Thoracic Procedures i A Complete Hospital Manual of INSTRUMENTS AND PROCEDURES A Complete Hospital Manual of INSTRUMENTS AND PROCEDURES MM Kapur MBBS FRCS Former Professor of Surgery All India Institute of Medical Sciences New Delhi Examiner Universities of India and Royal College of Surgeons England Member of Hospital Management Board All India Institute of Medical Sciences New Delhi JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi SUBSIDISED L C EDITIONS LOW COST S E NBT INDIA This book has been prepared and subsidised by the Government of India, under the Core Books Project on Medical Sciences, through the National Book Trust, India for the benefit of students. Price: Rs. 142.00 Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd EMCA House, 23/23B Ansari Road, Daryaganj New Delhi 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672 Fax: +91-11-23276490, +91-11-23245683 e-mail: [email protected] Visit our website: www.jaypeebrothers.com Branches • 202 Batavia Chambers, 8 Kumara Krupa Road Kumara Park East, Bangalore 560 001 Phones: +91-80-22285971, +91-80-22382956, +91-80-30614073 Tele Fax : +91-80-22281761 e-mail: [email protected] • 282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza Pantheon Road, Chennai 600 008 Phones: +91-44-28262665, +91-44-28269897 Fax: +91-44-28262331 e-mail: [email protected] • 4-2-1067/1-3, 1st Floor, Balaji Building, Ramkote Cross Road Hyderabad 500 095, Phones: +91-40-55610020, +91-40-24758498 Fax: +91-40-24758499 e-mail: [email protected] • 1A Indian Mirror Street, Wellington Square Kolkata 700 013, Phone: +91-33-22451926 Fax: +91-33-22456075 e-mail: [email protected] • 106 Amit Industrial Estate, 61 Dr SS Rao Road Near MGM Hospital, Parel, Mumbai 400 012 Phones: +91-22-24124863, +91-22-24104532, +91-22-30926896 Fax: +91-22-24160828 e-mail: [email protected] A Complete Hospital Manual of Instruments and Procedures © 2005, MM Kapur All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher. This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. First Edition : 2005 ISBN 81-8061-546-4 Typeset at JPBMP typesetting unit Printed at Gopsons Papers Ltd., A 14, Sector 60, Noida To My Father, My Teachers and All Students with an abiding commitment to the quality of surgical care Preface There has been a quantum change in the hospitals and nursing home care scene in India and possibly other countries in South East Asia. This has been as a result of an ever increasing demand for curative care required by an ever increasing population. It is estimated that there are approximately 15 thousand hospitals in this country with an ever increasing demand for training and training material for the surgical teams. There has been a parallel high cost technological advance in diagnostic and therapeutic instrumentation, which has produced a multiplicity of options for hospital administrators and a consequent enlargement in training requirements of hospital workers. The training requirements have increased on another count, the opening up of new health care facilities in the private and public sector has caused an internal migration of trained staff. With the presence of demand for patient care the medical team leader and training personnel have less available time for training of new entrants and their replacements. The absorbance of new technology by all members of the surgical team is essential to render the team as a functioning unit. It ensures continuous chain of uniform patient care and a similar appreciation of the needs of good care of instruments. Both contribute to good quality of care. This manual addresses these problems by providing access to information on all instruments in use for diagnostic and curative purposes in hospitals and nursing homes. It takes care of the traditional instruments in use in the wards, operation theater, recovery rooms and out patients. Additional chapters also includes information on new advanced instruments, like — Cryo surgery viii A Complete Hospital Manual — Laser — Fibro-endoscopy — Laparoscopy and ultrasonic instruments The information would be of help in recognition of instruments, relating them to procedure, appreciating the underline principle of function, the procedures required for their preparation for use. The requirements of maintenance and storage. It is also the purpose of this volume to provide information on assessing the quality of instruments. Team member responsibilities as regards functions in the operating rooms anesthesia requirements and recovery of patients receive special emphasis. The information provided would enable the OT staff to assemble sets of instruments for operation lists received. It would also enable them to identify instruments to be procured for any new procedure being added to