# Kelly forceps



## JJR512 (Oct 3, 2010)

I've seen some other EMTs (of all levels, -B, -I, & -P) carrying around Kelly forceps in their EMS pants or in one of those holster kits that hangs from a belt and has trauma shears, a penlight, and one or two other things. One day I asked someone what it was for, and they basically said it's just for holding something or clamping something and you don't have enough fingers. He gave an example of a bleeding artery that might need to be clamped off while we take care of some other problem.

I just kind of said "huh" to that, but one day when I was buying some other things, I saw these were pretty inexpensive so I got a pair, and yeah, they've been in my EMS pants, in the other little slot behind my trauma shears. But I have to admit, I'm still not really sure what they're for, and it's really more that they're there just to have _something_ to occupy the other slot on my EMS pants more than anything else.

So a couple questions:

1. Is the example the guy gave me plausible? Would you really use a non-sterile item to clamp an artery? I didn't think this sounded right at first, but then I realized that we'd normally just pinch it or apply pressure with gloved fingers that aren't sterile, so maybe it's fine.

2. Have you ever actually used Kelly forceps in the field for EMS-related purposes? If so, could you please describe the situation?

Also, Wikipedia has the following to say regarding the serrated clamping surface of forceps. Because it's Wikipedia, and there's no reference listed for this particular "fact", I wanted to find out if this is true or not:


> Serrated forceps are used on tissue; counter-intuitively, teeth will damage tissue less than a smooth surface (you can grasp with less overall pressure).


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## TransportJockey (Oct 3, 2010)

Most carry them because they usually come with the holster people insist on buying. As for using them... If any medic or EMT I knew actually used one to clamp off an artery, they'd be out on their *** so fast their head would spin


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## Shishkabob (Oct 3, 2010)

jtpaintball70 said:


> Most carry them because they usually come with the holster people insist on buying. As for using them... If any medic or EMT I knew actually used one to clamp off an artery, they'd be out on their *** so fast their head would spin



EMT?  Sure, I can see them getting in trouble for it.

Medic?  Not so much.  We're taught how to do "invasive" clamping of arteries, even if that means stick our hands in there and clamping down ourselves (or is that just around my area?).  If, somehow, an artery was sticking out of a wound and I, somehow, had Kelly's on me, I'd clamp it before going to a tq, if pressure didn't work.



You can EASILY defend doing something if the patient lives.... and all medical directors I've spoken to have said do what you need to to help the patient so long as you can justifiably defend it later.  Guidelines, not protocols.


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## CAO (Oct 3, 2010)

Reminds me of Black Hawk Down.

Off the top of my overworked head, I can't really think of a practical use.  I'm not saying there aren't any.  I've just yet to find myself in a position where I thought "Ya know what? I sure wish I had some Kelly forceps right about now."

As for the artery clamping, I don't even see it as a last resort.  We've got pressure, elevation, pressure points, and tourniquets.  We've got fluids to make up for losses on the way.  By the time I'm about to start fishing around for somebody's femoral artery with a pair of pliers, I'm hoping I'm wheeling them into the ED.


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## Shishkabob (Oct 3, 2010)

CAO said:


> As for the artery clamping, I don't even see it as a last resort.  We've got pressure, elevation, pressure points, and tourniquets.  We've got fluids to make up for losses on the way.  By the time I'm about to start fishing around for somebody's femoral artery with a pair of pliers, I'm hoping I'm wheeling them into the ED.





Pressure points and elevation do nothing.


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## TransportJockey (Oct 3, 2010)

Linuss said:


> EMT?  Sure, I can see them getting in trouble for it.
> 
> Medic?  Not so much.  We're taught how to do "invasive" clamping of arteries, even if that means stick our hands in there and clamping down ourselves (or is that just around my area?).  If, somehow, an artery was sticking out of a wound and I, somehow, had Kelly's on me, I'd clamp it before going to a tq, if pressure didn't work.
> 
> ...



Keep in mind the two states I've actually worked in. CO is fairly restrictive, and NM is protocol based. While I'm sure I could justify it, I'd get reamed for it. And in medic school we were never taught invasive clamping. If it's an extremity they concentrated on breaking the older EMTs prejudice against tq'ing the extremity.


