Transcript PERIOPERATIVE NURSING - Nurses Rock Society #23

PERIOPERATIVE
NURSING
SUTURE
BY MURSIDI H.A
WHAT IS SUTURE
“a thread, wire, or other materials
used in the operation of stitching
parts of the body together”
 “to suture is to unite by stitching
(sewing) until healing take place”
 Purposes – ligating bleeding vessels,
suturing internal structures, wound
closure and retraction purposes

Characteristic of Suture
Materials

Physical characteristic







Monofilament or Multifilament
Capillarity
Predetermined diameter (caliber)
Good tensile strength
Knot strength
Maintained elasticity
Memory capacity
Characteristic of Suture
Materials

Handling characteristic



Pliability (easily bends)
Co-efficient of frictions (slip easily) – to
prevent tissue drag, knot slippage and to
facilitate knot tying
Tissue-reaction characteristic



Non-allergenic
Non-carcinogenic
Minimal tissue reactions
TYPES OF SUTURE MATERIALS

ABSORBABLE SUTURE




“a sterile, flexible strand prepared from
collagen derived from healthy mammals or
synthetic polymers”
Capable of being absorbed by living tissues
through hydrolyzed or enzymatic process
May be impregnated with coating, softening
or anti-microbial agents
Varies in treatments, colour, sizes, packaging
and resistance to absorption according to
purposes
Types of Absorbable sutures

COLLAGEN DERIVED


SYNTHETIC DERIVED




Surgical Gut
Coated Vicryl
Monocryl
PDS
DERIVED FROM SILKWORM LARVA

Silk suture
TYPES OF SUTURE MATERIALS

NON-ABSORBABLE SUTURE




“a strands of materials that effectively
resist enzymatic digestion in living tissue”
May be uncoated or coated with substance
to reduce capillarity and friction
Encapsulated by tissues around it during
healing
Required removal of suture after wound
healing
Types of Non-Absorbable sutures

SYNTHETIC DERIVED





Ethilon (Nylon)
Prolene
Ethibond
Monosof
SURGICAL WIRE

Stainless steel wire
INDIVIDUAL CHARACTERISTIC OF
SUTURE
(collagen derived absorbable sutures)
SUTURE TYPES
SURGICAL
GUT
PLAIN
(yellow)
RAW
MATERIALS
INTERACTION
COLLAGEN
DERIVED
FROM
MAMMALS
Ligate superficial
ABSORBABLE Vessels, SC tissue,
oral mucosa,
7-10 DAYS
ophthalmology cases
COLLAGEN
DERIVED
TREATED
WITH
CHROMIUM
SALTS
Fascia or peritoneum
ABSORBABLE
Large vessels ties,
WITHIN TWO
muscle or mucosal
WEEKS
layers
USAGE
CHROMIC
(brown)
(blue)
[dye]
INDIVIDUAL CHARACTERISTIC OF
SUTURE
(synthetic absorbable sutures)
SUTURE
Coated
VICRYL
TYPES/
COLOR
INTERACTION
USAGE
MIXTURES
OF LACTIC
AND
GLYCOLIC
ACID
POLYMERS
AND
CALCIUM
STEARATE
ABSORBED
BY SLOW
HYDROLYSIS
IN TISSUES
2 – 3 WEEKS
Ligate or suture
tissues for
approximation
SYNTHETIC
POLYMERS
UP TO THREE
MONTHS
Fascial closure,
elderly or oncologic
patients
BRAIDED
(violet)
[undyed]
MONOMONOCRYL FILAMENT
(Clear)
PDS
RAW
MATERIALS
MONOFILAMENT
(Clear)
INDIVIDUAL CHARACTERISTIC OF
SUTURE
(synthetic non-absorbable sutures)
SUTURE
TYPES/
COLOR
ETHILON
Nylon
MONOFILAMENT
(Green)
RAW
MATERIALS
INTERACTION
POLYAMIDE
POLYMER
NONABSORBABLE
REMAINS
POLYMER
ENCAPSULATED
PolyPropylene
MONOFILAMENT
(Blue)
OF
PROPYLENE
IN BODY
TISSUES
ETHIBOND
Polyester
Fibre
BRAIDED
(Green/
White)
POLYSTER
FIBRE WITH
POLYBUTILATE
PROLENE
USAGE
Skin Closure,
retention, plastic
surgery,
ophthalmology and
micro surgery
Abdominal surgery,
General plastic
and Cardiovascular
surgery
INDIVIDUAL CHARACTERISTIC OF SUTURE
(SILK AND SURGICAL WIRE)
SUTURE
SILK
STEEL
WIRE
TYPES/
COLOR
RAW
MATERIALS
INTERACTION
USAGE
PROTEIN
FIBRE SPUN
BY
SILKWORM
VERY SLOWLY
ABSORBED
AND
DISSAPEAR
AFTER FEW
YEARS
Most body tissues
for ligating and
suturing
NONABSORBABLE
General and skin
closure, tendon
repaired,
cranioplasty
BRAIDED
(Black)
MONO OR
MULTIFILAMENT
(Silver)
AN ALLOY OF
IRON
(Stainless or
Silver wire)
MONOFILAMENT SUTURES
PLAIN GUT
POLYPROPYLENE
PROLENE
STEEL WIRE
CHROMIC GUT
SILK
BRAIDED/MULTIFILAMENTS
SUTURES
CHROMIC GUT
SILK
CHROMIC GUT
SILK
NYLON
VICRYL

