Knot tying as a medical student?

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CuriousGeorge2

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Hello,

I am starting my surgery rotation next week and am pretty sure I want to go into some type of surgery. I'd like to make a good impression so I was planning on learning basic knot tying before it starts. At this point all I know is how to do an instrument tie. I got an ethicon knot tying board and booklet and there are a bunch of different knots in here. I was wondering which one's would be good to know as a medical student?

Also, is there a good surface to practice suturing on? I have been using a sponge but it's not so great.

I am also open to any other tips for excelling on this rotation :) !

Thanks in advance,
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Knot tying - I would practice your instrument ties and two-hand tying the most. The surgeons I was with wouldn't allow me to one-hand tie. In all honesty, I instrument tied about 95% of the time though.

Surfaces - Get a chicken breast and suture that up. You can also go to the meat counter and ask about pigs feet - that works too. If you don't want to work with meat, try a banana - heard that works pretty well too.
 
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Instrument tie and two-hand tie.

Make sure you have a really good sense for the length of a centimeter (when they ask you to cut).

I like pigs feet for practicing closing on skin. Chicken skin is just not the same.

Practice with dental floss or something thin. Once you have the knots down, ditch the thick Ethicon rope and work on developing your muscle memory for tying. Practice two hand tieing as though there was a needle on one of the ends. Switch hands.
 
Everyone will be happiest if you just two-hand tie.

Depending on the situation, instrument-tying will look like you don't know how to tie by hand, and the one-hand tie is usually reserved for when they know you can two-hand tie.

Make sure you can tell when a knot is lying flat and square, and when you're just throwing down half-hitches. This will all be easier if you actually ask someone who knows what they're doing to show you sometime.

coffeebeanjenn said:
Practice two hand tieing as though there was a needle on one of the ends. Switch hands.
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This too.
 
also make sure to steal some sterile gloves from the hospital to practice with, it's a completely different feel than w/o gloves on. And practice opening/closing and manipulating the needle driver w/o putting your fingers through the finger holes.
 
Don't steal the gloves. Ask the OR nurses if they have any to spare, because if they get touched while someone's opening them, then they're "contaminated" but not at all dirty.
 
CuriousGeorge2 said:
Hello,

I am starting my surgery rotation next week and am pretty sure I want to go into some type of surgery. I'd like to make a good impression so I was planning on learning basic knot tying before it starts. At this point all I know is how to do an instrument tie. I got an ethicon knot tying board and booklet and there are a bunch of different knots in here. I was wondering which one's would be good to know as a medical student?

Also, is there a good surface to practice suturing on? I have been using a sponge but it's not so great.

I am also open to any other tips for excelling on this rotation :) !

Thanks in advance,
Click to expand...

One non-surgeon med student's opinion:

1. Things to know: when you actually want to use a surgeon's knot; instrument and two-handed ties; one-handed ties in your spare time, especially since it seems like people generally don't let students do one-hand ties. I can count the number of times I was allowed to do this in the OR; your mileage may vary. Couldn't hurt getting familiar with two-layer dermal closures (you'll hear "deep superficial, superficial deep" a lot), running subcuticular stitches, etc. Vertical and horizontal mattress stitches, probably not so much, but good to know.

2. Stuff to suture on: might as well go for pig's feet, I guess.

3. Things in general: it's surgery. It's polarizing for med students -- fairly long hours compared to other rotations except ob/gyn, which is its rough equal, and has a higher than usual concentration of malignant personalities. Don't be offended if someone gets pissy in the OR and takes it out on you because someone lit the fuse on their tampon that morning. Make friends with the OR staff, especially the scrub tech, and especially especially if she seems like a somewhat haggard one who has weathered lots of medical students and will not have you ****ing with her ecosystem. Read up on cases.

You'll get the hang of it. :thumbup:
 
turkeyjerky said:
also make sure to steal some sterile gloves from the hospital to practice with, it's a completely different feel than w/o gloves on. And practice opening/closing and manipulating the needle driver w/o putting your fingers through the finger holes.
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Why the heck do they put the finger holes in them even? I mean I know why, it helps you avoid dropping them while passing it... I guess.
 
badasshairday said:
Why the heck do they put the finger holes in them even? I mean I know why, it helps you avoid dropping them while passing it... I guess.
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Some people palm it, some people don't. Kind of depends on what move I'm doing.
 
TheProwler said:
Some people palm it, some people don't. Kind of depends on what move I'm doing.
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I see. I'm a novice so I still put my fingers through the holes. I try not doing it, but then I go even slower. It looks really slick though doing it without using the holes. Plus it is so much faster if you know what you are doing.
 
badasshairday said:
I see. I'm a novice so I still put my fingers through the holes. I try not doing it, but then I go even slower. It looks really slick though doing it without using the holes. Plus it is so much faster if you know what you are doing.
Click to expand...

If you're going to palm it, you need to be able to do it well. If you look clumsy, you're going to get yelled at. And you certainly should not "walk" your fingers in and out of the holes. If you palm it, you need to be able to open/close the driver smoothly with it in your palm. Some attendings will also not like it if you palm (and this isn't just a med student thing...I have a few attendings that get irritated when residents do it).

As the Prowler said, it ultimately depends on the move. I actually went back to using the fingers for some things, especially when it's a fine movement and/or sewing in a hole. Palming is good for things where you need a lot of wrist movement or speed.
 
