Two-hand Tie, anyone?

[71263]

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Does anyone have any tips for doing a two hand tie, or know of any sites or resources that can teach me how to suture a bit better? Right now Im still learning, and Id rather slip up and look like an idiot now, while Im on OB, then mess up when I do surgery, which Im actually seriously considering. Any ideas?

 

[subtle1epiphany]

Does anyone have any tips for doing a two hand tie, or know of any sites or resources that can teach me how to suture a bit better? Right now Im still learning, and Id rather slip up and look like an idiot now, while Im on OB, then mess up when I do surgery, which Im actually seriously considering. Any ideas?

http://www.bumc.bu.edu/Dept/Content.aspx?DepartmentID=69&PageID=6067
http://cal.vet.upenn.edu/projects/surgery/5000.htm

It thought these two sites were awesome and I used them to get the basics down. Hope they help.

 

[mules05]

I believe Ethicon (ethicon.com, maybe?) offers a practice kit, which includes an instruction booklet. I inherited mine from a friend a year ahead of me, though, so I don't know if it still exists. Once you get the basic hand motions down, either via websites, instruction manuals, or having a friend teach you, the best way to get good is to pick up some ties and practice during any down time. I did this and after 2-3 weeks felt confident with both the 2-hand and 1-handed knot.

 

[cyclohexanol]

http://www.bumc.bu.edu/Dept/Content.aspx?DepartmentID=69&PageID=6067
http://cal.vet.upenn.edu/projects/surgery/5000.htm

It thought these two sites were awesome and I used them to get the basics down. Hope they help.

I have also used and recommend the upenn site linked by the previous poster. 👍
I haven't seen the bumc site, thanks for the link!

 

[AwesomO]

The best thing you could do is get some practice in. What I did was buy a bunch of discount dental floss at the store and practiced my two hand tie on anything with a handle.

 

[manleyjb]

This one is pretty good also



http://www.vet.purdue.edu/vcs511/

 

[primadonna22274]

Here's a weird tip: once you figure out how to throw the knots, just see which hand feels right. I'm right-handed in every other thing I do but I throw my knots left-handed. Always have. No idea why. I really didn't even realize it until my cardiothoracic surgery rotation when my PA preceptor pointed it out to me. Strange but it's always felt right.
Don't be afraid to seek out the PAs on the wards/in the OR. They do a lot of sewing and will usually be happy to give you some pointers if you ask nicely.
😉

 

[Blade28]

There are lots of ways to teach yourself - Ethicon, Surgical Recall, websites, etc. - but the best way is to ask an MS-IV or surgery resident to show you.

 

[Ashers]

There are lots of ways to teach yourself - Ethicon, Surgical Recall, websites, etc. - but the best way is to ask an MS-IV or surgery resident to show you.

I did that on OB/gyn... asked the OB chief, when the Gyn chief found out, she was like "Why didn't you teach yourself with the book first?!" And started telling me how I should've read the suture book, taught myself, then just asked a resident to make sure I was doing it right.

I had looked at the book, didn't follow what the pictures were demonstrating (I believe it was Ethicon), so I asked. Ugh.

 

[Top Gun]

I did that on OB/gyn... asked the OB chief, when the Gyn chief found out, she was like "Why didn't you teach yourself with the book first?!" And started telling me how I should've read the suture book, taught myself, then just asked a resident to make sure I was doing it right.

I had looked at the book, didn't follow what the pictures were demonstrating (I believe it was Ethicon), so I asked. Ugh.

Here's a tip. If you want to ask someone for help with learning sutures and ties, try going to someone lower down the hierarchy, like an MS IV or an intern. This woman probably thinks that because she is a chief resident, she is above teaching a lowly third-year med student how to tie.

 

[Ashers]

Here's a tip. If you want to ask someone for help with learning sutures and ties, try going to someone lower down the hierarchy, like an MS IV or an intern. This woman probably thinks that because she is a chief resident, she is above teaching a lowly third-year med student how to tie.