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## TransportJockey (Oct 3, 2010)

CAO said:


> Reminds me of Black Hawk Down.
> 
> Off the top of my overworked head, I can't really think of a practical use.  I'm not saying there aren't any.  I've just yet to find myself in a position where I thought "Ya know what? I sure wish I had some Kelly forceps right about now."
> 
> As for the artery clamping, I don't even see it as a last resort.  We've got pressure, elevation, pressure points, and tourniquets.  We've got fluids to make up for losses on the way.  By the time I'm about to start fishing around for somebody's femoral artery with a pair of pliers, I'm hoping I'm wheeling them into the ED.



I can see practical use, especially for those of us who live in states with some ungodly long transport times (think several large counties with no hospital at all). And as for pressure points and elevation. Skip them. If direct pressure ain't working go straight to a tourniquet.


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## Shishkabob (Oct 3, 2010)

PS-- By "clamping down ourselves" I mean using our hands/ fingers.



Could have sworn I saw something of it in the Brady Paramedic text SOMEWHERE, but I'm too lazy to go out to my trunk for it.


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## TransportJockey (Oct 3, 2010)

Linuss said:


> PS-- By "clamping down ourselves" I mean using our hands/ fingers.
> 
> 
> 
> Could have sworn I saw something of it in the Brady Paramedic text SOMEWHERE, but I'm too lazy to go out to my trunk for it.



I've never seen the Brady book, so if you get the energy to look let me know. When I get home I'll try to find the box with my Mosby Medic book and see, but I don't think that's covered at all


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## CAO (Oct 3, 2010)

Linuss said:


> Pressure points and elevation do nothing.



True.  Typing by habit straight from the textbook.  Shoulda gone back and fixed that.


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## Shishkabob (Oct 3, 2010)

Doubt I'll find it, as I can never find stuff when I want to.


But alas, if someone is bleeding out and the only way I can stop it is direct digital pressure / Kellys, and no TQ, then you bet your butt I will.



I'd love to see someone getting angry for something that really isn't (too) invasive / dangerous if it's that or death of the patient.


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## JJR512 (Oct 3, 2010)

About being invasive: I could be mistaken, but my impression was for an artery that was sticking out, with an end exposed. I didn't expect he meant to try to clamp off an end that's retracted into other tissue.

Before I posted this thread, I did a search for "kelly forceps" and came across a couple of threads in which people were asking, "What should be in a BLS bag?" But nobody said _why_, so that's why I'm asking now. I wonder if people who said BLS bags should include them were just saying that out of habit, or because they've seen them in their own service's bags, without really knowing why or what they're there for.

Still, I thought maybe Kelly forceps were one of those kinds of things that though you might rarely, maybe even never, actually need them, if it ever happened that you _did_ need them it'd be in a hurry, so that's why some people put them in their pants or holster kits. Basically, the theory being it's better to have it and not need it than need it and not have it.


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## CAO (Oct 3, 2010)

JJR512 said:


> About being invasive: I could be mistaken, but my impression was for an artery that was sticking out, with an end exposed. I didn't expect he meant to try to clamp off an end that's retracted into other tissue.



Gotcha.  That's what I get for watching the movie so recently.

That's a horse of a different color.  In this case, I'd be much more likely to consider it, especially if there was an issue with the tourniquet.

Transport times in my area are generally less than ten minutes.  I've yet to work with much longer, even with my rural clinical rotations.  I'll be the first to admit this will throw off my opinion.

I've looked for invasive clamping in my Mosby's, but I was unable to find it.  We're still in the warm-up chapters, so I might have overlooked it not being familiar with the later material yet.


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## Lifeguards For Life (Oct 3, 2010)

I don't even think we carry hemostats on the rescues here...


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## Aidey (Oct 3, 2010)

I don't carry them, they aren't on my ambulance, but I have used them, and could use them currently, I just don't _need _to use them. 

I used them working wildland fire and extensively in dialysis (for clamping lines, not people). They can be handy to hold things if you don't have another set of hands, but that is mainly in a non-surgical or non-wound care setting. 

