What do ya think of this?

[SwampFox320]

http://www.sportsmansguide.com/cb/cb.asp?a=350920

I was just goofin around and ran across this, is this a good deal to pick up for the BOB or not so much?

Thanks!
Fox

[DrBaboon]

It's in the ballpark (or a little lower than average) for price.

We had a little discussion of that type of kit a while ago in 2nd 1/2 of the sterilization thread.

http://www.survivalfiles.info/forums/showthread.php?t=61

As long as these kits keep being available in a CANVAS pouch, they are OK.

Those kits on the market that have pouches/cases that can't withstand heat and water/steam during sterilization are not helpful IMHO.

I have not seen the instruments in the SG kit firsthand, but I have seen the kits sold by a couple of different vendors. The ones I have seen have been so-so in quality, which is probably adequate for many purposes.

The penlight is pretty useless IMHO. It's just an obstacle to sterilizing the kit, and is disposeable. (I would not count on it having live batteries when you need a light - but I don't think anyone buys one of these kits for the penlight).

It's a little hard to tell about the 3 hemostats, but it looks as if one of them might be curved when I use the zoom. It's often a little easier to tie a bleeder that you clamped when using a curved hemostat, as you can work the loop of suture behind the tip of the jaws a little easier without stretching the tissue or pulling the hemostat off the tissue. There's also a skill to learn in how to be the assistant holding the hemostat as someone else ties, and then releasing the hemostat without making things jump or loosing control of the bleeder while you let the person tying the suture tighten the noose. That requires you to vary how tightly closed the jaws of the hemostat are, as the tissue gets constricted by the noose.

The main instrument missing from pretty much all of these kits is a needle holder. Some people also call them needle drivers. It's possible to find one that can fit inside this pouch with the other instruments, which is another good reason to remove stuff like the penlight and the betadine and the alcohol pads, and the suture.

Other things that might make a kit like this more useful: A couple of small retractors. Stuff like that turns up on eBay, as well as at surplus vendors and liquidators from time to time.

As you might know, I have concerns about how enthusiastically people want to suture wounds. Closing wounds by any method increases the odds of a wound infection, and makes it harder to deal with other injuries below the skin if you didn't already deal with them. Any foreign material in a wound needs to come out, and wounds often need to be irrigated whether or not they are closed.

IOW - using a kit like this really means anticipating additional needs - skills, materials, capabilities.

When there is doubt, it is better not to close a wound, and I think it's a fairly good assumption that wounds that develop in austere circumstances will often not be clean wounds.

Why have a kit like this?

Well, more important than learning to suture, people need to learn sterile handling and technique. People need to learn to tie bleeders, which involves some of the same skills as suturing. IOW - this becomes a vehicle to learn those skills and develop those capabilities.

For people getting one of these kits, I would also encourage having a supply of something that can be used as an outer wrapper when sterilizing the kit inside the pouch.

That could optimally be done by getting a box of sterilizer pouches. Again - those turn up on eBay and at liquidators somewhat often. The indicators on the pouches merely indicate whether it's been exposed to steam or (not very likely) gas sterilization with ethylene oxide. The indicator *does not* tell you that the sterilization has been effective. You're going to have to make your own best judgement about the effectiveness of your method of sterilization.

I've given some thought to how I might do that if I did not have access to "off the shelf" standards of sterilization. It's pretty easy to cobble together a tube of culture media. Ideally, one could have a spore forming bacteria on the culture medium, and you'd include that tube or vial with the instruments in the pouch before sterilizing it. If the culture grows after sterilization attempt, you were not successful.

Ordinary food-type gelatin + bouillon = culture medium.

I don't know about having a spore forming bacterial culture around when you need it, but having a bunch of mixed bacteria around is as simple as harvesting some from your used TP after wiping.

Another reason for having a kit like this: For someone else to use if they have more training than you do, and they don't have instruments anymore.

I can't claim that the link will always work, and sooner or later, they will run out:

http://www.sciplus.com/singleItem.cfm?terms=7965&cartLogFrom=Search

They are calling this a hemostat, but it's actually a needle holder.

