Instrument Manufacturing Process

Materials Used:

  • 400 Series Stainless Steel (Martensitic): Hard, used for sharp cutting edges. Instruments include scissors, osteotomes, chisels, rongeurs, forceps, hemostatic forceps, and needle holders.

  • 300 Series Stainless Steel (Austenitic): Offers high corrosion resistance, more workable and malleable. Used for retractors, cannulas, rib spreaders, and suction devices.

Passivation is a chemical treatment used in the production of instruments. It creates a protective corrosion-resistant surface by forming a thin clear layer of oxide.

Hand-Held Instruments

Instrument Structure

  • Jaws: The working end that contacts patient tissue and organs.

  • Box Lock: The weakest part, most difficult to clean, where the instrument halves join.

  • Shanks: Provide closing force for the jaws when ratchets are engaged.

  • Ratchets: Control the clamping force and hold the instrument closed with interlocking teeth, difficult to clean, and must be open during sterilization.

  • Finger Rings: Used to hold and control the instrument, come in various shapes.

Grades and Characteristics of Hand-Held Instruments

  • Surgical Grade: Highest quality, reusable, often made from U.S. or German steel.

  • Floor Grade: Lower quality, often from Pakistan, usually single-use or limited-use.

  • Disposable: Single-use, marked "single use," should not be reprocessed.

Special Instrument Features

  • Gold Finger Rings: Indicate tungsten carbide edges or inserts.

  • Black Finger Rings: Indicate very sharp "supersharp" scissors.

  • Satin Finish: instruments used for laser procedures due to their non-reflective nature.

- Heat-fused nylon (often referred to as "dipping") is an identification method. It's a liquid powder-coating process that leaves a colored nylon layer on the instrument.

Lubrication

  • Instruments should be lubricated manually or mechanically in an instrument washer.

  • Manual lubrication must be performed in the preparation and packaging area, with instruments exposed to the lubricant solution and air-dried without wiping or rinsing off the lubricant.

Spotting, Staining, Pitting, and Marking

  • Spots: Usually removable with a cloth or eraser, caused by water quality or steam residues.

  • Stains: Often caused by "electrolysis" from dissimilar metals exposed to a solution.

Inspection and Maintenance

  • Forceps: Check tips and serrations for cleanliness, proper alignment, debris, and missing teeth.

  • Suction Tubes: Match stylettes, remove before sterilization, include in set but not inserted.

  • Visual Inspection: Use a lighted magnifying lamp for detailed checks.

Special Instruments and Considerations

  • Laparoscopy: Surgery in the abdomen.

  • Arthroscopy: Surgery in a joint.

  • Endoscopy: Surgery through a natural opening.

  • Insulated Instruments: Check with an insulation tester; damaged insulation can pose a safety threat.

  • Scopes: Should not be placed beneath other instruments.

Scope Warmers

Pre-warm scopes to body temperature to keep them fog-free during procedures.