BLADES

deep knife- 7 handle with 15 blade; Used to cut deep, delicate tissue inside knife- 3 handle with 10 blade; Used to cut superficial tissue. skin knife-4 handle with 20 blade; Used to cut skin.

SCISSORS

Straight Mayo scissorsUsed to cut suture and supplies. Also known as: Suture scissors.

Curved Mayo scissors- Used to cut heavy tissue (fascia, muscle, uterus, breast)

Metzenbaum scissors- Used to cut delicate tissue

CLAMPING and OCCLUDING Hemostat- used to clamp blood vessels or tag sutures. Its jaws maybe straight or curved. Other names: crile, snap or stat.

Hemostat, mosquito (left to right) used to clamp small blood vessels. Its jaws maybe straight or curved.

Kelly, hemostat, mosquito (left to right) used to clamp larger vessels and tissue

Burlisher- used to clamp deep blood vessels. It has two closed finger rings. Burlishers with open finger rings are called tonsil hemostats. Other names: Schnidt tonsil forcep, Adson forcep

Right Angle- used to clamp hard-toreach vessels and to place sutures behind or around a vessel. A right angle with a suture attached is called a tie on a passer. Other names: Mixter

Hemoclip applier with hemoclipsapplies metal clips onto blood vessels and ducts which will remain occluded.

GRASPING and HOLDING Allis- used to grasp tissue. It is available in short and long sizes. A Judd-Allis holds intestinal tissue; a heavy allis holds breast tissue.

Babcock- used to grasp delicate tissue (intestine, fallopian tube, ovary)

Kocher- used to grasp heavy tissue. May also be used as clamp. The jaws may be straight or curved. Other names: Oschner

Foerster sponge stick- used to grasp sponges. Other names: sponge forcep

Dissector- used to hold a peanut

Backhaus towel clip- used to hold towels and drapes in place. Other names: towel clip

Pick ups, thumb forceps, and tissue forceps- are available in various lengths, with or without teeth, and smooth or serrated jaws.

Russian tissue forceps- used to grasp tissue

Adson pick ups- are either smooth: used to grasp delicate tissue; or with teeth: used to grasp the skin Other names: dura forceps

long smooth pick-ups are called dressing forceps. Short smooth pick-ups are used to grasp delicate tissue

DeBakey forceps- used to grasp delicate tissue, particularly in cardiovascular surgery.

Thumb forceps- used to grasp tough tissue (fascia, breast). Forceps may either have many teeth or a single tooth. Single tooth forceps are called rat tooth forceps.

Mayo-Hegar needle holders- used to hold needles when suturing. They may also be places in the sewing catergory.

Deaver retractor (manual) - used to retract deep abdominal or chest incisions.

Richardson retractor- (manual) - used to retract deep abdominal or chest incisions.

Army-navy retractor- used to retract shallow or superficial incisions. Other names: USA, US Army

Goulet (manual) - used to retract shallow or superficial incsisions.

Malleable or Ribbon retractor (manual) - used to retract deep wounds.

Weitlaner retractor (self-retaining) used to retract shallow incisions

Gelpi retractor (self-retaining) used to retract shallow incisions

Balfour with bladder blade- used to retract wound edges during deep abdominal procedures.

DUTIES of SCRUB NURSE Before an operation Ensures that the circulating nurse has checked the equipment Ensures that the theater has been cleaned before the trolley is set Prepares the instruments and equipment needed in the operation Uses sterile technique for scrubbing, gowning and gloving Receives sterile equipment via circulating nurse using sterile technique Performs initial sponges, instruments and needle count, checks with circulating nurse When surgeon arrives after scrubbing Perform assisted gowning and gloving to the surgeon and assistant surgeon as soon as they enter the operation suite Assemble the drapes according to use. Start with towel, towel clips, draw sheet and then lap sheet. Then, assist in draping the patient aseptically according to routine procedure Place blade on the knife handle using needle holder, assemble suction tip and suction tube Bring mayo stand and back table near the draped patient after draping is completed Secure suction tube and cautery cord with towel clips or allis Prepares sutures and needles according to use During an operation Maintain sterility throughout the procedure Awareness of the patients safety Adhere to the policy regarding sponge/ instruments count/ surgical needles Arrange the instrument on the mayo table and on the back table Before the Incision Begins Provide 2 sponges on the operative site prior to incision Passes the 1st knife for the skin to the surgeon with blade facing downward and a hemostat to the assistant surgeon Hand the retractor to the assistant surgeon Watch the field/ procedure and anticipate the surgeons needs Pass the instrument in a decisive and positive manner Watch out for hand signals to ask for instruments and keep instrument as clean as possible by wiping instrument with moist sponge Always remove charred tissue from the cautery tip Notify circulating nurse if you need additional instruments as clear as possible Keep 2 sponges on the field Save and care for tissue specimen according to the hospital policy Remove excess instrument from the sterile field Adhere and maintain sterile technique and watch for any breaks End of Operation Undertake count of sponges and instruments with circulating nurse Informs the surgeon of count result Clears away instrument and equipment After operation: helps to apply dressing Removes and siposes of drapes De-gown Prepares the patient for recovery room Completes documentation Hand patient over to recover room

