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newSchoolWorks.com › VoTechWorks › Health & Personal Services › Surgical Technology › Surgical Instrumentation: Identification, Handling, and Set Management › Lesson 4
HLT-SURG65-03 · Lesson 4 · 26.5 clock hours · demo

Clamping and Occluding Instruments: Hemostats, Clamps, and Forceps

Objective. Students will identify at least 30 clamping and occluding instruments by name and demonstrate correct palm-grip and finger-ring handling technique for ring-handled clamps without cross-contaminating the sterile field.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed clinician in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

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Clamping and Occluding Instruments: Hemostats, Clamps, and Forceps

Clamping and occluding instruments are among the most frequently handled tools in the surgical technologist's repertoire. Mastering their identification and correct handling is essential for maintaining a safe, efficient sterile field and supporting the surgical team.

What Clamping Instruments Do

Clamping instruments control bleeding by compressing blood vessels, grasp and retract tissue, or occlude hollow structures temporarily during a procedure. Most are ring-handled with a ratchet locking mechanism that holds the jaws at a set tension. The scrub surgical technologist must know each instrument by sight, name, and clinical application so that the correct clamp reaches the surgeon's hand immediately—without hesitation and without contamination.

The Hemostat Family

Halsted mosquito hemostat is the smallest common hemostat. Its jaws are fully serrated and delicate, designed for clamping small superficial vessels and fine tissue in shallow wounds. Available in straight and curved versions.

Kelly hemostat is a medium-sized clamp whose serrations cover only the distal half of the jaws, allowing a gentler grip on larger vessels. It is a workhorse instrument in many general and gynecologic cases.

Crile hemostat closely resembles the Kelly but has fully serrated jaws from tip to shank. It provides a more secure grip and is used on medium-sized vessels.

Rochester-Pean clamp is a heavy, fully serrated hemostat used on large vessels and thick tissue pedicles. Its size makes it easy to distinguish from the lighter hemostats.

Occlusion and Tissue Clamps

Kocher clamp (Rochester-Ochsner) has heavy, fully serrated jaws with prominent interlocking teeth at the tip. Those teeth make it extremely secure for grasping tough tissue such as fascia, but the teeth also make it traumatic—it should never be used on delicate or hollow structures.

Allis clamp has multiple fine, interlocking teeth along the edges of its jaws. It grasps tissue firmly but is less traumatic than the Kocher. It is commonly used to hold fascia, breast tissue, or the appendix during retraction. It should not be used on bowel intended to remain viable.

Babcock clamp has smooth, rounded, fenestrated jaws shaped to encircle tubular structures without crushing them. It is the preferred instrument for grasping bowel, fallopian tube, ureter, and other delicate hollow organs.

Right-angle clamp (Mixter or thoracic right-angle) has jaws set at 90 degrees to the shank. This geometry allows the surgeon to pass a tie or vessel loop around a structure in a tight space. It is essential in dissection around vessels and ducts.

Sponge-holding forceps (sponge stick) are large ring-handled forceps with oval, fenestrated jaws. They hold a folded gauze sponge for skin preparation, blunt dissection, or hemostatic pressure. They must never be confused with tissue clamps.

Jaw Types at a Glance

Grip Techniques and Passing Safety

Two grip styles apply to ring-handled clamps.

Thumb-finger grip (operating grip): the thumb occupies one ring, the ring finger the other, with the middle finger supporting the shank. This grip gives the surgeon control for fine placement.

Palm grip (passing grip): the scrub grasps the clamp with all four fingers wrapped over the shanks and the thumb underneath, ratchet facing the palm. The instrument is presented handle-first to the surgeon's waiting hand in a smooth, controlled motion. The scrub's fingers never enter the rings during a pass—this prevents the surgeon from being struck by an unexpected movement and keeps the tip pointed away from all personnel.

Safety rule: always pass with the tip directed away from yourself, the surgeon, and the patient. Confirm ratchet position before passing. Never reach across the sterile field. Release the instrument only when you feel the surgeon's hand accept it.

