r/surgery • u/DontGetIrony • 5d ago

I did read the sidebar & rules Thoracostomy forceps

Hiya, paramedic here.

Where I work we carry Spencer-Wells forceps for thoracostomy. I've just seen someone who works elsewhere saying they use Kelly forceps for the same. I wasn't aware of the differences until I looked into it a little, and it doesn't sound like there's much in it for this purpose.

Those of you who do more thoracostomies than me (i.e. >4ish a year), do you think the choice of forceps makes a difference?

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u/Smedication_ Resident 5d ago

No. Biggest difference is the practitioner. Skill and patient size are the two biggest determining factors. Massively obese? Hard to go deep enough. Young and Super muscular build? Muscle is extremely strong and tough to get through. Little old lady? Ribs are so close together it’s hard to get a finger through (at least with size 8 glove fingers).

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u/DontGetIrony 5d ago

I may not have done loads of them, but I've done enough to know this is all true 😂 thanks.

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u/DocHawkeye 5d ago

Don't think so. I just ask for a "big ass kelly" and use whatever is on the tray...

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u/DontGetIrony 5d ago

I hope you don't have any colleagues named Kelly and/or an overzealous HR department.

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u/jay_shivers Attending 5d ago

An attending once forced me to place a tube with just a knife and a finger, after that I imagine I don't care what instrument you give me

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u/BlueSyncope 2d ago

I have been told this too. Just get in the chest.

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u/Gorenden 5d ago

You can use any, id be comfortable with either, what i do find annoying is trying to place the chest tube over a Kelly and making sure it goes in if the pt is deep

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u/5_yr_lurker 4d ago

I used Kelly because that's what we had. Shouldn't matter, just need something robust enough to make a decent thoracostomy hole. I never used the forceps to direct, just my finger.  Every single  one was at the apex of the pleural cavity. Done over a 100.