Instrumentation
Managing surgical instruments: what to do when something is missing or faulty
Inspect instruments before use and respond clearly when an item is absent, damaged or unsuitable.
A problem with an instrument rarely arrives at a convenient moment. A clamp may not lock, scissors may not cut as expected, an item may be absent from the set or a device may not assemble correctly. Under pressure, it is tempting to keep trying and hope it will work.
The safer response starts earlier: inspect, identify and communicate.
Presence is not the same as readiness
An instrument can be on the table and still be unusable. During set-up, inspect according to local policy and the manufacturer’s instructions. Depending on the instrument, this may include cleanliness, integrity, alignment, movement, ratchet function, insulation, completeness and compatibility with other components.
Do not improvise tests that could damage the instrument or create a hazard. When you are unsure, involve an experienced colleague and follow the approved process.
Name the problem precisely
“It does not work” gives the team little information. A more useful statement identifies what you observed:
- “The ratchet does not hold.”
- “The jaws do not align.”
- “This component is missing.”
- “The insulation appears damaged.”
- “The item in the set does not match the requested size.”
Clear language makes it easier to decide whether the instrument should be replaced, removed from use or handled through the local reporting pathway.
If something is missing
First confirm the discrepancy without losing control of the sterile field or the count. Check the agreed locations and communicate with the circulating nurse. Consider the stage of the procedure and how urgently the item is required.
Do not hide the absence while searching silently. The team needs an accurate picture to choose a safe alternative or obtain a replacement. Any substitution must be clinically appropriate and accepted by the responsible professionals; resemblance alone is not enough.
If something fails during use
Maintain control of all parts, announce the problem and follow the team’s instructions. If breakage is suspected, account for fragments and follow the local count and incident procedures. Separate the item so it cannot accidentally return to the field, while preserving any required traceability.
The priorities are the patient, the integrity of the operative field and a shared understanding of what happened.
Learn from the fault
After the case, complete the required reporting or decontamination pathway and document details according to local policy. Ask whether the issue could have been identified during preparation and whether the next team needs to know about a recurring problem.
Professional reliability is not never encountering faulty equipment. It is recognising the problem early, communicating it without ambiguity and preventing the same item from creating a second risk.
Continue with Surgical counts for sponges, needles and instruments.