Nursing responsibilities

1. Instrument nurse

Colloquially referred to as ‘scrub nurse’, the instrument nurse is a member of the sterile team who scrubs, gowns and gloves for the surgical procedure.  The scrub nurse is on
works directly with the surgeon within the sterile field, passing instruments, sponges, and other items needed during the procedure. She/He is the members of the surgical team
who prepares and preserves a sterile field in which the operation can take place.

Duties of scrub nurse:

-Before an operation

 Ensures that the circulating nurse has checked the all the equipment needed during procedure.
 Ensures that the theatre has been cleaned before the trolley is set.
 Prepares the instruments and equipment needed in the operation.
 Prepare own self by using sterile technique like scrubbing, gowning and gloving.
 Receives sterile equipment via circulating nurse using sterile technique.
 Performs initial sponges, instruments, and needle count, checks with circulating nurse.

-When surgeon arrives after scrubbing

 Help with gowning and gloving to the surgeon and assistant surgeon as soon as they enter the operation suite
 Assemble the drapes according to use. Start with towel, towel clips, draw sheet and then lap sheet.
 Assist the surgeon in draping the patient aseptically according to routine procedure.
 Place blade on the knife handle using needle holder, assemble suction tip and suction tube.
 Bring mayo stand and back table near the draped patient after draping is completed.
 Secure suction tube and cautery cord with towel clips or Allis.
 Prepares sutures and needles according to use.

-During An Operation

 Maintain sterility throughout the procedure.

 Awareness of the patient's safety.
 Adhere to the policy regarding sponge/ instruments count/ surgical needles.
  Arrange the instrument on the mayo table and on the back table
 Before the incision begins, provide two sponges on the operative site prior to incision.
 Passes the first knife for the skin to the surgeon with blade facing downward and a hemostat to the assistant surgeon.
 Passes the retractor to the assistant surgeon.
 Watch the field/ procedure and anticipate the surgeon's needs.
 Pass the instrument in a decisive and positive manner as needed in the procedure.
 Watch out for hand signals to ask for instruments and keep instrument as clean as possible by wiping instrument with moist sponge
 Always remove charred/burned tissue from the cautery tip
 Notify circulating nurse if you need additional instruments as clear as possible.
 Always keep 2 sponges on the field throughout the procedure.
 Save and care for tissue specimen according to the hospital policy
 Remove excess instrument from the sterile field.
 Adhere and maintain sterile technique and watch for any breaks. If any breaks found then inform immediately to the surgeon.

-End of operation

 Undertake count of sponges and instruments with circulating nurse and correlate with the pre-surgery findings.
 Informs the surgeon regarding count result.
 Assist the surgeon for suturing the surgical incision.
 Apply the dressing over the surgical site.
 Clears away instrument and equipment.

2. Nurse assist
OR assistants work under the supervision of other medical professionals with more advanced training. Generally, their responsibilities include maintaining a clean and sterile
environment before, during, and after surgery; providing basic care to the patient during surgery; and assisting the surgeon or other members of the medical team on an as-
needed basis.

These job responsibilities may require nurse assist to do the following:

 Cleaning and sterilizing the operating room before and after the procedure.
 Cleaning and sterilizing all surgical instruments and equipment before, during, and after the procedure.
 Arranging all surgical instruments and equipment in an accessible, organized manner for easy use during the procedure.
  Helping surgeons, anesthesiologists, and other members of the surgical team get properly dressed for the procedure.
 Transporting the patient to and/or from the operating room.
 Verifying patient information and confirming the procedure before it is performed.
 Handing surgical instruments to surgeons as requested during the procedure.
 Measuring the patient’s vital signs and keeping a record of them during surgery.
 Collecting the patient’s specimens for laboratory analysis.
 Assisting the surgeon with basic medical functions during the procedure, such as applying clamps, cutting sutures, or dressing wounds.
 Assisting the patient and helping them get comfortable after the procedure is complete.

3. Circulating nurse

The circulator is responsible for managing the nursing care of the patient within the operating room and coordinating the needs of the surgical team with other care providers
necessary for completion of surgery. Circulating nurse observes the surgery and the surgical team and assists the team to create and maintain a safe and comfortable
environment for the patient. She/He assesses the patient's condition before, during, and after the operation to ensure an optimal outcome for the patient. She/He must be able
to anticipate the scrub nurse's needs and be able to open sterile packs, operate machinery and keep accurate records.

