The functions of hemostatic clamps exactly match their name. Also, tools can be used as accessories for fixing napkins and balls, but such cases are rare. Moreover, if they served for such a purpose at least once, they are by no means allowed to be used for their main purpose, since the deformation of the working parts is inevitable, and their functional properties are lost. Such instruments should be marked and used only for fixing in the future.
In this article, we will take a closer look at surgical hemostatic forceps.
Clamp requirements
The hemostatic clamp has the following requirements:
- strong fixation without the possibility of slipping;
- permanent preservation of properties with repeated use;
- closing and opening of the branches should occur in the handssurgeon with ease;
- the presence of a locking mechanism that will prevent arbitrary opening of the jaws;
- working parts should not open when falling from a meter height;
- numerous closure of branches should not lead to distortion;
- low weight, which will not cause a rupture under the weight of the clamps located at the edges of the wound;
- compliance with ergonomic requirements;
- possible use of a coagulation instrument (electrosurgical option);
- small sizes that will not block the view on the operating field;
- The ratio of the size of the ends and the diameter of the vessels.
Clamp groups
The following groups of hemostatic clamps are distinguished:
- used for temporary occlusion of blood vessels before ligatures or electrocoagulation. That is, in fact, hemostatic instruments;
- temporarily stopping the flow of blood before restoring the integrity of the vessel through a vascular suture (vascular instruments, which include a straight clamp);
- accelerated thrombotic gaps after suturing (crushing).
Clamps come in straight and curved.
Clamp structure
The hemostatic clamp consists of parts such as:
- sponges (branches);
- deaf or collapsible lock;
- handle with rings;
- cremalers.
Types of branches
Depending onfrom the shape of the branches are divided into the following types:
- elongated triangular (Halstead clamps);
- trapezoid with teeth (Kocher clamp);
- trapezoid pointed (metal Billroth clamp);
- oval (Pean clip).
In addition, the jaws can be straight and curved, and their cutting on the working surfaces can be oblique or transverse.
The surgeon is obliged to check before the operation what condition the hemostatic clamps are in, since the wear of the teeth of the cremalier can cause spontaneous opening of the instrument or the most dangerous clamping of large vessels, and the misalignment of the parts can prevent the bleeding from stopping in time and effectively.
Surgical Clamp Usage Guide
To bandage the small vessels of fatty tissue under the skin, it is imperative to perform a number of the following steps:
- Using two tweezers, the first assistant should twist the edge of the wound closest to him. In this case, one of the planes becomes open for review.
- Another assistant removes blood from the surface of the wound with the edge of a gauze ball, which is clamped in tweezers, showing transverse bleeding sections of blood vessels.
- To save material, the gauze ball should be presented in the form of a cube, and its faces are sequentially used to drain the wound by means of a surgical forceps.
- The surgeon, one by one, clamps the ends of the vessels with the tips of the clamp, while the handle of the instrument thenshould be placed on the appropriate edge of the wound. Thus, the ends of the vascular clamp should act as a continuation of the vessel. Since the latter is located at the level of the wound or in fatty tissue under the skin, the clamp must be applied to the vessel along with a minimum amount of tissue surrounding it.
- If you need to stop bleeding from the vessels of the frontal-parietal-occipital region, then the clamps must be applied so that one end is located on the wall of the vessel, and the other is on the tendon helmet. If the lumen of the vessel is blocked by the inverted edge of the helmet, clamping the vessel and placing the clamp on the edge of the wound helps to stop the bleeding faster and more reliably
- If bleeding is minor, Halstead clamps should be applied. If the ends of the vessels have a small diameter, then you will need a Kocher instrument or a direct Billroth hemostatic forceps.
- When bleeding is temporarily stopped in one plane of the wound, the same actions must be done on its other side. At the same time, the assistant should work with the clamps, and the surgeon should pull the edge of the wound with tweezers.
What to do next?
After the clamps are applied, it is necessary to visually assess how thorough the temporary hemostasis is.
Finally stops bleeding with ligatures:
- on the side of the wound that is the closest, the first assistant sets the clamp in a vertical position;
- a ligature is wound up by a metal surgeon;
- the assistant should tilt the clamp towards him soso that its end is clearly visible;
- then under the end of the clamp you need to make a loop and gradually tighten the first knot;
- the ends of the fingers should be very close to the ends of the hemostat, which prevents the thread from breaking; in the process of tightening the knot, the clamp is removed;
- after the clamp is removed, you need to tighten the knot to the end and ensure that the ligature is aligned with the vessel wall. Such a technique requires training and attentiveness, since asynchronous actions will lead to a breakdown of the node;
- when the first knot is tightened, you need to make and tighten the second one.
The loops should eventually form a "sea" knot (facing away from the skin), while the "female" knot is erroneous and invalid due to too high a probability of untying.
Other clamps also do the same.
Rules to follow during the operation
In the process of applying ligatures, the second assistant cuts off the ends of the threads with Cooper's scissors, observing the following rules:
- the plane of the blades of the scissors in the divorced state must be aligned to the thread at an angle of 40-50 degrees;
- pull the ends of the ligatures carefully;
- before the folded threads cross, the lower blade must rest on the knot;
- the length of the cut end of the ligature should be no more than 1-2 millimeters.
On the other side of the wound, the surgeon performs the same actions with the clamps, whilewhile the first assistant tightens the ligatures. The duties of the other assistant remain the same.
