Thursday, October 19, 2017

Curved Surgical Instruments - What's the Deal?

One of the liberties of being "just a  scrub nurse" was the privilege of asking dumb, foolish questions. When there was a lull in surgical action such as waiting for a phone call from pathology or passing  time until an esoteric instrument was flashed,  the time was ripe to pose philosophical queries to the attending surgeon. Surgeons could come up with some convoluted answers to foolish  questions when they were caught off guard. Timing and delivery of the question was the key to obtaining an offbeat answer.

Here is a sampling of some questions I asked in a foolish attempt to resolve the greatest mysteries of the operating room; "Why do cloth shoe covers track blood on the floor a greater distance than new-fangled plastic disposable covers?...  How normal is 0.9 saline?... Can you sleep on a mattress suture?... and perhaps the ultimate question... "Why is the working end of many surgical instruments curved?"
Four lovely curved clamps in the foreground with the tips arching forward. A pair of straight Allis forceps, straight  hemostats, and a lone, proud Babcock sitting in the background. An obscure visual treasure of glimmering stainless steel enhanced with graceful arching curves, glowing in the brilliant overhead light of the tiled temple. The astounding beauty of those gracefully curved clamps surrounded by the deep sky blue surgical  towel is so easy to overlook while we live out our remaining days craving the cheap balm of a glowing screen. Hmm.. Maybe I could scrub for just one more case.😃




Here are some candid responses straight from the surgeon's masked mouth: "Instruments are curved to match the curve of the human hand....Because that is the way it's done Fool, now hand me a sponge stick and get back to work...There are no straight lines to be found in nature; that's why instruments are curved... Curved instruments have greater utility and are more useful."  That last answer probably made the most sense, but it's still not an elaborate rationale for instrument curves.

With the luxury of time to think about it and lots of experience watching curved instruments in action here is  my foolish explanation. When cutting with a straight bladed scissors the operators hand is directly in-line with the direction of the cut. This can obscure the view of the cutting activity. Curved scissors place the operating hand at a 30-45 degree angle (depending on the acuteness of the curve) to the area being cut, providing an unobscured view. Curved needle holders drivers as you whippersnapperrns call them, follow the same principle.

When using just about any hinged surgical instrument the opposable thumb is moved away from the index finger when spreading the jaws or blades, in the case of scissors.  It takes physical space to accommodate this thumb/index finger span. Curved instruments create an angle to move the hand above the area of work providing room for the necessary finger span. A long handled, curved instrument allows the surgeon to work in some very deep wounds such as encountered with obese patients.

Retractors have gracefully curved blades to distribute pressure over a wide area to minimize trauma. Wrapping those blades with saline soaked lap sponges helps too.  I believed that aggressive retraction caused as much trauma as any blade. Whenever a resident was pulling back so hard on a retractor that he assumed the position of a water skier, tissues were being stretched to the limit. Aggressive retraction always bugged me. Surgery should not resemble a taffy pull.

Old school nurses had the responsibility to ensure surgical instruments were in proper working order. If a surgeon encountered a  hemostat or needle driver with misaligned jaws, it was his prerogative to "fix" the offending instrument by opening it up and bending one arm up and the other down. Instruments that had been curved via this "repair" were rendered useless and thrown into the trash where they belonged. Curves, in this case, served to identify a non-functioning piece of equipment.




3 comments:

  1. This comment has been removed by a blog administrator.

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  2. It's not that complicated. There are no straight lines to be found in nature so it's logical to used curved instruments when working on people.

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  3. How true! Maybe they should make ORs with curved walls instead of square corners. It would drive the circulator crazy looking for a place to toss bloody drapes. YIKES no corners.

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