What would do if you accidentily got a scalpel cut?

[Cheisu]

What would you do if you punctured your glove and accidentally cut yourself with a scalpel during surgery?

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[SocialistMD]

Shoot myself in shame for being so stupid and clumsy.

The only time you use the scalpel is at the very beginning of the case. It then leaves the field and shouldn't really come back out. No one should ever be cut with the blade of a scalpel (except the patient, of course).

The real concern is a needle-stick.

 

[Cheisu]

I volunteer in ER and someone came in with a scalpel cut (they weren't a patient).

 

[SocialistMD]

I volunteer in ER and someone came in with a scalpel cut (they weren't a patient).

Then they weren't in the OR, either. If someone was practicing at-home medicine and cut him/herself, I would treat it like any other knife wound.

And watch out for those ED yokels; put a scalpel in their hand and they will probably find a way to cut themselves and everyone else around them...

 

[Winged Scapula]

I've never been cut by a scalpel nor have I ever seen it. As Socialist notes, you don't really use the scalpel for very long in most procedures and its a pretty unusual injury. I would venture that whomever cut themselves with a scalpel was doing it in some lab rather than the OR.

Needle sticks? They happen...I got stuck by an attending when we were both closing abdominal wounds. Probably my fault, as I moved my hand north while he was coming out south, but it happened so fast that I can't be sure.

At any rate, every hospital has a policy of how to handle environmental/workplace accidents.

 

[Blade28]

The only time you use the scalpel is at the very beginning of the case. It then leaves the field and shouldn't really come back out. No one should ever be cut with the blade of a scalpel (except the patient, of course).

I beg to differ. Occasionally the scalpel will come out for:

(1) BKAs/AKAs
(2) Opening a vessel for AV fistula, graft, CABG, etc.
(3) Toe amps

And watch out for those ED yokels; put a scalpel in their hand and they will probably find a way to cut themselves and everyone else around them...

Except for when a patient has an abscess...then the ol' 16- or 18-Ga needle comes out. Cruciate incision? Open and explore widely? Not exactly.

 

[Leforte]

Actually, we do neck dissections with the scalpel as the primary cutting instrument throughout the case with some attendings - can be a bit of a scary dissection when around carotid, IJ, vagus, etc. We use the scalpel all the time with parotidectomies, too (bipolar through the parotid once we've exposed nerve underneath and cut the bipolared gland with the scalpel). I can think of several other surgeries, also, where we use the scalpel a ton.

Like the others have said - if you use controlled movements, and hand off the instuments appropriately, there should NEVER be a surgeon/scrub cut with the scalpel. I never seen nor heard of this occurring where I train in the OR.

 

[smq123]

I volunteer in ER and someone came in with a scalpel cut (they weren't a patient).

Just because they had a scalpel cut doesn't mean that they were a surgeon. People in family med, peds, and IM may also have to use scalpels.

You also have to ask if that person was a med student, doing an anatomy lab dissection. It does happen - people sometimes accidentally cut themselves with dirty scalpels in anatomy lab. (Ewww...)

 

[Dr. V]

I have been cut with a scalpel, it was one of those *&#$*(*%# "Safety" scalpels.

I was putting in a central line during a code as an intern and was going to close the scalpel, problem was it was already closed and I opened it into the palm of my hand. Just a small stab wound that needed no "treatment" with the only danger being the blood borne pathogens.

I went through the procedure and was tested, patient had already been tested as he had been in house for over a month.

I was lucky because it had already been used and was bloody.

One of our attendings said that he has NEVER been cut with a scalpel until they came out with the "safety" scalpels and then he got bit too. He has been in practice for several years.

Seems one of the older well known names wrote in one of the journals about how he had never had a cut in years measured in decades and proceded to cut himself with a "safety" scalpel when they came out.

The old ones are much better and actually safer in my opinion. They are always ready to use, no fiddling with anything with slick gloves.

Seems the "safety" of the new ones is only in the eyes of the beuracrats that never add anything useful to healthcare.

 

[Winged Scapula]

I volunteer in ER and someone came in with a scalpel cut (they weren't a patient).

I just reread this and saw the unintentional humor. What time we could save with OR turnover if we just sent all our patients to the ER to have their scalpel cuts closed!

 

[SocialistMD]

I beg to differ. Occasionally the scalpel will come out for:

(1) BKAs/AKAs
(2) Opening a vessel for AV fistula, graft, CABG, etc.
(3) Toe amps

You use the same scalpel?

On BKAs/AKAs, I do the skin incision first and then put away the knife. The rest of the case can be done with the bovie, some silk, the Metz and the Gigley.
On fistulas, I've only used an eleven blade on the vessel or Tenotomy scissors, again, not what I used to open.
On toe amps, I again only use the knife on the skin at the beginning.
Different strokes for different folks, I guess.

 

[Blade28]

You use the same scalpel?

On BKAs/AKAs, I do the skin incision first and then put away the knife. The rest of the case can be done with the bovie, some silk, the Metz and the Gigley.
On fistulas, I've only used an eleven blade on the vessel or Tenotomy scissors, again, not what I used to open.
On toe amps, I again only use the knife on the skin at the beginning.
Different strokes for different folks, I guess.

