The functions of the hemostatic clamps exactly match their name. Also, tools can be used as auxiliary devices 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 deformation of the working parts is inevitable, and their functional properties are lost. Such tools must be marked and used in the future only for fixation.
In this article, we will consider in more detail surgical hemostatic clamps.
Clamping requirements
The following requirements are met for hemostatic clamp:
- strong fixation without the possibility of slipping;
- continuous preservation of properties during repeated use;
- the closing and opening of the branches should occur in the hands of the surgeon with ease;
- the presence of a locking mechanism that eliminates the arbitrary opening of the branches;
- working parts should not be opened when falling from a meter height;
- multiple closure of branches should not lead to skew;
- low mass, which can not cause a gap under the influence of the gravity of the clamps located on the edges of the wound;
- compliance with ergonomic requirements;
- possible use of a coagulation instrument (electrosurgical option);
- small sizes that do not block the view on the surgical field;
- 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 the temporary closure of blood vessels before applying ligatures or electrocoagulation. That is, in fact, hemostatic instruments;
- temporarily stopping the flow of blood before restoring the integrity of the vessel through the vascular suture (vascular instruments, which include the clamp straight);
- accelerated thrombotic gaps after suturing (crushing).
The clamps are straight and curved.
Clamp structure
The styptic clamp consists of such parts as:
- sponges (branches);
- blind or collapsible lock;
- handles with rings;
- cremalleiers.
Types of branches
Depending on the shape, the branches are divided into the following types:
- elongated triangular (Halstead clamps);
- trapezoid with teeth (Kocher clamp);
- pointed trapezoidal (metal Billroth clip);
- oval (Pean's clip).
In addition, the branches can be straight and curved, and their cutting on the working surfaces - oblique or transverse.
The surgeon is obliged to check before the operation what condition the hemostatic clamps are in, since wear of the teeth of the cremallera can cause spontaneous opening of the instrument or dangerous clamping of large vessels, and the skew of parts can interfere with the time and effectively stop the bleeding.
Surgical Clamp Guide
To bandage the small vessels of fatty tissue under the skin, it is imperative to perform a number of the following actions:
- With the help of two tweezers, the first assistant should turn out the edge of the wound closest to him. In this case, one of the planes becomes open for viewing.
- Another assistant by the edge of a gauze ball, which is clamped in tweezers, removes blood from the surface of the wound, 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 consistently used to drain the wound by means of a surgical clamp.
- The surgeon presses the ends of the vessels one by one with the clamping tips, while the handle of the instrument must then be placed on the corresponding edge of the wound. Thus, the ends of the vascular clamp should be a continuation of the vessel. Since the latter is located at the level of the wound or in the fatty tissue under the skin, the clamp must be applied to the vessel with a minimum amount of tissue surrounding it.
- If you want to stop bleeding from the vessels of the fronto-parieto-occipital region, then clamps need to be applied so that one end is located on the vessel wall, 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 positioning the clamp on the edge of the wound helps to stop bleeding faster and more reliably
- If the bleeding is minor, it is worth putting Halstead clamps. If the ends of the vessels have a small diameter, then you will need a Kocher tool or hemostatic direct Billroth clamp.
- When bleeding is temporarily stopped in one plane of the wound, the same actions must be done on its other side. In this case, 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, you need to visually assess how thorough temporary hemostasis is.
Finally, bleeding stops through ligatures:
- from the side of the wound that is closest, the first assistant installs a clip in an upright position;
- a ligature is started by a metal surgeon;
- the assistant must tilt the clip to himself so that its end is clearly visible;
- then under the end of the clamp you need to make a loop and gradually tighten the first node;
- the ends of the fingers should be very close to the ends of the hemostatic clamp, which prevents the possibility of rupture of the thread; in the process of tightening the assembly, the clamp is removed;
- after the clamp is removed, it is necessary to tighten the knot to the end and ensure that the ligature is aligned with the vessel wall. Such a technique requires training and attention, since asynchronous actions will lead to a node failure;
- when the first knot is tightened, you need to make and tighten the second.
The loops should eventually form a “marine” knot (oriented in the opposite direction to the skin), while the “female” knot is erroneous and unacceptable due to the too high probability of untying.
Other clamps also perform similar actions.
Rules to be observed during the operation
In the process of applying ligatures, the second assistant cuts the ends of the threads with Scissors Cooper, observing the following rules:
- the plane of the scissor blades in a diluted state must be built to the thread at an angle of 40-50 degrees;
- pull the ends of the ligatures carefully;
- before the folded threads intersect, the lower blade should rest on the knot;
- the length of the cut end of the ligature should be no more than 1-2 millimeters.
On the other hand, the surgeon performs the same actions with clamps, while the first assistant tightens the ligatures. The duties of the other assistant remain the same.