care & handling of laparoscopic instruments50-slides... · pelvic laparoscopy (or pelviscopy)...

Care & Handling of

Laparoscopic Instruments

PREZIO Health is an approved continuing education provider through the California

Board of Registered Nurses (CBRN).

Students who successfully complete this course are eligible for 1.0 nursing contact

hour and/or 1.0 CEU through IAHCSMM and CBSPD

CBRN provider number: CEP16176

IAHCSMM approval code: 00041613A

CBSPD approval code: 23689WCOR13

3

Describe instruments used in laparoscopic procedures.

Identify most common laparoscopic surgical procedures.

Discuss patient safety including infection prevention and best

demonstrated practices.

Review cleaning processes.

Examine insulation testing and its dynamic role in patient safety.

Describe laparoscopic instruments inspection process.

Care and Handling of Laparoscopic Instruments

Course Objectives


Minimally Invasive Procedures: Overview

One of the most influential

developments of the 20th

century was minimally

invasive surgery.

Minimally invasive surgical

techniques allow surgeons to

examine and operate on

internal organs through small

incisions, puncture holes, or

natural body openings rather

than by dissection.

http://images.google.com/url?sa=i&rct=j&q=minimally+invasive+surgery&source=images&cd=&cad=rja&docid=WDaun_zWz1LELM&tbnid=_SECFiQHihdQJM:&ved=0CAUQjRw&url=http://www.beltina.org/health-dictionary/minimally-invasive-surgery-endoscopic-laparoscopic.html&ei=AxjTUfHxLYeu9ASW14DgCw&bvm=bv.48705608,d.eWU&psig=AFQjCNEyBcFY_QeCyLFW09zjbwP2UKf_2w&ust=1372875114919106


Endoscopic vs. Laparoscopic Surgery

Endoscopy:

An illuminated usually fiber-optic

flexible or rigid tubular instrument

for visualizing the interior of a

hollow organ or part (as the

bladder or esophagus) for

diagnostic or therapeutic purposes

that typically has one or more

channels to enable passage of

instruments (as forceps or

scissors).

Examples: bronchoscopy,

cystoscopy.

Laparoscopy:

1: visual examination of the inside

of the abdomen by means of a

laparoscope—called also

peritoneoscopy

2: an operation (as tubal ligation or

gallbladder removal) involving laparoscopy.

Examples: laparoscopic

appendectomy, LAVH.

Ref. 3 and 4


Common Laparoscopic Procedures

Laparoscopic Cholecystectomy

Gallstones are a relatively common

condition that causes severe pain

in the abdomen.

Sometimes even though there are

no gallstones, the gallbladder does

not function normally and could

cause similar symptoms as

gallstones.

In these cases, a surgeon may

choose to remove the gallbladder.

Ref. 5

http://images.google.com/url?sa=i&rct=j&q=laparoscopic+cholecystectomy&source=images&cd=&cad=rja&docid=b30t2zSTHxZoIM&tbnid=OIFu3UIAsu6nsM:&ved=0CAUQjRw&url=http://www.yalemedicalgroup.org/stw/Page.asp?PageID=STW028966&ei=ih7TUbGPKYvg8wS6rIDQCw&bvm=bv.48705608,d.eWU&psig=AFQjCNGX2xgy1wMY7nCkFTerjJ_iBGot0g&ust=1372876798657050



Laparoscopic Appendectomy

If the appendix becomes

infected it must be surgically

removed before it ruptures and

spreads infection to the entire

abdominal space.

In the laparoscopic

appendectomy, several small

incisions are made in the

abdomen. In one incision a

laparoscope is inserted. Small

instruments are inserted in the

other incisions and used to

remove the appendix.

Ref. 6

http://images.google.com/url?sa=i&rct=j&q=laparoscopic+appendectomy&source=images&cd=&cad=rja&docid=37Prv8YtygU5JM&tbnid=EbyV5tNDACNWOM:&ved=0CAUQjRw&url=http://www.websurg.com/Laparoscopic_appendectomy-ot02en334_jp.htm&ei=nCDTUZi8CIPC9QTjrIDADQ&bvm=bv.48705608,d.eWU&psig=AFQjCNHN4sSKJP31nRxVL4lhye-HaTbcXg&ust=1372877311366422



LAVH

LAVH is the “in-house” term for

Laparoscopic Assisted Vaginal

Hysterectomy.

