Hemostatic clamps are used to stop bleeding, with their help there is a capture and temporary compression of a bleeding vessel or stump of a cut vessel. The range of sizes of these tools totals several tens. This diversity is explained by the presence of vessels of different sizes from 1 to 20 mm and the use of various hemostasis techniques. Small vessels cut during the operation are captured with a clamp, and then they are ligated (sutured) with a stump above the clamp.
Hemostatic clamps, which are used to temporarily compress 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 hard materials. Clips, which are also called vascular, are made of elastic materials, this is due to the peculiarities of their design. The names of these tools are fully consistent with their purpose. In emergency cases, they can be used to fix napkins.
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. Further they should be marked and used only for fixing balls and napkins.
Clamp Requirements
Hemostatic clamps must meet the following requirements:
- Reliable fixation at the end of the vessel; no slippage is allowed.
- With repeated use, 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 opening. 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 ergonomic rules.
- Lightness, eliminating tearing of tissues that may occur under the weight of the clamps placed on the edges of the wound.
- Should allow the use of an electrocoagulator.
- Their dimensions do 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 conduct electrocoagulation (clamp styptic gear).
2. Vascular clamps that temporarily stop the blood flow and allow you to restore the integrity of the vessel (vascular suture).
3. Crush clamps, which contribute to the formation of a blood clot in the lumen of the vessel after applying the clamp.
Design features
Hemostatic clamps consist of the parts listed below:
- Sponge (jaws).
- Handle with rings.
- Collapsible or dead lock.
- Kremalerov.
Shape of sponges
- Triangular elongated, for example, the neurosurgical clamps of Halstead.
- Pointed trapezoidal, for example, Billroth's clip.
- Trapezoidal with teeth, for example, Kocher clamp.
- Oval, for example, Pean's clip.
Clips can have straight and curved jaws. Notches on the surfaces of the jaws are allowed both transverse and oblique. Hemostatic curved 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 closed, one of its teeth enters the lumen between two others.
Before the operation, the surgeon must personally monitor the condition of the hemostatic clamps (toothed, straight, curved - it does not matter), since:
- damage to the teeth of the cremallera can cause the instrument to self-open, which is very dangerous when clamping a large vessel.
- skewed 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
The following types of clamps are distinguished:
1. Hemostatic straight tooth clamp, 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 closing the lock, one of the teeth should fall between the other two.
2. With a transverse notch, they are identical to serrated, 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. The sponges are in the longitudinal section in the form of a truncated cone; on their working surface there is a thin transverse notch. Available curved or straight 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, also straight and curved. Designed for operations on the vessels of the face, the arachnoid membrane of the brain, in pediatric surgery, for operations on the parenchymal organs.
5. Deep cavity, designed for hemostasis of blood vessels and ligation in deep wounds. Their length is 26 cm, the lips have a straight or curved shape and a short length.
“Mosquito” type clamps are also called Halsted clamps. Differ in a thin working surface. The Mosquito clip curved is used for newborns. Carries out hemostasis of small vessels in the process of neurosurgical operations.
Billroth's clamp captures and clamps vessels. It has working jaws and a small notch, as well as a conical surface on the outside. Exciting branches are equipped with notches, resulting in less tissue damage.
Popper's Clamp is a long straight surgical clamp that is used in operations on the gallbladder.
How is the clamp applied?
Before starting the operation, the surgeon must personally check the operation of the clamps. This is especially true for working with large arteries. For example, the imposition on the diaphragmatic gastric ligament, or rather, on the left gastric artery passing through it, of a clamp that is defective, is fraught with slipping of the end of the vessel, which can lead to serious bleeding.
How to steal clamps?
The width of the site of the mesentery (ligament) with the vessels that pass through it must be inversely proportional to its thickness.
Keep in mind the following:
- the remaining large stump may necrosis, which can cause purulent inflammation;
- the appearance of a large area of a deserted surface can lead to adhesive disease;
- the ligature, which was applied to bulk fatty tissue, can be disrupted at any time.
On the most critical sections of the ligament (mesentery), those that will not be removed, clamps and ligatures should be applied by the surgeon, and the assistant will apply them to the removed sections of the mesentery.
The excision of the ligament or mesentery between the clamps is made closer to the area that remains. The volume of the remaining stump is better to do a little more, this will guarantee that the breakdown of the ligature does not happen.
Clips and ligatures on the ligaments are recommended to be applied at a slight angle, because this increases the volume of the stump, and this contributes to a more durable fixation of the ligature.
The following rules must be followed:
1. Do not pull the ends of the ligatures. So they can be torn from the end of the vessel.
2. An angle of 40-50 degrees between the plane of the divorced blades of the Cooper scissors and the threads should be observed.
3. The lower blade of the scissors must be rested against the knot.
4. The cut end of the ligature should not exceed 1-2 mm.
Hemostatic forceps to limit wounds
To isolate the wound from the skin, the most commonly used is a styptic dentate forceps clamp (1,160 mm long).
In shallow wounds, it is more advisable to use straight lines. But for attaching gauze napkins to subcutaneous fat, curved hemostatic clamps are more suitable.
Surgical Instrument Storage
Instruments are stored in a heated, dry place at a temperature of 15–20 ° . It is not allowed to be in the same room with substances whose vapors can cause corrosion of metals (formalin, iodine, bleach).
Tools intended for current use are laid out in cabinets, while sorting them by type and purpose. Those made of carbon steel are treated with neutral petroleum jelly or coated with paraffin during long-term transportation or storage. For this, petroleum jelly is melted to a temperature of 60-70 ° C, immersed in tools, and then wrapped in waxed paper.
Tools from the following materials are not subject to greasing: 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. Tooling should only be carried out with gloves, as Traces of fire may cause rust.
We examined in detail the medical hemostatic clamp , its types, rules of use and storage.