Like Linuss I was taught to stick my hands in and pinch off whatever was bleeding if necessary.


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## abckidsmom (Oct 3, 2010)

The only thing I've ever used Kellys for is line and tube management, in the hospital.  A tourniquet, looped around the vent circuit can be clipped to the sheet or the gown and keep the tension off of the tube.  Same for multiple lines, except those can be all corralled in the triangle between the handles of the clamp.

Can't say that I've ever seen a single bleeding artery that needed to be clamped...the couple of ripping amputations I've seen had relatively little bleeding.

I have used Kellys to hold IV bags up when we were in a house...slip the point through the loop on the bag and clip it to a curtain or something.

They're for keeping things still for me...these are the kinds of instances where I look for them.


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## Aidey (Oct 3, 2010)

abckidsmom said:


> The only thing I've ever used Kellys for is line and tube management, in the hospital.  A tourniquet, looped around the vent circuit can be clipped to the sheet or the gown and keep the tension off of the tube.  Same for multiple lines, except those can be all corralled in the triangle between the handles of the clamp.



We did that a lot in dialysis to with all the lines and such.


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## firetender (Oct 4, 2010)

I've used Kelly's forceps to remove a piece of meat from a trachea that was obstructed by it. It was the Cafe Coronary from Hell, but it worked.


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## Lifeguards For Life (Oct 4, 2010)

firetender said:


> I've used Kelly's forceps to remove a piece of meat from a trachea that was obstructed by it. It was the Cafe Coronary from Hell, but it worked.



magill forceps or kelly forceps?


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## JJR512 (Oct 4, 2010)

Looking at Post #s 15, 16, and 17, it seems like it can be more of a useful tool that's not directly part of patient care. I mean, not in direct contact with a patient. Kind of like having a multi-tool (Gerber or Leatherman) in a pouch on my belt. Someone once asked me what I could do to a patient with it. Well nothing, of course, but I've lost count of the number of trim-panel screws I've tightened with it in the back of ambulances.


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## EMS49393 (Oct 4, 2010)

I side with the IV bag wranglers.  It's all I've ever used the kelly forceps for.  When I was employed at a place that afforded me the means to hang my bag on a stretcher IV pole that also held my pump, I stopped carrying them.  I really need to dig those suckers out again.


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## usalsfyre (Oct 4, 2010)

While not Kellys specifically, curved hemostats make a darn good blunt disection tool for the crichothyroid membrane. Hopefully these would be sterile of course, not the ones riding around in your pocket for upteen years...


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## firetender (Oct 4, 2010)

*Got me!*



Lifeguards For Life said:


> magill forceps or kelly forceps?



Magill (brain fart!) Kelly's are for roaches (now you know why!).


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## citizensoldierny (Oct 5, 2010)

Linuss said:


> PS-- By "clamping down ourselves" I mean using our hands/ fingers.
> 
> 
> 
> Could have sworn I saw something of it in the Brady Paramedic text SOMEWHERE, but I'm too lazy to go out to my trunk for it.



It was definitely in the Caroline book, but with the catch all of if allowed by local protocols or some such thing.


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## Bullets (Oct 5, 2010)

ive used it to hang iv bags from car liners when we were on a lengthy pin job. Get in the vehicle and start treatment while the Rescue cuts. Hang bags from the ceiling. also, use it to hlod down the sheet thats covering my and the pt's face.

hold sheets over DOAs at MCIs, as a curtain, when its windy, ect. i find a use for them all the time. also, when the nurses cant find theirs, im johnny on the spot with mine, always make a nurse happy. ill pull a set from equipment


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## JJR512 (Oct 6, 2010)

There was one other thing I mentioned, and I don't think I've seen anyone comment on it yet. And that's that in the Wikipedia article—which again, has no references that I noticed, at least for this part, so I have no idea how accurate this is or not, which is kind of why I'm asking about it—said that the serrated clamping surface is actually counter-intuitively less harmful to tissue than a smooth surface would be. I believe the article said this is because you can use less pressure with the serrated tips. Does anyone know if this is correct, or sounds plausible?