A hysterectomy is the surgical

removal of the uterus (and

sometimes additional reproductive

organs). It is performed to remove

uterine fibroids, treat

endometriosis, remove cancer

and many other conditions.

A version of LAVH can also be

done with robotic assistance.

Ref. 7

http://images.google.com/url?sa=i&rct=j&q=LAVH&source=images&cd=&cad=rja&docid=ju1gfEl-t4YRaM&tbnid=0JnySXqP10qOFM:&ved=0CAUQjRw&url=http://missdeborde.tumblr.com/&ei=Vz7TUd_-Koa68wTa7IGYBQ&bvm=bv.48705608,d.eWU&psig=AFQjCNGx7ILp3ASejMjiMHLOSIQjW6efoA&ust=1372884937668127



•Get tissue samples (biopsy).

•Look around and diagnose the cause

of any symptoms.

•Remove scar tissue or other abnormal

tissue, such as from endometriosis.

•Repair or remove part or all of the

ovaries or fallopian tubes.

•Repair or remove parts of the uterus.

•Do other surgical procedures (such as

appendectomy, removing lymph

nodes).

Ref. 8

Pelviscopy

Pelvic laparoscopy (or pelviscopy) is surgery to examine pelvic organs

using a laparoscope. A pelviscopy can be used to:

http://images.google.com/url?sa=i&rct=j&q=pelviscopy&source=images&cd=&cad=rja&docid=e9zKCLPoWUladM&tbnid=wkKnA9dTouwR_M:&ved=0CAUQjRw&url=http://health.allrefer.com/health/pelvic-laparoscopy-pelvic-laparoscopy.html&ei=PELTUb7uB5LQ9gTKr4CIBg&bvm=bv.48705608,d.eWU&psig=AFQjCNFjJQ5EqhaOG-cd3wL8HhjOGKdgbQ&ust=1372885920229849



If you want to learn more about the specifics of various

laparoscopic procedures, visit these websites:

www.websurg.com

http://images.google.com/url?sa=i&rct=j&q=websurg&source=images&cd=&cad=rja&docid=Vkgxm49_BNntdM&tbnid=ZvZp4g3Qf598WM:&ved=0CAUQjRw&url=http://www.websurg.com/&ei=eUPTUfjqNoy89QSwioCoCw&bvm=bv.48705608,d.eWU&psig=AFQjCNEQb5H3FFwNt8hAH61W9oSgQvC-7Q&ust=1372886252293133


Advantages of Laparoscopic Procedures

Smaller incisions Less likely to suffer wound-related

complications.

Less post-operative pain

Decreased hospital stay Some laparoscopic procedures are

performed on an outpatient basis.

Accelerated recovery and

improved outcome

http://images.google.com/url?sa=i&rct=j&q=patient+leaving+hospital&source=images&cd=&cad=rja&docid=YxI6XfTVDt2iRM&tbnid=7sliRY3EqsyqhM:&ved=0CAUQjRw&url=http://www.uamshealth.com/?id=109&sid=1&ei=TlDTUdSPGIa69gSh14HIAw&bvm=bv.48705608,d.eWU&psig=AFQjCNHdI1aV_bcmZz0sGVfBofxXXIlwIw&ust=1372889507333617


Instruments Used in Laparoscopic Procedures

Trocars and cannula

Insufflators & Veress needle

Light source & light cord

General lap. instrumentation

Laparoscope (scopes are discussed in a separate

presentation)

http://images.google.com/url?sa=i&rct=j&q=lap+instrument+holder&source=images&cd=&cad=rja&docid=wzTZ-BllmiuYgM&tbnid=TqHaHwF5jgEaxM:&ved=0CAUQjRw&url=http://cardinalhealth.com/us/en/distributedproducts/ASP/DL1-1.asp?cat=med_surg&ei=1lDTUc3MNITc9ASepIC4Bw&bvm=bv.48705608,d.eWU&psig=AFQjCNHy4YgFccRNdHARvUVgpl3g9eWaSQ&ust=1372889671378679

13

Yello-Port

Reusable Trocar System

Stainless Reusable

Trocar System

Trocars and cannula are instruments used to access the surgical

site through small incision or puncture holes (an access port). They

are made in both reusable and disposable varieties.


Trocar & Cannula

14

The insufflator is a device that enables visualization of the internal

surgical area by creation of a pneumoperitoneum. This is

accomplished through pumping carbon dioxide gas into the

abdomen under pressure through the Veress needle.

