{"id":1404,"date":"2010-12-05T10:46:34","date_gmt":"2010-12-05T10:46:34","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/instrumental-knots\/"},"modified":"2023-11-13T10:48:50","modified_gmt":"2023-11-13T10:48:50","slug":"instrumental-knots","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/minor-surgery\/skills\/instrumental-knots\/","title":{"rendered":"Instrumental Knots"},"content":{"rendered":"<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Introduction<\/strong><\/span><\/h3>\n<p><span style=\"color: #003366;\">Basic principles for tying <span style=\"color: #33cccc;\"><strong>instrumental knots<\/strong><\/span> with the aid of a <span style=\"color: #33cccc;\"><strong>needle holde<\/strong><\/span>r:<\/span><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Multiple sutures are tied with the same thread.<\/span><\/li>\n<li><span style=\"color: #003366;\">Each stitch requires a surgical knot and two single knots.<\/span><\/li>\n<li><span style=\"color: #003366;\">Two threads of considerably different lengths are tied together.<\/span><\/li>\n<\/ul>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<p><span style=\"color: #003366;\"><em><strong>Instrumental Knotting<\/strong><\/em><\/span><\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/124602755?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\"><\/iframe><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><em><strong>Instrumental Knotting: Atraumatic Thread<\/strong><\/em><\/span><\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/124602758?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\"><\/iframe><\/p>\n<hr \/>\n<p><strong><span style=\"color: #003366;\">Tie a surgical knot as follows: <\/span><\/strong><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Hold the needle between the left thumb and forefinger <em><strong>[Figure 60]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Hold the needle holder in the right hand with the jaws pointing left.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1389\" style=\"margin: 10px auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-60.jpg\" alt=\"\" width=\"300\" height=\"225\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-60.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-60-300x225.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 60<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><strong><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1390\" style=\"margin: 10px auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-61.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-61.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-61-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><span style=\"width: 300px; display: block;\">Figure 61<\/span><\/span><\/strong><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Place the needle guide against the thread <em><strong>[Figure 61]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">With the left hand, pass the long thread around the jaws of the needle holder twice, moving the thread away from you <em><strong>[Figure 62]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"margin-top: 10px; margin-bottom: 10px; display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1391\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-62.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-62.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-62-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 62<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Open the jaws of the needle holder and use them to grip the end of the short thread <em><strong>[Figure 63]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"margin: 10px 0px; display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1392\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-63.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-63.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-63-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 63<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Let the double loop around the jaw of the needle holder, slip off and pull the thread tight<em><strong> [Figures 64, 65]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">The needle holder moves toward you.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><strong><span class=\"jce_caption\" style=\"margin-top: 10px; margin-bottom: 10px; display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1393\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-64.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-64.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-64-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><span style=\"width: 300px; display: block;\">Figure 64<\/span><\/span><\/strong><\/p>\n<hr \/>\n<p><strong><span class=\"jce_caption\" style=\"margin-top: 10px; margin-bottom: 10px; display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1394\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-65.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-65.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-65-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><span style=\"width: 300px; display: block;\">Figure 65<\/span><\/span><\/strong><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Open the needle holder to release the short thread.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><strong><span style=\"color: #003366;\">Tie a single knot on top of the previous knot:<\/span><\/strong><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Place the needle holder under the thread<em><strong> [Figure 66]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"margin-top: 10px; margin-bottom: 10px; display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1395\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-66.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-66.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-66-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 66<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Loop the long thread around the needle holder once<em><strong> [Figure 67]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"margin-top: 10px; margin-bottom: 10px; display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1396\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-67.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-67.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-67-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 67<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Open the jaw of the needle holder and use it to grip the end of the short thread <em><strong>[Figure 68]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"margin-top: 10px; margin-bottom: 10px; display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1397\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-68.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-68.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-68-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 68<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Let the single loop slide off the jaws of the needle holder and pull the thread tight <em><strong>[Figures 69, 70]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">The needle holder moves away from you.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"margin-top: 10px; margin-bottom: 10px; display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1398\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-69.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-69.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-69-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 69<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"margin-top: 10px; margin-bottom: 10px; display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1399\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-70.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-70.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-70-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 70<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Open the needle holder to release the short thread.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><strong><span style=\"color: #003366;\">Tie a single knot on the top of the previous knot in the opposite direction:<\/span><\/strong><\/p>\n<ul>\n<li><span style=\"color: #003366;\">Place the needle holder against the thread <em><strong>[Figure 71]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><strong><span class=\"jce_caption\" style=\"margin-top: 10px; margin-bottom: 10px; display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1400\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-71.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-71.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-71-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><span style=\"width: 300px; display: block;\">Figure 71<\/span><\/span><\/strong><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Loop the long thread over the needle holder once, moving the thread away from you <em><strong>[Figure 72]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Open the jaw of the needle holder and use it to grip the end of the short thread <em><strong>[Figure 72]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"margin-top: 10px; margin-bottom: 10px; display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1401\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-72.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-72.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-72-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 72<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Let the single loop around the jaw of the needle holder slide off and pull the thread tight <em><strong>[Figures 73, 74]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">The needle holder moves toward you.<\/span><\/li>\n<li><span style=\"color: #003366;\">Open the needle holder to release the short thread.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"margin-top: 10px; margin-bottom: 10px; display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1402\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-73.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-73.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-73-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 73<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"margin-top: 10px; margin-bottom: 10px; display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1403\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-74.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-74.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/MinorSurgery_ms-fig-74-300x200.jpg 300w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><strong><span style=\"width: 300px; display: block;\">Figure 74<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Cut both threads simultaneously 1 cm from the knot.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Introduction Basic principles for tying instrumental knots with the aid of a needle holder: Multiple sutures are tied with the same thread. Each stitch requires a surgical knot and two single knots. Two threads of considerably different lengths are tied together. Procedure Instrumental Knotting Instrumental Knotting: Atraumatic Thread Tie a surgical knot as follows: Hold [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[76],"tags":[146],"class_list":["post-1404","post","type-post","status-publish","format-standard","hentry","category-skills","tag-minor-surgery"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Instrumental Knots - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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