Practical Guide for Beginner OR Nurses
Working in the operating room requires more than simply recognizing surgical instruments.
Every instrument has a specific purpose, an appropriate grip, and a safe handling technique. Learning these basic skills improves surgical efficiency while protecting both the patient and the surgical team.
In this guide, you’ll learn how to properly use the four essential surgical instruments found in almost every operating room.
Quick Facts
| Instrument | Primary Use |
|---|---|
| Scalpel | Skin and tissue incision |
| Needle Holder | Holding and driving suture needles |
| Forceps | Grasping tissue or surgical materials |
| Surgical Scissors | Cutting tissue and sutures |
1. Scalpel
What is a Scalpel?
A scalpel is the primary cutting instrument used to make precise incisions through skin and soft tissue.
The blade is attached to a reusable handle, and different blade sizes are selected depending on the surgical procedure.
Common Scalpel Handles
No.3 Handle
Used with smaller blades such as No.10, No.11, and No.15.
Ideal for
- General surgery
- Plastic surgery
- Fine dissection
No.4 Handle
Designed for larger blades such as No.20–24.
Commonly used for
- Orthopedic surgery
- Large skin incisions
- Trauma surgery
Long Handle (Microsurgery)
Provides excellent control for delicate microsurgical procedures.
Proper Scalpel Grip
Pencil Grip
Best For
- Precise dissection
- Plastic surgery
- Fine tissue handling
Advantages
- Excellent precision
- Better fingertip control
- Small delicate movements
Palmar Grip
Best For
- Skin incision
- Long straight cuts
- General surgery
Advantages
- Greater cutting force
- Improved stability
- Comfortable for long incisions
Scalpel Safety Tips
- Always cut away from yourself.
- Keep the blade visible whenever possible.
- Never pass a scalpel by holding the blade.
- Remove blades using a needle holder or blade remover.
- Dispose of used blades immediately in a sharps container.
2. Needle Holder
What is a Needle Holder?
A needle holder is designed to securely grasp a surgical needle during suturing.
Unlike a hemostat, the jaws are shorter and stronger to prevent the needle from slipping.
Correct Needle Position
The needle should be grasped approximately two-thirds from the tip.
Holding the needle too close to the tip or swage increases the risk of bending or breaking the needle.
Proper Needle Holder Grip
Place the thumb and ring finger lightly inside the rings.
Many experienced surgeons use a modified grip that allows quicker release and smoother needle rotation during continuous suturing.
Common Mistakes
- Holding the needle at the tip
- Locking the ratchet too tightly
- Using the needle holder as tissue forceps
- Applying excessive force
3. Forceps
What are Forceps?
Forceps are used to grasp, stabilize, retract, and manipulate tissue during surgery.
Choosing the correct type helps minimize tissue trauma.
Types of Forceps
Dressing Forceps
Features
- Smooth tips
- Non-toothed
- Less traumatic
Common Uses
- Delicate tissue
- Gauze handling
- Fine manipulation
Tissue Forceps
Features
- Toothed tips
- Strong grip
- Prevent tissue slippage
Common Uses
- Skin
- Fascia
- Tough tissue
Proper Forceps Grip
Hold the forceps like a pencil using the thumb and index finger.
Avoid squeezing excessively, as unnecessary pressure can damage tissue.
4. Surgical Scissors
What are Surgical Scissors?
Surgical scissors are designed to cut tissue, sutures, and surgical materials safely and accurately.
Different scissors are used depending on the tissue type.
Proper Scissor Grip
Insert the thumb and ring finger into the rings.
Support the shank with the index finger to improve stability and precision.
Cutting Sutures
Lift the suture slightly before cutting.
This technique reduces the risk of accidentally injuring surrounding tissue.
Common Surgical Scissors
Mayo Scissors
Used for
- Fascia
- Heavy tissue
- Sutures
Metzenbaum Scissors
Used for
- Soft tissue
- Delicate dissection
- Fine surgical procedures
Basic Instrument Handling Tips
General Principles
- Keep instrument tips visible at all times.
- Use each instrument only for its intended purpose.
- Pass instruments firmly and safely to the surgeon.
- Avoid excessive gripping force.
- Maintain a neutral wrist position during use.
Common Beginner Mistakes
Frequent Errors
- Using forceps instead of a needle holder
- Holding scissors too tightly
- Grasping tissue with excessive force
- Passing sharp instruments unsafely
- Using the wrong scalpel grip for delicate dissection
- Holding the needle in the wrong position
Key Takeaways
Essential Points to Remember
Mastering the proper handling of scalpels, needle holders, forceps, and surgical scissors is one of the first milestones for every operating room nurse.
Understanding the correct grip, instrument selection, and safe handling techniques improves surgical precision, minimizes tissue trauma, and creates a safer operating environment for both patients and the surgical team.
Frequently Asked Questions (FAQ)
Which scalpel handle is most commonly used?
The No.3 handle is the most commonly used handle in general surgery because it accepts blades such as No.10, No.11, and No.15.
Where should a needle be held with a needle holder?
Approximately two-thirds of the distance from the needle tip.
What is the difference between tissue forceps and dressing forceps?
Tissue forceps have teeth for gripping skin and fascia, while dressing forceps have smooth tips designed for delicate tissue.
Which scissors are used for delicate tissue?
Metzenbaum scissors are preferred for delicate soft tissue dissection, while Mayo scissors are used for heavier tissue and sutures.