Veress Needle


Insufflator

Insufflator


Laparoscopic Instrument Types

There are dozens of

different types of

laparoscopic

instruments.

We will examine a few

of the main families of

laparoscopic

instruments.



Atraumatic

Graspers Teeth

Dissectors

Traumatic

Graspers

Retractors

Needle

Holders



Biopsy Cups Universal

Handles Scissors

Cautery

Instruments &

Cords

http://images.google.com/url?sa=i&rct=j&q=laparoscopic+cautery+hook&source=images&cd=&cad=rja&docid=0u44OYwuWfc-DM&tbnid=9VvbSaKuI3uuxM:&ved=0CAUQjRw&url=http://www.venusmedsys.com/bipolar-monopolar-cautery-electrodes.html&ei=lGbTUc6zI4y89QSwioCoCw&psig=AFQjCNEVhgh4t5u7FxoCruv8_XoO80uvpg&ust=1372895211862375

Types of Rigid Scopes Hysterscope, Offset

Used in minimally invasive gynecological procedures such as

Laparoscopic Hysterectomies.

Types of Rigid Scopes Laparoscope, 10mm

An endoscope used to examine and visualize the peritoneal cavity in minimally invasive procedures such as:

•Laparoscopic Cholecystectomy

•Laparoscopic Banding

•Laparoscopic Nissen Fundoplication

Types of Rigid Scopes Laparoscopes come in a variety of lengths

diameters. The distal tip, which contains

the objective lens, can be angled at varying

degrees from 0 to 45 and so on.

0 degree, 10mm

30 degree, 10mm

30 degree

45 degree

4mm

The angle of the objective lens determines the surgeons view of the

internal surgical site, whether that be inter-abdominal, urethral etc.

Identifying Parts and Components Rigid Scopes: External

Insertion

tube

Eye Piece Assembly

Light Post assembly

Eye Piece Cap

Eye piece Window

Glass light fibers Objective lens

Parts and Components Eye piece internal assembly

Eye piece Window

Focus Lens

Parts and Components Internal Components

The glass light fibers are angled to

correctly match the objective for

the proper illumination of the field

of view as in this schematic of a 30

degree lens.

Light Fibers

Spacers Rod Lenses

Objective Lens

A typical scope has 6-10

rod lenses

Objective System

Optical Lens System


Patient Safety Begins With Decontamination

Healthcare staff who are responsible for

processing laparoscopes and

associated items can have a

major impact on the risk for surgical site

infections (SSI) during

laparoscopic procedures.

Over 90% of infection outbreaks related

to laparoscopic instruments can be

prevented if processing of instruments

and equipment is properly conducted.

Ref. 9


Decontamination: Care & Handling

AORN recommends that individuals

handling laparoscopic instruments

should be competent in their care and

handling.

Instruments with lumens are among the

most difficult to decontaminate

effectively.

Always wear personal protective

equipment and follow standard

precautions.

Ref. 10

http://images.google.com/url?sa=i&rct=j&q=surgical+ppe&source=images&cd=&cad=rja&docid=JV_uTnUuxsd5-M&tbnid=dJKNYZqVcRITdM:&ved=0CAUQjRw&url=http://www.remm.nlm.gov/percutaneous_ppe.htm&ei=yGnTUaPCApDY8gTN14DABw&psig=AFQjCNHnOE686KLNTTUkCGkNnnHqmUsR-g&ust=1372896066862728


Multi-Part Instruments: Care & Handling

There are various styles of instrumentation. It is vital that you know which

instruments can be dis-assembled for cleaning. If you don’t know, ask!

3rd Generation:

Can be completely dis-

assembled for proper

cleaning.

2nd Generation:

With flushport only.

1st Generation:

No dis-assembly. Very difficult to clean.


Assembly: Care & Handling

It is important to remember that surgical

instruments are complex and fragile.

Personnel who are responsible for

instrument care should:

•Be cautious when handling instruments.

•Use all instruments, tools, and equipment

for their intended purpose only.

•Follow processing protocols carefully.


Inspection: Care & Handling

Check for scissor

functionality, smooth open

and closing of jaws.

Check jaw alignment,

of all double action

dissectors and

forceps to ensure

they open and close

symmetrically.

Check alignment of

tips when closed.

Check tips of cautery

instruments for

cleanliness and defects.

Forceps with ratchets

must securely lock in

place and release as

designed.

