1. Place the hemostat in the center of your hand for encirclement, without putting your fingers in the finger rings. This will provide you better roatation and will remove twisting of tissue and provides optimal rotation for placing the tie. These handles should be anywhere else far away from the wound to avoid impeding the encircling handle of the knot tier.

2. Slide the surrounding ligature from the clamp to the tissue by depressing the handles away from the tier, and elevate the tip near the tier as soon as the ligature has surrounded the forceps clamps. The elevated clamp tip provides the knot tier with two alternatives: You can trap the ligature underneath the clamp prior tying.

3. If the knot tier ties off of the tip, continue holding the hemostat with the tip elevated. The individual who is tiying the knot, can now place the 1/2 hitch there making beneath the tip and tighten it with a single tactic. When you tie off the tip it has one less step than the ligature is trapped & performs the best in layers where you have two of your hands of the knot tier have better access to the wound.

4. A differnet method for additional security in deep wounds or with critical ties, prior to tying, the tier can put the ligature around the tip of the hemostat. The person holding the clamp traps the ligature beneath the tip by gently pressing the clamp deeper into the wound & rotating the tip away from the tier. By doing this method, you can postion the clamp to let the knot be tied on the side of the jaws. If you fail to push away the tip from the knot tier it will cause a slipping of the ligature under-neath the tip, this then forces the tier to tie of the tip.