How to put needle in needle holder: grip, angle and ratchet

Before you start: the right holder and needle

Match the needle holder to the needle. Heavier holders such as the Mayo-Hegar pattern suit medium and large needles, while finer needles need a finer holder. Using a heavy holder on a delicate needle can crush or bend it. See Mayo-Hegar needle holders for typical use.

Check that the jaws are clean and in good condition. Worn or dirty jaws lose grip and allow the needle to rotate, which is a frequent cause of frustration.

Handle the needle only with the instrument, never with fingers, to reduce the risk of injury.

Practise first on a training pad or suture board with a spare needle. Muscle memory built outside the theatre makes handling smoother when it counts.

Where to grasp the needle

Grasp the needle with the tip of the jaws, roughly a third to a half of the distance from the swage (where the suture is attached) toward the point. Avoid grasping directly on the swage, which can weaken it, and avoid gripping too close to the point, which can damage the tip.

Position the needle at right angles to the holder in the plane of curvature, so that the needle's arc follows the movement of the wrist. The curve should sweep through the tissue without twisting.

• Jaw tip, not the root of the jaws
• About a third to a half back from the swage
• At a right angle to the holder

Closing the ratchet

Close the ratchet by squeezing the rings until the first or second tooth engages. One or two clicks usually suffice; over-closing puts unnecessary stress on the needle and the jaws. TC inserts hold the needle firmly even at a lighter lock.

To open, ease the rings together slightly then separate them, using a small outward movement of the thumb. Practise this smoothly so you can release the needle without jerking the instrument.

Our guide on holding surgical instruments shows the correct finger positions.

Common errors and how to avoid them

Typical errors include gripping too far back so the needle sticks out too little, loading at an angle that makes the curve fight the wrist, leaving the ratchet fully locked for long periods and using a worn holder. Each of these leads to bent needles or inconsistent bites.

If the needle slips, do not squeeze harder. Stop, reposition and check the jaws, because slipping usually signals wear or a mismatch between needle and holder.

Also avoid regripping the needle in mid-pass more than necessary. Each regrip adds a chance of slipping and prolongs the step.

Choosing and maintaining needle holders

Choose holders that fit the needle sizes you use, and inspect the jaws regularly. REDA's needle holder range covers Mayo-Hegar, Olsen-Hegar, Crile-Wood, Ryder, Webster, DeBakey and micro patterns, many with TC jaws.

Avoid mixing up needle holders and haemostats on the tray, because haemostat jaws are not designed to hold needles. Read needle holder versus hemostat for the difference.

Beckfinity can provide needle holders for training sets and for your theatres. Contact our team for a quotation.