Hemostatic forceps: description and reviews

Hemostatic clamps serve to stop bleeding, with their help, a seizure and temporary squeezing of the bleeding vessel or stump of the cut vessel occurs. The range of sizes of these instruments is several dozen. This diversity is due to the presence of vessels of different sizes from 1 to 20 mm and the use of various hemostatic techniques. The small vessels cut during the operation are grasped by a clamp, and then ligated (stitched) with a string above the clamp.

Hemostatic clamps, which are used to temporarily squeeze 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. Clamps, which are also called vascular, are made of elastic materials, this is the reason for their design features. The names of these tools fully correspond to their purpose. In emergency cases, they can be used to fix napkins.

However, it should be remembered: hemostatic clamps, at least once used for fixing napkins or cotton and gauze balls, can no longer be used for their intended purpose. This is due to deformation of their working part and loss of functionality. In the future, they should be marked and used only to fix the balls and napkins.

Clamping requirements

Hemostatic forceps must meet the following requirements:

• Reliable fixation on the end of the vessel, slipping is not allowed.
• When used repeatedly, their properties should not be lost.
• The tool should easily close and open under the influence of the surgeon's hand.
• The locking mechanism must reliably fix the jaws, preventing their spontaneous breaking. For this, for example, a fixator in the form of a cremalier is suitable.
  When falling from a height of 1 meter, the tool should not spontaneously open the working surface, and multiple closing and opening of the brushes should not cause them to skew.
• Must comply with the rules of ergonomics.
• Lightness, eliminating tissue ruptures, which can occur under the weight of clamps applied to the edges of the wound.
• Should allow the use of an electrocoagulator.
• Their size does not overlap the overview of the operating field.
• The ends of the instruments must correspond to the diameter of the vessels.

Clamping Classification

Hemostatic clamps are divided into several subgroups:

1. Hemostatic clamps, providing a temporary clamping of blood vessels before applying ligatures or performing electrocoagulation (clamp hemostatic toothed).

2. Vascular clamps temporarily stopping the blood flow and allowing to restore the integrity of the vessel (suture of the vascular seam).

3. Crushing clamps that promote the formation of a thrombus in the lumen of the vessel after the clamp is applied.

Design Features

Hemostatic clamps consist of the parts listed below:

• Sponges (brunch).
• Handle with rings.
• Collapsible or deaf lock.
• Cremaliers.

The shape of the jaws (brunch)

1. Triangular elongated, for example, neuro-surgical clamps of Halstead.
2. Trapezoidal pointed, for example, the clamp of Billroth.
3. Trapezoid with teeth, for example, the clamp of Kocher.
4. Oval, for example, Pean's clamp.

Clamps can have straight and curved jaws. The incisions on the surfaces of the jaws are allowed both transverse and oblique. Hemostatic curvature is often used.

Clamp of Kocher

The clamp of Kocher at the end has teeth. They are fixed firmly on the end of the vessel, tk. When closing one of its teeth enters the gap between the two others.

Before the operation, the surgeon must personally check the condition of the clamps of hemostatic (dentate, straight, curved - does not matter), because:

• Damage to the teeth of the crimper can cause self-opening of the tool, which is very dangerous when clamping a large vessel.
• Skewing the working parts will not effectively stop the bleeding.

The clamps differ in the shape of the jaws, the profile of the working surface, the purpose and size of the tools.

Types of clamps

There are the following types of clamps:

1. A hemostatic straight dentition, 15 to 20 cm long, has a detachable or screw lock, with oblique incision 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 be between the two others.

2. With transverse notching, they are identical to serrated, but the working surface has a transverse cutting. Made of stainless steel, the surface is polished to shine. Length from 16 to 20 cm, can be straight or curved.

3. Neurosurgical hemostatic clamp "Mosquito", light, 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. Produced curved or straight vertically and horizontally. They are used mainly for hemostasis of small vessels during neurosurgical operations.

4. Children's type "Mosquito" in terms of design are similar to the previous one, but they have thinner brunches. Length 12.5 cm, also straight and curved. Designed for carrying out operations on the vessels of the face, the arachnoid membrane of the brain, in pediatric surgery, for operations on the parenchymal organs.

5. Deeply hollow, designed for hemostasis of vessels and ligation in deep wounds. Their length is 26 cm, the sponges have a straight or curved shape and a short length.

Clamps of the "Mosquito" type also bear the names of Halstead clamps. They are distinguished by a thin working surface. изогнутый используется для новорожденных. Clamp "Mosquito" curved is used for newborns. небольших сосудов в процессе нейрохирургических операций. Carries out hemostasis of small vessels during neurosurgical operations.

The clamp of Billroth grasps and clamps the vessels. It is with working sponges and a small notch, as well as a conical surface from the outside. Fascinating brunches are notched, resulting in less tissue injured.

Popper's clamp is a long, straight surgical clamp that is used in operations on the gallbladder.

How is the clamp applied?

Before the operation, the surgeon must personally check the operability of the clamps. Especially it concerns the work with large arteries. For example, the imposition on the diaphragm-gastric ligament, or more precisely, on the left gastric artery passing through it, the clamp that is defective, is fraught with the escape of the end of the vessel, which can lead to serious bleeding.

How correctly to stab clamps?

The width of the mesentery (ligament) with the vessels that pass through it must be inversely proportional to its thickness.

It is necessary to remember the following:

- the remaining stump of a large size can necrotic, which can cause purulent inflammation;

- the appearance of a large area of the deserosized surface can lead to a commissural disease;

- ligature, which was imposed on bulk fat, can be broken at any time.

On the most important parts of the ligament (mesentery), those that will not be removed, the clamps and ligatures should be imposed by the surgeon, the assistant puts them on the mesentery to be removed.

The excision of the ligament or mesentery between the clamps is made closer to the site that remains. The volume of the remaining stump is better to do a little more, this will serve as a guarantee that the breakdown of the ligature will not occur.

It is recommended to apply clamps and ligatures to the ligaments at a slight angle, because While the volume of the stump increases, and this contributes to a stronger fixation of the ligature.

There are the following rules that need to be adhered to:

1. Do not pull the ends of the ligatures. So they can be torn from the end of the vessel.

2. You should observe an angle of 40-50 degrees between the plane of the dilated blades of Cooper scissors and threads.

3. The lower blade of the scissors must be restrained in the knot.

4. The cut end of the ligature should not exceed 1-2 mm.

Hemostatic forceps for wound limitation

To distinguish the wound from the skin, the most commonly used clamp is a hemostatic dentate straight (1 160 mm long).

In shallow wounds, it is more expedient to use direct ones. But for attaching gauze wipes to the subcutaneous fat, the curved hemostatic clamps are more suitable.

Storage of surgical instruments

The tools are stored in a heated dry place at a temperature of 15-20 ° C. It is not allowed to find in one room with them substances whose vapors can cause corrosion of metals (formalin, iodine, bleach).

Instruments designed for current use are laid out in the cabinets, sorting them by type and purpose. Those of them that are made of carbon steel, for long transportation or storage are treated with neutral petrolatum or covered with paraffin. To do this, Vaseline is melted to a temperature of 60-70 ° C, the tools are immersed in it, and then wrapped in paraffined paper.

Do not lubricate tools made of the following materials: stainless steel, aluminum, brass, bronze. Preparation of the toolkit for lubrication is as follows: degrease or boil in water with soda and soap, dry, inspect for rust, remove any rust, remove by polishing. The instrumentation should be processed only with gloves, because Traces of traces can lead to rust formation.

We have considered in detail the medical hemostatic clamp, its types, rules of application and storage.