Medical Office Surgery Instrument Identification
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Snohomish County Medical Assistants “Medical Office Surgery Instrument Identification” CEU Correspondence Program # 8854-PRG7 Course Participation: September 1, 2008 – December 31, 2008 Contact Credit: 2 Units – Category Clinic Program Evaluation After reading the enclosed text, please answer the exam questions so we may assess your participation in this program. After completing the assessment, please send it by email to [email protected] or mail your completed information form with the appropriate fee, and a self-addressed stamped envelope to : Snohomish County Medical Assistants 205 E Casino Road Suite B-16 PMB#81 Everett, WA 98208 Allow 4-6 weeks for processing the return of your completion grade notice and certificate of program participation. You must receive 70% or better of correct answers to qualify for the CEU units to be awarded. All responses must be postmarked no later than December 31, 2008 to qualify for this course registration on your transcripts for January 2009. Payment can be made by check or money order only. No cash or credit cards can be accepted please! If you should have any questions, please contact the Snohomish County Medical Assistants Education Chair at [email protected] or call PH# 425-513-2946 before 9:00pm PST. PLEASE PRINT: NAME ______________________________________________________________________ ADDRESS ___________________________________________________________________ CITY ________________________________ STATE ______________ ZIP ______________ Email: ____________________________________ Phone ___________________________ FEES: AAMA MEMBER $15.00 NON-MEMBER $25.00 AAMA MEMBER? YES __________ NO ___________ *IF YES, PLEASE PROVIDE AAMA MEMBER NUMBER ________________________________ *IF NON-MEMBER, PLEASE PROVIDE SOCIAL SECURITY NUMBER #___________________ *Your Program CEUs cannot be posted to your AAMA transcripts without the required information. 1 “Medical Office Surgical Instrument Identification ” By Sheri R. Greimes CMA PBT RMA RPT The healthcare industry has made so many advances in the past few decades, even within the past few years, so that surgery is not restricted to hospitals only anymore. Surgeries performed outside the hospital are known as Ambulatory surgery or Outpatient surgery and are easily outnumbering the total inpatient surgeries performed today. This has been a culmination of 30 years of change that has lead to significantly lowered costs and increased patient convenience in having minor surgical procedures done within the doctor’s office. Surgery is defined as a branch of medicine that treats diseases, injuries, and deformities by manual or operative methods. Surgeries normally take place in hospitals, but more and more are occurring in doctor’s and dentist’s offices as well and specially designed “Surgical Suites”. These surgical suites are built with the conveniences and full complements of surgical equipment and facilities, but with low overhead and costs for the provider-owner. The in-office surgeries allows the physician to schedule surgeries according to their personal preference or needs, provides a convenient and low-cost alternative to high surgical service costs for the patients, and easy access for providers and patients alike. There are various types of surgery that take place in a provider’s office, such as; laceration repairs, cyst and lesion removals, biopsies, wound debridement, tumor removal, vasectomies, circumcisions, dermatology procedures, minor cosmetic surgery and minor orthopedic procedures. The responsibility of the medical assistant in assisting the provider during any of these surgical procedures is to be educated and informed on all aspects of the surgical preparation, the patient preparation and the equipment preparation. There are set-up procedures and prescreening procedures that must be followed to ensure that the patient is properly informed, has consented to have the procedure, and is properly prepared for the procedure. The procedure set-up has to be 100% correct in preparation in order to prevent errors and delays during the procedure. It is the medical assistant’s duty to verify that every possible equipment and supply needs are ready for the provider before the procedure starts so not to delay the surgery or cause delayed treatment to the patient. It would be quite alarming if a person was undergoing an office procedure and the provider had to stop at a critical point during the procedure in order to allow the medical assistant to leave the room to obtain the proper equipment and supplies. Another part of the medical assistant’s duties are to identify and know the function of medical equipment and most importantly, how to care for the expensive and costly equipment properly. Instrument Identification 2 Instruments are named by their function, their design, or by the surgeon who designed them. More detailed or descriptive names are given for procedure specific or specialty specific instruments, such as a Sims Uterine dressing forceps. This instrument was designed by Dr. J. Marion Sims, a