Chapter 3. Basic methods and instruments

Table of Contents
Appropriate surgical technology[md]the equipment you need
Scalpels and dissectors
Scissors
Forceps
Retractors and hooks
Suture materials
Needles and their holders
Suture methods
Using tubes in surgery, especially nasogastric tubes
Drains and draining
Miscellaneous equipment and materials
Instrument sets

Appropriate surgical technology[md]the equipment you need

You may step into a beautifully organized theatre, or you may have to create it from scratch. To help you in this task we have listed everything you might need to do the procedures we describe, down to the last needle and cake of soap. To minimize the tediousness of long lists we have distributed the equipment through the text, and summarized it in Appendix A. We have included everything which you could reasonably have[md]but may not have at the moment. For example, many district hospitals don't have skin grafting knives, pneumatic tourniquets, simple bone drills, Kirschner wire, or manometers for measuring the central venous pressure (A 19.2)[md]but you could reasonably have them, so we have included them. Some of the special methods we describe don't need any extra equipment[md]for example, the plastic bag method for burnt hands (58.29). Learn to recognize the instruments you use and to know them by their names. When you first arrive at a hospital check the theatre equipment and find out what is missing!

When you order equipment that is not listed here try to make sure that: (1) It will work reliably without needing to be returned to the makers to be mended. (2) It will work well in your hands. (3) You can afford both its initial and its running costs. (4) Spares are available. (5) You can easily learn how to use it and teach other people to do the same.

If you want to be well supplied, encourage and motivate your storeman. Look at what he has and how he does things. Don't forget to visit your central medical stores; you may find things you need, which the storeman there cannot identify, and you can make good use of. The equipment we list is the equipment he should stock, so do your best to see that government does this.

You will certainly have to improvise. If you don't have the standard stainless steel instruments, don't hesitate to use ordinary steel ones, if you can buy, adapt, or make them. Before stainless steel came into routine use in the 1920s, all surgical equipment was made of ordinary steel, and had to be dried and carefully wiped with an oily rag after each operation. For example, you can use an ordinary steel carpenter's drill instead of a bone drill, and a sterile pair of ordinary pliers may be the best way to remove a plate. If you have no Kirschner wires you may be able to use sharpened bicycle spokes. Don't store instruments of ordinary steel sterilized in packs or drums. The interior of these is damp and they will rust rapidly.

STORES AND EQUIPMENT QUANTITIES OF ITEMS. The quantities of each item we suggest are those appropriate to an initial stock. The quantities of each item we list are sufficient to make all the sets suggested in Section 4.12. You will probably have to make do with less.

CATALOGUE NUMBERS. Where an item is available from UNICEF, we have given its UNIPAC number. We have given the suppliers of a few items which are difficult to get. These have been listed with three letters in brackets, for example, (EVE) for the Everett Needle Company, and the supplier's names are listed in full in Appendix B.

SUPPLY CYCLES. If your supply period for a consumable item is ''X' months, try to keep three times the quantity of it you consume during this period in stock, so that one indent can go astray without causing disaster.

ORDERING EQUIPMENT. When you order equipment, try to include the catalogue number. Where possible write to the supplier and ask for a ''proforma invoice' giving the exact details and costs, etc. This will make ordering much easier.

WHERE THE EQUIPMENT IS DISCUSSED. The anaesthetic equipment is in Primary Anaesthesia, the obstetric equipment is in Section 15.1a and in Primary Mother Care .

The theatre. Theatre furniture and lighting, gowns, gloves and drapes (2.1 and 2.3), drains and tubing (4.10). Miscellaneous smaller items of theatre equipment (4.11).

Preventing sepsis. Sterilizing equipment (2.3), antiseptics and disinfectants (2.5).

Preventing bleeding. Haemostats and arterial clamps (3.2), tourniquets (3.9).

Cutting and holding tissues. Scalpels and dissectors (4.2), scissors (4.3), forceps (4.4), retractors (4.5), suture materials (4.6), needles and their holders (4.7).

Special procedures Operating on bones and joints (7.4), intestinal surgery (9.3), obstetrics (15.1), proctology (22.1), urology (23.1), eye (24.1), ENT (25.1), dentistry (26.1), first aid equipment (50.3), tracheostomy (52.1), skin grafting (57.1), neurosurgery (63.1), chest aspiration (65.1), plastering (70.1), bone traction (70.9).