Instrument Tie[edit | edit source]
Let's review some basic suturing terms.
- Running end of the suture - The end of the suture still attached to the suture needle. This end is typically longer than the other end.
- Tail end of the suture - This end of the suture is not attached to the suture needle. Ideally, this suture should be less than 2 cm in length to instrument tie efficiently.
Step-by-step Procedure to Instrument Tie[edit | edit source]
1
You can practice this skill either after you have placed a stitch or when tying a free knot.
2
If you have a free end, then ensure the free end (tail) is no longer than 2 cm
If you do not have a free end of the suture material, place an additional stitch but do not pull the suture material through all the way. You will use this loop as the tail for the remainder of the instructions
3
Hold the needle driver in your dominant hand such that the jaws are slightly open
4
Hold the suture attached to the needle (running end) in your non-dominant hand
5
Tie the first knot with a surgeon's knot
- Place the needle driver in between the tail and running end of the suture
- The needle driver should be closed but not locked
- Using your non-dominant hand, wrap the running end of the suture around the jaws of the needle driver two times
- With the jaws of the needle driver, grasp the tail of the suture
- Pull through the suture such that the knot lies flat
- This means you will pull the running end and the tail of the suture in the opposite direction from where they originated
6
Tie the remaining knots as single knots
- Re-set yourself up such that the needle driver is in between the tail and running end of the suture
- Using your non-dominant hand, wrap the running end of the suture around the jaws of the needle driver one time
- With the jaws of the needle driver, grasp the tail of the suture
- Pull through the suture such that you are making a square knot
- This once again means that you will pull the running end of the suture and the tail in the opposite direction from where they originated
7
Repeat this until you have completed the appropriate number of knots for the type of suture you are using
8
Cut the suture tails to 3 mm in length