Miscellaneous equipment and materials

Some of the humblest equipment is also the most necessary. Here are many of the things which you should not be without.

TUBE, rectal, rubber, (a) child's size 8 mm (24 Ch), five only; (b) adult's size 10 mm (30 Ch), five only. You can also connect these to a large bore funnel and use them to give an enema. Introduce them carefully: you can easily perforate the sigmoid colon.

CONNECTOR, end-to-end, polypropylene, external diameter (a) 4 mm, (b) 7 mm, (c) 10 mm, (d) 15 mm, (e) 19 mm, ten only of each size. Use these to join short lengths of tubing together for suction or drainage etc.

CONNECTORS, plastic 3 way ''Y', assorted sizes, 20 only.

CLIP, towel, cross action, 90 mm, 28 only. These are the simplest towel clips.

CLIP, towel, with ratchet, Backhaus, six only. These are more expensive than the towel clips listed above, but they have several other uses, including holding the sucker tube, and the ribs in chest injuries (65.6).

FORCEPS, sponge holding, Rampley, straight, (a) 240 mm, box joint, 22 only. (b) 120 mm, two only. Use these for swabbing, and for ''swab dissection'.

LOUPE, binocular, Bishop Harman, [mu]2 magnification, one only. Perch its two lenses on the very tip of your nose, or wear it over your spectacles. Curl its ear pieces, so that it fits your face. This is a twentieth the price of a binocular loupe, and is invaluable for fine operations like repairing nerves (55.9), or arteries (55.6), or ''cut-downs' (A 15.2), or removing splinters. The disadvantage of a loupe is that it focuses close to your nose, so use short-handled instruments.

TROCAR AND CANNULA, straight, with nickel silver or stainless steel cannula and metal handle, (a) 4 mm (12 Ch). (b) 8 mm (24 Ch). (c) 12 mm (36 Ch), one only of each size. The small size is useful for tapping hydroceles, the middle one for suprapubic cystotomy, and the largest one for chest drainage.

CANNULA WITH SIDE ARM, one only. Attach suction to the side arm and use it to aspirate the gall bladder etc. (13-1).

PROBE, malleable, with eye, nickel silver, 150 mm, 3 sizes, one only of each size. Use this to probe perianal fistulae etc.

DIRECTOR, hernia, Key's, one only. Use this for opening the neck of a hernial sac.

DIRECTOR, probe-ended, Brodie, 165 mm, one only. Use this for exploring sinuses.

d RING CUTTER, one only. If you don't have this, you may be able to remove a ring with soap and string (75-5).

NEEDLE, aneurysm, Dupuytren, (a) one needle curving right, (b) one needle curving left, one only of each kind. These are curved needles on the end of a handle. Use them for passing a ligature under something (3-4).

NEEDLE, aneurysm, small, with blunt point, three only. Keep these in your ''cut down sets' (A 15.2,) and use them to pass ligatures under a vein.

CATHETER, metal female, three only.

BRUSH, for cleaning instrument jaws, ten only. The jaws and joints of surgical instruments need brushing regularly. You can also use suede brushes with bronze bristles.

RAZOR, safety, for preoperative preparation, ten only. Shaving a patient preoperatively is not the essential ritual that it was once assumed to be (9.1). You can also adapt a safety razor for skin grafting (57.7).

BUCKET, stainless steel, with handles, six only.

KIDNEY DISH, stainless steel, with half curled edges, 4 sizes 100 to 300 mm, two dishes of each size only.

GALLIPOT, stainless steel or autoclavable plastic, set of six sizes 40 to 200 mm, two sets only. Use these for lotions, swabs etc.

JAR, stainless steel with dropover lid, 150[mu]150 mm, two only. Use these for spirit swabs.

JUG, plastic, autoclavable, conical, 3 litre, one only. Stainless steel jugs have become standard, but plastic ones are satisfactory.

BIN, soiled, two only.

JELLY, hydroxymethylcellulose, sterile, ''KY jelly' 1 kg only. This is a sterile non-greasy jelly for catheters etc.

''BIPP', bismuth iodoform and paraffin paste BPC, 1 kg only. This is a mildly antiseptic self-sterilizing anaesthetic packing material. You can leave it in the nose for a week without significant infection, or much smell (25.6). If you don't have any, smear gauze or bandage with any non-adherent antiseptic ointment.

CARPENTER'S EQUIPMENT (a) Saw, one only. (b) Twist drill, one only. (c) Hammer, claw head, one only. If you cannot get the surgical equivalent of these, you will find them very useful.

OTHER MATERIALS include gauze, cotton wool, bandages, adhesive tape, and laparotomy pads (1.12).