TENSILE STRENGTH AND DIAMETER



SUTURE LENGTH



Refer to knot pull strength of the suture rather
than straight pull strength
Suture diameter refer to the size of the strand
(heavy size 7 to fine size of 11-0)
Standardized length - 50 or 60 inches
Precut length – 17,18 or 24 inches
SUTURE PACKAGING


Sealed in a primary inner packet with inside dry
and outer, see-through peel-back packet –
sterilized
Sterility maintained until opened or date of
expiry arrived
SUTURE
SIZE
SUTURE
NAME
BATCH
NUMBER
SUTURE
LENGTH
NEEDLE
SIZE &
SHAPE
PRODUCT NAME
IDENTIFCATION OF SUTURE
SUTURES COLOUR CODING
PACKAGES
SUTURE
PLAIN GUT
CHROMIC GUT
SILK
NYLON
PROLENE
VICRYL
ETHIBOND
PDS
STAINLESS STEEL
COLOUR CODE
YELLOW
BROWN
LIGHT BLUE
GREEN
ROYAL BLUE
PURPLE
ORANGE
GREY
SILVER
COLOUR CODING AND
PACKAGES OF SUTURES
ASEPTIC TRANSFER OF
SUTURE

METHOD 1 – Retrieval by scrub person




Hold the packet flaps between extended thumbs
Rolls hands outward to peel outer packet apart
Exposed inner packet (suture) are then grasp by
scrub person
METHOD 2 – “Flipping” suture packet


Standing a safe distance from sterile trolley, the
circulator rolls the flaps of the outer package
backwards
Project (flips) the inner packet onto sterile trolley
ASEPTIC SUTURE TRANSFER
TECHNIQUE
SUTURE RETRIEVAL
TECHNIQUE
FLIPPING TECHNIQUE
SURGICAL NEEDLES
• Made of a steel alloy with high carbon
content (stainless steel)
• Varies in shape, size, point design and wire
diameter
ANATOMY OF NEEDLE
BASIC PARTS OF SURGICAL
NEEDLES
 THE
EYE
ROLLED END
ATRAUMATIC
REGULAR EYE
SPRING EYE
SPRING DOUBLE
BASIC PARTS OF SURGICAL
NEEDLES
 THE
BODY
SHAPE
1/2 Circle
3/8 circle
1/4 Circle
5/8 Circle
J shape
compound
½ curve
straight
GENERAL USES OF NEEDLE
ACCORDING TO IT’S SHAPE
BODY SHAPE
Straight
Circle 3/8
Circle ½ and
½ curve
Circle 5/8
COMMON USAGE
Flat or shallow depth of skin wound
Shallow depth of skin wound
General purposes, interior of any
wound
Circle 1/4
Deepest, smallest maneuvering room
wounds such as vaginal hysterectomy,
hemorrhoidectomy
Same as 1/2 circle
J Curve
Deep inaccessible wound or flat wound
BASIC PARTS OF SURGICAL
NEEDLES

Taper cut
THE POINT
Spatulated end
Cutting edge
Blunt Point
COMMON USAGE OF ATRUMATIC
NEEDLES
NEEDLE TYPES
COMMON USE
TAPER POINT
Soft tissue closure below skin surfaces, dura,
fascia, GI, muscle, nerve, pleura, vessels
BLUNT POINT
Friable tissues, spleen, liver, kidneys, cervix
CUTTING EDGE
Ligaments, tendons, calcified or fibrous tissue,
thoracic, plastic, Ob & Gyn, scar tissue
REVERSE
CUTTING
Skin closure, retention suture, S/C, ligaments or
fibrous tissue, mucosa
TAPER CUT
Bronchus, calcified tissues, nasal & oral cavity,
periosteum, trachea, uterus, vessels
SPATULATED
CURVED
Ophthalmic surgery for muscle and retinal
repair, eyelid suturing
WORKING WITH SUTURES AND
NEEDLES

MOUNTING THE
NEEDLE

THREADING THE
NEEDLE
WORKING WITH SUTURES AND
NEEDLES

PASSING THE
NEEDLE HOLDER
WITH SUTURE

NEEDLES’ COUNTS
TYPES OF WOUND SUTURING
OTHER METHODS OF WOUND
CLOSURE

SURGICAL STAPLER

SKIN STRIPS
& SKIN GLUE
TISSUE REACTION AFTER SUTURING



Suture act as a
foreign substance
Begins when the
suture inflicts injury
to the tissue during
insertion
Increased factors
include allergic,
absorption period,
cell reactions and
types of suture
Comparison of tissue resorption according to
sutures
REMOVAL OF WOUND CLOSURE
(SUTURE AND STAPLE)
THANK YOU