancellous
bone)
Shaft – into the femoral canal

Indications
Displaced intracapsular #

Technique
the displaced femoral head is removed
and the appropriate size prosthesis is
then inserted

challenges of hemiarthroplasty
1. loosening of prosthesis – esp. in
physically active persons
2. dislocation – related to poor
technique – inadequate repair of
the capsule
3. increase wear of acetabulum – due
to inc. activity
 Total Hip Arthroplasty
Indications
1. osteoarthritis
2. rheumatoid arthritis
3. avascular necrosis of the femoral head secondary to
a. steroids
i. where there is posterior hip displacement
b. trauma
i. displaced femoral neck #
Failure
1. loosening of the device – main reason for failure and
mainly occurs at the acetabular cup or the femoral end
a. mechanical
b. infection
Dynamic Hip Screw
indications – extracapsular #
basicervical #
intertrochanteric #
subtrochanteric #

Technique
1.
2. when it collapses over the # site
the sliding mechanism prevents
the screw from entering the
pelvis
3. the sliding =a safety mechanism

Reasons for failure

1. mechanical
2. infection

Aka: Richards; screw or sliding

barrel and pin

135 degrees
Steinman Pin
Description
Steel
Variable diameter
2 pointed ends or 1 pointed one blunt
The threaded pin allows for good
drainage
The threads are in the bone where they
are needed
The smooth ends are in the soft tissue (
less traumatic)

Design can be either

fully smooth – greater loosening
fully threaded
partially threaded ( middle third )

sites of insertion
[Link] femur
[Link] 3rd of tibia – most common
site
[Link] tibia - occ.
[Link] – occ.
Indications
Skeletal traction
1. temporary stabilization of # femur and tibia
2. maintain limb length until operative Mx
3. to treat open # if external fixation is unavailable
4. provides longitudinal forces and rotational stability
Complications
1. common peroneal nerve injury
a. pain over the 1st inter digital cleft of the foot leading to
b. foot drop
c. inability to dorsiflex toe
2. infection/ local sepsis at the pin site
a. Fever
b. Pus draining through wound

Technique
1. informed consent
2. aseptic techniques
3. local anesthesia – soft tissue and periosteum
4. proximal tibial insertion – 2.5 cm distal and posteriolateral to the tibial tuberosity
5. pin placed from lateral to medial

Steinman pin converges at end k wire does not.

POP
hemi hydrated calcium Sulphate
add water = exothermic reaction ( plaster
degrades)
is reversible thus if add water it softens
and useless
When all air spaces saturated = no more
bubbles = change from powder to rock
hard mass = stabilizes #

Indications
maintain alignment after reduction
reduce tension after post op repair of
tendon, nerve, ligaments, vessels
serial casting eg. Club foot, cerebral palsy,
metatarsus adductus

advantages
cheap
molds well
hypoallergenic
dec. hospital stay

disadvantages
poor water resistance
poor radiolucency
heavy
risk of burns – exothermic rxn
pressure necrosis – too thight, to prevent
pad well
compartment syndrome – too tight
Fiberglass
made from woven fiberglass that is
coated with polyurethane resin.
is webbed in texture and appearance
and it is often colored. Common
fiberglass cast colors include blue, pink
and green
Fiberglass casts are lighter and
stronger than plaster casts. They also
last longer as they are more resistant
to water damage and wear. However,
neither type of cast is waterproof
Fiberglass is more porous than plaster,
so that a fiberglass cast is often more
comfortable to wear.
fiberglass cast takes 30 minutes to two
hours to dry as opposed to up to 48
hours for a plaster cast. However,
plaster is easier to mold than
fiberglass.
Is more expensive than POP
Dynamic Condylar Screw
95 degree angle
Lag Screws
To fasten together fractured
bone segments and to affix
bone plates.
Gigly Saw
To cut bone, e.g., in
amputations
Rongeur’s
To excise, trim and sculpt soft
(cancellous) or hard (cortical)
bone.

Rongeurs: To cut or remove

small pieces of tissue or
bone.

Certain rongeurs are designed

for use on soft tissue and
cancellous bone only.
Bone Cutters
To cut bone or to remove
bone splinters.
Bone Shield

Placed at the proximal and

distal end of the proposed
site of cutting on a long bone
Bone Curette
To scrape, shape and clean
bone
Periosteal Elevator
-To elevate and dissect bone, tissue,
nerves.

-To clean and scrape bone.

-To expose fracture sites or bone in

other procedures.

