How to load and hold a suture needle

This guide is an excerpt from our complete online suturing course. The suture pad and kit used in the images and video is our corresponding suture practice kit. Click the links below to learn more: 


So you are learning how to suture. You've come to the right place. My name is Dr. David Naysmith. I am a plastic surgeon and professor in Canada. 

This short guide will answer a few questions: 

  • How is the needle constructed 
  • How to load suture needle with needle driver 
  • How to hold the suture needle 
  • Where to hold the suture needle 

How is the suture needle constructed? 

This is a great question and one that should be answered early, as knowing how the suture needle is constructed and how to use it will diminish your frustration significantly. 

Figure 1

Most needles used for suturing are curved – some short, some long, some sharp point, some cutting point. 

Almost all sutures are now swaged onto the needle. That means the suture material fits smoothly into the non-working end of the needle. The swaged end is round. The remainder of the needle, the body, is flat. 

The eyed needle is the other kind, but these went out with the Dodo bird. 

Why is this important? If you place the needle driver jaws on the round part of the needle one of two, or possibly both will happen: the needle will rotate in the jaws of the driver – this is very frustrating.

Figure 2

Figure 3

Place the jaws on the swaged bit of the needle and push it with your finger – it rotates. (See figures 2 and 3)

The other thing that can and will happen is that you will bend the needle when driving it through tissue equally frustrating and poor form. 

Figure 4

How do you load the suture needle? 

It all starts with the suture packaging. 

Figure 5

To open the suture and keep it sterile, grab the “wings” on the end of the package and pull them apart to expose the suture in its holder.

Figure 6

Note the placement of the needle in the package. This is not coincidence.

The needle is positioned so you can pick it up with the driver and grasp it on the flat of the needle just below the round swaged bit.

Where to hold the suture needle

This is what I call the 2/3 : 1/3 rule

2/3s of the needle is available to go through tissue and the needle will not rotate or bend (unless you are very rough with it). 

Figure 7

Figure 8

By the way, why don’t we grab it closer to the working end?

Because there isn’t enough needle sticking out when you place it in tissue and you can’t find the needle to pull it through! This is really frustrating. 

Figure 9

And that's it! That's how you load a suture needle with needle drivers and how and where to hold the needle. 

If you want to learn more, consider purchasing our suture practice kit & course. 

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