Duties/Responsibilities of Circulating Nurse:

-Before an operation

 Checks all equipment for proper functioning such as cautery machine, suction machine, OR light and OR table.
 Make sure that theater is clean.
 Arrange furniture according to the need of the procedure.
 Place a clean sheet, arm board (arm strap) and a pillow on the OR table.
 Provide a clean kick bucket or pail.
 Collect necessary stock and equipment.
 Turn on the aircon (AC) unit and adjust the temperature of the OT room as per the patient need.
 Help scrub nurse with setting up the theater Assist with counts and records.

-During the induction of anesthesia

 Turn on OR light.
 Assist the anesthesiologist in positioning the patient.
  Assist the patient in assuming the position for anesthesia.
 Anticipate the anesthesiologist’s needs.

-After the patient is anesthetized

 Reposition the patient per anesthesiologist’s instruction.

 Attached anesthesia screen and place the patient's arm on the arm boards.
 Apply restraints on the patient.
 Expose the area for skin preparation.
 Catheterize the patient as indicated by the anesthesiologist
 Perform skin preparation.

-During operation

 Remain in theater throughout the operation.

 Focus the OR light every now and then.
 Position kick buckets on the operating side.
 Replenishes and records sponge, instruments and needles or sutures.
 Ensure the theater door remain closed and patient's dignity is upheld throughout the procedure.
 Watch out for any break in aseptic technique. If any breaks found, then inform immediately to the surgeon.

-End of operation

 Assist with final sponge and instruments count and documented.

 Signs the theater register.
 Ensures that all the specimens are properly labelled and signed.

-After an operation

 Assist the scrub nurse for patient dressing.

 Helps in removing and disposing the drapes.
 Helps to prepare the patient for transporting to the recovery room.
 Assist the scrub nurse, taking the instrumentations to the service (washroom).
 Make arrangement for preparation of theater for the next case.