I'm not sure if I really buy that or not. Maybe it's true if I'm manually holding _just enough_ pressure on the forceps to clamp something, but if I lock it, that's another story. If I lock the forceps on an ordinary piece of paper, even on the first lock setting, holes get left in the paper. Now I know an artery is tougher than a piece of paper, but it's also thicker, which seems it would take more force to squeeze the handles together enough to get them to lock, which in turn means more force being exerted on the artery, or whatever is in there.

I just...I just don't see how the serrated surface can _not_ rip up or shred or otherwise damage an artery, vein, or other tissue. But all the Kelly forceps I've ever seen have been serrated, and part of me wants to assume they're like that for a reason.


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## Lifeguards For Life (Oct 6, 2010)

JJR512 said:


> There was one other thing I mentioned, and I don't think I've seen anyone comment on it yet. And that's that in the Wikipedia article—which again, has no references that I noticed, at least for this part, so I have no idea how accurate this is or not, which is kind of why I'm asking about it—said that the serrated clamping surface is actually counter-intuitively less harmful to tissue than a smooth surface would be. I believe the article said this is because you can use less pressure with the serrated tips. Does anyone know if this is correct, or sounds plausible?
> 
> I'm not sure if I really buy that or not. Maybe it's true if I'm manually holding _just enough_ pressure on the forceps to clamp something, but if I lock it, that's another story. If I lock the forceps on an ordinary piece of paper, even on the first lock setting, holes get left in the paper. Now I know an artery is tougher than a piece of paper, but it's also thicker, which seems it would take more force to squeeze the handles together enough to get them to lock, which in turn means more force being exerted on the artery, or whatever is in there.
> 
> I just...I just don't see how the serrated surface can _not_ rip up or shred or otherwise damage an artery, vein, or other tissue. But all the Kelly forceps I've ever seen have been serrated, and part of me wants to assume they're like that for a reason.



 Generally Forceps with serrated inner flanges are really more of a grasping than clamping tool. The principle you mentioned holds true if using the forceps to grasp  and manipulate something, not so much if you intend to clamp down for a prolonged time.

This is a book on foot and ankle surgery with a section on various hemostats and forceps. Some information that may interest you begins on page 6.
http://books.google.com/books?id=sG...serrated forceps for clamping vessels&f=false


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## Veneficus (Oct 6, 2010)

I always found forcepts useful in EMS for getting the damn cotton out of the asa bottle.

Secondarily, they worked well to clamp IV tubing to push a med or to temporarily halt flow for a few seconds.


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## abckidsmom (Oct 6, 2010)

Veneficus said:


> I always found forcepts useful in EMS for getting the damn cotton out of the asa bottle.
> 
> Secondarily, they worked well to clamp IV tubing to push a med or to temporarily halt flow for a few seconds.







Nurses don't use metal clamps on IV tubing...just sayin'.

That's what those plastic doodads all over the place are for.  Just wait till you rip through the line on a central line, spewing blood all over the place.


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## dixie_flatline (Oct 8, 2010)

Umbilical cord?


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## Charmeck (Oct 8, 2010)

Veneficus said:


> I always found forcepts useful in EMS for getting the damn cotton out of the asa bottle.
> 
> Secondarily, they worked well to clamp IV tubing to push a med or to temporarily halt flow for a few seconds.



I like the aspirin bottle idea.  you could even use them to break that seal in a brand new bottle it peeling it off is not working.


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## JJR512 (Oct 8, 2010)

dixie_flatline said:


> Umbilical cord?



I guess you could...But if you're on duty, there should be an OB kit in your rig...At least, it's required to have them on Maryland ambulances, and it makes sense for them to be on ambulances, so I'm going to assume that pretty much all ambulances have OB kits on board (and yes, I know the dangers of making assumptions)...And presumably, in an L&D situation, someone's gotten that kit out already...And every OB kit I've ever seen, or read a description of, has two umbilical cord clamps in it.

If you're not on duty, then if you have your Kelly forceps with you, you're probably enough of a whacker to have an OB kit in your trunk.  (If not, you should really get one; they're not that expensive!)


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