-Periosteal elevators are used to strip

portions of the membrane
(periosteum) covering the exterior
surface of a bone.
Chisel
To cut a window in the bone
cortex to allow
harvesting of pure soft bone
Bone Levers
Gouge
• To scoop away
strips of soft
bone,
especially in
bone grafting.
Foots and west self retaining
retractor
Bone holding
ring forcep

To hold, stabilize, rotate,

reduce and compress bone

To position bone screws and

plates and insert K-Wire
Osteotome
To shape and sculpt bone,
particularly
Cancellous

Beveled on both sides, chisel only

beveled on one side.
AO screw driver
To place and remove bone
screws
Mallet
To exert force on
osteotomes, chisels,
gouges, etc.

To drive the instruments for

inserting nails into the
medullary
canal.
Ilizarov external fixator
Langenbeck Retractors
Lane Retractors
• Lane retractors – a
light general
purpose retractor
with short shallow
hooks at one end
and a tongue at the
other
Kocher’s
Bone Lever
Plate Buttress
Tibial Plate
Narrow DC plate for
forearm
Surgical steel
Null pins
Used for SCFE
Stirrups
Soft Collar
Philadelphia Collar
Orthoband
Skin Traction material
Esmarch
Skeletal traction
Cast cutter
Cast Spreader
Scissors
Manual Saw
Wire cutter
T handle
Below Knee metallic splint
Thomas splint
Bohler’s Braun Frame
 Traction: Maintain Reduction
• SKIN TRACTION: Buck's skin traction is widely
used in the lower limb for femoral fractures,
acetabular and hip fractures.

• reduces pain and maintains length in

fractures.

• Weight is 5-7LBS
 Skeletal Traction
• Tibial: weight 1/7 th pts body wgt.
• Steinman pin used with stirrup and braun’s frame

• Other pin is the denham pin which had a threaded

middle portion to keep it in place in the tibia

• Distal femur: wgt. 1/10 pts body weight

• Calcaneal : same as skin

• Pass steinman pin from medial to later in femur, in tibia

pass lateral to medial to avoid peroneal nerve
 Gallow’s Traction
• Indications Gallows Traction
• Child must weigh less than 12 kg
• Femoral fractures
• Skin must be intact
• Both the fractured and the well femur are placed
in skin traction and the infant is suspended by
these from a special frame. Vascular compromise
is the biggest danger. Check the circulation twice
daily. The buttocks should be just off the bed.
Ent Instruments
Alligator and Crocodile
forceps
To remove foreign
body from ear nose or
throat
Ear Syringes
•This instrument is the metallic
aural syringe, an instrument used
for syringing of the ear, an OPD
procedure.

Indications for ear syringing:

Wax removal
•Foreign body removal
•Removal of otomycotic debris

The syringe has a nozzle for

insertion into the external
auditory canal. Water at body
temperature is loaded into the
syringe. The syringe is held by
inserting fingers into the rings at
the back. The third ring is on the
piston that forces the water out
when pushed.
Killian’s nasal speculum
This is one variety of nasal
speculum and is used for both
nasal examination and surgery.

It comes in several sizes, from

small to long-bladed. A screw in the
handle can be tightened to hold the
blades of the speculum in the open
position. This gives the speculum
its self-retaining feature, very useful
during septal surgery.

The Killian’s nasal speculum is

used in:
• Anterior rhinoscopy
•Anterior nasal packing
•Septoplasty
•Polypectomy
•Nasal foreign body, rhinolith
removal
•Turbinate reduction surgeries
Thudichum nasal
speculum

The instrument has two flanges that

can be inserted into the nostril
during anterior rhinoscopy. The
flanges widen to open up the nasal
cavity, offering a better view of the
structures inside the nose.

Uses of the Thudichum’s nasal

speculum:
•In anterior rhinoscopy
•Foreign body removal from the
nose
•Peroperatively, for nasal packing
•In septal surgeries (septoplasty
and SMR) while making the incision
Ring Curette
Removal of foreign body
Myringotomy Knife
Posterior Rhinoscopy
Mirror
This instrument is the St. Clair
Thompson post-nasal or posterior
rhinoscopy mirror.

Uses:

Examination of the post nasal

space by a procedure called
posterior rhinoscopy, an out-patient
procedure.
The mirror is warmed and
introduced into the oral cavity while
the tongue is depressed with a
tongue depressor. The mirror is
turned upwards in order to examine
the post nasal space.

The shaft of the instrument is bent

to achieve a bayonet shape, a
feature that helps differentiate it
from the indirect laryngoscopy
mirror. The mirror is available in 5
sizes.
Indirect Laryngoscopy
Mirror
This mirror is used to examine the larynx
in the outpatient using a procedure called
indirect laryngoscopy.