well-known American gynecological surgeon, for the specific use of introducing dressings into the uterine cavity. Specialty instruments are designed to meet specific needs within specialty practices; GYN, ENT, Surgical. Identifying features are ring handles, rachets, serrations, blades, grooves and other defining features of the instrument. Ring handles are featured on most instruments used for grasping and cutting, the fingers secured within the center of the rings and providing a controlled grasp on the instrument. Rachets are located between the ring handles and are ridged teeth that are designed to “lock” and hold the ring-handles together, providing a firm grip on tissues or objects they are grasping. The blades of the instruments may have grooves or “serrations” which allows for a tighter hold of the item being held, providing a “non-slip” surface. The box lock is a special design for medical instruments that has the hinge pins contained within the inside of the instrument hinge and not the outside, which if outside they could cause tissue damage or become snagged on items within the surgical site. Some are named for rather obvious functions, such as a skin rake or retractor, whereas others may be named for a specific use and used for something totally different, such as a Bachaus towel clamp being used during vasectomies to isolate the Vas Deferens. Instruments are categorized by their function: 1. Clamping, grasping 2. Cutting, slicing 3. Probing, dilating When identifying instruments, look for special characteristics of the instruments to remember what they are used for, the inventor’s name, or the specific function they were designed or developed for. There are literally thousands and thousands of different instruments that are available for minor office surgery, some looking all the same with subtle differences. A general overview will be given of the most commonly used minor surgical equipment and instruments to provide education at a common level of instrument identification and care. Forceps Forceps have multiple designs and functions, used to grasp and hold tissue or dressing are the most common use. There are forceps that resemble common “tweezers” and forceps that look like scissors. Some people may refer to forceps as “pick ups’, hemostats, and drivers, but all having a 3 function of their own. The ring-handle type forceps come in various lengths of shafts and may be straight or curved in design. The thumb blade designs come with specifically design blades for specific uses and range in various lengths of blades. Hemostatic forceps are designed to clamp blood vessels to stop blood flow and Kelly hemostatic or Crile hemostatic forceps are widely known. Kelly and Crile are design almost alike except Kelly forceps feature half-blade serrations, Crile have full-blade serrations. The handle shafts can be designed to different lengths starting at 2 inches and up to 9 inches. The forceps have ring handles with rachets to lock in place for stopping blood flow within the blood vessels. Crile hemostatic forceps Mosquito hemostatic forceps are formed almost exactly like Crile forceps, but are much smaller and delicate in shape and size. The small size of the forceps allows for greater control and maneuverability when grasping the thinnest layers of tissue or most delicate tissues, or working in a smaller surgical site. Mosquito hemostatic shafts can range from 1 inch to 6 inches in length. The blades have full serrations and are very light in weight. Care should be taken not to bend the small, thin shafts of the forceps. Tissue forceps can have either ring handles with ratchets or be designed as thumb blades with teeth to “bite” into the tissues they are holding and prevent the tissue from slipping during surgery. The tissue forceps most used are the Adson tissue forceps and the Kocher tissue forceps. The teeth are shaped to penetrate into the tissues without causing the tissues to be torn, performing a clean puncture. Teeth are placed on both blades and may number in one to four teeth. They resemble a tooth and sometimes are referred to “rat-tooth” forceps. Allis tissue forceps are designed differently and resemble curved ‘hands” that are used to lift delicate vessels and tissue. 4 Dressing forceps are designed to hold or place gauze sponges and dressings during the surgery procedure. The instruments can resemble the ordinary “ tweezers” shape that contain two blades or ring- handle forceps. The design of the forceps can be very specific for its use. The specially designed forceps have been developed for use in handling specific tissues or in performing specific procedures, such as the ear forceps. There are two types commonly used; the Bayonet ear forceps and the Duckbill or Alligator ear forceps. The Bozeman uterine forceps and Foerester sponge forceps are used during gynecological surgeries and procedures, proving long shaft handles that allow insertion deep into the vaginal cavity 5 and pelvic space. Shaft handles range in lengths of 6 to 10 inches. The Foerester sponge forceps are also used to transfer and move items within a sterile surgical tray during the operative procedure.