DRUG STUDY
Name of Drug Dosage/Frequency Mechanism of Indication Contraindication Adverse effect Nursing responsibilities
/Route/Time action
Generic Ketamine interacts Ketamine is Where there is Side effects associated with the  Assess respiration and
Name: Adult and Pediatric Dosage with N-methyl-D- indicated as an significant cephalopelvic use of ketamine include: notify physician
Ketamine Forms & Strengths aspartate (NMDA) anesthetic agent disproportion. immediately if patient
receptors, opioid for recommended  alcoholism  Emergence reactions exhibits any interruption
Brand Names: Injectable solution: receptors, diagnostic and  alcohol  High blood in respiratory rate (apnea)
Ketalar Schedule III monoaminergic surgical intoxication pressure (hypertension) or signs of respiratory
 10mg/mL receptors, procedures. If  increased spinal  Increased cardiac output depression, including
Drug Class:  50mg/mL/ muscarinic skeletal muscle fluid pressure  Increased intracranial decreased respiratory
General  100mg/mL/ receptors, and relaxation is  increased pressure rate, confusion, bluish
Anesthetics, voltage sensitive needed, it should pressure in the  Fast or slow heart rate color of the skin and
Systemic Dosage Considerations -- Cation channels. be combined with eye  Seizures mucous membranes
Should Be Given as Unlike other a muscle relaxant.  significant  Visual hallucinations (cyanosis), and difficult,
Follows: general anesthetic If the surgical uncontrolled  Vivid dreams labored breathing
agents, ketamine procedure high blood  Double vision (dyspnea). Monitor pulse
Adult Anesthesia Induction does not interact involves visceral pressure  Low blood oximetry and perform
with GABA pain, it should be  sudden and pressure (hypotension) pulmonary function tests
-Load receptors. supplemented serious  Increased intraocular (eye) to quantify suspected
 IV: 1-4.5 mg/kg with an agent that symptoms of pressure changes in ventilation and
slow IV once   obtunds visceral heart failure  Injection site pain respiratory function.
 Alternatively (off- pain. Ketamine called acute  Involuntary eye Apnea or excessive
label): 0.5-2 mg/kg can be used for decompensated movement respiratory depression
slow IV induction of heart failure requires emergency care.
if adjuvant drugs anesthesia prior  failure of the Less common side effects of  Monitor signs of laryngeal
(eg, midazolam) other general heart to ketamine include: spasm, including tightness
are used, OR anesthetic agents maintain  Severe allergic reaction in the throat and chest,
 IM: 6.5-13 mg/kg and as a adequate (anaphylaxis) wheezing, cough, and
IM once supplement of low circulation  Cardiac arrhythmia severe shortness of
 Alternatively (off- potency agents.  decreased lung breath. Notify physician
 Depressed cough reflex
label): 4-10 mg/kg function  Muscle twitching or nursing staff
IM once if adjuvant Reports have  delirium immediately if these
 Increased salivation
drugs (eg, indicated a  abnormal liver reactions occur.
 Muscle spasms
midazolam) are potential use of function test  Assess signs of increased
 Difficulty speaking or
 used ketamine as a breathing intracranial pressure,
therapeutic tool  Respiratory including decreased
-Maintenance for the depression or apnea with consciousness, headache,
 50% of IV ketamine management of large doses or rapid lethargy, seizures, and
induction dose depression when infusions vomiting. Notify physician
administered PRN, administered in or nursing staff
OR lower doses. immediately of these
 0.1-0.5 mg/min IV These reports signs.
continuous have increased the  Be alert for signs of
infusion interest in emergence reactions,
ketamine in this including nightmares,
Resistant Depression (Off- area and several hallucinations, and other
label) clinical trials are changes in mood and
 Infusion: 0.5 mg/kg launched for this behavior. Report these
IV twice weekly; indication. signs to the physician or
not to exceed 6 nursing staff.
weeks; therapy >6  Assess blood pressure
weeks not studied (BP) and compare to
normal values. Report
Pediatric changes in BP, either a
Sedation/Analgesia (Off- problematic decrease in
label) BP (hypotension) or a
 ACEP recommends sustained increase in BP
as safe in children (hypertension).
 3 months or older  Assess heart rate, ECG,
and heart sounds,
especially during exercise.
Intramuscularly (IM) Report abnormal heart
 4-5 mg/kg IM once, rhythms or symptoms of
ACEP Clinical arrhythmias, including
Guidelines (Green palpitations, chest
2004); may give a discomfort, shortness of
repeat dose (range breath, fainting, and
2-5 mg/kg) if fatigue/weakness.
 sedation  Be alert for residual
inadequate after 5- muscle rigidity and
10 min or if increased skeletal muscle
additional doses tone. Report a sustained
are required  increase in muscle tone.
 Monitor injection site for
Intravenously (IV) pain, swelling, and
 Various irritation. Report
recommendations prolonged or excessive
 1.5-2 mg/kg over injection site reactions to
30-60 sec; may the physician.
administer
incremental doses
of 0.5-2 mg/kg IV
q5-15min PRN if
initial sedation
inadequate (Mace
et al., Ann Emerg
Med, 44: 342-377
[2004]), OR  
 0.25-0.5 mg/kg
(Harriet Lane)
Oral
 6-10 mg/kg PO
once; mix with 0.2-
0.3 mL/kg of a
beverage; give 30
min before
procedure

16 years or older
-Load
  IV: 1-4.5 mg/kg
slow IV once
 Alternatively (off-
label): 0.5-2 mg/kg
slow IV if adjuvant
drugs (eg,
midazolam) are
used, OR
 IM: 6.5-13 mg/kg
IM once
 Alternatively (off-
label): 4-10 mg/kg
IM once if adjuvant
drugs (eg,
midazolam) are
used

-Maintenance
 50% of IV ketamine
induction dose
administered as
needed, OR
 .1-0.5 mg/min IV
continuous
infusion

