Clamp confusion

[Don't Pass Point]

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So, I am junior surgery residents who is having a little bit of confusion regarding the difference between some clamps.

Specifically, I am trying to figure out what the difference between a mosquito and a crile is. One source I read said that a mosquito is 5" and a crile is 5.5". Another said the tips are slightly different. To make matters even more confusing, I have heard the term used interchangeably for the same instrument in the OR.

 

[ACSurgeon]

So, I am junior surgery residents who is having a little bit of confusion regarding the difference between some clamps.

Specifically, I am trying to figure out what the difference between a mosquito and a crile is. One source I read said that a mosquito is 5" and a crile is 5.5". Another said the tips are slightly different. To make matters even more confusing, I have heard the term used interchangeably for the same instrument in the OR.

Better yet scrub techs will have their own definition. I never get a Kelly when I ask for one. Same for other clamp types...

 

[dpmd]

The naming can have regional differences. I just ask for a clamp if they give me something too big or too small I ask for smaller or bigger. When you work with the same people over and over they get to know what you like to use for different things so then it doesn't matter as much what you call it.

 

[Dr.LeoSpaceman]

In general, a mosquito will have a finer tip and shorter jaw. Otherwise, they are very similar. Both come in straight and curved, both have teeth running perpendicular to the jaw for the full length.

 

[mimelim]

**** dude, I just put my hand out and the instrument I was thinking about slams into my hand. Who needs names when you have telepathic scrub nurses?

 

[LucidSplash]

**** dude, I just put my hand out and the instrument I was thinking about slams into my hand. Who needs names when you have telepathic scrub nurses?

Those of us in places without regular specialty-specific techs. I miss having dedicated techs all the time. Sigh.

 

[Jolie South]

Those of us in places without regular specialty-specific techs. I miss having dedicated techs all the time. Sigh.

I am on a rotation where we go to bumble f*** satellite hospitals and damn man, I asked for a flush for an angio and got handed a bulb syringe.

I can’t wait to go back to the mothership.

 

[deleted50541]

I am on a rotation where we go to bumble f*** satellite hospitals and damn man, I asked for a flush for an angio and got handed a bulb syringe.

I can’t wait to go back to the mothership.

I was out for a heart procurement this week at a small hospital in East Jesus and their only sternal saw wasn't working.

*Sigh*..."Ok, you got a Lebsche knife?"

They did and it worked fine. But I'm bringing the battery powered saw from now on.

 

[vhawk]

**** dude, I just put my hand out and the instrument I was thinking about slams into my hand. Who needs names when you have telepathic scrub nurses?

Cool, I have the exact opposite.

Me: Kelly
Scrub: *hands me right angle*
Me: not that, Kelly please
Scrub: *hands me Halsted*
Me: Getting warmer, the kelly is the curved clamp, medium sized, the one right there on the Mayo? The one I gave back to you five minutes ago? Kelly?
Scrub: My name is Amanda, not Kelly.

 

[idiot07]

I was out for a heart procurement this week at a small hospital in East Jesus and their only sternal saw wasn't working.

*Sigh*..."Ok, you got a Lebsche knife?"

They did and it worked fine. But I'm bringing the battery powered saw from now on.

Inevitably, the instruments are terrible on procurements you just have to accept it. I got handed a standard sternal saw without the blade guard once, which was interesting....I kinda like using the lebsche knife. It works better than the saw when you're going through the costal cartilage and soft tissue on sternectomies and other chest wall resections, and you kinda feel like you just walked off the set of "The Knick".....in a good way and without the substance abuse.

 

[DoctwoB]

Got handed a ureteroscope yesterday that clearly had some damage from processing at the tip. All other scopes dirty (6 hours to clean) or sent for repairs. Sure enough as soon as i deflect the scope in the patient I hear the cable snap and I’m left with a scope that only deflects in one direction. It was like trying to drive a car that only turns right, lots of spinning around to turn the other way.