A few of my non-medical friends have this item. It's adequate - it's not top shelf.

There are 2 advantages to this particular needle holder (besides low price)...

Most needle holders have 2 loops in the handle - like scissors do or like the hemostats in the SG kit you originally mentioned. A needle holder is often longer, and the width of the loops/"ears" gets wider, too. Many needle holders will not fit into this SG pouch - but this style of needle holder will just barely fit once you have removed the other items I mentioned above. The other reason to consider this type of needle holder is that I think it's easier to learn to use for a beginner than the more common type of needle holders that have the loops/ears.

The way this type of needle holder releases is to squeeze harder/all the way - the ratchet lock goes past the ends of the teeth, and the ratchets go around each other. IOW - you squeeze a bit to lock the jaw on the needle, and sqeeze all the way to release.

Using a "regular" needle holder, you have to learn how to hold it, and sew without your fingers in the ears, and be able to "pop" the ratchet open without repositioning your hand. Most medical people have long since learned to do this, but a beginner has no muscle memory one way or the other.

With either style of needle holder, you are driving the needle with a forearm rotation, not a straight shove.

How is a needle holder different than a hemostat? A hemostat is meant to clamp tissue - it has a longer jaw, and serations. Needle holders have comparatively short jaws that are either flat or have fine texture to be able to exert enough force on a steel needle that it won't slip or twist. Hemostats do a poor job of holding needles, and often chip the needle. Chipped needles drag in tissue, and make the needle holes more traumatic than desired.

Basically, if you are using one of these kits, you need a needle holder.

You also need a wider variety of suture than what comes in this kit - but that's not a problem. There are lots of sources of suture for reasonable prices. Get together with your buddies. Mix and match, trade 'em like baseball cards.

Like Jonas Parker said in the other thread, he has better instruments than are included in a kit like this. So do I. These kits are what they are, which is adequate for some purposes.


Some comparisons:

http://www.majorsurplusnsurvival.com/Merchant2/merchant.mv?Screen=PROD&Product_Code=106489&Category_Code=19

--- fewer hemostats, 2 different sizes of bandage scissors. Bandage scissors don't help you deal with suture. The pouch doesn't open up and lay flat to give you a work area that hopefully is sterile (assuming you sterilized the pouch and its contents). Price is lower than SG, however. Still no needle holder, and has no suture.

http://www.majorsurplusnsurvival.com/Merchant2/merchant.mv?Screen=PROD&Product_Code=100243&Category_Code=19

--- seems to be the same or comparable kit as the one you found at SG. Has one less hemostat, and has a bandage scissor instead. Price is higher than at SG by a significant amount. The picture shows you how the pouch opens up and folds out to give you a working area.

http://www.majorsurplusnsurvival.com/Merchant2/merchant.mv?Screen=PROD&Product_Code=1002431&Category_Code=19

--- yet again - a similar kit. I don't know what they mean when they say "pack cloth" and show a loop on the back to attach it to a belt or pack. If they mean it's nylon or something like cordura, I would not be enthused about the pouch, as it probably won't hold up to sterilization and may not dry off and vent from steam getting inside the way canvas would. Since I would recommend using the pouch as an inner wrapper in conjunction with an outer wrapper, the ability to attach is to a belt or pack is of no value, and merely hinders doing so.

http://www.majorsurplusnsurvival.com/Merchant2/merchant.mv?Screen=PROD&Product_Code=101825&Category_Code=19

--- similar instrument assortment, no needle holder again. I don't have the book, so I can't rate it, but it's probably OK and worth a little cost. The price is lower than the SG kit, but the main reason I wouldn't get this kit is that the case isn't steam/pressure cooker friendly.

http://www.majorsurplusnsurvival.com/Merchant2/merchant.mv?Screen=PROD&Product_Code=101828&Category_Code=19

--- same kit as immediately above, but no book, and a buck less.


Other items you might consider:

http://www.majorsurplusnsurvival.com/Merchant2/merchant.mv?Screen=PROD&Product_Code=104756&Category_Code=19

--- the sutures are a gamble as to what you'll get. There will probably be a few in there that are useful. Some may end up being for very specialized uses and/or be extremely small. Like 7-O suture for example, it's small enough you need magnification to comfortably work with it, and it's for certain fine work.