How indirect laryngoscopy is done:

•The indirect laryngoscopy mirror is

warmed to avoid fogging on it.
•The patient is asked to protrude his/her
tongue which is then held with a piece of
guaze.
•The patient is directed to breathe
through his/her mouth.
•The warmed indirect laryngoscopy mirror
is then introduced into the oral cavity with
the mirror facing downwards. (Check its
temperature by touching the back of your
hand with it, it should not be hot.)
•The mirror is brought to rest against the
uvula but do not touch the posterior
pharyngeal wall to avoid setting off the
gag reflex.
•Once the laryngeal inlet is visualized, the
patient is asked to say ‘eee’ to check the
movement of the vocal cords.
• Structures seen on indirect laryngoscopy (in order):

• Base of the tongue (posterior one-third of the tongue)

• Vallecula
• Median and lateral glossoepiglottic folds
• Epiglottis
• Pharyngoepiglottic folds
• Aryepiglottic folds
• Arytenoids
• False vocal cords
• True vocal cords
• Tracheal rings

• Indications for indirect laryngoscopy:

• Examination of the larynx in cases of change in voice

• Examination for dysphagia
• To look for vocal cord mobility prior to thyroid surgery
• To look for the primary in cases of neck metastases

• The shaft of the indirect laryngoscopy mirror is straight, a feature which helps differentiate it
from the posterior rhinoscopy mirror which has a bent shaft
Jobson horne’s probe and
ring forcep
Ear wax removal
Removal of foreign body from the
ear
Removal of otomycotic debris or
discharge from the external
auditory canal
Probing of aural polyp or other
mass in the ear canal
Probing of nasal masses and
checking their sensitivity to touch
Mastoidectomy trocar
Luc oval forceps
Tilley’s Nasal dressing
forceps
To perform anterior nasal packing
To remove foreign bodies, crusts or
packs from the nose
To pack the nose with gauze strips
during nasal surgeries or sinus
surgeries
To remove cartilage and bone
pieces during septoplasty or SMR
Lack’s tongue depressor
It has two blades at right angles to each
other. One of them is slightly wider than
the other and is completely flat. This is
the part of the tongue depressor that is
inserted into the oral cavity. The other
blade is narrower and has a slight curve
at its free end, like a handle. This is the
part of the instrument that is held in your
hand.

Uses of the tongue depressor:

Examination of the oral cavity – vestibule,

buccal mucosa, gums, floor of the mouth
Examination of the oropharynx and
posterior pharyngeal wall
Used in posterior rhinoscopy, along with
the postnasal mirror
For the ‘cold spatula test’ – to assess
(approximately) the nasal airway/ patency
in the OPD
To perform minor procedures in the oral
cavity
To take a throat swab or a swab from the
tonsil
Rigid Bronchoscope
Head mirror
Otoscope insufflator bulb
Cannulas
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.

Blue 22G

Pink 20G

Green 18G

White 17G

Grey 16G

Orange 14G
Central vein 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
• 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
• 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.

