Tuesday, September 26, 2017

Surgical Instrument Identification Marking

"Fetch me one of those thingamajigs
with the red and black marking tape"
Carbon based lifeforms have had a fascination with placing marks on things that has evolved over countless millenia. Dogs and cats spray urine and bears strip bark and arrange tree leaves in unique patterns as a marking technique. Homo sapiens of the office sitting operating room  administrative ilk are fond of putting their mark on surgical instruments. See that elegant arrangement of  Germany's finest  set of  VMueller surgical instruments (above)  all decked out with tacky  little identifying bands. I think the green/yellow, red/black tape markings look  worse than a dog spraying a fire hydrant with urine. Marking surgical instruments is a crude way for administrative busy bodies  to seek control over a situation that they have no business fooling around with.

It's not too hard to figure out the marking behavior of dogs, cats and bears, but to find the motivation for  defacing marking surgical instruments we have to delve into the mindset of misguided individuals who likely have rarely set foot in an operating room. How about this gem from an instrument defacing  marking advocate?  "Marking surgical instruments corrects the lack of process visibility and identification for all perioperative stake-holders."

I guess this is a convoluted way of saying you cannot tell what something is just by looking at it or using it. It's not all that difficult to learn the nomenclature of surgical instruments and have a general idea of how the instrument is used. A Penfield is a Penfield because that's what it is. The black and red tape is not what gives an instrument it's identity. So the instrument is the instrument, ineffable, a well defined entity completely independent of the strips of colored tape applied on the whim of an administrative wisenheimer.   If you are working in the perioperative arena and don't know the identity of your instruments, the only steak you should be holding is a T-bone.

"We mark our instruments so as to organize them into sets for a specific case. Green/black markings mean the instrument is part of the fem-pop bypass tray," said nursing supervisor, Mary Marks-a-Lot
This is wrong headed thinking of the highest order. The surgery determines the type of instrument used not the instrument determining  the surgery. The tail is wagging the dog with case specific instrument trays and the circulating nurse  will be running like a whippet to the nearest autoclave to flash sterilize the instruments you really need for unexpected circumstances. I often fantasized about instrument marking misfits standing directly in front of the autoclave when I suddenly cracked the door after a flash sterilization cycle. Maybe a blast of scalding steam to their sensory regions would bring them to their senses.

Instruments used in case specific trays are also more subject to wear and tear because they are used in the same manner time after time. For maximum instrument life it's best to use them on a rotating basis with different cases through varying services. Auto mechanics don't have a breaker bar just for working on struts - they use it wherever it's needed. Surgical instruments should be used as needed and not assigned to a case specific use.

Scrub nurses have enough to keep track of; sponges, needles, and instruments. an additional duty of inspecting each instrument for loose or missing tape is stretching the limit. ID tape is just one more unnecessary worry for a harried nurse.

Microorganisms are crafty little devils and I suspect they could use the ID markings as a sort of shield to escape the unpleasant effects of gas or heat sterilization. I always suspected that tape margin where it interfaces with the instrument surface as an area for assorted biomass crud build-up. Instruments just look cleaner without identification tape.

I usually tried to avoid pharmaceutical reps and medical equipment sales people like the plague. The very reserved German fellow that represented VMueller instruments was a source of information and a true expert on the care and feeding of surgical instruments. He summed up my feelings perfectly when he surveyed an instrument tray with ID tapes plastered on his beautiful product, "Dumkopfs!" he hollered followed by some German cuss words He did not have to explain who or what he was referring to while I nodded my head in somber agreement.


  1. I've never worked in medicine, so I'll expose my ignorance here. Who selects what instruments to use for a particular procedure? Does the surgeon choose each time, or do the nurses or others assemble the instruments based on the kind of procedure and what the surgeon prefers to use?

  2. I can't speak for current practices, but we had instrument trays for general use sterilized, wrapped and ready to go. The most common was a laparotomy tray that contained everything to enter and remove or repair abdominal organs.

    Individual surgeons had preference cards on file that included glove sizing, sutures, and any special request for an unusual instrument. Sometimes surgeons asked for strange things like tablespoons which they used as a scooping tool.

    We had an assortment of specialty and oddball instruments that were individually packaged after ethylene gas sterilization.

    If we needed an instrument that was not open on the back table, the circulator ran to a smaller nearby autoclave and "flashed" it for 3 minutes. We usually dunked it in a basin of water back in the OR to cool it off. Big ortho instruments and weighted speculums are tough to cool, so care was necessary.

    Thanks so much for your question and hope I was able to shed some light on the subject

  3. The latest in instrument identification involves laser etching. Hospital administrators believe this discourages theft. As a traveling nurse the fancy ID just increases the souvenir value.

  4. I was not much of a purloiner, but worn needle holders (drivers to you whippersnapperns) have great utility in any household. My favorite use is to remove the tops of those supposedly easy open cans especially when that ring opener thing breaks off.

  5. Thank you for another useful and relevant blog on sterilization of surgical instruments . This site has been quite beneficial to us, and I have learned a lot from it.