Name of Drug Dosage/Frequency Mechanism of action Indication Contraindication Adverse effect Nursing responsibilities
/Route/Time
Generic For oral dosage forms The exact mechanism Metronidazole is indicated  Where there Metronidazole may  Watch for seizures;
Name: (capsules or tablets): of action of for the treatment of is significant cause side effects. Tell notify physician
Metronidazol metronidazole has confirmed trichomoniasis cephalopelvic your doctor if any of immediately if patient
e For amebiasis infections: not been fully caused by Trichomonas disproportion. these symptoms are develops or increases
 Adults—500 or 750 established, vaginalis (except for in the  meningitis not severe or do not go seizure activity.
Brand Names: milligrams (mg) 3 however, it is first trimester of pregnancy) due to an away:  Monitor signs of
Flagyl, Flagyl times a day for 5 to possible that an and the patient's sexual infection peripheral neuropathy
ER, Metro 10 days. intermediate in the partners, bacterial vaginosis,  low levels of a  vomiting (numbness, tingling).
Gel, Metro  Children—Dose is reduction of certain types of amebiasis, type of white  nausea Perform objective
Lotion,  based on body metronidazole which and various anaerobic blood cell  diarrhea tests (nerve
Metronidazol weight and must is only made by infections. The above called  constipation conduction,
e,Noritate, Ro be determined by anaerobic bacteria anaerobic infections may neutrophils  upset stomach monofilaments) to
sadan Cream your doctor. The and protozoa, binds occur on the skin and skin  alcoholism  stomach cramps document any
dose is usually 35 deoxyribonucleic acid structures, the abdomen,  alcohol  loss of appetite neuropathic changes.
Drug Class: to 50 milligrams and electron- the heart, reproductive intoxication  headache  Monitor signs of
Nitroimidazol (mg) per kilogram transport proteins of organs, central nervous  a low seizure  dry mouth disulfiram-like
es, Antibacteri (kg) of body weight organisms, blocking system, and the respiratory threshold  sharp, reaction (i.e., toxicity
al, per day, divided nucleic acid system. Some may also be  a painful unpleasant occurring when this
Topical, Vagin into 3 doses, for 10 synthesis. After present in the bloodstream condition that metallic taste drug is taken with
al days. administration, in cases of septicemia. affects the  furry tongue; alcohol). Signs include
Preparations, metronidazole enters Common infections treated nerves in the mouth or tongue throbbing headache,
Other, Antibio For bacterial infections: cells by passive by metronidazole are legs and arms irritation difficulty breathing,
tics,  Adults—Dose is diffusion. Following Bacteroides species called nausea, vomiting,
Other, Cephal based on body this, ferredoxin or infections, Clostridium peripheral sweating, thirst, chest
osporins, weight and must flavodoxin reduce its infections, and neuropathy pain, palpitations,
Other, Topical be determined by nitro group to nitro Fusobacterium infections, as  prolonged QT tachycardia,
Antimicrobials your doctor. The radicals. The redox well as Pepto coccus and interval on hypotension, syncope,
dose is usually 7.5 potential of the Pepto streptococcus EKG agitation, confusion,
milligrams (mg) per electron transport infections.  seizures weakness, vertigo,
kilogram (kg) of portions of anaerobic  chronic kidney and blurred vision.
body weight every or microaerophilic It is also used off-label in the disease stage Report these signs to
6 hours for 7 to 10 microorganisms treatment of Crohn's 5 (failure) Some side effects can be the physician
days. Your doctor renders disease and rosacea, as a  kidney disease serious. If you immediately.
may increase your metronidazole prophylactic agent after with likely experience any of the  Assess dizziness that
 dose as needed. selective to these surgery, and in the reduction in following symptoms, call might affect gait,
However, the dose organisms, which treatment of Helicobacter kidney your doctor balance, and other
is usually not more cause nitro group pylori infection It has also function immediately: functional activities
than 4000 mg per reduction, leading to been studied in the  Cockayne Report balance
day. the production of prevention of preterm births syndrome  numbness, pain, problems and
 Children—Use and toxic metabolites. and to treat periodontal  Child-Pugh burning, or functional limitations
dose must be These include N-(2- disease. class A liver tingling in your to the physician and
determined by hydroxyethyl) oxamic impairment hands or feet nursing staff and
your doctor. acid and acetamide,  Child-Pugh  seizures caution the patient
which may damage class B liver  rash and family/caregivers
For trichomoniasis DNA of replicating impairment  itching to guard against falls
infections: organisms.  Child-Pugh  hives and trauma.
 Adults—The tablet class C liver  peeling or  Be alert for confusion,
can be given 3 impairment blistering skin agitation, headache,
different ways: as a  flushing or other alterations in
single dose of 2  stuffy nose, mental status. Notify
grams, as 1 gram 2 fever, sore the physician
times a day for 1 throat, or other promptly if these
day, or as 250 signs of infection symptoms develop.
milligrams (mg) 3  joint pain  Monitor IV injection
times a day for 7  dizziness site for pain, swelling,
days. The capsule  difficulty and irritation. Report
dose is 375 mg 2 speaking prolonged or
times a day for 7  problems with excessive injection site
days. coordination reactions to the
 Children—Use and  confusion physician
dose must be  agitation
determined by
your doctor.

