POIE 4033 SURGICAL INSTRUMENTATION AND EQUIPMENT POWERED SURGICAL INSTRUMENTS SITI ZAIRINI AHMAD ILKKM KUBANG KERIAN
LEARNING OUTCOMES At the end of this learning session, the students will be able to 1. Explain overview and types of powered use by an surgical instrument 2. Perform the proper methods in handling power surgical instrument 3. Perform in care, cleaning and packaging for sterilization of powered surgical instruments
OVERVIEW OF POWERED SURGICAL INSTRUMENT Most surgical instruments have movable parts that are manipulated by the surgeon. Has two type.. PNEUMATIC • COMPRESSED AIR • COMPRESSED NITROGEN ELECTRIC • BATTERY • ALTERNATING CURRENT
OVERVIEW OF POWERED SURGICAL INSTRUMENT Powered surgical instrument are complex assemblies of BONE SKIN GEARS ROTATING SHAFTS SEALS Powered surgical instrument are used primarily for - PRECISION DRILLING - CUTTING - SHAPING - BEVELING - GRAFT - ABRADE SKIN
OVERVIEW OF POWERED SURGICAL INSTRUMENT The instrument may have OSCILLATING MOVEMENT (a cutting action from side to side) are used to cut or remove bone or skin. RECIPROCATING MOVEMENT (a cutting action from front to back) ROTARY MOVEMENT Used to drill holes or to insert screws, wires, or pins.
OVERVIEW OF POWERED SURGICAL INSTRUMENT
• The heat generated by powered instruments can damage bone cells; irrigated • Blood loss from bone is reduced by the tiny particles that these high-speed instruments pack into the cut surfaces; recommend wearing protective eyewear; a face shield or space headgear should be considered if splatter is anticipated. OVERVIEW OF POWERED SURGICAL INSTRUMENT
• When a powered instrument is being used, particularly one with a rotating movement, all team members must be very careful to keep their hands away from the blade. Most powered instruments have a safety mechanism on the handpiece. Some are operated by foot pedals. OVERVIEW OF POWERED SURGICAL INSTRUMENT
TYPES OF POWERED SURGICAL INSTRUMENT AIR-POWERED INSTRUMENT ELECTRICALLY POWERED INSTRUMENT BATTERY POWERED INSTRUMENT ALTERNATING CURRENT SONIC ENERGY INSTRUMENT
ELECTRICALLY POWERED INSTRUMENTS • Electrically powered instruments such as saws, drills, dermatomes, and nerve stimulators • Has potential explosion hazards in the OR • Most of the motors are designed to be explosion-proof. All must have spark-proof connections • Heat generated when using; need dripping of saline solution
AIR-POWERED INSTRUMENTS • Air-powered instruments are small, lightweight, free of vibration, and easy to handle for pinpoint accuracy at high speeds • In operating air-powered instruments, medical-grade compressed air or pure (99.97%) dry nitrogen • Supply is either piped into the OR or from a black cylinder tank on a stable carrier • The operating pressure is usually within a range of 70 to 160 psi; and storage pressure in the cylinder is at least 500 psi • psi = pounds per square inch
JHGJ
BATTERY POWER • Some battery-operated instruments are cordless and have rechargeable batteries in the handpiece. • Others have cords that attach to a battery charger, which is plugged into an electrical outlet. • The batteries are charged and sterilized for use on the sterile table.
ALTERNATING CURRENT • Power switches should be off before cords are plugged into electrical outlets. • The power supply cord should be connected to the outlet before anesthetic gases are administered and should not be disconnected during anesthesia administration. • The anesthesia provider should be alerted that electrical equipment will be used. • The scrub person may be able to disconnect the instrument from its power source when it is not in use so a team member cannot inadvertently activate it.
ALTERNATING CURRENT • Many of these instruments are activated by foot pedals. • The circulating nurse can move the foot pedal away from the surgeon until it is needed.
SONIC ENERGY • Some instruments are activated by sonic energy to move cutting edges in a linear direction. • This is a power assist without the rotary motion and high speed of other electrically powered instruments.
HANDLING POWERED INSTRUMENT HANDLE AND STORAGE PREVENTION INADVERTENT ACTIVATION TESTING FUNCTION SET UP ALONE USE SMALL STERILE TABLE / BASIN SAFETY SWITCH IS ON HANDLE WITH CARE ALWAYS INSPECT THE HOSE AND CORD ASSEMBLE APPROPRIATELY AND SECURELY SAFETY SWITCH IS ON TEST FUNCTION SAFETY SWITCH IS ON SET UP INSTRUMENT ATTACHMENT
CLEANING AND PACKAGING FOR STERILIZATION Powered instruments should always be operated, cleaned, and sterilized according to the manufacturer’s directions Clean and decontaminate the instrument immediately after use to maintain optimal function Lubricate the instrument as recommended by the manufacturer Packaging
CLEANING AND PACKAGING FOR STERILIZATION Clean and decontaminate the instrument immediately after use to maintain optimal function - Scrub person should wipe off any debris between uses - All accessories are disassembled for cleaning - The air hose should remain attached to the handpiece during cleaning - The motor is not immersed in liquid
CLEANING AND PACKAGING FOR STERILIZATION Clean and decontaminate the instrument immediately after use to maintain optimal function - The power mechanism cannot be cleaned in a basin of solution or put in a washer-sterilizer, a washerdecontaminator, or an ultrasonic cleaner. - The surface of the instrument is wiped with a mild detergent, and caution is used to prevent solution from entering the internal mechanism. - The detergent is wiped off with a damp cloth, and the mechanism is dried with a lint-free towel.
PREPARATION OF POWER INSTRUMENT SYSTEM BATTERIES / NITROGEN TANK • Inspect and test air-powered according to manufacturer instruction before use • Batteries fully charged • Air hose no leakage • Pressure of compressed air piped in / cylinder at least 1000 psi on pressure gauge • Electric cord in good condition and functioning well • Foot paddle of the system ready and functioning
PREPARING THE STERILE POWER INSTRUMENT ACCESSORIES FOR USE • Check for sterility of the power instrument • Prepare the complete sterile accessories • Batteries and nitrogen tank • Obtain identification details of the patient • Name, I/C number, R/No & Types of surgery
ASSEMBLING THE POWER SYSTEM & INSTRUMENT FOR USE 1. Assemble the power system a. Connect the drill or saw 2. Insert battery through the sterile casing to the power system 3. Test the running of the power system 4. Place the power instrument in the lined sterile basin with the trigger in safety mode when not in use
ASSEMBLING THE POWER SYSTEM & INSTRUMENT FOR USE 5. When passing powered instrument to surgeon intraoperatively, make sure the tip of hand piece pointing downward 6. Always be certain that it’s in the safety mode when changing attachment
CARE AND MAINTAINANCE AFTER USE • Check power drill in safety mode • Dismantle the attachment and remove battery from the power drill • Recharge the battery after use • Clean power system with damp cloth, dry with free lint towel and send for reprocess
https://www.youtube.com/watch?v=LkQ6wWP8pCw https://www.youtube.com/watch?v=JF_l3fPwEMY https://www.youtube.com/watch?v=ON0rFtUNDRs https://www.youtube.com/watch?v=A5Hlp-e5dJ4
JHGJ