(About Accessory Instruments)
Instrument usage: Accessory instruments are instruments that do not fall within the other general instrument categories due to their function. Many accessory instruments are used to enhance the use of basic instruments or to facilitate the procedure.1 They can be considered miscellaneous items and can include measuring instruments, picks, cautery devices, implantable items such as arc bars, mirrors, and manufacturer’s specialty items.2 The accessory instruments are used in all specialties of surgery and are just as important during a surgical procedure as the more commonly known instrumentation.
Key differences:
Measuring instruments can include calipers, depth gauges, and rulers that are vital to accurately measure during a surgical procedure.
Picks come in an array of sizes and angles that are specific to the surgical specialty. The tips can be difficult to visualize, but the scrubbed personnel must be able to distinguish the correct pick for the surgeon.
Cautery devices can include loops or needle tip cautery tips that are used to control bleeding and for diathermy.
Implantable items, such as arc bars, screws, plates, and wires are used and remain in patients after the procedure.
Mirrors can be used to visualize hard to see areas in the body.
Manufacturer’s specialty items found on specific manufacture’s trays, especially in orthopedics and neurosurgery, can contain items that are used with a specific system.
Safety on the sterile field:
Picks should be handled as a sharp item and the tips should be protected to prevent damage, as well as injury to the scrubbed personnel.
Cautery devices must be handled carefully and according to manufacturer’s instructions for use on the surgical field to prevent a burn or a fire.
Implantable items must be recorded in the operative record, in order that the scrubbed personnel can keep track of the size and quantity of items implanted.
Mirrors should be examined prior to use for visibility and cracks, and an anti-fog solution can be used to prevent fogging when inserting into the body.
Manufacturer’s specialty items should be maintained within the sterile tray that they were processed in and be used only with items from the same manufacturer and according to the use that it was intended by the manufacturer.
Instrument names:
Accessory instruments are commonly called by their name “ruler” and the intended use, such as “bone tamp” or “dental mirror”. The surgeon may also call it by the manufacture’s trade name, if it is a specialty item.
References:
1. Rothrock, Jane C. Alexander's Care of the Patient in Surgery-E-Book. Elsevier Health Sciences, 2018.
2. Nemitz, Renee. Surgical Instrumentation-eBook: An Interactive Approach. Elsevier Health Sciences, 2017.