No, the OB chief was über cool, and she was the only one around, so I asked her (L&D board was really quiet, other residents were in surgery, or at their continuity clinics). Otherwise, I would've asked one of the PGY-2s. The Gyn chief was the one who had a cow that I asked ANYONE. The intern was the 2nd scariest person next to the gyn chief, and there were no M4s on the OB/gyn rotation or in that hospital. I'm not as stupid as my post made me sound -- there was a well thought out plan. 😉

 

[PeeWee137]

ethicon still makes those practice boards. google their website and email customer support. its free, and i got my board in a day. granted, on the practice board they use big fat rope instead of sutures, but it at least helps you to figure out how to make the knots.

 

[Blade28]

No, the OB chief was über cool, and she was the only one around, so I asked her (L&D board was really quiet, other residents were in surgery, or at their continuity clinics).

No one told you yet? NEVER say the dreaded "Q" word! 😱

 

[Ashers]

No one told you yet? NEVER say the dreaded "Q" word! 😱

Hey, I'm done with OB/gyn now, so using it in past tense is fine. I don't care if I curse the board now.

We were warned about saying all permutations of "the board is slow."

 

[Blade28]

Hey, I'm done with OB/gyn now, so using it in past tense is fine. I don't care if I curse the board now.

We were warned about saying all permutations of "the board is slow."

Ah yes, OB/GYN and their "board."

 

[71263]

Thanks for the resources guys! 🙂

It looks like I could use all the help I can get tho... jeez...

 

[primadonna22274]

OR ask the PA, as I suggested. They're more than likely going to be happy to help and have done more than their share of sewing 😉

Here's a tip. If you want to ask someone for help with learning sutures and ties, try going to someone lower down the hierarchy, like an MS IV or an intern. This woman probably thinks that because she is a chief resident, she is above teaching a lowly third-year med student how to tie.

 

[Buckeye(OH)]

May I also suggest:

1. Practice your two handed tie with an instrument in one hand
2. Practice tying with your non-dominant hand

 

[Cholinergic]

What knots, etc should you go into a surg rotation knowing? Instrument tie and two hand tie?

 

[Top Gun]

What knots, etc should you go into a surg rotation knowing? Instrument tie and two hand tie?

You should at least have mastered the instrument tie and two-hand tie by the time you're done with your surgery rotation. Knowing how to do a one-hand tie is the icing on the cake.

 

[Blade28]

Knowing how to do a one-hand tie is the icing on the cake.

...but never do the one-handed tie unless you're given the OK by a resident/attending.

 

[Thievery Corp.]

...but never do the one-handed tie unless you're given the OK by a resident/attending.

I would like to inquire as to why. I ask because I have surgery next, would like to do very well, and can do a one-handed tie...

 

[primadonna22274]

Yeah, why? We used to practice our one-handed ties during lecture in PA school, under the table of course...why ask the resident if we can do them? I don't get it. And yeah, I do those left-handed too. Dunno why.

I would like to inquire as to why. I ask because I have surgery next, would like to do very well, and can do a one-handed tie...

 

[Leforte]

Because you're supposed to know the two handed tie well before going on to a one-handed tie. At my med school, interns were not allowed to do one-handed ties. In my internship, no one cared, but I've seen many rotating interns who could throw one-handed ones well, but when it came time for a two handed tie, were all thumbs.

A good way of doing it would be to do some two-handed ties when asked to suture, and after several times, ask "hey I've been practicing my one-handed ties, too - could I try one here?" Most residents/attendings would give you the go if you've demonstrated proficiency in the more basic two-handed tie.

BTW, I too one-hand tie with my left hand because I drive the needle with my right hand, and it is useful with non-popable sutures so you can get two ties out of one suture. (if that sentence made any sense)

 

[Blade28]

Because many people who do one-handed ties can't do a proper two-handed square knot. And trust me, if you're quickly throwing down one-handed ties and then the attending asks you to do a two-handed tie...and you can't... 👎

Leforte gives great advice - ask to show your team a one-handed tie once you've shown you're proficient with two-handed ties.

I can one-hand tie with my left hand, albeit slowly. When using swedged-on needles I just transfer the needle-driver to my left hand and tie with my right - one extra step, I know. 🙂

Edit: to all the students here, make sure you're throwing square knots. Make sure, if you're using one-handed ties, you know if the attending likes the first two throws to be in the "same direction" to cinch down the knot.