What to Teach a New Technician: Part II
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INSTRUMENT WHISPERER What to Teach a New Technician: Part II BY RICK SCHULTZ he Instrument Whisperer retractor is used to move tissue, muscle column in the May/June issue and organs aside in order to expose of PROCESS addressed the the surgical site. It is important for the importance of process in the technician to know the proper names and Thiring, training and retention of quality how to measure (See Figure A) to ensure Sterile Processing (SP) professionals. It the correct retractor is placed into the also specifically addressed the importance surgical set. of instrument inspection and the new technician’s need to know the basic instrument groups. That article focused on inspection of scissors, needle holders and hemostats. This article focuses on Figure B the following three instrument groups: • Retractors; • Suction devices; and • Scalpel handles Note: Once the right person has been hired, it is beneficial to have them observe four or five surgeries of various specialties, so they can see the use of the products they will be putting into trays. Figure A Retractors Retractors play a crucial role in surgery. Two common types of hand-held As with all surgical instruments, it is retractors are the Kelly retractor important to learn the most commonly- (Figure B) and the Richardson retractor used retractors, their main differences (Figure C). and how to properly inspect them. The difference between these retractors There are several broad categories of is the depth and width of the blades. A Figure C retractors: Kelly retractor is always larger than a • Hand-held retractors – A hand-held Richardson retractor. Kelly retractors such as the Auvard and Richardson, (manual) retractor must be held in have larger blades (for example, 3” wide can be plated. While inspecting each position by a surgical assistant, resident, x 3 1/2” deep compared to the largest instrument for bioburden, it is also physician assistant and/or the surgeon Richardson retractor blade of 1 5⁄8” wide necessary to determine whether the finish during the procedure. This type of x 2 1⁄2” deep. Some hand-held retractors, of these instruments has been damaged. 90 PROCESS JULY / AUGUST 2020 www.iahcsmm.org INSTRUMENT WHISPERER A plated finish will wear out over time. It is important to visually inspect the finish for flaking by using use gloved hands to massage the instrument over a white piece of paper. If specks of the finish fall onto the paper, remove the instrument from service and replace. • Self-retaining retractors – These retractors have a ratchet-type mechanism to hold the instrument in the retracted position (this means they stay open on their own). A common example is the Figure E Weitlaner retractor. (Figure D) Figure F • Malleable retractors - A malleable retractor can be bent and shaped, so it never be used as a cleaning device. For can perform the proper retraction. The cleaning, a proper sized brush may be metal is soft, allowing it to continually be used. angled/bent for the surgical application. House suction tubes are available Many SP departments will straighten out with irrigation; therefore, they have two the malleable retractor for tray assembly. channels with stylets. The irrigation Senn retractors and Volkman retractors channel is used to flush the surgical site are commonly-used retractors. The while the suction channel removes blood Senn retractor always has three prongs; and fluids. however, the Volkman retractor can be When cleaning and inspecting suction two-prong, three-prong, four-prong, tubes, it is important to inspect for sharp five-prong or six-prong. The count sheet edges and dents, especially at the distal should indicate the number of prongs, tip. Many times, the tip will become and whether the prongs are sharp or damaged by other instruments. Very blunt. small dents may be acceptable if they Figure D do not affect the flow of fluid through Suction the instrument; however, if the dent is Suction tubes are used to remove debris severe and a cleaning brush is not able When inspecting self-retaining retractors, and fluids from surgical sites. They are to pass through, the instrument must be it is very important to test the ratchet often measured in the French scale (FR; repaired or replaced. mechanism to ensure it is functioning also called the French gauge system). FR Yankauer suction tubes (Figure G) properly. This is achieved by pushing the is commonly used to measure the outside should be disassembled at the tip for lever down and allowing it to spring back diameter of suction tubes. For example, cleaning and inspection. Special attention into the locking position. Baron suction tubes are available in 3, 5 should be given to the threads, as this is Another popular self-retaining and 7 French. New technicians should an area where blood and tissue collect. abdominal retractor is the Balfour become familiar with the commonly- A brush may assist with the cleaning retractor (Photo E). This retractor system used suction tubes, including Baron, process of the Yankauer. The threads may may have a set of blades for the retractor House, Frazier and Poole. (Figure F) be cleaned with a nylon brush to remove arms, and various sizes of the center Some suction tubes, such as the blood. The brush must be the proper blade. It is very important that the new Frazier, are equipped with stylets. The diameter and should be longer than the technician verifies that all the correct stylet is designed to help dislodge bone instrument, so it completely exits the components are in the surgical tray. chips during surgery. The stylet should distal tip. www.iahcsmm.org JULY / AUGUST 2020 PROCESS 91 INSTRUMENT WHISPERER Scalpel handles Some knife handles are made of brass. Scalpel handles are numbered #3, #3 Over time, this metal commonly long, #3 angled, #4 and #7. Each handle deteriorates and becomes discolored. has designated scalpel blades that Although the brass is covered by nickel exclusively fit the handle. For example: plating, the nickel eventually wears off. The recommendation is to simply replace • Handle #3 holds blades #10, #11, #12, the brass handle with a stainless-steel #12b, #15, #15c. knife handle. In addition to inspecting • Handle #4 holds blades #20, #21, #22, the blade for wear, the handles must also #23, #25. be inspected for damage and the presence • Handle #7 holds blades ##10, #11, #12, of blood and tissue, especially in the #12b, #15, #15c. groove where the blade is inserted. Watch for Part III in the September/ A specialty handle, called a micro- October Instrument Whisperer column, blade handle or beaver handle, holds very where technician training for tissue Figure I fine scalpel blades. For proper cleaning, and dressing forceps and laparoscopic unscrew the collette (distal tip). instruments will be addressed. RICK SCHULTZ, the Instrument Whisperer™, is an author, inventor and lecturer, and the retired Chief Executive Officer of Spectrum Surgical Instruments Corp. He served as contributing editor of IAHCSMM’s Central Service Technical Manual (Fifth, Sixth, Seventh, Eighth Editions). Rick authored the textbooks Inspecting Surgical Instruments: An Illustrated Guide and The World of Surgical Instruments: The Definitive Inspection Textbook, which was released in June 2018. Schultz was named IAHCSMM’s Educator of the Year in 2002, and in 2006, was named American Hospital Association Educator of the Year. In 2007, he was named by Healthcare Purchasing News as one of the 30 Most Influential People in Healthcare Sterile Processing. Schultz currently provides educational lectures to Central Service professionals at IAHCSMM’s annual conferences and conducts operating room personnel lectures across the country. 92 PROCESS JULY / AUGUST 2020 www.iahcsmm.org.