Instrument tying

Medical skill data
Subskill of	SMW:off Basic Surgical Skills Technique Review of the Cognitive Task Analysis with a simulation model SMW:on
Equipment	Needle driver forceps suture scissors suture

Instrument Tie

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

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

Page data
Keywords	surgery, suturing
SDG	SDG03 Good health and well-being
License	CC-BY-SA-4.0
Organizations	ASAP
Language	English (en)
Related	0 subpages, 3 pages link here
Views	65 page views (analytics)
Created	July 30, 2021 by Manisha
Last edit	September 18, 2026 by Felipe Schenone
Cite as	ASAP (2021–2026). "Instrument tying". Appropedia. Retrieved September 30, 2026.
API queries	basic, semantic, html, files, more