(About Powered Devices)
Instrument usage: Powered instruments are used to drill, cut, shape, and bevel bone, or for skin grafting and abrading skin.1 The use of a powered instrument prevents using a manual instrument that can fatigue the user and may not be as powerful.1 These instruments include microsurgical air-powered drills, saws, reamers, and abraders that are operated by a foot pedal or have fingertip control.1 These instruments come in various sizes and shapes. Powered instruments can be powered by compressed air or nitrogen or they can connect to electrical power, such as a battery or plug.1
Key differences:
The action of the powered instrument can be rotary, reciprocating, or oscillating.1 Some instruments can have a combination of actions that can be changed by adjusting the controls.1
Rotary movement is used when a hole needs to be drilled or to insert a screw, wire, or pin.1
Reciprocating is a front to back movement and oscillating is a side to side movement that are both used to cut or remove bone or skin.1
Drills, burrs, blades, reamers, and abraders come in many different sizes and can be disposable.
Battery powered instruments are cordless and have rechargeable batteries that must be attached to a battery charger between uses and then sterilized.
Safety on the sterile field:
Powered instruments must be assembled correctly because they are complex, with gears, rotating shafts, and seals.1
The operator of the powered instrument should also be in control of the foot pedal, which will prevent premature activation of the device. The foot pedal should be moved away when not in use so that it is not inadvertently activated.1
Before passing a powered instrument, the scrub personnel should check that it is working and if the battery is fully charged and working.
Electrically powered equipment should only be plugged into a power source that is in the off position and should be connected to the outlet before anesthetic gases are administered, but not disconnected until anesthetic gases are stopped.1
When passing a powered instrument, it is important to have the safety latch engaged so that the instrument does not start operating if activated accidentally.
Scrub personnel should be certain that drills, burrs, blades, reamers, or abraders are cleaned with sterile water and that no bone chips are left in the ridges.
Drills, burrs, blades, reamers, or abraders that are disposable should be kept with other sharp items on the sterile field and disposed of in a sharps container.
Heat is generated when powered instruments are used and the heat can damage bone cells, so sterile saline is commonly dripped using a bulb syringe onto the operative area to keep the heat to a minimum.
Surgical team members must wear eye protection and a face shield to prevent splatter of blood and bone.1
Surgical team should keep their hands away from powered instruments when activated.1
Air-powered instruments should be used at the correct pressure (measured in pounds per square inch, PSI) set by the manufactuer.1
Instrument names:
Powered instruments are commonly called by their name such as “reamer” or “saw” and by the size of the instrument, such as “25mm reamer” or “10mm saw blade.”
References:
1. Phillips, Nancymarie. Berry & Kohn's Operating Room Technique. Elsevier Health Sciences, 2016.