the existing procedures list. Ready access to this information can indeed be used by trainees for self learning and can also provide the basis for training of trainers. Special attention has been paid to including information on prevention of nosocomial transmission of new disorders like HBV, HCV and AIDS. This text is an effort to improve the quality of surgical care through continuing education of all cadres in the surgical team. It does also provides precepts and an information base which could be of value for those resolving issues (health service providers and legal profession) in the application of Consumer Protection Law (CPL). There are in all 24 chapters in this manual. The printed text will be followed later by a CD Rom for self- learning and easy access to instruments and sets. MM Kapur Acknowledgements I have felt for many years that there is an urgent need for a manual of all member of surgical team in large hospitals. As we all know over the year hospital care of patient has grown many fold in our courtesy but the training and the training material of the surgical team has leagued behind. This manual I feel will fill this gap in a small way and provide a ready reference material for those interested in providing quality care. I wish to acknowledge my debt to many of my colleagues at the All India Institute and some outside the institute they have provided me unlimited encasement and help in outlining this material and they are: Prof Surya Bhan Department of Orthopedic Prof Sumpat Kumar Department of Cardiothoracic Surgery Prof Ravi Bhatia Department of Neuro Surgery Prof S Ghosh Department of Ophthalmology Prof Sudhir Bahadur Department of ENT Prof Vijay Laxmi Department of Anesthesia Prof V Bhatnagar Department of Pediatric Surgery Prof Khazanchi Department of Surgery Prof SN Wadhwa Department of Urology Dr Navedita Sharda Department of Gynecology Prof S Sawhney Department of Radiology I also wish to acknowledge my gratitude to National Book Trust for sponsoring this project and Jaypee Brothers Medical Publishers for undertaking this task. This entire project would not have been possible without untiring effort of Mr. Ajay Kumar Belwal for providing excellent support in preparing the manuscript. Contents 1. Infection Control, Sterilization and Care of 1 Surgical Instruments 2. Electrical Instruments—Laser, 29 Cryoprobes, Ultrasonic Equipments 3. The OR Complex, Its Management and 48 Operation Table 4. Anesthesia Equipment and Anesthetics 73 5. Ligature and Suture Materials 104 6. Operating Microscopes 114 7. Endoscopy 119 8. General Surgical Instruments 132 9. General Surgical Sets and Procedures 178 10. Gynecological and Obstetric Sets and 228 Procedures 11. Urologic Sets and Procedures 272 12. Endocrine Surgery Procedures 298 13. Orthopedic Instruments Sets and 308 Procedures 14. Ophthalmic Instruments and Procedures 395 15. Dental Instruments and Procedures 424 16. Ear, Nose & Throat Instruments and 435 Procedures 17. Neurosurgical Instruments and Procedures 467 xii A Complete Hospital Manual 18. Plastic Surgery Instruments and Procedures 494 19. Thoracic Instruments and Procedures 530 20. Cardiovascular Instruments and 551 Procedures 21. Pediatric Surgery Procedures and 582 Instruments 22. Imaging Procedures and Equipment 605 23. Plaster of Paris (POP) Technique 617 24. New Emerging Techniques 632 Appendices I to VI 641 Index 683 Care of Surgical Instruments 1 One Infection Control, Sterilization and Care of Surgical Instruments VENTILATION OF OT The ventilation system has a very large part to play in limiting infection. The temperature at 68 to 70°F (20-23°C) with a humidity of 30 to 60 percent. This reduces bacterial growth and static electricity. Each OT should have independent temperature controls. Air flow should be filtered through high-efficiency particulate air (HEPA) system with 15 air exchange per hour at least three must be fresh air. Air enters the OT through vents in the ceiling and leaves through vents near the floor. There must be a positive pressure in the OT compared to wash rooms, utility rooms and corridors. The air ventilation system must have a routine for inspection and maintenance including change of filters. INFECTION CONTROL Infection will occur if high standards of preoperative, intra- operative, and postoperative rules are not observed in relation to the care of instruments and patients. If there is any break of these rules by the surgical team. Mechanism The occurrence of infection and cross-infection will rise, produc- ing anything from minor wound infections to a major disaster 2 A Complete Hospital Manual (tetanus) thus standing rules and procedures need to be defined by hospital Infection Control Committees (ICC) and observed by the surgical teams.