Free CIS Exam Flashcards

A clamping instrument with serrated jaws, a ratcheted finger ring handle, and a box lock, used to occlude blood vessels. Common types include Kelly, Crile, Mosquito, and Rochester-Pean, differing by size, jaw length, and serration pattern.

A spring-loaded bone-biting instrument with a footplate that slides under bone to punch away small pieces. Primarily a neurosurgical/spinal instrument used to remove bone and disc material near the spinal cord and nerve roots.

An instrument that holds tissue or organs aside to expose the surgical site. Handheld retractors (e.g., Army-Navy, Deaver, Richardson) require an assistant; self-retaining retractors (e.g., Weitlaner, Balfour, Gelpi) hold open by a ratchet or frame.

A clamping instrument that grips suture needles. It has short, sturdy jaws (often with tungsten carbide inserts and cross-hatched serrations) and a ratchet. Distinguished from a hemostat by its heavier, shorter jaws designed not to nick the needle.

Both cut bone, but an osteotome is beveled (sharpened) on both sides of the blade for splitting bone, while a chisel is beveled on only one side for shaving or paring bone. Recognizing the bevel is a common ID distinction.

A heavy instrument with sharp, cupped, biting jaws used to cut and remove bone or tough tissue. Single-action rongeurs have one hinge; double-action rongeurs have two hinges for greater mechanical force on dense bone.

Thumb forceps grasp tissue. Tissue forceps have teeth (e.g., Adson with teeth, rat-tooth) to hold tissue securely; dressing/smooth forceps have serrated but toothless tips for handling dressings and delicate tissue without trauma.

Mayo scissors (heavy, for tough tissue and suture), Metzenbaum scissors (lighter, longer shanks, for delicate tissue), and suture scissors. Curved blades cut tissue; straight blades cut suture. Type and tip shape are key ID features.

The hinge mechanism where the two halves of a ringed instrument interlock and pivot. It is a critical inspection point: debris, stiffness, cracks, or misalignment at the box lock indicate a defect and require repair or removal from service.

The interlocking teeth on the finger-ring shanks that lock a clamp closed at set positions. During functionality testing, the ratchet must hold each click without springing open; a slipping ratchet means the instrument cannot maintain clamping force.

The working tips of a clamp. Serrations (horizontal, longitudinal, or cross-hatched) increase grip. Atraumatic jaws use fine serrations to avoid tissue damage. Worn, misaligned, or non-meeting jaws fail inspection because they will not grip.

Anatomy of a ringed instrument: finger rings (where fingers go), shanks (arms from rings to box lock), box lock (hinge), and jaws/tips (working end). Knowing these parts is essential for describing defects and ordering repairs.

Hard cutting/gripping inserts bonded into jaws of needle holders and scissors for durability and precision. Industry convention marks TC instruments with gold-colored finger rings or handles, allowing quick visual identification.

About 40% lighter than stainless steel and non-magnetic, ideal for microsurgery and MRI environments. Anodized titanium shows distinctive blue or purple color. It is corrosion-resistant but softer and more costly than stainless steel.

Martensitic stainless (e.g., 410/420) is hardenable and used for cutting instruments; austenitic stainless (300 series) is more corrosion-resistant and used for non-cutting items. The chromium oxide passive layer protects against corrosion.

A manufacturing finishing process that builds the protective chromium oxide layer on stainless steel, improving corrosion resistance. Damage to this passive layer (scratches, harsh chemicals, saline) is a common cause of staining and pitting.

Single-use (disposable) devices are FDA-labeled for one patient and must not be reprocessed unless by a validated reprocessor. Reusable instruments are designed and validated to withstand repeated cleaning and sterilization cycles.

Hybrid devices combining a reusable handle or component with single-use disposable parts. Processing must follow the IFU precisely so the reusable portion is cleaned and sterilized while the single-use portion is discarded.

Methods to identify instruments. Laser marking and chemical etching are preferred because they do not break the surface integrity; acid etching done improperly can corrode. Marking tape is discouraged because it harbors soil and can shed during cycles.

Keeping soil moist immediately after surgery (with an enzymatic spray/gel or moist towel) so blood and bioburden do not dry. Dried soil is far harder to remove and can damage instruments, making point-of-use care a key decontamination step.

Enzymatic detergents use proteases/lipases to break down organic soil and are used for soaking/precleaning. Neutral-pH detergents are general washing agents. Both must be diluted and used per IFU; wrong pH or concentration can stain or corrode instruments.

Utility water is acceptable for initial washing/flushing; critical (treated) water (deionized/RO) is used for final rinse to prevent mineral spotting, staining, and residue. Poor water quality is a leading cause of instrument spotting and corrosion.

An ultrasonic cleaner uses high-frequency sound waves to create tiny imploding bubbles (cavitation) that dislodge fine soil from hard-to-reach areas. Instruments must be open/disassembled, fully submerged, and dissimilar metals kept separate.

Objective checks that cleaning was effective, such as ATP bioluminescence tests, protein/hemoglobin residual tests, and visual inspection under magnification. Verification confirms the washer and manual processes are removing bioburden, not just appearing clean.

