How much force does it take to close and open the ratchet on your needle holders and hemostats? Do you have certain instruments that are more stiff or require more force?
It should not take a lot of force to open and close the ratchets on most surgical instruments. Over the course of a surgery day, repeatedly having to apply extra force due to stiff instruments can add to the trauma on the surgeon’s body.
There aren’t many studies or other publications on the subject; one that I have found is an article by a South Australian surgeon, Michael Patkin.
Patkin M. Surgical instruments and effort referring especially to ratchets and needle sharpness. The Medical Journal of Australia 1970;1:225.
Patkin has an interesting website as well with plenty of thoughts and observations on human surgery and ergonomics.
There is not (at least that I am aware) any standard for optimal force required to open or close instruments, but based on my reading of Patkin and my own experience in surgery, I suggest aiming for about 3 pounds of force to close the first ratchet, and about 1 pound of lateral force to open the ratchet.
Thumb forceps can also be stiff and difficult to operate. Often, the larger thumb forceps are stiffer than the smaller Adsons or Adson-Browns. If you are experiencing difficulty with your non-dominant, thumb forcep hand, consider choosing a smaller thumb forcep that closes with less pinch force.
In order to reduce the force required by instruments and needle holders, try the following:
- Make sure that you are using good protocols for cleaning and processing
- Get scissors and needle holders sharpened and get jaws replaced when they get dull or smooth.
- Discard needles when they are dull. It takes extra force to penetrate the tissue with a dull needle, and causes extra tissue trauma for the patient.
- If you have the chance to make purchasing decisions, choose instruments that don’t require a lot of force to open and close.
Your hands and the patient’s tissues will thank you!