(About Clamps)
Instrument usage: Clamps are used for holding tissue or other surgical material.1 All clamps have finger rings or ring handle where the user’s can hold the instrument.1 The shank of the clamp can have varying lengths. The ratchet allows the tip to be locked in three positions.1 The joint of the clamp can be a box lock, screw joint, or semibox joint, which joins the two halves of the instrument allowing the instrument to open and close.1 The jaw of the clamp can be traumatic, which cruses tissue, or atraumatic which is non-crushing so that the tissue remains undamaged.2 The length the of shank of the clamp depends upon the intended function and the depth of the body cavity. Clamps can be straight or curved and are used in all surgical specialties.
Key differences:
The jaws of the clamp are key in determining how the clamp will be used.
Hemostat clamps are traumatic clamps that have deep transverse cuts in the jaw that will sever vessels and tissue.1 This will prevent bleeding and slipping of the tissue.1 Some examples of a hemostat clamp are Halsted clamps and Kelly clamps.
Non-crushing clamps have vertical serrations or finely meshed, multiple rowed teeth that cause minimal trauma to the tissue.1 These clamps prevent leakage when clamping the bowel, vessels, or ducts that need to maintain their integrity and be reanastomosed.1 Some examples of these clamps are Debakey clamps and bowel clamps.
Grasper/holding clamps have transverse serrations and large teeth at the tip used for tissue retraction.1 Some examples of these clamps are Kocher clamps and Allis clamps.
Safety on the sterile field:
It is important to use the clamps for their intended use and not use them to clamp tubing. This can cause malalignment of the clamp, cracking, or breaking.1
Scrub personnel should inspect each clamp prior to placing on the Mayo stand to be certain that it functions properly, is aligned, and the tip meets properly.1 Also, observe for worn spots, chips, dents, cracks, or sharp edges.1 Any damaged clamp should be set aside and sent for repair or replacement.1
Clamps should be cleaned between use and debris should be removed using water and next saline.1
Clamps should be closed on the first ratchet when passing to surgeon.2 This will make it easier to open and apply during the surgical procedure.
Instrument names:
It is important to know the names of the clamps and the specific usage for the clamp. There are also slang names for many of these clamps that vary with surgeon and facility. Some common names for a Halsted clamp are “Point” or “Crile.” A mosquito clamp can also be called “snap.” Kocher clamps can also be called “Ochsner.”
Sometimes the surgeon will use a hand signal of holding hand out to indicate the need for a clamp. This most often means a basic Halsted clamp.
References:
1. Rothrock, Jane C. Alexander's Care of the Patient in Surgery-E-Book. Elsevier Health Sciences, 2018.
2. Phillips, Nancymarie. Berry & Kohn's operating room technique. Elsevier Health Sciences, 2016.
3. Criscitelli, Theresa. Fast Facts for the Operating Room Nurse: An Orientation and Care Guide. Springer Publishing Company, 2021.