For oral dosage form

(extended-release tablets):
 For bacterial vaginosis:
 Adults—750
milligrams (mg)
once a day for 7
days.
 Children—Use and
dose must be
determined by
your doctor.

Name of Drug Dosage/Frequency Mechanism of action Indication Contraindication Adverse effect Nursing responsibilities
/Route/Time
Generic Name: For induction of The action of propofol Used for induction and/or Where there is Propofol may cause  Monitor
Propofol anesthesia: involves a positive maintenance of significant serious side effects hemodynamic status
modulation of the anesthesia and for cephalopelvic including: and assess for dose-
Brand Names: 3-16 years 25 35 mg/kg IV inhibitory function of management of refractory disproportion.  cough, related hypotension.
Diprivan perfusion over 20-30 the neurotransmitter status epilepticus. When general  upper airway  Take seizure
seconds (older children gama-aminobutyric anesthesia or obstruction, precautions. Tonic-
Drug Class: may require lower doses as acid (GABA) through sedation are  apnea, clonic seizures have
Sedatives, General compared to younger ones) GABA-A receptors. contraindicated or  shallow or slow occurred following
Anesthetics, in patients with a breathing, and general anesthesia
Systemic Maintenance of known allergy  shortness of with propafol.
anesthesia: and/or breath  Be alert to the
2 months-16 years 0.125- hypersensitivity to potential for drug
0.3 mg/kg/min IV, after 30 propofol or its The most common side induced excitation
mins, decrease the infusion components. effects of (e.g., twitching,
rate if clinical signs of light Administer with Propofol include: tremor, hyper clonus)
anesthesia are absent, caution to patients  fast or slow heart and take appropriate
older children may require with hypovolemia, rate, safety measures.
lower doses compared to 5 epilepsy, lipid  high or low blood  Provide comfort
years metabolism pressure, measures; pain at the
disorders, or  injection site injection site is quite
 Sedation prior to severe cardiac or reactions common especially
procedure: respiratory (burning, when small veins are
18 years l mg/kg IV loading disease. Delayed stinging, or pain), used
dose and then 05 mg/kg IV convulsions have  apnea,
been associated  rash, and
with the use of  itching
propofol,
therefore special
care should be
taken when it is
used for day case
procedures.
Abrupt
discontinuation
may provoke rapid
awakening,
anxiety, and
agitation.

NCP for 6 hours post CS

Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective data: Risk for bleeding STG: STG:
related to post- After 3 hours of 1. Establish rapport 1. To gain client’s cooperation. Goal Met
“May mga lumalabas po na partum nursing intervention,
dugo sa ari ko”, as complications the patient will 2. Assess vital signs, 2. To determine if intravascular After 3 hours of nursing
verbalized by the patient. identify individual including blood fluid deficit exists. intervention, the patient was
risks and engage in pressure, pulse, and able to identify individual risks
appropriate respirations. and engage in appropriate
behaviors or lifestyle Measure blood behaviors or lifestyle changes
changes to prevent pressure to prevent or reduce
Objective data: or reduce frequency lying/sitting/standing frequency of bleeding
of bleeding episodes. as indicated to episodes.
-Pale skin evaluate for
-BP: 100/70 orthostatic
hypotension;
monitor invasive
hemodynamic
parameters when
present.

3. Note client report of 3. Can help identify bleeding into

pain in specific areas, tissues, organs, or body cavities.
whether pain is
increasing, diffuse,
or localized.

