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Ligature Cutters are a vital part of the essential medical device kit for all In Patient Mental Health units as advised by the Resuscitation Council (UK) Quality Standards Quality Standards | Resuscitation Council UK
There are a number of devices on the market and no specified cutter, therefore it is important for you to make yourself familiar with the device in your placement areas. It is very unlikely that as a student you would be expected to use the cutter itself as this would be an emergency situation which has very little opportunity for simulated practice and often requires restraint. However it is important that you understand where they are kept, what they look like and what will happen during the emergency. You may be required to take the cutter to the incident.
What is a ligature?
A ligature is an item that a person has used to prevent the flow of mainly oxygen, but could be blood. The use of a ligature to prevent the flow of oxygen can be use in four main ways;
Complete suspended strangulation - where the body is suspended using a ligature point
Incomplete suspended strangulation - the body is not completely suspended by the ligature
Lying strangulation - the person has used a ligature point and created a tension whilst lying down
Unsuspended strangulation - the torso is not under any ligature pressure
Over the last decade an enormous amount of work has been undertaken to ensure in patient mental health units have risk assessed ligature points, and taken the appropriate action to reduce these. Examples of this are the use of door alarms, magnetic curtain tracks and boxing in pipes etc. However it is important to understand that a person can use a ligature for a fatal result without a ligature point, and there is no limit to the items that can be used as a ligature including the patients hair.
It is vital that you continue to communicate with the person throughout the incident, de escalation and occasionally restraint maybe required to remove the ligature. following the use of a ligature a risk assessment will be required and an understanding of the patients reasons and thought process when using the ligature.
What is a ligature cutter?
A ligature cutter is a medical device that removes a ligature in the safest and quickest manner possible.
Here are some examples of cutters available within the UK:
Watch
It is important to ensure you are aware of the blade within the cutter and ensure your own safety, ensure your fingers are not likely to be caught by the blade when cutting.
Whilst it is good practice to shout for the ligature cutter in all situations, always try to remove any ligature by hand first as in many cases this is easier and of less risk.
Always cut from the front of the patient, never from behind and therefore putting pressure on the windpipe.
It is good practice to introduce the cutter in the flattest way possible and then turn the blade into the ligature to cut.
Be aware that you may need to work at cutting the ligature, it may need some "sawing" through.
Watch the video below to see how the foldable cutter is used.
Once a ligature cutter is used there will be a process to follow to ensure the cutter is sharpened and cleaned before it can be re used. You will find information about this within the trust policies and procedures. PPE should be considered if there are any risks from bodily fluids.
Check your Knowledge!
Check your Knowledge!
Click on the button below to navigate to the 'Take a Test' area of ClinicalSkills.net. Please make sure you're logged into ClinicalSkills.net already, otherwise you may not be able to open and take the test. Once you have reached the 'Take a Test' area, select 'Local Tests' and then click on the test called 'Ligature Cutters' to begin. You will need to score 80% or more to pass. Make sure you've read the ClinicalSkills.net procedure thoroughly before taking the test as many of the answers will be found within there!
Watch this space quiz coming soon...........
Other Materials
Other Materials
Physical Healthcare Post-Ligature
It is vital that anyone who has had a ligature removed has an A-E assessment as soon as is practicable after the event.
Be aware that patients may refuse physical observations post ligature, remember that we can always perform visual observations. Respiratory rate, CNS AcVPU, visual and listening observations for neurological observations such as any changes to their gate, speech, movement, and facial muscles.
Example of a ligature flow chart that includes post ligature care, thank you Rotherham Doncaster and South Humber NHS Trust (RDASH) for sharing. Please explore the policies of your placement areas for their policies and procedures. Please note this flow chart was written before the trust adopted use of the NEWS2 escalation tool. where the chart states complete EWS, this will be an A-E assessment using the NEWS2 scoring and escalation tool.
Date reviewed:
Next review: August 2023
Page updated
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