Handling of Surgical Instruments scalpel | Bovie | scissors | forceps | needle driver | curette   Holding the scalpel like a pencil allows short, fine, precise incisions. The index finger may be placed on the top side of the instrument to control depth and force applied to the blade. Skin is stabilized during the execution of an incision by exerting tension with the opposite hand. The thumb is placed on one side of the cut with the other fingers placed on the opposite side. Hold the single electrode handle of the electrocautery instrument in a modified pencil grip between the thumb, middle and ring fingertips. Leave the index finger free as a "trigger finger." Coagulation is done with the tip of the instrument perpendicular to the wound. Scissors are most commonly held with the ring finger in one loop and the thumb in the other, with the index finger resting on the hinge. This "tripod" grip provides the best configuration for stability and control. Hold the tissue forceps so that one blade functions as an extension of the thumb, and the other blade as an extension of the opposing fingers, in a modified pencil grip. The shank of the instrument rest on the metacarpalphalangeal joint. This grip gives the widest range of maneuverability. Variations should be made in the needle driver grip according to circumstance. The palmed grip (shown in the graphic) is the strongest grip and provides the greatest pressure in driving a needle through tough material. The thumb and index finger grasp the driver near the needle; the driver may be rotated in the palm between the fingers and thumb for any desired change in direction. More delicate work should be executed using a different grip, such as a thumb-ring finger grip. The curette is held in a pencil grip, making a delicate draw cut in soft tissue, such as endometrium. Use a back and forth rotating motion or a pulling stroke, rather than a pushing stroke which can slip the instrument deeper into the wound. Technique in the Use of Surgical Tools, Robert M. Anderson, M.D., and Richard F. Romfh, M.D) Video Resource: Fundamentals of Surgical Techniques, Larry C. Carey, M.D. 1991 (VHS 20 minutes) available from Ciné-Med's ACS/USSC Educational Library (General Interest Topics) Back Home | Welcome | Clinical Update | Managing Your Residency | Basic Science Board Review | Opportunities | Links | Contributors | Contact Us