🧵regarding some technical aspects of the needle holder and where to grip surgical needles, something you may not know about the packages they come in, and a comment about the ratchet.
Oriented more toward the younger folks...
(1/ )
Oriented more toward the younger folks...
(1/ )
A good general rule is that the needle should be gripped about 2 mm from the tip of the needle holder.
This location usually provides enough strength to the grip and allows for the most freedom of motion of the needle holder.
This location usually provides enough strength to the grip and allows for the most freedom of motion of the needle holder.
Of course there's nothing preventing you from gripping it more proximal -- say 4 mm. And indeed that does provide a stronger grip (it's been studied).
The downsides are:
- the needle is more likely to bend
and
- the jaw tips protrude more and may hit things and get in the way.
The downsides are:
- the needle is more likely to bend
and
- the jaw tips protrude more and may hit things and get in the way.
One 'classic' position to grip the needle is at its
'halfway' point.
This gives you optimal control of the needle, but it doesn't always work because the tissue you are going though is often too thick for this (meaning it won't go all the way through the tissue).
'halfway' point.
This gives you optimal control of the needle, but it doesn't always work because the tissue you are going though is often too thick for this (meaning it won't go all the way through the tissue).
Another 'classic' location is about 2/3 back from the tip of the needle.
Here you still have good control of the needle, and it is able to pass through more tissue.
This one is generally more practical than the 'halfway' position.
Here you still have good control of the needle, and it is able to pass through more tissue.
This one is generally more practical than the 'halfway' position.
Sometimes you need to get through some extra tissue, so it's tempting to choke back and grip close to the 'swage' (where the thread inserts).
You know you're not supposed to do this, but everyone does it occasionally, and if you tell me that you never do this, you're lying...
You know you're not supposed to do this, but everyone does it occasionally, and if you tell me that you never do this, you're lying...
Specifically, you're not 'supposed' to do this because:
- it's harder to follow the true curvature of the needle
and
- it's *really* easy to bend or break the needle this way
So you all are adults and can judge for yourselves, but be careful when using this technique.
- it's harder to follow the true curvature of the needle
and
- it's *really* easy to bend or break the needle this way
So you all are adults and can judge for yourselves, but be careful when using this technique.
Most suturing is done with the needle at a right angle to the needle holder, but sometimes the situation calls for the needle to be at an acute or an obtuse angle.
The grip strength on the needle is generally maintained, and only starts to decrease at extreme angles.
The grip strength on the needle is generally maintained, and only starts to decrease at extreme angles.
Many times the needles come packaged so that it facilitates picking them up right at one of the two classic locations we just mentioned:
-the midpoint (red arrow)
-or about 2/3 back (blue arrow)
-the midpoint (red arrow)
-or about 2/3 back (blue arrow)
You'll remember that we just said that the needle should be 2 mm from the tips of the jaws.
It so happens that many of the packages are such that the needle holder naturally will pick up the needle in that (2 mm) location.
It so happens that many of the packages are such that the needle holder naturally will pick up the needle in that (2 mm) location.
In terms of the ratchet:
'Clicking' the ratchet *once* generally provides a strong enough grip on the needle for most applications.
'Clicking' it to the 2nd or 3rd notch provides a *slightly* stronger grip, but tends to make it more likely to bend.
(this has also been studied)
'Clicking' the ratchet *once* generally provides a strong enough grip on the needle for most applications.
'Clicking' it to the 2nd or 3rd notch provides a *slightly* stronger grip, but tends to make it more likely to bend.
(this has also been studied)
I don't have a summary slide, so some history:
The needle holder you are familiar with is called a "Mayo-Hegar" needle holder.
'Mayo' as in the Mayo brothers (or the Clinic)
'Hegar' as in the dilators (named after a German gynecologist).
First available ~ the 1920's
⬛️
The needle holder you are familiar with is called a "Mayo-Hegar" needle holder.
'Mayo' as in the Mayo brothers (or the Clinic)
'Hegar' as in the dilators (named after a German gynecologist).
First available ~ the 1920's
⬛️
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