Simple Running Demonstration


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    00:04 A simple running technique is probably the fastest running technique that there is.

    00:09 It's just a simple spiral binding of the wound, quite honestly.

    00:13 But that said, there's a couple of ways to do it.

    00:15 And I'd like to show you a couple of the techniques that you'll find will work pretty well.

    00:18 So there are some rules when you have a running technique as opposed to interrupted techniques.

    00:22 One of them is you typically will start on the dominant hand side and work to the nondominant hand side.

    00:27 That's a typical rule. Not all cases are like that.

    00:30 But for the simple running, that is the case for sure.

    00:32 Okay, so I'm sewing right handed.

    00:35 So I will encourage that if you're right handed also, you'll start in the right hand side.

    00:38 If you're a lefty, you started the left hand side. Work to the right.

    00:42 Okay, so start with the simple interrupted stitch on the right hand side of the wound for the righties that are going right to left. Okay.

    00:52 This is our anchor stitch. Nothing special.

    00:55 Just as simple interrupted. just to put it together.

    00:58 The difference is we're not going to cut both tails off, We're just going to cut off the little tail.

    01:04 And that will leave your long strand with a needle on it ready to be running out.

    01:13 If you need to pause for a second, feel free to pause the screen to get to this point.

    01:18 And then we'll continue on together when you're ready.

    01:24 Okay, let's proceed. We have two decisions here.

    01:27 You can have the stitches that you see straight across like this, or you can have them on an angle.

    01:32 The difference is all made with the next movement.

    01:35 Make sure you have you're knot up in this faraway position.

    01:38 Don't have to be down at the bottom.

    01:39 And you can move your knot anywhere you want on simple interrupted.

    01:42 Anywhere else that you feel, you know, it's not a big deal.

    01:45 But that's it for this one, we're going to poke either right next to it or right a couple one bite away from it. So half a centimeter.

    01:53 So either we're going to poke in and go straight underneath to the other side.

    01:55 And by doing that, we're going to mirror this stitch.

    01:59 However, by being straight across at the bottom, just like a figure of eight.

    02:02 If one straight across, the next one has to be on an angle on the top.

    02:06 So if I want it angled on the bottom, that means it'll be straight across to the top.

    02:10 If I have a straight across at the bottom, it means it's going to be on an angle on the top.

    02:14 So it's all up to you to decide this is the one move that matters more than anything else as far as deciding that.

    02:19 This is the move where you make the whole thing look a certain way or not.

    02:23 So for my purpose is, I'm going to have it.

    02:25 So I want to have it. So the angle is on the bottom.

    02:28 So I'm going to go right next to this knot. I want to puncture in.

    02:31 So you go right next to the knot and poke through the other side.

    02:35 Or you move over that distance and you poke from here straight underneath.

    02:40 If I want the angle at the bottom, I poke next to the knot and angle.

    02:43 If I want to have a straight across at the bottom or angle to the top, I move over.

    02:47 It's all in this little movement here.

    02:48 It's either here, or it's here that dictates everything. Okay? So, I have committed to going like this.

    02:59 So they're going to poke in, and I going to angle and I'm choosing to be - well, I think it's a reasonable distance for these pulleys in line with my incision as I go. Okay.

    03:15 Yes, I'm crossing both of them.

    03:16 You don't have to. You can come up in the middle and tighten it up as you go.

    03:20 I'm tightening every single one as I go.

    03:22 To make sure I'm happy with it.

    03:26 Poke in. And I'm going to curve the needle.

    03:29 Okay, try to make sure you're symmetric in how far away you are from the incision.

    03:34 And then pull line incision every single time.

    03:38 Okay, a certain point here, we're going to run out of suture.

    03:41 And that's okay. Do they have to be perfect? No, it's okay. It won't be perfect.

    03:46 We may want them to be perfect. But they won't be perfect.

    03:49 Just all manner of practice. Practice, practice, practice.

    03:57 Consistency is key.

    03:58 Just do everything the same and will look the same.

    04:01 You poke in. Angle over.

    04:06 It's too high and more a little bit. There you go.

    04:11 As you can see, it goes pretty quick once you get moving.

    04:14 Again, angle over.

    04:18 You got to choke up a little bit to get a little more grab.

    04:23 Okay. You get the idea? I'm going to move the camera a little bit Got a more room to go.

    04:28 And I would obviously do this with a brand new suture.

    04:32 Otherwise, you may find yourself running out of strand you're like, "Oh, man." That's a bummer and it happens.