 

[TraumaLlamaMD]

Got handed a ureteroscope yesterday that clearly had some damage from processing at the tip. All other scopes dirty (6 hours to clean) or sent for repairs. Sure enough as soon as i deflect the scope in the patient I hear the cable snap and I’m left with a scope that only deflects in one direction. It was like trying to drive a car that only turns right, lots of spinning around to turn the other way.

 

[HighPriest]

I had a scrub tech once for an ear case who had to have been 75 years old (He knew Roy Rogers when he was anything other than old, if that tells you anything). He knew all the instruments just fine, but he couldn't see the tips. Ear instruments can all start to look exactly the same if you can't see the tip well enough. So he would just guess and hand me a random instrument. Over, and over, and over again... I swear it added no less than 45 minutes to a case that only took 2 hours to start with.

Had a tonsil bleed come in to a workshed hospital where they waited until after the patient was asleep to tell me that they weren't sure what a suction bovie was, and that when they found out they realized that they hadn't stocked them in 5 years. I know for a fact that they stock shaw knives, and I've only met one surgeon once who actually uses a shaw knife.

 

[Pir8DeacDoc]

I had a scrub tech once for an ear case who had to have been 75 years old (He knew Roy Rogers when he was anything other than old, if that tells you anything). He knew all the instruments just fine, but he couldn't see the tips. Ear instruments can all start to look exactly the same if you can't see the tip well enough. So he would just guess and hand me a random instrument. Over, and over, and over again... I swear it added no less than 45 minutes to a case that only took 2 hours to start with.

Had a tonsil bleed come in to a workshed hospital where they waited until after the patient was asleep to tell me that they weren't sure what a suction bovie was, and that when they found out they realized that they hadn't stocked them in 5 years. I know for a fact that they stock shaw knives, and I've only met one surgeon once who actually uses a shaw knife.

Ear cases with inexperienced techs are the absolute worst. You're under a scope, concentrating on the anatomy or next step and they hand you some huge instrument that isn't even close to what you need... Uggh

And how did you stop the tonsil bleeder? Tonsil balls and a regular bovie? Hopefully it was an "easy" tonsil bleed. Those can be dreadful, I would assume especially without the proper device.

 

[HighPriest]

Ear cases with inexperienced techs are the absolute worst. You're under a scope, concentrating on the anatomy or next step and they hand you some huge instrument that isn't even close to what you need... Uggh

And how did you stop the tonsil bleeder? Tonsil balls and a regular bovie? Hopefully it was an "easy" tonsil bleed. Those can be dreadful, I would assume especially without the proper device.

He was an experienced tech. Knew all the instruments. Just couldn’t see them, and none of them were labeled in any meaningful way.

But you’re right. Nothing worse than asking for a retractor and being handed some two foot long ortho instrument along with a slack jawed, blank stare. Honestly, that’s one of the few things that actually ticks me off a little, because they’re giving you something that’s so obviously incorrect. You need no training to realize that instrument is bigger than the entire operating field, and is useless for anything I need to do. I wouldn’t be mad at all if they thought it was funny. It makes me angry that they don’t.

So, yeah, it wasn’t a nightmare bleed, fortunately. Just one predominate oozer and a bunch of tiny ones that like to tag along. They had a long metal suction, to I played a high stakes game of operation and used that along with bovie to create my own, un-insulated, suction bovie. Don’t touch the walls.
Put a stitch in around the predominate bleed.

Do not recommend.

 

[VisionaryTics]

Ear cases with inexperienced techs are the absolute worst. You're under a scope, concentrating on the anatomy or next step and they hand you some huge instrument that isn't even close to what you need... Uggh

One of our retired otologists got fed up and just put colored stickers on all the instruments with numbers written on them.

e.g. "Red 1" = weapon, "Blue 2" = Rosen needle, etc

 

[HighPriest]

One of our retired otologists got fed up and just put colored stickers on all the instruments with numbers written on them.

e.g. "Red 1" = weapon, "Blue 2" = Rosen needle, etc

Yeah, that is the best option for sure. We ended up numbering them and then just placing a laminated card with the set as a legend. i was in the military at the time, and so the wheel needed re-inventing every time we switched hospitals.

