Hello everybody. Mike here from Surgtech Academy and today I'm going to
demonstrate basic instrument passing with and without hand signals. At this
point we have already ready to go, the patient is prepped and draped, cords are
thrown off, and the surgeon is ready to start. Now the first thing you want to
remember is that you want to make sure the Mayo stand is at an acceptable level
ergonomically and it's still sterile. We can't have the Mayo stand above chest
level or below waist level as those areas are contaminated. So you may need
your circulator to get you a step stool to go higher or you may need anesthesia
to raise the O.R. bed just to make sure that we're sterile and the Mayo stand is
comfortable and doesn't cause back pain. Before we get started I want to spend a
second teaching my surgeons everything they need to know when participating in
this exercise. As the surgeon your main jobs are to verbally ask for instruments
and to use hand signals to ask for instruments. And those three main hand
signals are scissors, tissue forceps, and stitch. Alright, so scissors, tissue
forceps, and stitch. And there actually could be a fourth visual which is please
just give me what I need! But that might take a while for you to get that one. And
there's also two main hand positions that surgeons receive the instrument. The
first way is the easiest where you stand there with your hand extended at waist
level like you're going to shake somebody's hand. Most instruments are
received using this method. The second way is to shape your hand like you're
putting a book on the shelf. We use this hand shape for the scalpel and the
tissue forceps. Now when teaching instrument passing I
tell my students to follow four main rules. Right. And those rules are to pass
firmly, and then middle finger on the box lock, pass the instrument straight up and
down, or pass it in position to use. So for most of our basic instruments it
looks like this. So I'm gonna start with the scissors. Straight up and down, my
middle fingers on the box lock, and I'm gonna pass firmly. Surgeon's hand is
like there shaking your hand. Just like that, alright.
Kocher, middle finger on the box lock, straight up and down, pass firmly. You
hear that cool little click? Allis forceps, middle finger on the box
lock. pass firmly. Kelly, guess what, middle finger on the box lock, straight
up and down, pass firmly. Alright even a Babcock, middle finger on the box lock,
pass firmly. Now it's important to try and stay away from the tips of the
instruments as it is the sharpest and you could cut your glove. Also remember
that curved instruments are passed with a tips curving toward the midline of the
surgeon and press firmly so that the surgeons grasp reflex is initiated. You
saw that a couple of times I was passing instruments that my grasp reflex
automatically tried to grasp the instrument. Alright, now like everything
else in surgery, there are exceptions to the rule. There are a couple of
instruments on my Mayo stand that are unique. Now the first one I want to talk
about is the scalpel. Now the first thing I still tell my students is to avoid the
tip as this will inevitably cut your finger and I will have to send you to
the emergency room for stitches. So I have them grab the top of the scalpel
and instead of placing firmly in the surgeons palm we're gonna place it in
the webbing between the thumb and the index finger. It places just like this.
Alright I'll show you that again. Sharp needle down, ring finger right in the
middle, placing it in the webbing. Now the second unique instruments are tissue
forceps. Now these are very similar to the scalpel. I tend to grab the
instrument mid-instrument and place it back in the surgeons webbing between the
thumb and the index finger. Just like this.
Alright, again. Thumb, middle finger, passing it right into the webbing. And then
the last instrument I want to pass is the needle holder. It is very similar to
most of the basic instruments except that we have a needle direction to think
about. I tell my students to make sure that the needle tip is point toward the
midline and at the surgeons heart. Alright. So even still my finger is at the box
lock, I'm going to point it, I'm gonna pretend point it towards the surgeon. Me.
Nice and firm. And it's still, they have that grasp reflex. Now if you want to
tell them you don't have to tell them to point it at the surgeon's heart. You can
pick any anatomy you want to. But that visual seems to work for my students.
And well, that's it passing of the basic instruments with and without hand
signals. This is Mike from Surgtech Academy wishing you a great day in
surgery and reminding you to be a superstar in your O.R.