Keep in mind that while there are many types of materials in suture, it comes down to whether you leave absorbable suture inside or you put non-absorbable suture in the skin. You plan to remove the non-absorbable suture. Cutting needles penetrate skin well. Generally, non-cutting needles are used for deeper tissues. There are many sizes and cross sections of needles, appropriate to what you are trying to do.

And, while it's never a happy time to think about amputations, having a Giggli saw around, and sterilized when you need it, makes life a little easier...

http://www.majorsurplusnsurvival.com/Merchant2/merchant.mv?Screen=PROD&Product_Code=085312&Category_Code=21

Are there other vendors out there? Sure.

I'm mostly trying to give some examples of how you might approach looking at some of this stuff.

It doesn't make any sense to link to something on eBay, because that will come and go in a few days at most.

But FWIW, I have seen a wide variety of sutures on eBay, as well as other supplies and tools.

[Jonas Parker]

Try http://www.cheaperthandirt.com/MOLLE607-45517-538.html .

Remember, all the instruments in the world are worthless if you don't have somebody nearby who has the knowledge and is properly qualified to use them.

I carry Steri-Strips, which I ordered through my local pharmacy, as my first option of wound closure. These are sterile and require little training to use.

After you decide where to buy instruments, and what you need (the Doctor is right... curved hemostats are a lot easier to use in clamping off "bleedere" than straight hemostats, and an "needle holder" is a "must"), download Ethilon's book on suturing and surgical knots at:

www.jnjgateway.com/public/NLDUT/Wound_Closure_Manual1.pdf (http://www.jnjgateway.com/public/NLDUT/Wound_Closure_Manual1.pdf)

then read it and practice!

As far as other instruments, sterile "one use" scalpels are available at your local farm and feed store. Cheaper Than Dirt has a reasonable variety of good instruments at fair prices. The little canvas pouch isn't very important to me not only because I don't have one, but also because I'm planning on using chemical sterilization should I need to use my instruments.

I hope I haven't confused the issue too much here.

[DrBaboon]

I carry Steri-Strips, which I ordered through my local pharmacy, as my first option of wound closure. These are sterile and require little training to use.

A little clarification - Jonas Parker and I are not disagreeing here. He's making the point that you can effectively close some skin lacerations with Steri-Strips.

I also know a little bit about his background, and I know that he has better than average experience in healthcare. I am also pretty sure that he has a grasp of wounds that should not be closed by any method, and left open.


The little canvas pouch isn't very important to me not only because I don't have one, but also because I'm planning on using chemical sterilization should I need to use my instruments.

For readers who are not in healthcare, I should point out that I'm confident Jonas Parker has other materials and planning to provide for a sterile work area to engage in instrument handling and related tasks. To be clear to everyone else, part of what I was suggesting as a use for the pouch was to become that sterile work area. Are there other ways to meet that need? Of course. The pouch is simply one way to do so. I don't believe Jonas Parker is suggesting skipping the step of providing for a sterile work area for your instruments.

The 2nd location that needs attention is the site on the patient where the work is being carried out. Aside from skin preparation/disinfection, wound irrigation (if applicable), local anesthetic use or other steps, another sterile work area is needed. Most often that's accomplished with fabric or paper drapes. Many things can be used, as long as you have a way to sterilize them before use.

[DrBaboon]

It's kind of hard to take on a topic like this -- as simple as it is -- without it bringing up other subjects.

Let's touch on one related subject by asking a question for members:

Who is familiar with how to put on a pair of sterile latex gloves without contaminating them?


Here's one portrayal:

http://www.ansellhealthcare.com/University/RiskMIHospital/DonningTSGloves.aspx

It's not the most clear presentation, IMHO. Members would probably be using the approach they call "open donning."

If it's not clear from the photos, all surgical gloves are packed with a sterile inner wrapper, and that inner wrapper is folded so it initially opens like a book. There is labelling, and the right glove is under the right hand side, and the left glove is under the left hand side. The right and left "pages" are sort of like those books with fold out panels.