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Maybe I'm an idiot, but why wouldn't they let you do one-handed ties? Those were the only ones I did on surgery. Now, I'm no knot tying guru and I haven't given it a whole bunch of thought, but once I learned a one-handed knot the two-handed knot seemed kind of pointless, not to mention less efficient.
 
^^ Agree. I actually got asked, "Wait, do you not know how to tie one-handed??" by a neurosurgery resident.
 
I've had good success with one handed and not been scolded by attendings (knock on wood). However, some residents have give me a heads up that until you get good at one handed, some attendings don't like students to one hand because its hard to judge tension so you can end up ripping through tissue especially if its delicate.
 
(1) Keeping your fingers in the needle-driver holes is helpful when you're sewing in a deep hole, as it keeps your hand out of the wound.
(2) Attendings don't like it when you tie one-handed if you don't understand how to throw a square knot or if you keep throwing air knots.
 
I always tie one handed, and I think that if you have practiced it that way and do it well, then they won't stop you. I have only had someone request I tie two handed once, and it was on transplant, and this attending made the PGY2 tie two handed also. I'm not even good with two handed ties anymore, because I never do it. Unless your using silk ties in the OR it is not a skill that really comes in handy. It's very awkward to do a two hand tie with a needle/needle-driver attached at one end.

I think the keys are: don't make a big deal about it, when they ask if you can tie/suture/do-anything-at-all, if you have experience with it just say yes and then do it the way you are most comfortable. If they don't like it, they will correct you. And they are aware that people do things differently, so they might say "you did that well, but I prefer this technique" just learn how to do it their way, because it's good experience. Fill up your toolbox.
 
Buzz Me said:
I always use a two-handed tie when securing the #1 PDS during fascial closure.
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I always use a two-handed tie when I'm doing a double throw for a surgeon's knot. And I almost always use the two-handed tie when I'm operating with the people who think you should always use a two-handed tie ;)
 
I'm only a first year, but before med school I was first assist for a surgeon. He would never let students one- hand tie. He always said to master two- hand tie first then one- hand tie!
 
Buzz Me said:
Yeah, it always looks bad when students tie one-handed, but then struggle when asked to tie two-handed.
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personally I never understood the fascination with never letting students one-hand tie. Is it because it is more difficult for residents and attendings to observe the technique?

Regardless if you can one-hand tie you better be able to two-hand tie.
 
duckie99 said:
personally I never understood the fascination with never letting students one-hand tie. Is it because it is more difficult for residents and attendings to observe the technique?

Regardless if you can one-hand tie you better be able to two-hand tie.
Click to expand...


Personally I think one- hand tie is harder.
 
I don't know...I can sit there and do one-handed ties with both hands while talking to people all day, but the two-handed requires me to watch my hands and concentrate.

You should learn both. More to appease the personal preference of who you are with than specific needs, at least as a medical student.

I watched videos on youtube, but once you get the motion in your hands and do it for a night, it is pretty easy. I carried around packets of suture but have also used fishing line and string from a crafts store. The one hand tie is basically what kids do at summer camp when making bracelets.

I'd just suture whatever material you can find. Chicken breast works well, but I've found pig feet/tails, fruit skins and cloth to all be good at learning how to gauge the force and curve of the needle.

Oh, whenever anyone says, "I'm pretty sure I'm going into ______", the chances they change their mind double. You still need to learn how to suture for other specialties...just not to the point of it being second nature or being able to jog backwards while eating a sandwich.
 
mostly, i get to do subcuticular closures, and almost never any of the other techniques
 
I only do one-hand ties and instrument ties. I don't think I remember how to do 2-hand ties. But in EM, you don't need to. When in Rome, though...
 
on my surgery rotation, I was first asked to do an instrument tie, then two hand, and then one hand tie. I am a lefty so my knot tying technique was different than the attending though my knots all came down square. He was pissed at the beginning but let it fly after watching me carefully haha. No residents on my either surgery rotations so I got to do a **** ton.

P.S its a bitch being a lefty in the OR, surgery world is not made for lefties
 
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I honestly thought this thread was about someone asking about getting married :)
 
TheProwler said:
It's not that bad.
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yeah but you definitely get teased by the scrub techs and the attending in the beginning until they know you. Happened to me on both rotations.
 
duckie99 said:
personally I never understood the fascination with never letting students one-hand tie. Is it because it is more difficult for residents and attendings to observe the technique?

Regardless if you can one-hand tie you better be able to two-hand tie.
Click to expand...

I've been told by surgeons that they find two handed provides a more secure (not necessarily stronger) knot than one handed. Like many things in surgery, who knows if its true or if it is lore/anecdotal?
 
But when you pull each side after a one-handed tie, isn't it supposed to convert it to the square?

I can see how it feels more secure when you are throwing it, but I think a lot of it just hinges on individual preferences and programs. The ob/gyn people all do subcuticular with a Keith needle. It just seemed like one of those quirky program specific things. (Yea, I know some don't consider them surgeons but some of the bigger pelvic surgeries are pretty complex)
 
duckie99 said:
personally I never understood the fascination with never letting students one-hand tie. Is it because it is more difficult for residents and attendings to observe the technique?
Click to expand...


this is my understanding.
 
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