    04:41 Poke in. Angle over.

    04:44 And again, I'm just doing this, this way because I so choose to do it this way. Chose to this way rather.

    04:51 But that said you could have done it with the angle on the top and that's fine too.

    04:54 In the event that you somehow have a patient that cares one way or the other or there's someone that ask you to do it one way or the other then you know how to do it.

    05:02 Now, I may want to pinch this a little more.

    05:04 But as I'm pulling this apart, I don't see any airspace so I'm doing okay.

    05:07 Okay, if I crunch it more then I'm just crunching it more, I'm actually helping.

    05:10 As long as I've managed my tension, life is good.

    05:13 And that can also pop out, and then go back in.

    05:16 You don't have to do more than one, but like I was doing.

    05:19 depends on the needle, you have to. Okay.

    05:21 When I get to the other end, okay, what I'm going to do is I'm going to leave a little bit of a loop.

    05:31 All right. So when I have that little loop there, this is how I finish it off.

    05:36 I am going to leave that loop as my little tail.

    05:41 And the long strand, in this case, not so long anymore with a needle.

    05:44 And I'm going to go once, twice, and grab the middle of that loop.

    05:53 Okay. Do it again. So you can see it.

    05:55 Once. So separate the long strand from the little tail little.

    05:58 A little loop, in this case.

    06:00 Once, twice. Grab the middle of that, and pull it.

    06:05 Okay, and that is how we finish it.

    06:08 And then treat that loop like the tail.

    06:18 And then a certain point here, we will be done.

    06:24 Sometimes you take to kind of put your instrument in the middle of this little loop and go side by side to kind of tighten it up.

    06:30 And when you're all the way done with this, you'll cut off all three.

    06:35 Okay. And that my friends is how you do a simple running technique.

    06:41 Beneficial to do this.

    06:43 If you want to just close a deeper layer really fast, you can do the top of the skin with this.

    06:47 But realize though, it's like a spiral bound book.

    06:50 If I grab one of these and pull up, let's say like this. "Oh no, what's going to happen? Well, these are really tight. These are really tight.

    06:58 These aren't really that affected. These aren't really that affected.

    07:00 But these are pinched in too tight. And this is all loose now.

    07:03 So that's not good, right? That's a concern.

    07:06 If I have an elbow or weird external joint, maybe this would not be a good thing because that tension pulling over time is going to effectively do this.

    07:13 And they open up and dehiscence spot on my wound.

    07:16 And then I'll find that I would have been better to do some simple interrupted or some, maybe some horizontal mattress to manage the tension.

    07:24 So, again, realize this is just a gross approximation stitch.

    07:28 It can go very quickly.

    07:29 Great for doing for your deep layers, the tissue before you do your skin layers on top.

    07:33 And always if you're doing deep layers, realize that you're going to use an absorbable suture, not a nonabsorbable suture for the skin.

    07:40 Okay, so have fun.

    07:42 And then again, remember the big decision to make is this very first one here.

    07:45 If you poke in right next to the knot an angle on the bottom, it'll look like this.

    07:49 If you move over and then poke in here to come out here, well, you're going too see the opposite of this, right? You're going to see the angle on the top from this point to that point. From this point to that point, right? So just make the decision based on what you want to look like and it's all up to you. Have some fun with it.

    About the Lecture

    The lecture Simple Running Demonstration by John Russell, DNP, APRN, AGACNP-BC, FNP-BC, CCRN, CRNFA is from the course Suturing.

    Included Quiz Questions

    1. On the right side of the wound for right-hand dominant practitioners and the left side of the wound for left-hand dominant practitioners.
    2. On the left side of the wound for right-hand dominant practitioners and the right side of the wound for left-hand dominant practitioners.
    3. At the proximal end of the wound.
    4. At the distal end of the wound.
    1. Leave a loop on the last stitch, wrap the remaining long strand around the needle holder twice, grab the middle of the loop with the needle holder, and pull tightly.
    2. Cut the last stitch to form two tails, and knot each separately by wrapping the remaining long strand around the needle holder twice and tightly pulling each tail.
    3. Run the long strand through the last three stitches, wrap it around the needle holder once, pass it through the fourth stitch, and tightly pull it to form a knot.
    4. Pass the remaining long strand under the last stitch four times, and then form a knot by grasping the center of the last stitch and pulling tightly.

    Author of lecture Simple Running Demonstration



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