4. Changes in these signs may be

4. Assess skin color and indicative of blood loss affecting
moisture, urinary systemic circulation or local
output, level of organ function such as kidneys
consciousness, or or brain.
mentation.
5. To evaluate bleeding risk. An
5. Review laboratory abrupt drop in Hb of 2 g/dLl can
data (e.g., complete indicate active bleeding.
 blood count [CBC],
platelet numbers
and function, and
other coagulation
factors such as
Factor I, Factor II,
prothrombin time
[PT], partial
thromboplastin time
[PTT], and
fibrinogen)
6. To identify medications that
6. Importance of might cause or exacerbate
periodic review of bleeding problems
client’s medication
regimen

7. To determine abnormal signs

7. Instruct at-risk client and symptoms of bleeding.
and family regarding
specific signs of
bleeding requiring
healthcare provider
notification, such as
active bright
bleeding anywhere,
prolonged epistaxis
or trauma in client
with known factor
bleeding tendencies,
black tarry stools,
weakness, vertigo,
and syncope.
 8. May prevent blood loss
8. Teach techniques for complications, especially if
postpartum client to client is discharged early from
check her own hospital.
fundus and perform
fundal massage as
indicated and the
need to contact
physician for post
discharge bleeding
that is bright red or
dark red with large
clots.

NCP for 1 hour prior to OR( for cs)

 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective data: Deficient knowledge STG: 1. Establish rapport 1. To gain client’s cooperation. STG:
“after ko po ma CS, ano po related to unfamiliarity After 2 hours of nursing Goal Met
ba mga bawal kong gawin with condition and intervention, the client will 2. Determine the client’s 2. The individual may not be After 2 hours of nursing
at mga bawal ko po na information resources as verbalize understanding of ability, readiness, and physically, emotionally, or mentally intervention, the client
kainin?, as verbalized by evidenced by request for condition, disease process, barriers to learning. capable at this time. verbalized understanding
the patient. information. and treatment. of condition, disease
3. Be alert to signs of 3.The client may need to suffer the process, and treatment.
Objective data: avoidance consequences of lack of knowledge
-Asking too much before he or she is ready to accept
-Inappropriate behavior information.
-Inaccurate follow-through
of instruction or 4.Note personal factors 4.That affect ability and desire to
performance on a test or (e.g., age and learn and assimilate new
procedure developmental level, information, take control of
gender, social and cultural situation, and accept responsibility
influences, religion, life for change.
experiences, level of
education, and emotional
stability)

5.Assess the level of the 5.The client, SO(s), and/or

client’s capabilities and caregivers may need help to learn.
the possibilities of the
situation

6. Provide information 6. Reducing the amount of

relevant only to the information at any one given time
situation helps to keep the client focused
and prevents client from feeling
overwhelmed.

7. Provide positive 7. his could encourage

reinforcement continuation of efforts. Avoid the
 use of negative reinforcers (e.g.,
criticism, threats)

8.Discuss the client’s 8.So that the client feels

perception of need. Relate competent and respected.
the information to the
client’s personal desires,
needs, values, and belief.

9.Identify information that 9. Enhances possibility that

needs to be remembered information will be heard and
(cognitive) understood

10.Identify information 10.The affective learning domain

having to do with addresses a learner’s emotions
emotions, attitudes, and toward learning experiences, and
values (affective) attitudes, interest, attention,
awareness, and values are
demonstrated by affective
behaviors.

11. Identify outcomes 11. Understanding what outcomes

(results) to be achieved will be can help client realize
importance of learning the
material, providing motivation
necessary to learning

12. Include the affective 12. The learner’s emotional

goals (e.g., reduction of behaviors affect the learning
stress) experience and need to be actively
addressed for maximum
effectiveness.