The exposed panel of each page has folded back edges, and lets you lift it by a folded edge and open the panel without touching INSIDE the panel. That exposes the glove on that side. The cuff of the glove is folded back over the glove, so when you do what is shown on the web page, you are only touching INSIDE the glove for the glove you start with.

The 2nd glove donned is picked up with the first hand that you gloved, and it's handled by picking up the 2nd glove with a finger or 2 in the folded cuff, which is the OUTSIDE of that 2nd glove.

That's what they mean - inside to inside, outside to outside.

Everyone goes through a fair number of glove packages learning how to do this.

[Jonas Parker]

To be clear to everyone else, part of what I was suggesting as a use for the pouch was to become that sterile work area... The pouch is simply one way to do so. I don't believe Jonas Parker is suggesting skipping the step of providing for a sterile work area for your instruments.

The 2nd location that needs attention is the site on the patient where the work is being carried out. Aside from skin preparation/disinfection, wound irrigation (if applicable), local anesthetic use or other steps, another sterile work area is needed. Most often that's accomplished with fabric or paper drapes. Many things can be used, as long as you have a way to sterilize them before use.

That pouch, laid out flat, is an awfully small work area for anyone but an experienced surgeon to work from, and much too small for me to try it!. I bought some tightly-woven smooth finished heavy cotton towels from Cheaper Than Dirt a few years back, which can be wrapped in brown paper (or another towel) and put in my pressure cooker to sterilize. It's the towels that will be used to "drape" the patient and to cover a small work table where the instruments are.

[DrBaboon]

I bought some tightly-woven smooth finished heavy cotton towels from Cheaper Than Dirt a few years back, which can be wrapped in brown paper (or another towel) and put in my pressure cooker to sterilize. It's the towels that will be used to "drape" the patient and to cover a small work table where the instruments are.

Yeah - you've got a set-up you are comfortable using and works well. I agree that you won't benefit from one of these kits, including the pouch.

I think I picture the towels you have - they are really handy for a lot of medical and surgical purposes. I know someone who used to cut a round hole in the center for making window drapes, and pre-packed his instruments in the towels when autoclaving.

I've got a fair number of them, too, of different eras.

I was also recently given a few more by an OB-Gyne when we were serving as range officers.


It's easier thinking about how I would use my regular equipment and supplies from the office if I needed to shift into austere medicine mode. I picked up a couple of styles of instrument kits from some of the catalogs most of us probably receive without intending to rely on them or use them in the office. I got them partly out of curiosity, and partly because of the questions I was getting from friends who saw them and wondered about buying them or ways to use them. I think I got my money's worth on the kits in terms of the satisfaction of checking them out -- sort of looking at it as spending hobby time and money.

I ended up putting additional instruments in, removed the stuff that isn't autoclaver friendly, and autoclaved the kit. I found that the folded up pouch with instruments fit into a 5 1/4 x 10 1/4" sterilizer pouch.

The packaged kit ended up going into a small emergency bag that I sometimes take when traveling. I didn't end up tying up my other instruments from the office that way.



So what do people want to do? We could add some other items or topics into this thread. We could leave this thread for now without adding other materials here, and start some additional discussions in their own threads.



Some examples might include: Any medical items members find for sale at places like CTD, SG or wherever; other tasks and skills related to using surgical instruments.

[DrBaboon]

http://www.cheaperthandirt.com/KEY302-2039-1395.html

It's a little hard to tell if this is the tight weave common in surgical towels, but it looks like it to me.

Jonas Parker or anyone ordered this particular item to see it first hand?

There are also lots of this type on eBay - search on surgical towel if interested.

[Jonas Parker]

http://www.cheaperthandirt.com/KEY302-2039-1395.html

It's a little hard to tell if this is the tight weave common in surgical towels, but it looks like it to me.

Jonas Parker or anyone ordered this particular item to see it first hand?

There are also lots of this type on eBay - search on surgical towel if interested.

That looks like them, but mine have blue trim (Coast Guard, you know)!
:p