Hi today, I’m going to be going over the difference between Palming a needle driver and holding a needle driver by putting our fingers through the holes in the instrument So just to clarify this is a needle driver It will look similar to another instrument that we use which is known as a hemostat a hemostat is basically used to clamp tissue when it’s bleeding or hold on to tissue and This is a hemostat when we open and close a hemostat It’ll be a more firmer Opening and closing of the instrument. This is a straight hemostat And we also have curved hemostats curved hemostats are also good when we are doing dissection as well This is your needle driver generally The tip of the needle driver will be a little bit thicker the serrations at the edge are more designed to hold a suture needle and When you open and close a mutable driver versus a hemostat, it’ll be easier The reason why I go over these two is in some cases at the bedside We may need to use a hemostat To perform a suturing technique over a needle driver because we don’t have a needle driver available to us in some circumstances So this is a needle driver right here the way you can hold a needle driver Especially if you’re a beginner You will put in your ring finger in one of the holes in your thumb in the other hole as such and then you will Generally guide the needle driver with your index finger or your pointer finger to go and drive the needle through the tissue The way you will open and close the needle driver is by applying pressure through your thumb by opening and closing So your thumb is applying the pressure to open and enclose the needle driver here in this scenario where your fingers are through the holes now a more advanced technique and the reason why we may use this technique is Palming the instrument where you’re actually driving the opening and closing of the needle driver with your thumb so as you can see here, my son my My palm is opening and closing the needle driver as such the reason why you may want to learn this Technique and this takes some practice and you shouldn’t be practicing on patience with this technique is that you have much more control over the direction that you angle your hand to drive the needle so you can go like this you can go like that and then in some cases when you’re at the bedside It’s pretty difficult to Position the patient in a way where you can just drive the needle right through so this is palming the instrument so I’m going to show you both techniques for driving the Suture needle through tissue the first time I’m going to use this technique where the fingers are through the holes I’m going to use my four step that I hold like a pencil Generally, I will use either my index finger and thumb with a forceps and sometimes my middle finger will go like this This is how I will hold it. I will pick up the needle this is AO silk suture on a CT one needle I will generally position the needle Driver right in the middle of the needle at a ninety degree or perpendicular angle to my needle driver this is the basic way to load a Needle on a needle driver. There are more advanced techniques and you will learn other ones, especially if you’re in surgical training but if you are a beginner or just doing bedside procedures and You are not surgical base, but you are doing a lot of bedside procedures. Maybe you’re family medicine or any others you will generally want to load it like this and this is how you will hold a Needle driver when you are putting your fingers through the hole now watch my index finger and watch my wrist my wrist Is what will drive the needle? Through the tissue a lot of mistakes people do when they initially learn how to suture is that they will just go like that and That is not how you do it you want to drive the needle in and pronate or Supinate, excuse me your wrist. So you’re turning it. Now. Sometimes your your needle driver will be loaded in and You will be too close to the tissue like I am here and I can’t drive it anymore so I will let go and you can see that the suture stays in the tissue and Then you will go to the back load now If I back-loaded this needle initially I would have bent the needle and then I will drive the needle through Here and I will drive it out of the tissue there. So here you can see that I Haven’t even used my forceps here now. Sometimes you will grab the forceps you will use the forceps to grab the needle as it comes out and then you will try to get it to come out like this the best way is to grab the needle on the other side and then continue your super natori motion continue to move your wrist and bring it out of the tissue and then bring it up as such and you will continue to bring it up sometimes when you’re when your Suture is pretty long. You may have to use your hands to bring it a little bit further out That was with my fingers through the holes. Now. I’m going to go ahead and use it in the By palming the instrument. So now I’m going to use the palming technique the plumbing technique is also kind of cool because it just looks cool that you can just you know, kind of flip the instrument and People will say oh wow. That’s a great great surgeon right there because they know how to Palm the instrument. So then I Will go ahead and load my needle again And You can see here. I’ve actually loaded my needle not exactly at a perpendicular angle but I’ve actually loaded it a little bit further away from me and this actually allows you to have a perfectly If you go like this, it will actually allow you to have a perfectly driven needle that comes right through the tissue and then here notice how I Opened it with my palm. I grabbed it back I’m still palming the instrument and I’m using the back of the needle to push it through then I’m kind of bringing it around and then You know what you can actually do is load your needle even for your next suture This is the best way if we’re running a running suture, I’ll just close it bring it up And then I’m ready for my next suture This is a pretty Advanced way of suturing it’s an advanced technique. It’s a little bit more challenging. I’m not going to go over all of the other nuances to suturing but that’s palming the instrument so and and it’s already loaded and so if this tissue Was at an angle And I’ll just even get rid of the the needle driver so let’s just go ahead and say that the tissue was at an angle My wound is at an angle. It’s pretty hard to do it with my fingers in the holes and and get this done But if I have this and then I can bring my finger even higher to the head. I have an easier time You can see here have an easier time of just manipulating The needle driver and you can also Bring it through the tissue a lot easier Like that so that’s that’s it for this video edition. Thanks for joining us and good luck out there on the field

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