No, on BKAs/AKAs we'll start with the #10 blade. Then, clamps, Bovie, silk ties, Metz (as you alluded to), and Gigli. Sometimes the knife will be used for bigger portions.

#11 blade to open small vessels, then tenotomies for Vascular, forward/backward-biting scissors for Cardiac.

Agreed, scalpel for skin only on toe amp.

Don't forget scalpels are also often used during debridements, when you're cutting to expose healthy bleeding tissue.

Additionally, at our (large) burn center we do a lot of tangential excisions (followed by skin grafts). These are usually done with a scalpel or Weck knife.

Our old-school endocrine surgeon here also often uses the #15 blade to cut tissue after tying vessels during thyroids/parathyroids.

 

[Winged Scapula]

You'll find a fair number of surgeons who trained before electrocautery who use the knife throughout the case for dissection (as well as others who use it in specific cases).

I was told the Chief of Surg Onc only did his mastectomies with the knife, so I was intruiged. As the fellow, he let me (but not the residents) do whatever I wanted (which was Bovie).

Anyway, different strokes for different folks, but I still say a scalpel injury is pretty rare in the OR. Many of the scrubs are now passing the knife in a kidney dish...for some reason it takes a bit of the "glamour" out of "scalpel please" and holding your hand out.

 

[Cheisu]

I just reread this and saw the unintentional humor. What time we could save with OR turnover if we just sent all our patients to the ER to have their scalpel cuts closed!

lol I bet.

 

[Blade28]

Anyway, different strokes for different folks, but I still say a scalpel injury is pretty rare in the OR. Many of the scrubs are now passing the knife in a kidney dish...for some reason it takes a bit of the "glamour" out of "scalpel please" and holding your hand out.

We only do that when the patient has Hep B/Hep C/HIV.

BTW, that's one of my pet peeves - how everyone gets all panicky and extra-cautious when the patient has a communicable bloodborne disease. I mean, yes, be careful, but don't go changing all your protocols and behaviors - you're bound to make a mistake or accidentally stick someone that way, especially if you're not used to performing in this manner!

All of a sudden people are cutting differently, capping (or not) their needles differently, using different trays/containers for sharps, being more tentative...

 

[madtowngirl]

You'll find a fair number of surgeons who trained before electrocautery who use the knife throughout the case for dissection (as well as others who use it in specific cases).

I was told the Chief of Surg Onc only did his mastectomies with the knife, so I was intruiged. As the fellow, he let me (but not the residents) do whatever I wanted (which was Bovie).

Anyway, different strokes for different folks, but I still say a scalpel injury is pretty rare in the OR. Many of the scrubs are now passing the knife in a kidney dish...for some reason it takes a bit of the "glamour" out of "scalpel please" and holding your hand out.

It seems like electrocautery's been around for awhile; Cushing used it in 1926. The link below is an article about its history (forgive my inability to make it into a neat hyperlink):

http://www.sciencedirect.com/scienc...d=709071&md5=55cb81c3e77320d602a11a7636240810

As an aside: Do you use tumescent solution for mastectomies that you do with a scalpel?

 

[Winged Scapula]

It seems like electrocautery's been around for awhile; Cushing used it in 1926. The link below is an article about its history (forgive my inability to make it into a neat hyperlink):

http://www.sciencedirect.com/scienc...d=709071&md5=55cb81c3e77320d602a11a7636240810

While it is true that the Bovie has been around for quite some time, you will still find surgeons who were not trained to use it during their residencies or simply prefer not to.

As an aside: Do you use tumescent solution for mastectomies that you do with a scalpel?

I've never done one with a scalpel. As I noted in my post above, the Chief preferred using the knife, but I've always used the Bovie so chose that. He and I were doing bilaterals and he did not use a tumescent solution for his side and I've never seen it done.

 

[Winged Scapula]

We only do that when the patient has Hep B/Hep C/HIV.

BTW, that's one of my pet peeves - how everyone gets all panicky and extra-cautious when the patient has a communicable bloodborne disease. I mean, yes, be careful, but don't go changing all your protocols and behaviors - you're bound to make a mistake or accidentally stick someone that way, especially if you're not used to performing in this manner!

All of a sudden people are cutting differently, capping (or not) their needles differently, using different trays/containers for sharps, being more tentative...

Right. There's a reason why we do it the same way everytime: it minimizes mistakes. One look at the comments above and it appears that one of the most common ways to injure oneself is with new devices which require a change in habit.

 

[Celiac Plexus]

The only time you use the scalpel is at the very beginning of the case. It then leaves the field and shouldn't really come back out. No one should ever be cut with the blade of a scalpel (except the patient, of course).

Huh. I have a different experience. Having operated a fair amount with an attending who refuses to use a bovie, I have done many inguinal, and abdominal dissections using only the same knife I used to open skin.

 

[Cheisu]

While it is true that the Bovie has been around for quite some time, you will still find surgeons who were not trained to use it during their residencies or simply prefer not to.