Prions resist routine sterilization, so suspected/confirmed Creutzfeldt-Jakob cases require enhanced protocols: keep instruments moist, special chemical treatment (e.g., sodium hydroxide or hypochlorite), and extended sterilization parameters per facility policy.

Hollow instruments (suctions, cannulated drills, scopes) must be brushed with a correctly sized brush and flushed because soil hides inside the channel. Inadequate lumen cleaning is a common cause of retained bioburden and sterilization failure.

Every instrument is inspected (often with lighted magnification) for cleanliness, corrosion, pitting, cracks, chips, and misalignment. Magnification reveals soil and defects invisible to the naked eye, especially in serrations and box locks.

A thin optical scope inserted into lumens and channels of flexible/rigid scopes and cannulated instruments to inspect interior surfaces for residual soil, scratches, or damage that surface inspection cannot detect.

Sharpness is verified by cutting test media: smaller scissors should cleanly cut a single layer of an index card (or designated test material) near the tips without snagging. Failure indicates dull blades needing sharpening or repair.

A functionality test where the needle holder clamps a wooden dowel or test pin and locks on a ratchet position; if the jaws spring open or the dowel turns easily, the holder will not grip a needle and fails inspection.

Tips and serrations of forceps and clamps must meet evenly when closed and held to a light source. Light gaps, overriding tips, or misaligned teeth mean the instrument cannot grasp properly and must be repaired or removed.

A water-soluble, steam-permeable lubricant applied to box locks and moving parts after cleaning to maintain smooth action and prevent stiffness. It must NOT be oil-based, because mineral oil blocks sterilant from reaching the metal surface.

Staining is surface discoloration (often removable); pitting is permanent surface erosion that traps soil and harbors bioburden; corrosion is active metal breakdown. Distinguishing them guides whether to clean, repair, or retire the instrument.

Scheduled service (sharpening, realignment, replacing inserts, repassivation) that keeps instruments functional and extends life. PM reduces failed sets, intraoperative breakdowns, and emergency repairs.

Trays are assembled to a standardized count sheet that lists each instrument, quantity, and configuration. Following the sheet ensures completeness, correct counts, and consistent set build for the OR and for sterilization validation.

Sets should generally not exceed about 25 lb to allow proper drying, sterilant penetration, and ergonomic handling. Overloaded or dense trays cause wet packs and inadequate sterilization.

Ringed instruments are placed open on a stringer or rack so the box lock and jaws are exposed to the sterilant. Instruments are arranged heaviest on the bottom, concave/cupped items face down, and lumens positioned for steam contact.

Paper-plastic pouches are used for small, light items. Place the instrument so the tip faces the peelable corner, do not overfill, and seal completely. Double pouching must follow IFU (no folding the inner pouch) so it opens aseptically.

Nonwoven or woven wraps create a sterile barrier. The wrap must be appropriate for the method and weight; envelope or square-fold techniques are used. Holes, snags, or thin spots compromise the barrier and require rewrapping.

Reusable metal containers with valves or filters that protect contents and allow sterilant entry. Each use requires inspecting gaskets, latches, and filters and changing/checking filters per IFU; a damaged gasket breaks the sterile barrier.

Impulse/continuous heat sealers join pouches with a complete, intact seal. Seal integrity (width, continuity, no channels or burns) is verified routinely because an incomplete seal allows contamination after sterilization.

Steam (moist heat) sterilizes by coagulating proteins; the four parameters are time, temperature, pressure, and saturated steam contact. Common cycles run near 270 to 275 F (132 to 135 C) for prevacuum loads, always per the device IFU.

Not every instrument tolerates every method: heat-/moisture-sensitive items (some plastics, optics, batteries) need low-temperature methods like hydrogen peroxide gas plasma or vaporized H2O2; the IFU dictates the validated method.

A low-temperature method for heat- and moisture-sensitive devices. It has lumen-length and diameter limits, cannot process cellulose materials (paper, linen, cotton), and requires specific tray and packaging materials per IFU.

A low-temperature gas method effective for complex, lumened, heat-sensitive devices. It requires a long aeration phase to remove toxic residual gas and is used less now due to safety and turnaround concerns.

A BI contains resistant bacterial spores and directly proves the sterilizer killed microorganisms (the only direct measure of lethality). A CI changes color to show a condition was met but does not prove sterility; both are used together.

Manufacturer-validated, device-specific reprocessing directions for cleaning, inspection, lubrication, packaging, and sterilization. IFUs are not optional; following them is the legal and accreditation standard, and they override generic department habits.

Vendor-supplied sets must arrive with enough lead time to be inventoried, decontaminated, and sterilized on-site before use, accompanied by IFUs and count sheets. They cannot go directly to the OR without full in-house reprocessing.

Software (often with unique instrument marking/barcoding) that records each item's location, processing history, repairs, and usage. Tracking supports recalls, productivity metrics (KPIs), set completeness, and documentation for audits.

A structured method to find the underlying cause of a failure (e.g., a wet pack or missing instrument) rather than just the symptom. Paired with Lean/Six Sigma and KPIs, RCA drives corrective action so the same error does not recur.