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
Hickman 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).
Scalpel handle and blades
• Left: #7 handle with a
15 blade – called the
deep knife. Used for
cutting deep delicate
tissues.
• Middle: #3 handle with
a 10 blade – called the
inside knife. Used to cut
superficial tissue.
• Right: #4 handle with a
20 blade – called the
skin knife. Used for
cutting skin.
Forceps: Dissectors
• Toothed: used to
grasp or pick up soft
tissue or bony tissue;
to hold skin while
suturing.
• Non-toothed: used for
holding internal
organs/tissues; to
pick up or grasp
tissue or items in the
surgical wound.
A.K.A dressing
forceps
Artery forceps
• These are clamping
and occluding
instruments.
• They are used to:
– Compress blood
vessels or hollow
organs for
hemostasis or to
prevent spillage of
contents.
– Tag sutures
• Varieties: its jaws
may be straight or
curved.
• A.K.A: Crile, Snap or
Stat.
Kocher’s Forceps
• Use: to secure
haemostasis or to
grasp tissue (e.g.
for fascia
approximation)
• Varieties:
– Straight or
curved
– Fine or heavy
Mosquito Artery forceps
• Use: to secure
haemostasis of
delicate tissues.
• Varieties:
– Straight or
curved
– Serrations along
the entire length
of jaw
• A.K.A: halsted
or snap clamp
Babcock Tissue Forceps
• These are atraumatic
forceps – they have a
bar on each blade
that comes together
gently without
damaging the tissues.
• Used to grasp
delicate tissue
(intestine,
appendix,fallopian
tube, ovary).
• Varieties:
– Various sizes.
– Heavy or delicate
jaws.
Allis tissue forceps
• An Allis is used
to grasp or hold
tissues or
organs.
• A "Judd-Allis"
holds intestinal
tissue; a "heavy
allis" holds breast
tissue.
• Varieties:
– Short and long
sizes.
– 4*5, 5*6, 9*10
teeth
– Angular jaws
Littlewood Tissue Forceps
• Used for the
same purpose as
the Allis, but is
heavier.
Sponge Holder
• To hold a sponge
during a patient’s
preoperative skin
preparation or
intraoperative
haemostatic exposure
• Varieties:
– Blades:straight or
curved
– Length:long or
short
– Jaws:smooth or
serrated
• A.K.A:Fletcher or
Foerster sponge
forceps; or stick
sponge.
Duval Lung Forceps
• Use: to hold lung
tissue.
• Varieties:
– Atraumatic
– Small, medium
or large tip
– straight
Bronchus Clamp
• To secure a part
of the lung
during
pulmonary
surgery.
• Varieties:
– Angled
– Atraumatic teeth
Dennis Brown Bowel
Forceps
• Used to pick up
the gut during an
abdominal
operation or
hernia repair.
Gallbladder Forceps
• Use: to grasp
tissue during
cholecystectomy
& common duct
explorations
 Surgical Scissors
• The curved patterns are preferred by most
surgeons for dissecting, since they provide a
better field of vision for the areas to be cut.
• Straight scissors are used when a straight cut is
desired, such as in sutures, nerves, vessels.
• Scissors are also used to spread and probe the
area of incision: The smaller sizes are used at the
surface, the larger sizes deeper in the cavities.
• Dedicate the different types for their specific
purpose, for example, using fine dissecting
scissors to cut suture can ruin the cutting edge.
McIndoe Scissors
• Have long handles
and narrow blades
• Uses:
– For dissecting soft
tissue e.g
peritoneum.
– For dissecting at
the bottom of a
deep wound.
• Varieties:
– Blades: curved or
straight flat blades
– Length: varies
• A.K.A: Metzenbaum
scissors
Curved Mayo scissors
• Used to cut
thick, heavy
tissue (fascia,
muscle, uterus,
breast).
• Varieties:
– regular and
long sizes.
Straight Mayo Scissors
• Used to cut
suture and
supplies.
• Also known as:
Suture scissors.
 Needle Holder
• They look similar to hemostats, but jaws are thicker
and shorter.
• They are available in many styles and sizes.
• Shorter ones are used for working close to the
surface.
• Longer ones are for deeper cavities.
• The smaller the needle, the smaller the jaws of the
needle holder.
• If the needle is too large to be held securely, select a
larger size needle holder.
• Otherwise, the needle may slip, or the needle holder
may be overstressed, causing fatigue or breakage.
Needle Holder
• This is a hinged (locking)
instrument used to grasp
the suturing device.
• Good quality is ensured
with tungsten carbide
inserts at the tip of the
needle holder.
• Left: a Mayo-Hegar
needle holder.
– used to apply heavy
sutures, such as in
cardiovascular
surgery;
– it is also used widely
in general surgery.
– Recommended for
suture sizes 2-0 and
larger
Langenbeck Retractors
• Use: to maintain
exposure during
plastic surgery or
general surgery
as a hand held,
right angle
retractor.
Deaver Retractor
• A manual type.
• Used to retract deep
abdominal or chest
incisions.
• Available in various
widths.
It is a thin, flat instrument
with curved ends. The
curved ends of the
retractor are placed at the
edges of the incision and
held there by hand or
clamped into place.
Balfour’s Self Retaining
retractor
– This is used to
maintain exposure
for abdominal
surgery.
– Varieties:
• Different
blades- open
side, solid side,
deep center, or
broad center.
• Sizes: pediatric
& adult
Doyen retractor
Beckmann Weitlaner
Retractor
• Use: This is used
to maintain
wound exposure
• Varieties:
• Sharp jaws
• Blunt jaws
Eyelid Retractor
Finochietto rib
spreader/retractor
• Use:to retract rib
& sternum
during thoracic
surgery.
Towel Clips
• Use: to attach &
secure drape material
or to grasp tissue for
the purpose of
applying traction.
• Varieties:
– Perforating or non
– perforating
– Hinged or spring
activated
– With or without
ballstops
– Various lengths
• A.K.A: Backhaus,
Edna, Jones, Peers
forceps; or Roeder
towel clamp.
Poole Suction
• to remove ascites
or irrigation fluid
from abdominal
or chest cavity.
Rectal Retractor
Rectal Speculum
• to provide
visualisation of
the rectum
Gallipot
To put cotton, gauze,
cream, solution during
dressing
Kidney Dish
To receive and hold soiled
dressings, fluids, needles or
instruments needed for a
minor procedure and other
medical waste.

It's shaped that way so it

can be placed under the
chin fitting snugly to the
neck to catch fluids such as
vomit and blood.