Bronchoscopy and Esophagoscopy | Page 6

so that one set will do for all tubes. The schema shows method of sponging. The carrier C, armed with the sponge, S, when rotated as shown by the dart, D, wipes the field, P, at the same time wiping the lamp, L. The lamp does not need ever to be withdrawn for cleaning during bronchoscopy. It is protected in a recess so that it does not catch in the sponges.]
[FIG 15.--Exact size to which the bandage-gauze is cut to make endoscopic sponges. Each rectangle is the size for the tubal diameter given. The dimensions of the respective rectangles are not given because it is easier for the nurse or any one to cut a cardboard pattern of each size directly from this drawing. The gauze rectangles are folded up endwise as shown at A, then once in the middle as at B, then strung one dozen on a safety pin. In America gauze bandages run about 16 threads to the centimeter. Different material might require a slightly different size and the pattern could be made to suit.]
[32] The gauze sponges are made by the instrument nurse as directed in Fig. 15, and are strung on safety pins, wrapped in paper, the size indicated by a figure on the wrapper, and then sterilized in an autoclave. The sterile packages are opened only as needed. These "bronchoscopic sponges" are also made by Johnston and Johnston, of New Brunswick, N. J. and are sold in the shops.
Mouth-gag.--Wide gagging prevents proper exposure of the larynx by forcing the mandible down on the hyoid bone. The mouth should be gently opened and a bite block (Fig. 16) inserted between the teeth on the left side of the patient's mouth, to prevent closing of the jaws on the delicate bronchoscope or esophagoscope.
[FIG. 16.--Bite block to be inserted between the teeth to prevent closure of the jaws on the endoscopic tube. This is the McKee-McCready modification of the Boyce thimble with the omission of the etherizing tube, which is no longer needed. The block has been improved by Dr. W. F. Moore of the Bronchoscopic Clinic.]
Forceps.--Delicacy of touch and manipulation are an absolute necessity if the endoscopist is to avoid mortality; therefore, heavily built and spring-opposed forceps are dangerous as well as useless. For foreign-body work in the larynx, and for the removal of benign laryngeal growths, the alligator forceps with roughened jaws shown in Fig. 17 serve every purpose.
[FIG. 17.--Laryngeal grasping forceps designed by Mosher. For my own use I have taken off the ratchet-locking device for all general work, to be reapplied on the rare occasions when it is required.]
Bronchoscopic and esophagoscopic grasping forceps are of the tubular type, that is, a stylet carrying the jaws works in a slender tube so that traction on the stylet draws the V of the open jaws into the lumen of the tube, thus causing the blades to approximate. They are very delicate and light, yet have great grasping power and will sustain any degree of traction that it is safe to exert. They permit of the delicacy of touch of a violin bow. The two types of jaws most frequently used, are those with the forward-grasping blades shown in Fig. 18, and those having side-grasping blades shown in Fig. 19. The side-curved forceps are perhaps the most generally useful of all the endoscopic forceps; the side projection of the jaws makes them readily visible during their closure on an object; their broader grasp is also an advantage., The projection of the blades in the side-curved grasping forceps should always be directed toward the left. If it is desired that they open in another direction this should be accomplished by turning the handle and not by adjusting the blade itself. If this rule be followed it will always be possible to tell by the position of the handle exactly where the blades are situated; whereas, if the jaws themselves are turned, confusion is sure to result. The forward-grasping forceps are always so adjusted that the jaws open in an up-and-down direction. On rare occasions it may be deemed desirable to turn the stylet of either forceps in some other direction relative to the handle.
[FIG. 18.--The author's forward grasping tube forceps. The handle mechanism is so simple and delicate that the most exquisite delicacy of touch is possible. Two locknuts and a thumbscrew take up all lost motion yet afford perfect adjustability and easy separation for cleansing. At A is shown a small clip for keeping the jaws together to prevent injurious bending in the sterilizer, or carrying case. At the left is shown a handle-clamp for locking the forceps on a foreign body in the solution of certain rarely encountered mechanical problems. The jaws are serrated and cupped.]
[FIG. 19.--Jaws of the author's side-curved endoscopic forceps. These work