Suturing – Instrument holding

Key principles

Maintain a light grip on the needle holders

• Thumb and ring finger, first knuckle only
• Not a death grip!
• Advanced: no thumb in the ring – use your thumb pad to open and close the ratchet

Thumb forceps held like tweezers or a pencil

• No overhand grips
• Advanced: don’t set them down

Rotate arm and wrist to move the needle

• Avoid pushing the needle through with a straight force
• If your needle is straightening on you, you aren’t rotating your arm

Needle holders are positioned over the knot for tying

• Between the strands of suture
• Not underneath either strand

Don’t pull up on the knot

• Keep needle holders close to the skin
• Don’t move the needle holders up and down
• Use your opposite hand to wrap the suture around the needle holders

Control your suture

• Keep your hands where you can see them
• Wrap or fold the suture into your other hand to keep it under control

How to use your thumb forceps to stabilize the needle

General