DUTIES of CIRCULATING NURSE Before an operation Checks all equipment for proper functioning such as cautery machine, suction machine, OR light and OR table Make sure theater is clean Arrange furniture according to use Place a clean sheet, arm board (arm strap) and a pillow on the OR table Provide a clean kick bucket and pail Collect necessary stock and equipment Turn on aircon unit Help scrub nurse with setting up the theater Assist with counts and records During the Induction of Anesthesia Turn on OR light Assist the anesthesiologist in positioning the patient Assist the patient in assuming the position for anesthesia Anticipate the anesthesiologists needs If spinal anesthesia is contemplated: o Place the patient in quasi fetal position and provide pillow o Perform lumbar preparation aseptically o Anticipate anesthesiologists needs After the patient is anesthetized Reposition the patient per anesthesiologists instruction Attached anesthesia screen and place the patients arm on the arm boards Apply restraints on the patient Expose the area for skin preparation Catheterize the patient as indicated by the anesthesiologist Perform skin preparation During Operation Remain in theater throughout operation Focus the OR light every now and then Connect diatherapy, suction, etc. Position kick buckets on the operating side Replenishes and records sponge/ sutures Ensure the theater door remain closed and patient s dignity is upheld Watch out for any break in aseptic technique End of Operation Assist with final sponge and instruments count Signs the theater register Ensures specimen are properly labeled and signed After an Operation Hands dressing to the scrub nurse Helps remove and dispose of drapes Helps to prepare the patient for the recovery room Assist the scrub nurse, taking the instrumentations to the service (washroom) Ensures that the theater is ready for the next case

PLACENTAL SEPARATION Definition Placental separation occurs when the placenta separates from the wall of the uterus prior to the birth of the baby. This can result in severe, uncontrollable bleeding (hemorrhage). Description The uterus is the muscular organ that contains the developing baby during pregnancy. The lowest segment of the uterus is a narrowed portion called the cervix. This cervix has an opening (the os) that leads into the vagina, or birth canal. The placenta is the organ that attaches to the wall of the uterus during pregnancy. The placenta allows nutrients and oxygen from the mother's blood circulation to pass into the developing baby (the fetus) via the umbilical cord. During labor, the muscles of the uterus contract repeatedly. This allows the cervix to begin to grow thinner (called effacement) and more open (dilatation). Eventually, the cervix will become completely effaced and dilated, and the baby can leave the uterus and enter the birth canal. Under normal circumstances, the baby will go through the mother's vagina during birth. During a normal labor and delivery, the baby is born first. Several minutes to 30 minutes later, the placenta separates from the wall of the uterus and is delivered. This sequence is necessary because the baby relies on the placenta to provide oxygen until he or she begins to breathe independently. SIGNS of PLACENTAL SEPARATION: a. The uterus becomes globular in shape and firmer. b. The uterus rises in the abdomen. c. The umbilical cord descends three (3) inches or more further out of the vagina. d. Sudden gush of blood. SIGNS and SYMPTOMS that D&C were already done:

Cramps, like menstrual cramps, will probably be your strongest sensation immediately after a D&C. Although most women experience cramps for less than an hour, some women may have cramps for a day or longer.

You may also have some light bleeding for several days.

You will most likely be placed in the recovery room immediately after the procedure. Most hospitals and outpatient clinics will keep you for an hour or until you become fully awake. You will need to arrange for a ride home.

It is suggested that you do not drive for at least 24 hours after anesthesia. This is recommended even after a sedative/local anesthesia because these drugs can temporarily impair your coordination and response time.

Naproxen or ibuprofen are usually given for relief from cramping. Narcotics are seldom, if ever, needed for the pain following the D&C.

