(About Needle Holders)
Instrument usage: Needle holders are used to grasp and hold suture needles.1 They can look similar to a clamp, with a ring handle and locking ratchet.1 Because this type of instrument grasps a metal suture needle and not tissue, it is damaged often and requires repairs and replacement.2 It is vital that the needle holder is used only for its intended purpose and that it is in working order, able to firmly grab the suture needle.2
Key differences:
The length of needle holders vary depending on whether they are needed superficially or deep in the body cavity. The jaws of the needle holder also vary and are designed for specific needs.2 Standard needle holder jaws have a longitudinal groove that releases tension and prevents the needle holder from moving or denting the needle.2 Diamond jaw needle holders have tungsten carbide in the jaw so that the needle does not rotate or move.2 The jaws can be straight, curved, or angled.1
Some needle holders, such as the Westcott, do not have a ratchet and instead have a spring action that can lock or be non-locking.
Safety on the sterile field:
The size of the needle holder should match the size of the needle—a large needle requires a large needle holder and a small fine needle requires a small fine tip needle holder, such as a vascular needle holder.1
When loading a suture needle onto a needle holder, the “no-touch technique” should be used whereby the needle is not handled with gloved hands.2
When pulling the suture out of the packet, the scrub personnel should grab the needle with the needle holder and gently pull from the packet.2
The needle holder should be positioned approximately two thirds from the tip of the needle unless the surgeon requests a different position.
When passing a needle holder, a neutral zone or hands-free technique should be used.3
When passing a needle holder with a suture on it, a forceps should also be passed because it will be used simultaneously with the needle holder. Then a suture scissor should be ready to be passed to cut the suture.
Instrument names:
Needle holders are commonly called for by their length, such as “long needle holder,” “medium needle holder,” or “short needle holder.” Sometimes the first name of the needle holder can be used, such as “Webster” for a Webster needle holder.
Sometimes the surgeon will use a hand signal, motioning with an upward movement like suturing, to indicate the need for a needle holder.
References:
1. Phillips, Nancymarie. Berry & Kohn's operating room technique. Elsevier Health Sciences, 2016.
2. Rothrock, Jane C. Alexander's Care of the Patient in Surgery-E-Book. Elsevier Health Sciences, 2018.
3. Guidelines for Perioperative Practice. Sharps Safety. AORN, Inc, Denver, CO; 2021