advice on cutting sutures?

[beep]

hi there.

i am looking for some advice on something pretty basic. i am on surgery and am having a lot of trouble cutting sutures with suture scissors (when someone else is suturing) in the or. i have a disability that keeps me from using my right hand to cut and also means that i am often positioned such that i must cross over my chest with my left arm when i cut. i get the scissors there and end up "sawing" on the suture usually. it is exasperating to my attendings. i've tried a backhand approach but that didn't work well. i keep the screw down and try for a 45 degree angle. anyone have any thoughts for me?

thanks!
beep

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[ericdamiansean]

I can't imagine how you are cutting it, but make sure you're cutting with the right portion of the scissors.

Try buying a cheap pair of suturing scissors and practice

 

[dilated]

I've actually had this problem once or twice and I have no idea why. It's especially annoying when trying to cut prolene with bloody scissors, it just kind of slips instead of cutting properly. Make sure it's clean, then blame the instrument if you must. 😛

 

[ericdamiansean]

I've actually had this problem once or twice and I have no idea why. It's especially annoying when trying to cut prolene with bloody scissors, it just kind of slips instead of cutting properly. Make sure it's clean, then blame the instrument if you must. 😛

Why don't you try cutting with the inner part of the scissors instead? It's usually sharper and transmits better force

 

[fakin' the funk]

When I was on OB, I had this problem sometimes. They told me that the scissors were "handed" (which blew my mind) and if I was gonna cut with my left hand I should pronate instead of supinate (or somesuch). It worked...sometimes...I think.

Good advice eh?

 

[Tired]

Why don't you try cutting with the inner part of the scissors instead? It's usually sharper and transmits better force

Because then you get yelled at. Extension of the scissor tips beyond the suture risks cutting tissue, which is never a good thing. Stick to the tips, even though it's harder.

 

[OnMyWayThere]

I was having this problem as well and would always blame the scissors but then I'd watch the attendings cut without a problem. Finally an attending told me to turn the scissors to the side right before I cut ... works like MAGIC. Go at it as you do and then turn the scissors 30 degrees to the side. Also, use the tip of the scissors as attendings tend to dislike going in further than a couple centimeters.

 

[LurkNoMore]

it is the pair of scissors fault... at least twice on surgery I was scolded for not cutting correctly, then when the resident or attending tried to use the scissors they were like "these are crap" and had the scrub nurse pull a new pair... I mean, I dont think they always sharpen them after surgery, just clean them up and put them back in the set. Just yesterday at the VA we were sewing up this old guys arm and the nurse got all pissy b/c I was cutting prolene with skin scissors (little tiny ones) b/c the suture scissors were sucking it up.... so I stopped, then the attending noticed the trouble we were having with the suture scissors, and was like... why don't you use those other ones, of course, at this point, miss unable to be fired finally offered to pull a pair of mayos for us, making cutting so much better.... 😍 VA support staff. It may help you to steady your left hand with your right hand underneath it (like they show in surgical recall), unless your condition limits your right arm to the point that this is impossible as well... good luck!

p.s. as far as bloody scissors, the scrub nurse will sometimes clean them up by cutting gauze (or some other thing... not sure what it is) cleans'em up niice.

 

[Dr JPH]

Push your thumb away and pull your fingers towards you.

This approximates the blades while you close them.

 

[Medstudentquest]

When I was on OB, I had this problem sometimes. They told me that the scissors were "handed" (which blew my mind) and if I was gonna cut with my left hand I should pronate instead of supinate (or somesuch). It worked...sometimes...I think.

Good advice eh?

Your problem was OB! Sorry I just couldn't resist. 🙂 Good advice indeed!

 

[MSmentor005]

Yes, turn the scissors to the side as you cut while pulling your fingers as JP described. Interestingly, an attending once told me, "think about what you're cutting, and cut". Sounds insulting but it actually works and I have used it in a pinch (zen suture cutting, I guess )

 

[beep]

Thank you all for the good advice.

 

[Pegsie]

I've found that putting adequate tension on the suture (i.e., pulling the suture like 0.5 cm to the side) and then supinating helps.

 

[cdql]

I've had similar issues. Be sure to cut with the tips, and approach the site you want to cut with your thumb in one circle of the scissor and your middle finger in the other. Your index finger should be hovering above the top of the screw that holds the scissor together.

Approach the site with your index finger on top so that your scissor is horizontal. As you prepare to cut, rotate the scissor into a vertical position, be sure you are cutting with the tips, and actually make the cut (mixing all 3 motions at once)

That'll help from looking stupid and continually "gnawing" away when the attendings/residents ask you to cut for them.

They love to joke that they handed you a pair of "med student scissors" aka scissors that can't do anything right.