Specialty Instrument Trays Tracheotomy, Vascular, Chest Plus

Specialty Instrument Trays Tracheotomy, Vascular, Chest Plus Large Self-Retaining Retractor Systems

DON”T FREAK OUT! Note the instruments that you have been learning are part of the Minor and Major Instrument Trays from AB-TECH and Mission Hospitals used in General Surgical and minor Procedures You will find a few variations or “specialty” instruments with ALL SPECIALTY TRAYS Focus on the variations as you learn these new trays

“TRACH TRAY” Tracheotomy Tray Tracheotomy- to make a “temporary” opening into the trachea EXAMPLES: Acute Head/Neck Trauma Aspiration of foreign body Trouble weaning off a ventilator Tracheostomy- “permanent” opening into the trachea EXAMPLES of Surgeries: Total laryngectomy surgery for throat cancer/cancer of the larynx Vocal Cord Surgery/Removal Chronic Head/Neck Trauma Chronic Ventilator Patient

“TRACH TRAY” Instrument Variations What you don’t know yet: Trach hook Trach spreaders

Tracheotomy Tray

The two instruments you didn’t recognize: Trach Hook (blunt tip) Trach Spreader “Three prong” Also come two prong

Peripheral Vascular (PV) Trays I. Minor PV Tray – Arteriovenous Fistula (AV Fistula) – Embolectomy removal of an embolus from a vessel Embolus is undissolved matter in the form of liquid, solid or gas Thrombectomy removal of a thrombus from a vessel Thrombus is a blood clot – Carotid Endarterectomy (CAE) – Any MINOR vascular procedure

Carotid Endarterectomy Instruments Carotid Endarterectomy- Removal of atherosclerotic plaque from the carotid artery for carotid artery disease FYI: Arteriosclerosis hardening of the arteries with age (we will all have this with age) Atherosclerosis blockage/plaque formation in an artery (affected by severity of arteriosclerosis) Can endarterectomize ANY artery, however, the carotid is the most common one done to the long term positive outcome, unlike endarterectomies of other arteries.

Carotid Tray/Instruments What you don’t know yet: (See instrument book) 1. Peripheral vascular clamping and occluding instruments 2. Rummel/tourniquet keeper p. 152 3. Bulldog clamps 4. Freer elevator p. 112 5. #4 Penfield elevator p. 79 6. Nerve hook p. 157 7. Potts-smith (potts) scissors p. 152 8. Tenotomy scissors p. 152 9. Dietric forceps (are just fine debakey forceps) 10. Geralds or Potts forceps p. 157 11. Mills ring forceps p. 157 12. Castro-viejo needle holders p.151 (come delicate or heavy and short or longer) 13. 4-12 Used in neuro and ophthalmic surgery as well

Carotid Endarterectomy Instruments Peripheral vascular clamping and occluding instruments: Peripheral debakey clamps p. 147 instrument book Right angle peripheral debakey clamp *FYI peripheral debakeys come in different sizes as well PDA (patent ductus arteriosis/coartation clamp/glassman) p. 148 instrument book Fogarty hydrogrip clamps (take disposable inserts) p. 147 top Bulldogs (see p.145 instrument book for examples of nondisposable variations) Henley clamp Martinez vascular clamp Javid shunt clamp p. 146

Peripheral Vascular Trays Major PV Tray: Femoral-Femoral Bypass Graft Femoral-Popliteal Bypass Graft Femoral-Tibial Bypass Graft Axillo-Femoral Bypass Graft AAA Repair (Abdominal Aortic Aneurysmectomy) All of the above are done to correct a stenosis or obstruction somewhere along the flow of these arteries. Lower extremity arterial blood flow is compromised (ischemia), which compromises the limb involved (potential necrosis of limb). We “bypass” or re-route the blood flow to go around the obstruction or stenosis. Obstructions usually caused by atherosclerosis or trauma. May also be used in conjunction with a “CHEST TRAY” for thoracic (lung) surgeries

Peripheral Vascular Instruments What you don’t know yet: Peripheral debakey clamps Satinsky clamps p. 149 Cooley clamps Aortic clamps Fogarty clamps Fogarty bulldog spring applier p.146

Alms retractor Potts-smith forceps AKA Geralds Peripheral debakey clamp Satinsky clamp VASCULAR INSTRUMENTS

PDAs (patent ductus arteriosis) Glovers/ Coarctation clamps Angled and straight Peripheral Debakey Satinsky VASCULAR CLAMPS All vascular clamps have debakey lined jaws and are considered clamping/occluding instruments

Potts-Smith scissors or Potts Tips come 25º, 45º, 60º, and reverse Also come in a castro style called “finger Potts” Used for extending an arteriotomy or duct incision Tenotomy scissors See used to cut delicate tissue such as vessels, ducts, nerves

Titanium “locking” Castro-Viejo Needle Holder Also come non-locking Come in a variety of finishes, lengths and jaw sizes See used in Ophthalmic, Cardiovascular, peripheral vascular, Neurosurgical and plastic surgeries Jaws are smooth for gripping delicate suture needles Should not use “fine tipped” castros on larger than 7-0 needle To preserve tips

Alms retractor Garrett dilators For dilating blood vessels Vascular dilators

Jackson Tunneler

Chest Trays Please note following instruments in your instrument book: Pennington forceps p. 12 (the Pennington has a much smaller than the Lovelace clamp but identical otherwise) Duval or Lovelace Lung forceps p.150 Sarot bronchus clamp p. 150 Giertz-Shoemaker rib shears (Guillotine) p. 153 Doyan raspatory p. 154 Alexander raspatory p. 154 Bailey rib approximator p. 155 Allison lung retractor (wisk/egg-beater) p. 155 Tuffier rib spreader/retractor p. 156 Burford rib spreader/retractor p. 156 Davidson scapula retractor (p. 890 ST for the ST)

Allison Lung Retractor

Duval Lung Clamp

Sarot Bronchus Clamp

Davidson Scapular Retractor

Giertz-shoemaker aka:”guillotine” Rib Shears Bethune

Bailey Rib Approximator

Doyan Pig Tails raspatories

Cameron Alexander Periosteal elevators

Finochietto Rib Retractor

Large Self Retaining Retractor Systems

Self-Retaining Bookwalter Retractor (Surgeon preference as there are others) Self-Retaining abdominal retractor Used with abdominal procedures Table post Rings x 2 (small & large) Couplers for connection Blades: Balfour, Richardson, Harrington, Malleables of various widths & lengths Will hand up wet/wrung out lap with each blade passed for protection

Omni-Tract (Surgeon preference as there are others) Self-Retaining abdominal retractor Used with abdominal procedures Table post Arm Couplers for connection Blades one piece: Bladder blades, Richardson, Harrington, Malleables of various widths & lengths Handles and screws for some of the three piece blades Will hand up wet/wrung out lap with each blade passed for protection

Omni-Tract Heavy Castro-viejo Needle holder