Impressing the scrub nurse

BACKGROUND

Correct handling and manipulation of a needle is not only a basic surgical skill and principle but it is also an important component of theatre etiquette as well as surgical safety. Scrub nurses are vital to safe and successful surgery. The surgeon and the scrub nurse should have a mutual respect for one another. It is the scrub nurse's duty to hand the surgeon the correct needle on the correct suture on the correct needle holder. Similarly, it is the surgeon's responsibility to hand back the needle and suture in a safe manner as demonstrated below. Junior surgical trainees in particular would benefit from getting into good habits early in their surgical careers.

TECHNIQUE

Traditionally, the suture is handed back to the scrub nurse as soon as the final throw has been placed, the suture has been cut and the needle remounted. Often, little attention is paid to how the needle is mounted when being handed back to the scrub nurse, which can potentially cause needle-stick injuries.^1–3 Needle-stick injuries are an occupational hazard; however, they can be minimised by simple and safe measures as shown below. This technique involves reverse mounting the needle in the jaws of the needle holder thereby preventing exposure of the sharp needle tip which could leave the surgeon, scrub nurse or patient's skin prone to inadvertent injury.

DISCUSSION

This technique is now standard surgical practice for the first author after the senior author introduced this concept when operating together. He had picked it up 20 years before from a New Zealand cardiac surgeon. We advocate this simple and easily replicable technique as a key step in handling needles. It has been reported recently in the dermatological literature,⁴ but we feel that it illustrates a simple, yet important, message and it is likely to have escaped the attention of most surgeons. This is not only safe surgical practice but leads to better working relations with theatre staff who are crucial to the practice of surgery and can help to reduce adverse incidents.^1–4

Figure 1.

The exposed sharpmounted on the needle holder as it is usually passed from surgeon to scrub nurse.

Figure 2.

The needle re-mounted with the tip securely locked in the jaws of the needle holder together with the swage thereby making it impossible to suffer a sharps injury from the tip.