One-Handed Knots

I’ve been doing a lot of procedures lately and I’ve been thinking about how we tie knots. Strange thing to think about, but we do it a lot. Most of the procedures that we do in the ICU require some suturing (chest tubes, arterial lines, central lines) and suture needs to be tied.

Now, most ICU providers who aren’t surgeons probably use an instrument tie for this. And it works fine. But I did a few surgical rotations in school and first assisted on lots of different cases. So the surgeons and surgical PAs taught me their ways. So the one that I use most often is the one-handed knot.

Once you get facile with it, it’s faster than an instrument tie. It also allows you to have a hand (somewhat) free for other things. I particularly like it when I’m putting in a line that I’d like to keep a finger on until that suture is good and secured. And – I think – it makes you look like you have some special skill.

There are lots of good instructional videos out there, but I really like this one from Rishi Kumar. He’s an intensivist (and a good follow in general, BTW) so he approaches this from that perspective. In this video, he walks you through the technique and explains why, as an intensivist, he uses the one-handed knot. (We have mostly the same reasons, so that probably biases me a little as well, haha!) Like him, I also prefer to tie left-handed, even though I’m right-handed. I don’t really know why, I guess that’s how I learned and it’s all muscle memory at this point. It probably is worth practicing with both hands and being ambidextrous with the technique.

You can get a knot tying board like he uses, or just get some extra suture (or regular old thread) and practice on anything. I like his steering wheel suggestion. I used to practice by sewing up rips and tears in my kids’ stuffed animals. Now that we have a puppy, there is ample opportunity to practice on her toys when she loves them too much! I also recommend wearing gloves when you practice because the feel is slightly different. But, please don’t wet your hand (like he suggests) if you’re practicing on your steering wheel in traffic!

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