03.04 Handling of Instruments - Needle Holder
If you are new to suturing, you will need to learn to recognize each of the instruments you are going to use, understand their function and practise the basic techniques of using them.
This section covers the needle holder.
In this module
03.04 Needle Holder
A needle holder has short powerful jaws and is ideal for gripping a needle securely while inserting sutures. Criss-cross lines cut into the jaws provide a firm grip on a curved needle.
03.04.01 Principles Video 1
The short powerful jaws and long handles provide a powerful squeezing force.
The surface of each jaw has criss-cross lines cut into it to improve the grip on a curved needle. The jaws' tips should be of tungsten carbide. This material is hard wearing and gives a good grip for needle and suture material.
Needle holders have a ratchet on the handles, usually with three notches. This allows you to position the needle precisely in the jaws and lock the handles closed. The ratchet’s teeth will tighten automatically as the handles are squeezed together.
To release the ratchet, the handles must be squeezed and then moved slightly apart.
Most ratchets are designed for right-handed surgeons. Releasing a right-handed ratchet with the left hand requires practice.
03.04.02 Principles Video 2
Needle holders come in a variety of sizes and types, and the length and gauge of the needle holder must be appropriate for the depth needed for suture placement and the size of the needle. The most common are those in the size range 12.7cm to 14cm, such as Mayo-Hegar and Kilner.
Other types include Castroviejo needle holders which are commonly used in vascular, ophthalmic, and delicate cosmetic surgery. They come in both locking and non-locking varieties, depending on surgeon preference, and are used for very fine sutures in the 4-0 and smaller range.
03.04.03 Practise Handling
The conventional hold is the same as for scissors. Place your ring finger and thumb in the holes. Use your index finger to steady the instrument so that you can position the jaws precisely.
An alternative grip is to hold the needle holder in your palm. Loosely grip the lower handle with your fingers and rest your thumb on the top handle. You can still use your index finger to control the jaws. Close the jaws using your thumb along the shaft of the instrument, and open by pressing the handle with the base of the thumb.
Once mastered, this grip can improve the efficiency and rhythm of your suturing. It removes the need for constantly taking your fingers in and out of the holes between bites in order to reposition the needle.
03.04.04 Practise Positioning the Needle
The central section of a curved needle is flattened. Grasp the needle on this flat section, about two thirds of the way from the point, with the tip of the needle holder’s jaws. If the needle is too near the hinge, the jaws will get in the way.
Angle the needle slightly forward in the instrument's jaws. This conforms to the natural direction of your hand when inserting a suture and is more comfortable.
Squeeze the handles together to engage the ratchet and lock the needle in position. To release, squeeze the handles again and then separate fractionally.
03.04.05 Things to Avoid
This section covers the most common problems encountered when learning to use a needle holder:
- incorrect hold
- mounting the needle incorrectly
- damaging the needle
- and confusing your needle holder with artery forceps
03.04.05.01 Incorrect Hold
Avoid using your index finger and thumb in the needle-holder's handles as this causes loss of control.
Keeping your finger and thumb in the handle holes while suturing restricts the mobility of your hand and arm. Use the palm grip for greater efficiency.
03.04.05.02 Mounting the Needle Incorrectly
Holding the needle too near its tip prevents you from taking a satisfactory bite because the needle holder's jaws will get in the way.
Holding it too near the swaged end may cause the needle to buckle or snap.
03.04.05.03 Damaging the Needle
When suturing, do not catch the emerging needle by the point with your needle holder. This will damage the needle.
03.04.05.04 Confusion with Artery Forceps
Needle holders and artery forceps look superficially similar, but it is vital that you don't confuse them. The handles or jaws of either may be curved or straight, but the crucial difference lies in the structure of the jaws.
A needle holder has short powerful jaws which should never be used to grasp tissue. The crushing action of the jaws will cause serious damage.
The artery forceps' jaws are long in relation to the handles and have parallel grooves cut in their surface. This allows them to grasp tissue without damaging it.