13. Begin with information

 the client already knows 13. This can arouse interest/limit
and move to what client sense of being overwhelmed.
does not know,
progressing from simple to
complex

14. Involve the client/SO(s)

with others who have the 14.This provides a role model and
same problems, needs, or sharing of information.
concerns (e.g., group
presentations, support
groups)

15. Provide information

about additional learning 15. This may assist with further
resources (e.g., learning and promote learning at
bibliography, Web sites, his or her own pace.
tapes)

INSTRUMENT USE
1. Babcock have jaws with atraumatic parallel serrations that are intended to hold a shorter section of the intestine with minimal trauma and
constriction. There is a ratchet on the inner side of the ring-handles so that the forceps can lock in place when needed during a surgical
procedure.
2.Vaginal Speculum A vaginal speculum is a medical device that allows physicians and health providers to better view a woman's cervix and vagina during
pelvic exams. Most specula are made of metal and plastic, and physicians insert a portion of the speculum into the patient's vagina to
separate the vaginal walls.
3.Tenaculum  It consists of a slender sharp-pointed hook attached to a handle and is used mainly in surgery for seizing and holding parts, such as
blood vessels.
4.Allis The Allis clamp is a surgical instrument with sharp teeth, used to hold or grasp heavy tissue. It is also used to grasp fascia and soft tissues
such as breast or bowel tissue.

5.Kelly curve used during surgery to compress the artery, clamp and seal small to medium size blood vessels or hold the artery out of the way
6.Mayo Curve allow deeper penetration into they wound than the type with straight blades. The curved style of scissors used to cut thick tissues such
as those found in the uterus, muscles, breast, and foot. Mayo scissors used for dissection are placed in this the tips are closed.
7.Deaver used to retract deep abdominal or chest incisions. Used in Cholecystectomy (removal of gallbladder) for retraction of right lobe of liver.
Used in Truncal vagotomy (division of the main trunk of the vagus nerve) for retraction of left lobe of liver.
8.Needle holder  is made from stainless steel and is used to hold a suturing needle during surgical procedures.
9.Blade handle Intended to be use with surgical blades for tissue separation and other procedure that require a sharp surgical blade to puncture or cut.  
10.Uterine forceps Uterine forceps, available at Surgical Holdings, are long, curved forceps used to grasp the uterus during uterine birthing and other
obstetrics and gynae surgery
11.Hysterometer Hysterometer is a sounding device that is used to measure the uterus. This device is used for preliminary hysterometer and is used to
assess the total uterine depth. It is sometimes referred to as an uterometer for measuring the depth of the uterine cavity and the cervix.
12. Ovum forceps Ovum Forceps, available at Surgical Holdings, used to grasp, hold, manipulate and remove tissue from inside the uterus including the
ovum and placenta. Ovum forceps are used during procedures such as caesarean section, hysterectomy, and uterine repair and are also
sometimes used as a hemostat.
13.Debakey Debakey forceps are a type of atraumatic tissue forceps used in vascular procedures to avoid tissue damage during manipulation. They
are typically large (some examples are upwards of 12 inches (36 cm) long), and have a distinct coarsely ribbed grip panel, as opposed to
the finer ribbing on most other tissue forceps.
14.Martin Pelvimeter is used in obstetrics and gynecology to assess the size of the female pelvis in relation to childbirth to determine whether natural vaginal
delivery is possible.
15.Kelly retractor Kelly Retractor has a right-angled blade that has a bent crescent-shaped lip. This retractor is commonly used to pull back, or retract, the
edges of wounds in order to expose the surgical area.
16.Simpson Luikart  is used to expedite delivery during prolonged labor. That forceps is also used during shoulder dystocia, fetal distress and meconium
staining of the liquor. Simpson-Luikart Forceps Has Curved Blades for A Safer Withdraw of The Baby's Head.
17. Mclane Tucker  are designed to aid in the delivery process by firmly grasping the fetal head and providing traction. The blades feature a more rounded
cephalic curve for the unmolded fetal head, commonly seen in multiparous women. The grooved handle provides a comfortable and
secure grip for the obstetrician.
18.Malleable retractor These retractors are made from malleable stainless steel, allowing for easy modification of retractor angle and shape. The blades are
available in a variety of sizes depending on the surgeon's need and are commonly used during orbital dissection to keep orbital fat out
of the surgical field.
19. Towel clip Towel clips are instruments that have proved to be indispensable in surgeries. One of their primary functions is to hold drapes in place3,
to keep only the operating field exposed.
20.Umbilical scissor Umbilical Scissors are non-ratcheted, finger ring scissors used for cutting the umbilical cord. These scissors feature wide, flat, curved
blades. They are typically used without clamping the umbilical cord because the curvature of the blades holds the cord in place.