I bet this is a dumb newbie question, but can't you go to classes or seminars to learn how/be licensed to use a new technique/instrument/procedure?

Right. There's a reason why we do it the same way everytime: it minimizes mistakes. One look at the comments above and it appears that one of the most common ways to injure oneself is with new devices which require a change in habit.

You mean like Shouldice? They do hernias over and over and over, and they have the most minimal mistakes of any hospital in hernia repairs, apparently.

 

[Cheisu]

.

 

[Winged Scapula]

I bet this is a dumb newbie question, but can't you go to classes or seminars to learn how/be licensed to use a new technique/instrument/procedure?

Sure you can attend seminars to learn about new procedures and devices...its how people who were not trained in laparoscopy during residency learned to do it, or how dermatologists learned to do facelifts, etc. But many are not interested in doing so..."if it ain't broke why fix it?" If their current practice is doing well, they may see no need to learn something new.

You mean like Shouldice? They do hernias over and over and over, and they have the most minimal mistakes of any hospital in hernia repairs, apparently.

Do not drink the Shouldice Kool-Aid. They have a high success rate because they very HIGHLY select their patient population and minimize failure by doing so. If I only chose young people with good tissues, of normal weight, with a primary hernia, I too would probably have a success rate of 100%.

 

[Blade28]

Do not drink the Shouldice Kool-Aid. They have a high success rate because they very HIGHLY select their patient population and minimize failure by doing so. If I only chose young people with good tissues, of normal weight, with a primary hernia, I too would probably have a success rate of 100%.

And according to Gawande in "Complications," some of the physicians performing herniorraphies there aren't even surgeons! They're just trained in that one procedure.

 

[Winged Scapula]

And according to Gawande in "Complications," some of the physicians performing herniorraphies there aren't even surgeons! They're just trained in that one procedure.

Thanks...that particular book is sitting on my shelf, hadn't gotten around to reading it yet. Maybe I'll take it on the road with me.

 

[SocialistMD]

Huh. I have a different experience. Having operated a fair amount with an attending who refuses to use a bovie, I have done many inguinal, and abdominal dissections using only the same knife I used to open skin.

Ah. I forgot about opening the fascia in an inguinal hernia. Still, I only make a nick in the fascia, then put in my scissors.

I've done quite a few hernias/appys with attendings who do not use caudery, but we do far more of the procedure with the scissors than the knife.

 

[Blade28]

Thanks...that particular book is sitting on my shelf, hadn't gotten around to reading it yet. Maybe I'll take it on the road with me.

Well I was biased to read it right away since I worked with him at the Brigham during an MS-IV away rotation.

 

[Pir8DeacDoc]

Actually, we do neck dissections with the scalpel as the primary cutting instrument throughout the case with some attendings - can be a bit of a scary dissection when around carotid, IJ, vagus, etc. We use the scalpel all the time with parotidectomies, too (bipolar through the parotid once we've exposed nerve underneath and cut the bipolared gland with the scalpel). I can think of several other surgeries, also, where we use the scalpel a ton.

Like the others have said - if you use controlled movements, and hand off the instuments appropriately, there should NEVER be a surgeon/scrub cut with the scalpel. I never seen nor heard of this occurring where I train in the OR.

Yes, nothing like taking down the jugular with a 10 blade to increase the sphincter tone. It's a beautiful thing when done appropriately.

 

[Cheisu]

And according to Gawande in "Complications," some of the physicians performing herniorraphies there aren't even surgeons! They're just trained in that one procedure.

That's actually where I got that fact from lol. Great book.

 

[Mman]

Right. There's a reason why we do it the same way everytime: it minimizes mistakes. One look at the comments above and it appears that one of the most common ways to injure oneself is with new devices which require a change in habit.

That's why they are called "universal precautions". The same for everybody. Not only because you do it the same way for everybody as practice for when the people with transmittable diseases come in, but because you don't know who has Hep C and HIV and whatever.

 

[Blade28]

That's why they are called "universal precautions". The same for everybody. Not only because you do it the same way for everybody as practice for when the people with transmittable diseases come in, but because you don't know who has Hep C and HIV and whatever.

I wish everyone practiced universal precautions.

 

[FliteSurgn]

I had the unfortunate experience of being on the receiving end of a scalpel just a few months ago. I was doing a combo case with an orthopod. I provided exposure and moved the big red and blue things out of the way. While I was holding the retractors, he proceeded to accidentally bury the dirty #15 scalpel to the hub in my dominant hand index finger thereby severing the digital nerve along the radial side of the finger. (ie. The part that makes a pincher grip with the thumb).

The injury was distal enough that the hand surgeon didn't think he'd have good success reconstructing the nerve. The numbness isn't that bad, I hardly notice it anymore. What was wayyy more annoying was the pain of the cut nerve ending. I had a full day of cases on the day following the injury. Everytime I tied suture or used a laparoscopic grasper, it sent electric shocks down the finger. Fortunately, that resolved within 3 or 4 weeks. Also fortunate that all the labs came back negative.

Always be careful...and beware of orthopods with sharp instruments.

 

[Blade28]

Ouch! Sounds bad - I'm sorry to hear that!