PERIOPERATIVE NURSING SUTURE BY MURSIDI H A WHAT

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” l “to suture is to unite by stitching (sewing) until healing take place” l Purposes – ligating bleeding vessels, suturing internal structures, wound closure and retraction purposes l

Characteristic of Suture Materials l Physical characteristic l l l l Monofilament or Multifilament Capillarity Predetermined diameter (caliber) Good tensile strength Knot strength Maintained elasticity Memory capacity

Characteristic of Suture Materials l Handling characteristic l l l Pliability (easily bends) Co-efficient of frictions (slip easily) – to prevent tissue drag, knot slippage and to facilitate knot tying Tissue-reaction characteristic l l l Non-allergenic Non-carcinogenic Minimal tissue reactions

TYPES OF SUTURE MATERIALS l ABSORBABLE SUTURE l l “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 l COLLAGEN DERIVED l l SYNTHETIC DERIVED l l Surgical Gut Coated Vicryl Monocryl PDS DERIVED FROM SILKWORM LARVA l Silk suture

TYPES OF SUTURE MATERIALS l NON-ABSORBABLE SUTURE l l “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 l SYNTHETIC DERIVED l l l Ethilon (Nylon) Prolene Ethibond Monosof SURGICAL WIRE l 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 BRAIDED (violet) [undyed] MONOCRYL FILAMENT (Clear) PDS RAW MATERIALS MONOFILAMENT (Clear) MIXTURES OF LACTIC AND ABSORBED BY SLOW GLYCOLIC HYDROLYSIS ACID IN TISSUES POLYMERS 2 – 3 WEEKS AND CALCIUM STEARATE SYNTHETIC POLYMERS UP TO THREE MONTHS Ligate or suture tissues for approximation Fascial closure, elderly or oncologic patients

INDIVIDUAL CHARACTERISTIC OF SUTURE (synthetic non-absorbable sutures) SUTURE TYPES/ COLOR ETHILON Nylon MONOFILAMENT (Green) RAW MATERIALS INTERACTION POLYAMIDE POLYMER NONABSORBABLE REMAINS PROLENE POLYMER Poly. Propylene MONOFILAMENT (Blue) OF PROPYLENE ETHIBOND Polyester Fibre BRAIDED (Green/ White) POLYSTER FIBRE WITH POLYBUTILATE USAGE Skin Closure, retention, plastic surgery, ophthalmology and micro surgery ENCAPSULATED IN BODY TISSUES Abdominal surgery, General plastic and Cardio-vascular surgery

INDIVIDUAL CHARACTERISTIC OF SUTURE (SILK AND SURGICAL WIRE) SUTURE SILK STEEL WIRE TYPES/ COLOR BRAIDED (Black) MONO OR MULTIFILAMENT (Silver) 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 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 NYLON VICRYL

l TENSILE STRENGTH AND DIAMETER l l l SUTURE LENGTH l l l 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 l l 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 l METHOD 1 – Retrieval by scrub person l l 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 l l 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 l THE EYE ROLLED END ATRAUMATIC REGULAR EYE SPRING DOUBLE

BASIC PARTS OF SURGICAL NEEDLES l 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 l 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 l MOUNTING THE NEEDLE l THREADING THE NEEDLE

WORKING WITH SUTURES AND NEEDLES l PASSING THE NEEDLE HOLDER WITH SUTURE l NEEDLES’ COUNTS

TYPES OF WOUND SUTURING

OTHER METHODS OF WOUND CLOSURE l SURGICAL STAPLER l SKIN STRIPS & SKIN GLUE

TISSUE REACTION AFTER SUTURING l l l 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)

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