Laparoscopic instruments should be inspected after use, ALL instruments in set!

Evaluate equipment’s integrity, function, and cleanliness.

All insulated laparoscopic instruments should be tested with a current tester every time the set is assembled!

Damaged instruments should removed from service.




Inspection: Insulation Testing

Equipment failures can compromise

patient safety in several ways. Prior to

use, all laparoscopic instruments must

be tested.

Compromised insulation can cause

internal patient burns. A video

example is shown on the next slide.

Surgeon and scrub tech can be

burned by broken insulation in

instruments.

Cracked insulation can allow

bioburden to become trapped and

instrument sterility is compromised.



This video

demonstrates the

escaping energy from

damaged insulation

on a laparoscopic

instrument, causing

unintended burns.

With proper

laparoscopic

instrument testing

each time the

instrument is

reprocessed, these

burns can be avoided.

The video continuously loops while this slide is shown.


Inspection: Additional Inspection Points

Check all mono and bi polar cords for signs of

damage such as cracks and tears.

Visually inspect insulation

on instruments for signs of

cracking and chipping.

Check all cautery

posts for damage.


Spaulding Classification System

Ref. 11

Group Quiz

SUPER TECH

What gas is commonly used to inflate the abdominal cavity

for a laparoscopic procedure?

Oxygen Carbon Dioxide

Carbon Monoxide Nitrous Oxide

SUPER TECH

What is the medical term for making internal organs easier

to visualize by inserting gas into the abdominal cavity?

Pneumoperitoneum Pneumothorax

Pneumonisis Indigestion

SUPER TECH

What instruments are used to access the surgical site

through small puncture holes?

Trocanter & Cannula Trocar & Candlestick

Trocar & Cannula Trocanter & Calendula

SUPER TECH

What is an advantage of minimally invasive surgery?

Smaller Incision Decreased Hospital Stay

Less Pain All of the above

SUPER TECH

What part of the laparoscopic instrument inspection process

contributes the most to patient safety?

Assuring it’s lubricated Checking for faulty insulation

Handle feels comfortable Tip protectors are secured

SUPER TECH

What is part of the laparoscopic instrument inspection process

contributes the most to patient safety?

Assuring it’s lubricated Checking for faulty insulation

Handle feels comfortable Tip protectors are secured

SUPER TECH

LAVH is an abbreviation for a surgical procedure. What

does the abbreviation stand for?

Look Around Very Hard Lap Assisted Vaginal Hysterectomy

Lap Assisted Vaginal Hysteroscopy Laparotomy And Vaginal Hysterectomy

SUPER TECH

Which instrument pictured above is a surgical electro-

cauterizing device?

Photo 1 Photo 2

Photo 3 Photo 4

1. AORN. Recommended practices for cleaning and processing endoscopes and endoscope

accessories. Standards, Recommended Practices, and Guidelines. Denver, Colo: AORN, Inc;

2007:531-537.

2. AORN. Recommended practices for selection and use of packaging systems. Standards,

Recommended Practices, and Guidelines. Denver, Colo: AORN, Inc; 2007:607-616.

3. http://www.merriam-webster.com/medlineplus/endoscopy

4. http://www.merriam-webster.com/medlineplus/laparoscopy

5. http://www.nlm.nih.gov/medlineplus/tutorials/cholecystectomyopenandlaparoscopic/gs019105.pdf

6. http://www.nlm.nih.gov/medlineplus/ency/presentations/100001_2.htm

7. http://www.acog.org/~/media/For%20Patients/faq008.pdf?dmc=1&ts=20130702T1700450796

8. http://www.nlm.nih.gov/medlineplus/ency/article/002916.htm

9. AORN. Recommended practices for cleaning and care of surgical instruments and powered

equipment. Standards, Recommended Practices, and Guidelines. Denver, Colo: AORN, Inc;

2012:487.

10. Seoane-Vazquez E, Rodriquez-Monguio R, Visaria J, Carlson A. Exogenous endoscopy-related

infections, pseudoinfections, and toxic reactions: clinical and economic burden. Curr Med Res

Opin. 2006;22:2007-2021.

11. Adapted from Recommended Practices for Selection and Use of Packaging Systems, Association

of Perioperative Registered Nurses, 2007 Standards, Recommended Practices, and Guidelines.


References

Congratulations!

care & handling of laparoscopic instruments50-slides... · pelvic laparoscopy (or pelviscopy)...

Documents