Maintaining the Sterile Field

After use, bloody clamps are returned to the back table promptly. Do not allow used clamps to accumulate at the surgical site or pile on the mayo stand unsorted. Count all clamps as part of the instrument count protocol. If a clamp is used to secure a sponge or drain, communicate clearly with the circulator so the count remains accurate.

Never set a clamp on a non-sterile surface and return it to the field. If sterility is questioned, remove the instrument and replace it. Patient safety depends on your vigilance.

Why Accurate Identification Matters for the CST Exam

The NBSTSA CST examination tests instrument identification and the principles of surgical instrumentation as core content. Knowing not only the name but the jaw design, intended tissue, and contraindications for each clamp demonstrates the clinical reasoning the exam requires. Build your mental instrument library now so that identification becomes automatic.

Key terms8

HemostatA ring-handled, ratcheted clamping instrument used to compress blood vessels and control bleeding during surgery.
RatchetThe interlocking teeth on the shanks of a ring-handled instrument that lock the jaws at a selected degree of closure.
Palm gripA passing technique in which the scrub wraps all four fingers over the instrument shanks, thumb underneath, and presents the handle to the surgeon without placing fingers in the rings.
Fenestrated jawA jaw design with an opening or window that reduces tissue trauma while maintaining a secure grasp; characteristic of the Babcock clamp and sponge-holding forceps.
Occlusion clampAn instrument designed to temporarily close off a hollow structure such as a vessel, duct, or segment of bowel without necessarily cutting it.
Right-angle clampA clamp whose jaws are perpendicular to the shank, allowing dissection and passage of ties around vessels or ducts in confined spaces.
Thumb-finger gripThe standard operating grip for ring-handled instruments, with the thumb in one ring and the ring finger in the other, providing precise control for placement.
Sterile field integrityThe condition in which all items within the established sterile boundary remain uncontaminated; the scrub surgical technologist is responsible for monitoring and maintaining this at all times.
In class: Instructor demonstration comparing grip techniques (palm grip for passing, thumb-finger for use) using Halsted, Kelly, Crile, Kocher, and Allis clamps; students practice each grip at their station until instructor confirms correct form. · Instrument family tree chart activity: students build a visual reference grouping clamping instruments by jaw type (smooth, serrated, toothed, angled) and typical tissue application using provided images and reference text. · Timed identification drill: instructor holds up instruments one at a time; students write the name and one clinical use on a whiteboard card; class reviews answers collectively after each round.
Materials: Halsted mosquito hemostats, Kelly hemostats, Crile hemostats, Kocher clamps, Allis clamps, Babcock clamps, Rochester-Pean clamps, right-angle clamps, sponge-holding forceps, instrument identification reference cards, Tighe textbook, small draped mayo stand
Check: Practical station check: student identifies 15 clamping instruments by name, demonstrates palm-grip passing technique for three different clamp types. Pass mark: 100% on sharps-safe passing form; 80% on instrument names (12/15 correct).

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Surgical Instrumentation
1. A surgeon asks for a clamp to encircle and grasp a loop of bowel without crushing it. Which instrument is most appropriate?
Surgical Instrumentation
2. Which jaw characteristic distinguishes the Kocher clamp from the Crile hemostat?
Intraoperative Care and Technique
3. During instrument passing, the scrub surgical technologist uses the palm grip. What is the primary safety reason for keeping fingers out of the rings during a pass?
Aseptic Technique and Sterile Field Management
4. The scrub notices that a Kelly hemostat used to clamp a vessel has been set on the circulator's unsterile back table by mistake. What is the correct action?
Surgical Instrumentation
5. Which hemostat has serrations limited to only the distal (tip) half of the jaws?
Surgical Instrumentation
6. A right-angle clamp is most useful when the surgeon needs to:
Surgical Instrumentation
7. An Allis clamp would be contraindicated for grasping which of the following structures?
Surgical Instrumentation
8. During a timed instrument identification drill, a student correctly names 13 out of 15 clamping instruments. According to the lesson's station check criteria, what is the outcome?
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