Surgery - pt. 12

If the surgeon asks for a "tie on a passer" he/she wants a strand of suture on a right angle clamp.  This is used to tie a structure deep in a cavity where the surgeon's hands can't reach.
If the surgeon asks for a "stick tie", "suture ligature", or "transfixion suture" they want a strand of suture on a needle.  Since this is usually used to tie off a blood vessel, it may be a nonabsorbable suture, size 3-0 on a small gastrointestinal needle.
There are a number of hand signals used by surgeons.  This is the signal for a hemostat or other appropriately sized clamp. This is the position of the surgeon's hand when accepting most instruments.  If the surgeon makes this signal and you are unsure what he/she needs, the safest instrument to place in his/her hand is a hemostat.
This is the hand signal for scissors.  When the surgeon needs dissecting scissors the Surgical Technologist must be aware of the strength of the tissue.  For tougher tissue (fascia, breast, muscle, uterus) the surgeon needs the curved mayo scissors.  For delicate tissue (ovaries, bowel) and for most general dissection, the surgeon uses the metzenbaum scissors.  The length of the scissors depends on the depth of the wound.  Specialty scissors are used on certain tissues.  For example,  Jorgenson scissors are used to cut across the cervix during an abdominal hysterectomy.
This is the hand signal for the knife or scalpel.  The scrub nurse passes this with the blade down and the handle pointed toward the surgeon.  Care must be taken to avoid injury when passing the scalpel.  A "no pass" zone should be established on the field.

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