Figure of Eight Suture

Exercise caution for injury to surrounding structures (risk of destructive compression to local nerves and larger vessels)

Preparation
1. Clean and prepare the site (e.g. Chlorhexidine)
2. Suture kit (e.g. large-bore Suture, forceps, needle driver)
Identify maximal site of Hemorrhage
1. Apply manual pressure to bleeding site with one finger, and shift finger position until bleeding is controlled
2. Attempt to map the suspected vessel's course by applying manual pressure proximal to bleeding site
Inject Local Anesthetic
1. Lidocaine 1% with Epinephrine
Suture
1. Estimate depth of suspected vessel (Suture passes should reach this depth for adequate Hemostasis)
2. Pass needle through tissue 5-10 mm to one side of the suspected vessel, and parallel to its mapped course
3. Repeat a second needle pass, parallel to the first pass, and on the opposite side of the vessel
Tighten
1. Slowly increase Suture tension until Hemostasis is achieved, and then apply a small amount of additional tension
2. Gradual, adequate tension (contrast with maximal tension) reduces risk of local injury to adjacent structures
Hemostasis is achieved
1. Tie Suture and monitor for further bleeding
2. Resulting Suture will appear in the form of an X
Hemostasis is NOT achieved
1. Re-map the suspected vessel to ensure Sutures will be parallel its course
2. Repeat suturing with an increased depth, tighten and tie Suture if Hemostasis is achieved
  1. See Skin Hemorrhage Management
  2. Consider alternative source of Hemorrhage (e.g. a second bleeding vessel)

Failed Hemostasis
Infection
Local structure injury
1. Needle injury
2. Compression (e.g. adjacent nerves)
3. Local ischemia (necrosis risk)