Another silly poll: Up or down?

[Espion]

In two consecutive surgeries with two different attendings I got admonished for holding the Metzenbaum's the "wrong way".

One said tips up, the other said tips down. I always thought you held them tips down.

Which is the most universally accepted way?

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[imtiaz]

ive always been told tips up.

 

[Blade28]

It all depends on what you're trying to cut. I used to think it was always tips pointing away from your palm, but if you're cutting suture, that's obviously no good.

Just ask the attending if you're unsure.

 

[Blade28]

More examples: usually, blunt dissection (done by spreading the Metz): tips up (facing the ceiling). Cutting between curved hemostats when removing bowel, or colon, or peritoneum: tips facing the same direction as the hemostats.

 

[Espion]

That makes sense.

Awkward moment in the OR #353

Attending: "Okay, cut." (referring to the suture, of course.)
Student: cuts with metzie tips down because in previous surgery, another attending told student that this was the proper way.
Attending: "What are you doing? You should point the tips up!"
Student blabs before thinking: "Eeesh, I was just told tips down."
Attending: "What idiot told you that?"
Student: *silence*

Grasshoppers. They were chirping. Good thing that mask covers most of my face, because I was red.

 

[imtiaz]

id get yelled at for using the metz to cut suture. youre not supposed to do that.

 

[Espion]

id get yelled at for using the metz to cut suture. youre not supposed to do that.

Its what they asked for and what they handed me. Me, I don't argue. Good to know, though.

 

[imtiaz]

Its what they asked for and what they handed me. Me, I don't argue. Good to know, though.

yeah, sorry if that came accross as a lecture or something. i didnt mean it that way. but basically what i was told is the metz are for dissection only, and theyre very sharp. using them to cut suture dulls them. to cut suture, youre supposed to use suture scissors only. but i have seen attendings use the metz to cut suture, ive never had the balls to do it myself though.

 

[Blade28]

Just use whatever the scrub tech hands you. 🙂

 

[Espion]

yeah, sorry if that came accross as a lecture or something. i didnt mean it that way. but basically what i was told is the metz are for dissection only, and theyre very sharp. using them to cut suture dulls them. to cut suture, youre supposed to use suture scissors only. but i have seen attendings use the metz to cut suture, ive never had the balls to do it myself though.

Heh, I know you didn't mean it like a lecture. I never read into things on the internet. 🙂 Stuff like that really is good for me to know. Better than gettin' yelled at, yo.

 

[tussy]

1. Direction of tips is dependent on what you are doing with the metz - there is no set guideline.

2. You should never cut suture with Metz - should use straight Mayo sissors for suture.

 

[Winged Scapula]

The argument is the same world over..and it does depend on what you're doing. Here's what I was taught.

Blunt dissection/Spreading: tips up
Cutting tissue between clamps/forceps: pointing sideways, in direction of clamps if they are being help in a med-lateral position
Sharp Dissection (ie, taking down adhesions): tips down
Cutting suture: supposed to use straight Mayos but especially if I'm deep in the abdomen and I've just cut some tissue between the clamps, I'm using the Metzs to cut the suture as well. I've never been yelled at for it (but it does dull the Metzs).