 

[vhawk]

Got handed a ureteroscope yesterday that clearly had some damage from processing at the tip. All other scopes dirty (6 hours to clean) or sent for repairs. Sure enough as soon as i deflect the scope in the patient I hear the cable snap and I’m left with a scope that only deflects in one direction. It was like trying to drive a car that only turns right, lots of spinning around to turn the other way.

Alternate ending: sure enough as soon as I deflect the tip breaks off and now there is a part or the scope in this dudes bladder. 4 hrs and 1 cystotomy later....

 

[DoctwoB]

Alternate ending: sure enough as soon as I deflect the tip breaks off and now there is a part or the scope in this dudes bladder. 4 hrs and 1 cystotomy later....

Not impossible, though going from a broken cable to broken fiber optics and cable x 2 is a stretch. Would still have pushed to just leave a stent and come back except this was a very sick kid and getting another anesthetic would be pretty rough.

In reality, this is exactly what disposable ureteroscopes are good for. Too expensive to use for every case, but keeping a few for issues like this would have been invaluable.

 

[armybound]

Got handed a ureteroscope yesterday that clearly had some damage from processing at the tip. All other scopes dirty (6 hours to clean) or sent for repairs. Sure enough as soon as i deflect the scope in the patient I hear the cable snap and I’m left with a scope that only deflects in one direction. It was like trying to drive a car that only turns right, lots of spinning around to turn the other way.

hopefully you'll do better than my hospital and won't get handed the same broken ureteroscope 3-4 times before they finally send it in for repair.

 

[HighPriest]

Was working at a hospital as a resident when we asked for a facial fracture set. They opened it, and a ladybug flew out. This was a sterile set, ostensibly, in the sterile core (now in the OR).
I mean, bioburden is one thing. But, if you have live insects in your set you gotta question your process.

 

[MediCane2006]

Was working at a hospital as a resident when we asked for a facial fracture set. They opened it, and a ladybug flew out. This was a sterile set, ostensibly, in the sterile core (now in the OR).
I mean, bioburden is one thing. But, if you have live insects in your set you gotta question your process.

I had this happen (but with a fly) fortuitously on the same day the charge nurse was giving me grief about my nail polish being “against policy”. I told her when there were no live insects on the surgical field we could revisit the issue of nail polish impacting sterility, and somehow it never came up again...

 

[vhawk]

I had this happen (but with a fly) fortuitously on the same day the charge nurse was giving me grief about my nail polish being “against policy”. I told her when there were no live insects on the surgical field we could revisit the issue of nail polish impacting sterility, and somehow it never came up again...

That's amazing

 

[Buzz Me]

Got handed a ureteroscope yesterday that clearly had some damage from processing at the tip. All other scopes dirty (6 hours to clean) or sent for repairs. Sure enough as soon as i deflect the scope in the patient I hear the cable snap and I’m left with a scope that only deflects in one direction. It was like trying to drive a car that only turns right, lots of spinning around to turn the other way.

I had to do an EGD once using a pediatric bronchoscope. The OR's two EGDs were both broken (days ago) and neither had been fixed yet. Thankfully I only had to examine the proximal esophagus.

I kid you not.

 

[ThoracicGuy]

I had to do an EGD once using a pediatric bronchoscope. The OR's two EGDs were both broken (days ago) and neither had been fixed yet. Thankfully I only had to examine the proximal esophagus.

I kid you not.

That sounds horrible.

 

[rigid]

I had to do an EGD once using a pediatric bronchoscope. The OR's two EGDs were both broken (days ago) and neither had been fixed yet. Thankfully I only had to examine the proximal esophagus.

I kid you not.

I see what you did here

 

[vhawk]

I see what you did here

I'm sure it was unintentional. Dont be so childish