EMBRYONIC PREGNANCY Although the term may not be familiar to most people, a blighted ovum is actually a fairly common pregnancy complication. Also known as an embryonic pregnancy, a blighted ovum refers to the failure of the fetus to develop despite the fact that normal conception, implantation and growth of the placenta having taken place. Credited as causing 50% to 60% of all first trimester miscarriages, a blighted ovum will always end in pregnancy loss within the first 12 weeks of pregnancy. Signs of a Blighted Ovum Symptoms of a blighted ovum pregnancy include spotting, cramps, vaginal bleeding as your hCG levels begin to fall, and/or failure to detect a fetal heartbeat by the 12th week of pregnancy. Additionally, an ultrasound showing an empty gestational sac can confirm that you have a blighted ovum. Treating a Blighted Ovum Most health care providers agree that it is best to let your body deal with the blighted ovum naturally, which it does most of the time. In some instances, the body may miscarry the pregnancy while in others the body will simply reabsorb the fertilized egg. A reabsorbed egg will likely cause you to experience a heavier than usual period or notice clots in your period. By allowing your body to handle the blighted ovum itself, you can avoid potential scarring thereby ensuring your fertility health. However, once a blighted ovum has been discovered, many women find it far too upsetting to just wait for a miscarriage to occur. In these instances, as well as for women who may have an infection or are experiencing heavy bleeding, it is possible to have either a suction curettage or dilation and curettage (D&C) procedure done. In suction curettage, your doctor will gently vacuum out the products of conception. This may be done under general or local anesthetic. For a D&C, youre cervix is dilated and the sides of your uterus are scraped down to ensure that all tissue has been removed. Again, anesthetic is usually used. These procedures are done to ensure that you do not suffer from an infection later on. Although both procedures are safe, there is a risk of scarring, which may affect your fertility. Layers of Uterus The layers, from innermost to outermost, are as follows: Endometrium The lining of the uterine cavity is called the "endometrium". It consists of the functional endometrium and the basal endometrium from which the former arises. Damage to the basal endometrium results in adhesion formation and/or fibrosis (Asherman's syndrome). In all placental mammals, including humans, the endometrium builds a lining periodically which is shed or reabsorbed if no pregnancy occurs. Shedding of the functional endometrial lining is responsible formenstrual bleeding (known colloquially as a "period" in humans with a cycle of about 28 days) throughout the fertile years of a female and for some time beyond. Depending on the species, menstrual cycles may vary from a few days to six months, but can vary widely even in the same individual, often stopping for several cycles before resuming. Marsupials and monotremes do not have menstruation. Myometrium The uterus mostly consists of smooth muscle, known as "myometrium." The innermost layer of myometrium is known as the junctional zone, which becomes thickened in adenomyosis. Parametrium The loose connective tissue around the uterus. Perimetrium The peritoneum covering of the fundus and ventral and dorsal aspects of the uterus. Layers of Skin

The layers of the skin are a lot like the layers of soil in a flowerbed. Each has its use and all the skin layers (or soil) work together to provide nutrients and protection for the stuff growing in it. Epidermis: This layer is made of skin cells at the end of their life-cycle. These cells provide protection from injury and a barrier to keep infectious organisms at bay. Think of this layer as the mulch covering the flowerbed. The epidermis holds in fluid and protects raw nerve cells from too much stimulation. Dermis: The top soil. This layer contains capillaries that feed the cells with nutrient-rich blood. Just like top soil, most things grow here - including hair follicles, nerve cells, and sweat glands. If damaged, the dermis will weep serous fluid and swell. Subcutaneous: The subcutaneous layer is also known as the hypodermis, and it is technically not officially skin, but rather attaches the skin to everything beneath. It also contains a layer of fat. Some of us have more fat than others, but this layer is always present in some form. In the flowerbed, this is the layer of sandy foundation that allows for drainage. Indeed, blood vessels in the subcutaneous layer feed and drain the capillaries of the dermis. Layers of Abdomen Skin is a soft outer covering of an animal, in particular a vertebrate. Other animal coverings such as the arthropod exoskeleton or the seashell have different developmental origin, structure and chemical composition. The adjective cutaneous means "of the skin" (from Latin cutis, skin). In mammals, the skin is the largest organ of the integumentary system made up of multiple layers of ectodermal tissue, and guards the underlying muscles, bones, ligaments and internal organs. Fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together in much the same manner as plastic wrap can be used to hold the contents of sandwiches together. It consists of several layers: a superficial fascia, a deep fascia, and a subserous (or visceral) fascia and extends uninterrupted from the head to the tip of the toes. Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to produce force and cause motion. Muscles can cause either locomotion of the organism itself or movement of internal organs. Cardiac and smooth muscle contraction occurs without conscious thought and is necessary for survival. The transversalis fascia (or transverse fascia) is a thin aponeurotic membrane which lies between the inner surface of the Transversus abdominis and the extraperitoneal fascia. It forms part of the general layer of fascia lining the abdominal parietes, and is directly continuous with the iliac and pelvic fasciae. The peritoneum is the serous membrane that forms the lining of the abdominal cavity or the coelom it covers most of the intra-abdominal (or coelomic) organs in higher vertebrates and some invertebrates (annelids, for instance). It is composed of a layer of mesothelium supported by a thin layer of connective tissue. The peritoneum both supports the abdominal organs and serves as a conduit for their blood and lymph vessels and nerves. FRACTIONAL D&C a diagnostic technique in which each section of the uterus is examined and curetted to obtain specimens of the endometrium from all parts of the organ. It is often performed in the diagnosis of endometrial cancer.