Hemostatic clamps are used to stop bleeding, with their help there is a capture and temporary compression of a bleeding vessel or a stump of a cut vessel. The range of sizes of these instruments is several dozen. This diversity is explained by the presence of vessels of different sizes from 1 to 20 mm and the use of various methods of hemostasis. Small vessels cut during the operation are grasped with a clamp, and then the stump is ligated (sutured) above the clamp with a thread.
Hemostatic clamps, which are used to temporarily clamp the vessels, have differences. A clamp designed to stop bleeding from small vessels can injure the end of the vessel. As a rule, it is made of rigid materials. Clips, which are also called vascular, are made of elastic materials, this is due to the features of their design. The names of these tools are fully consistent with their purpose. In emergency cases, they can be used to fixnapkins.
However, it should be remembered: hemostatic clamps, at least once used to fix napkins or cotton and gauze balls, can no longer be used for their intended purpose. This is due to the deformation of their working part and the loss of functionality. In the future, they should be marked and used only for fixing balls and napkins.
Clamp requirements
Hemostatic forceps must meet the following requirements:
- Reliable fixation at the end of the vessel, slipping is not allowed.
- When used repeatedly, their properties should not be lost.
- The instrument should close and open easily under the influence of the surgeon's hand.
- The locking mechanism must securely fix the branches, preventing them from opening spontaneously. For this, for example, a clamp in the form of a rack is suitable. When falling from a height of 1 meter, the tool should not spontaneously open the working surface, and repeated closing and opening of the jaws should not cause them to skew.
- Must comply with the rules of ergonomics.
- Lightness, excluding tissue ruptures that can occur under the weight of clamps applied to the edges of the wound.
- Must allow the use of an electrocoagulator.
- Don't block the view of the surgical field with its size.
- The ends of the instruments must match the diameter of the vessels.
Clamp classification
Hemostatic clamps are divided into several subgroups:1. Hemostatic clamps that provide temporary clamping of blood vessels before applying ligatures or electrocoagulation (hemostatic serrated clamp).
2. Vascular clamps that temporarily stop blood flow and allow you to restore the integrity of the vessel (suture of the vascular).
3. Crushing clamps that promote the formation of a blood clot in the lumen of the vessel after applying the clamp.
Design Features
Hemostatic forceps consist of the parts listed below:
- Sponges (branches).
- Handle with rings.
- Collapsible or blind lock.
- Kremaliers.
Shape of jaws (branches)
- Triangular elongated, for example, Halsted neurosurgical forceps.
- Trapezoid pointed, e.g. Billroth clamp.
- Trapezoid with teeth, e.g. Kocher clamp.
- Oval, such as Pean clip.
Clamps can have straight or curved jaws. Notches on the surfaces of the jaws are allowed both transverse and oblique. Curved hemostatic clamp is used quite often.
Kocher clamp
The Kocher clamp has teeth on the end. They are firmly fixed at the end of the vessel, because. when closing, one of its teeth enters the gap between the other two.
Before the operation, the surgeon must personally check the condition of the hemostatic forceps (serrated,straight, curved - does not matter), because:
- damage to the ratchet teeth can cause the tool to open itself, which is very dangerous when clamping a large vessel.
- skewed working parts will not effectively stop bleeding.
Clamps differ in the shape of the jaws, the profile of the working surface, the purpose and size of the instruments.
Clamp Types
The following types of clamps are distinguished:
1. The hemostatic forceps are straight toothed, 15 to 20 cm long, have a detachable or screw lock, with an oblique notch on the working surface of the jaws. The ends of the jaws have teeth on one side, one and two on the other side. When closing the lock, one of the teeth should fall between the other two.
2. With a transverse notch, they are identical to serrated ones, but the working surface has a transverse cut. Made of stainless steel, the surface is polished to a shine. Length from 16 to 20 cm, can be straight or curved.
3. Neurosurgical hemostatic clamp "Mosquito", lightweight, 15.5 cm long, has a screw lock. Sponges in longitudinal section in the form of a truncated cone, on their working surface there is a thin transverse notch. Are issued bent or direct vertically and horizontally. They are mainly used for hemostasis of small vessels during neurosurgical operations.
4. Children of the "Mosquito" type are similar in design to the previous one, but have thinner branches. Length 12.5 cm, there are also straight andcurved. Designed for operations on the vessels of the face, the arachnoid of the brain, in pediatric surgery, for operations on parenchymal organs.
5. Deep cavity, designed for hemostasis of vessels and ligation in deep wounds. Their length is 26 cm, the sponges are straight or curved and short in length.
Mosquito clamps are also called Halsted clamps. Differ in a thin working surface. The clip "Mosquito" curved is used for newborns. Performs hemostasis of small vessels during neurosurgical operations.
Bilroth clamp captures and clamps the vessels. It is with working sponges and a small notch, as well as a conical surface on the outside. Grasping jaws are knurled for less tissue trauma.
The Popper forceps is a long, straight surgical forceps used in gallbladder surgery.
How is the clamp applied?
Before starting the operation, the surgeon must personally check the operation of the clamps. This is especially true for large arteries. For example, applying a clamp that is defective to the phrenic-gastric ligament, or rather, to the left gastric artery passing through it, is fraught with the risk of slipping the end of the vessel, which can lead to serious bleeding.
How to get clamps correctly?
The width of the section of the mesentery (ligament) with the vessels that pass through it should be inversely proportional to its thickness.
Must remembernext:
- the remaining large stump can necrosis, which can cause purulent inflammation;
- the appearance of a large area of deserized surface can lead to adhesive disease;
- the ligature that was applied to the bulk fatty tissue can be torn off at any time.
The surgeon should apply clamps and ligatures to the most critical areas of the ligament (mesenteries), those that will not be removed, and an assistant will apply them to the removed areas of the mesentery.
Excision of the ligament or mesentery between the clamps is performed closer to the area that remains. The volume of the remaining stump is better to do a little more, this will serve as a guarantee that the ligature will not break.
Clamps and ligatures on ligaments are recommended to be applied at a slight angle, because. this increases the volume of the stump, and this contributes to a stronger fixation of the ligature.
There are following rules to follow:
1. Do not pull on the ends of the ligatures. So they can be plucked from the end of the vessel.
2. An angle of 40-50 degrees should be observed between the plane of the divorced blades of the Cooper scissors and the threads.
3. The lower blade of the scissors must be rested on the knot.
4. The cut end of the ligature should not exceed 1-2 mm.
Hemostatic forceps for wound restraint
To delimit the wound from the skin, most often use a hemostatic serrated straight clamp (1 160 mm long).
In shallow wounds it is more expedient to applystraight. But for attaching gauze pads to the subcutaneous fat, curved hemostatic clamps are more suitable.
Storage of surgical instruments
Tools are stored in a heated, dry place at a temperature of 15-20 °C. Substances whose vapors can cause corrosion of metals (formalin, iodine, bleach) are not allowed in the same room with them.
Tools intended for current use are laid out in cabinets, while sorting them by type and purpose. Those of them that are made of carbon steel, during long-term transportation or storage, are treated with neutral vaseline or coated with paraffin. To do this, vaseline is melted to a temperature of 60-70 ° C, tools are immersed in it, and then wrapped in paraffin paper.
Tools made of the following materials must not be lubricated: stainless steel, aluminum, brass, bronze. Preparation of tools for lubrication is as follows: degrease or boil in water with soda and soap, dry, inspect for rust, remove existing traces of rust by polishing. Processing of tools should be carried out only with gloves, because. sweat marks can lead to rust.
We examined in detail the medical hemostatic clamp, its types, rules for use and storage.
