The proper Instrument Transfer Methods outlined in this course are demonstrated in this video clip.
To accomplish an efficient transfer, the instrument must be positioned for the arch that is being treated and the operator must be able to grasp the instrument in a normal holding position without unnecessary hand movement while keeping the eyes on the field of operation.
The basic instrument transfers used in dentistry include the two-handed, single-handed and hidden-syringe methods.
In a two-handed transfer, the assistant picks up the used instrument with one hand and delivers a new instrument with the opposite hand. This transfer requires more movement and limits efficient use of the HVE and air-water syringe. Although this method is not the preferred transfer in most common operative procedures, it is well suited for oral surgery.
In a single-handed transfer, two areas of the assistant’s passing hand are used. The delivery portion of the hand includes the thumb and first two fingers and the pick-up portion includes the third and small finger. This technique allows the assistant to take the used instrument from the operator with the pick-up portion of the hand and deliver the new instrument with the delivery portion of the same hand. The assistant’s opposite hand is free for retraction or for oral evacuation.
Typically, an instrument can be divided into three areas: The working third is the part of the instrument that must be ready to use once it is delivered to the operator. The middle third includes the handle on which the operator rests the hand, and the assistant’s third is the non-working part of the instrument, held in the delivery portion of the assistant’s hand.
When using a single-ended instrument, such as the cotton pliers, there is only one working end. With a double-ended instrument such as an explorer, the assistant’s end and the working end may be interchangeable.
The hidden syringe technique, a special technique that is used to hide an instrument or device from the patient’s view, is reserved primarily for the transfer of the local anesthetic syringe to the operator. In the first part of such a procedure, the single-handed transfer can be used to exchange 2 x 2 gauze sponges, topical anesthetic or a cotton-tipped applicator. During the actual transfer of the syringe, the two-handed transfer must be used while the operator receives the syringe in a palm-grasped position. The syringe is hidden from the patient’s view, hence the name of the transfer.
This technique can be performed in the transfer zone or behind the patient’s head in order to be hidden from the patient’s sight. The disadvantages of behind-the-head transfer include the possibility of a needle stick and increased classification of motion.
Since the single-handed procedure is so widely used, it will be demonstrated here in a step-by-step procedure.
The transfer can be divided into three basic stages:
1) Instrument preparation
2) Instrument pickup
3) Instrument transfer
Assemble instruments and armamentarium before treating the patient. Place instruments on a pre-set tray in sequence of use. Place the tray as close to the patient as possible. Place the tray in a vertical or horizontal position with the non-working end close to transfer hand. Place auxiliary equipment, such as anesthesia and isolation materials, nearby.
Once the instruments are in position and the patient and operating team are seated, the following transfer can begin:
Pick up the instrument at the non-working third of the unit with the thumb and first finger. Rest the instrument on the middle finger with the working end in position for the correct arch. Maintain the instrument in this holding position near the transfer zone until the operator gives a signal for transfer.
While maintaining a fulcrum, the operator signals for the transfer by moving the instrument from the tooth and bringing it outside the mouth. Parallel the new instrument with the instrument in the operator’s hand.
Pick up the used instrument between the ring and middle fingers. The depth at which the instrument is picked up will vary with the assistant’s ability to return the instrument to the delivery portion of the hand. Tuck the used instrument toward the palm and deliver the new instrument securely in the operator’s hand.
Reposition the used instrument to the delivery portion of the hand. This is done by using the tip of the thumb to roll the instrument from the palm up to the ring finger until it is above the first knuckle. Then hold the index finger and middle fingers under the handle of the instrument to return to the original delivery position between the thumb and first finger.
When the fingers are wrapped around the instrument, take care to avoid puncturing the latex gloves.
If the instrument is to be used again, retain the delivery position. If not, return it to the proper position on the tray set up.
The baton method allows the assistant to flip the instrument from the pick-up position to the delivery portion of the hand. This method may require that the instrument be flipped twice to return it to the original end and may allow an accident to occur which could result in injury to the patient.
Some assistants find it easier to pick up the used instrument between the small finger and ring finger. In a weak hand, this can cause potential dropping of an instrument, especially a heavier instrument. That is why it is recommended to receive the instrument between the middle and ring finger. This provides greater stability. Remember, instrument exchange does not occur as a separate activity. The assistant is performing several tasks at one time, while anticipating the operator’s needs and observing the patient.
The assistant will be using the oral evacuator in the right hand, the air-water syringe in the left hand and transferring a new instrument to the operator with the left hand. To do this, the assistant removes the oral evacuator from the oral cavity, transfers the air-water syringe to the right hand with the oral evacuator, and exchanges the instrument. The transfer of the air-water syringe to the right hand eliminates the need to replace it on the unit, which would create unnecessary movement and delay in the procedure.
The video segments are excerpts from the videotape entitled, “Clinical Dynamics of Four‑Handed Dentistry,” and used with the permission of Health Sciences Products, Birmingham, Alabama. The entire video tape can be purchased at:
Health Science Products, Inc.
1489 Hueytown Road
Birmingham, AL 35023
Phone: 800-237-5794 or 205-491-0560