Hemostatic forceps serve to stopbleeding, with their help there is a seizure and a temporary squeezing of the bleeding vessel or stump of the cut vessel. The range of sizes of these instruments is several dozen. This variety is explained by 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 with a clamp, and then ligated (stitched) with a string above the clamp.
Hemostatic forceps that 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 case of emergency, they can be used to fix the 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 at the end of the vessel, slipping is not allowed.
- When used repeatedly, their properties should not be lost.
- The instrument should easily close and open under the influence of the surgeon's hand.
- The locking mechanism should 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 breaking of the brans should not cause them to skew. - Must comply with the rules of ergonomics.
- Lightness, eliminating tissue breaks that may occur under the weight of clips superimposed on the edges of the wound.
- Should allow the use of electrocoagulator.
- Its size does not overlap the overview of the surgical field.
- The ends of the instruments should correspond to the diameter of the vessels.
Clamp classification
Hemostatic clamps are divided into several subgroups:
1. Hemostatic clamps, providing temporary clamping of blood vessels before applying ligatures or electrocoagulation (hemostatic gear clamp).
2. Vascular clamps, temporarily stopping the blood flow and allowing to restore the integrity of the vessel (the imposition of a vascular suture).
3. Crushing clips that contribute to the formation of a blood clot in the vessel lumen after the clamp is applied.
Design Features
Hemostatic clamps consist of the parts listed below:
- Sponge (branches).
- Handles with rings.
- Folding or deaf lock.
- Kremalyerov.
Form of sponges (branches)
- Triangular elongated, for example, Halstead neurosurgical clamps.
- Trapezoid pointed, for example, Billroth clamp.
- Trapezoid with teeth, for example, the Kocher clamp.
- Oval, for example, Pean's clip.
Clamps can have straight and curved branches. Notches on the surfaces of the sponges are allowed both transverse and oblique. A curved hemostat clamp is used quite often.
Kocher Clamp
Kocher clamp on the end has teeth. They are firmly fixed at the end of the vessel, because when it closes, one of its teeth enters the gap between the other two.
Before surgery, the surgeon must personally monitor the condition of the hemostatic clamps (notched, straight, curved - does not matter), since:
- damage to the cremal teeth can cause the instrument to break open, which is very dangerous if a large vessel is clamped.
- skewing the working parts will not effectively stop the bleeding.
The clamps differ in the shape of the branches, the profile of the working surface, the purpose and size of the tools.
Types of clamps
The following types of clips are distinguished:
one.The clamp is a hemostatic straight gear, from 15 to 20 cm long, has 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 locking the lock, one of the teeth should fall between the other two.
2With a cross notch, they are identical toothed, 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.
3Neurosurgical hemostatic clamp "Mosquito", lightweight, 15.5 cm long, has a screw lock. Sponges in longitudinal section in the shape of a truncated cone, on their working surface is a thin transverse incision. Produced curved or straight vertically and horizontally. They are mainly used for hemostasis of small vessels during neurosurgical operations.
four.Children's type "Mosquito" design similar to the previous one, but have thinner branches. 12.5 cm long, also straight and curved. Designed for operations on the facial vessels, the arachnoid membrane of the brain, in pediatric surgery, for operations on parenchymal organs.
5. Deep cavitary, designed for hemostasis of blood vessels and the imposition of ligatures in deep wounds. Their length is 26 cm, sponges have a straight or curved shape and a short length.
Clamps like "Mosquito" are also called Halstead clamps. Differ in a thin working surface. Clip "Mosquito" curved used for newborns. Hemostasis small vessels in the process of neurosurgical operations.
The clip of Billroth captures and clamps the vessels.It has working lips and a small notch, as well as a conical surface on the outside. Exciting branches are equipped with notches, as a result of the tissue less injured.
The Popper Clamp is a long straight surgical clamp that is used in gallbladder operations.
How is the clamp applied?
Перед началом операции хирург должен лично check the operation of the clamps. This is especially true of working with large arteries. For example, the imposition on the phrenic-gastric ligament, or rather, on the left gastric artery passing through it, a clamp that is defective, is fraught with slipping the end of the vessel, which can lead to serious bleeding.
How to put on the clips?
The width of the area of the mesentery (ligament) with the vessels that pass through it should be inversely proportional to its thickness.
It is necessary to remember the following:
- the remaining large stump may necrosis, which can cause purulent inflammation;
- the emergence of a large area of deserous surface can lead to adhesive disease;
- the ligature, which is imposed on the bulk fatty tissue, can be torn off at any time.
The surgeon should impose clips and ligatures on the most critical areas of the ligament (mesentery), those that will not be removed, and an assistant imposes them on the sections of the mesentery that are removed.
Excision of the ligament or mesentery between the clampsproduced closer to the stretch that remains. The volume of the remaining stump is better to do a little more, it will serve as a guarantee that the failure of the ligature will not occur.
Clips and ligatures on ligaments are recommended to be applied at a small angle, since this increases the volume of the stump, and this contributes to a stronger fixation of the ligature.
There are the following rules to follow:
1. For the ends of the ligatures do not pull. So they can be plucked from the end of the vessel.
2. Observe an angle of 40-50 degrees between the plane of the divorced blades of the Cooper scissors and the threads.
3. The lower blade of the scissors must be rest against the knot.
4. The cut end of the ligature should not exceed 1-2 mm.
Hemostatic clamps to limit wound
To delimit the wound from the skin, most often use a clamp hemostatic toothed straight (1 160 mm long).
In shallow wounds, it is more expedient to use straight lines. But for attaching gauze wipes to the subcutaneous fat, curved hemostatic clamps are more suitable.
Storage of surgical instruments
Stored tools in a heated dry place.at a temperature of 15-20 ° C. It is not allowed to be in the same room with them substances whose vapors may cause corrosion of metals (formalin, iodine, bleach).
Tools designed for the currentuse, laid out on the cabinets, while sorting them by type and purpose. Those made of carbon steel are treated with neutral petroleum jelly or coated with paraffin during prolonged transportation or storage. To do this, vaseline is melted to a temperature of 60-70 ° C, tools are dipped into it, and then wrapped in waxed paper.
Do not grease the tools of the followingmaterials: 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 any traces of rust by polishing. Processing tools should be carried out only in gloves, because Sweat marks can cause rust.
We have examined in detail the medical hemostatic clamp, its types, rules of use and storage.
