Blunt suture needle use in laceration and episiotomy repair at vaginal delivery

Results 

Most participants reported a personal history of needle stick injury (83%) or a sharps glove perforation (86%), and all physicians surveyed admitted concern about needlestick injuries and exposure to blood-borne pathogens. Regarding prior blunt suture needle use, 74% reported use for closures at cesarean section.

Twenty-eight of the 80 surveys collected (35%) were completed by first-time study participants. Forty-three surveys (54%) were completed by physicians who had filled out a survey previously, and 9 surveys (11%) were left blank with regard to previous study participation. However, whether the participant had previously filled out a survey did not produce a statistically significant difference in blunt suture needle ratings (P = .09).

The results of blunt suture needle ratings are summarized (Table) according to level of training, given significant differences among groups.

TABLE. Blunt suture needle ratings by level of training

	Level of training (number of surveys)	Excellent	Good	Poor
	Attending (29)	20(69%)	6(21%)	3(10%)
	PGY 2-4 (31)	24(77%)	7(23%)	0
	Intern (20)	5(25%)	12(60%)	3(15%)
	Total (80)	49(61%)	25(31%)	6(8%)

PGY, postgraduate year. Monar. Blunt suture needle use in laceration and episiotomy repair. Am J Obstet Gynecol 2008.

Overall, most participants (74 of 80, 92%) rated the blunt suture needle as excellent or good (95% confidence interval 84.6 to 96.5), and only 1 participant switched to a sharp needle intraoperatively. No needlestick injuries or glove perforations occurred during blunt needle repairs. Ratings provided by physicians with training beyond internship were significantly higher than those provided by interns (P < .001). The majority of repairs were for first- or second-degree lacerations or episiotomies (73), with too few repairs for deeper lacerations/episiotomies (4) to compare ratings according to repair difficulty.

Comment 

It has been reported that 1-15% of surgical procedures are complicated by percutaneous injuries, mostly associated with suturing.5, 6 Vaginal procedures have especially high injury rates.7 This finding has been attributed to poor visibility and digital manipulation of suture needles7 and implies significant percutaneous injury risk for repairs at vaginal delivery.

The high prevalence of previous needlestick injuries among study participants (80%) is cause for concern. Studies show that using blunt suture needles may reduce and, in some cases, eliminate needlestick injuries in other surgical contexts.5, 6, 8, 9 Our finding that no injuries or glove perforations occurred during blunt needle repairs supports this literature and suggests an essential role for blunt needles in needlestick injury prevention in obstetrics.

Our study also demonstrates that technical satisfaction is high with blunt suture needle use, especially among those with greater surgical experience (PGY2 and above). A possible explanation for interns providing less favorable ratings is that blunt needles may require more pressure to penetrate tissues, the very characteristic that makes them less likely to penetrate a surgeon's glove or skin.5 The discrepancy may have been explained by the steep technical learning curve experienced by obstetrical interns, given that ratings by physicians PGY2 and above were uniformly favorable. Conversely, physicians with training beyond the intern year may also have provided higher ratings because of greater experience with their use in other settings or longer time for indoctrination of their utility by colleagues.

Our study has several limitations. Lack of randomization may have selected out less difficult repairs and led to more favorable ratings, given that the majority of repairs were performed for second-degree or less severe lacerations and episiotomies. Ratings were also possibly skewed by the fact that the physicians who requested the blunt suture needle were the only participants and that repetitive participation was allowed. Despite these limitations, self-reported bias was reduced because of anonymous survey collection.

The utility of blunt suture needles in the prevention of needlestick injuries in obstetrics and the paucity of literature in this regard necessitate attention to our findings. Given that numerous trials in other surgical disciplines demonstrate needlestick injury risk reduction with blunt needle use,8 a randomized trial for obstetrical repairs would be a useful future endeavor.