PERIOPERATIVE%20NURSING

1
PERIOPERATIVE NURSING

• SUTURE

BY MURSIDI H.A
2
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

3
Characteristic of Suture Materials

• Physical characteristic
• Monofilament or Multifilament
• Capillarity
• Predetermined diameter (caliber)
• Good tensile strength
• Knot strength
• Maintained elasticity
• Memory capacity

4
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

5
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

6
Types of Absorbable sutures

• COLLAGEN DERIVED
• Surgical Gut
• SYNTHETIC DERIVED
• Coated Vicryl
• Monocryl
• PDS
• DERIVED FROM SILKWORM LARVA
• Silk suture

7
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

8
Types of Non-Absorbable sutures

• SYNTHETIC DERIVED
• Ethilon (Nylon)
• Prolene
• Ethibond
• Monosof
• SURGICAL WIRE
• Stainless steel wire

9
INDIVIDUAL CHARACTERISTIC OF SUTURE(collagen
derived absorbable sutures)
SUTURE TYPES RAW MATERIALS INTERACTION USAGE
SURGICAL GUT PLAIN (yellow) COLLAGEN DERIVED FROM MAMMALS ABSORBABLE 7-10 DAYS Ligate superficial Vessels, SC tissue, oral mucosa, ophthalmology cases
SURGICAL GUT CHROMIC (brown) COLLAGEN DERIVED TREATED WITH CHROMIUM SALTS ABSORBABLE WITHIN TWO WEEKS Fascia or peritoneum Large vessels ties, muscle or mucosal layers
SURGICAL GUT (blue) dye COLLAGEN DERIVED TREATED WITH CHROMIUM SALTS ABSORBABLE WITHIN TWO WEEKS Fascia or peritoneum Large vessels ties, muscle or mucosal layers
10
INDIVIDUAL CHARACTERISTIC OF SUTURE(synthetic
absorbable sutures)
SUTURE TYPES/COLOR RAW MATERIALS INTERACTION USAGE
Coated VICRYL MONOCRYL BRAIDED (violet) undyed 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
Coated VICRYL MONOCRYL MONO-FILAMENT (Clear) 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
PDS MONO-FILAMENT (Clear) SYNTHETIC POLYMERS UP TO THREE MONTHS Fascial closure, elderly or oncologic patients
11
INDIVIDUAL CHARACTERISTIC OF SUTURE(synthetic
non-absorbable sutures)
SUTURE TYPES/COLOR RAW MATERIALS INTERACTION USAGE
ETHILON Nylon MONO- FILAMENT (Green) POLYAMIDE POLYMER NON- ABSORBABLE REMAINS ENCAPSULATED IN BODY TISSUES Skin Closure, retention, plastic surgery, ophthalmology and micro surgery
PROLENE Poly- Propylene MONO- FILAMENT (Blue) POLYMER OF PROPYLENE NON- ABSORBABLE REMAINS ENCAPSULATED IN BODY TISSUES Abdominal surgery, General plastic and Cardio-vascular surgery
ETHIBOND Polyester Fibre BRAIDED (Green/ White) POLYSTER FIBRE WITH POLYBUTILATE NON- ABSORBABLE REMAINS ENCAPSULATED IN BODY TISSUES Abdominal surgery, General plastic and Cardio-vascular surgery
12
INDIVIDUAL CHARACTERISTIC OF SUTURE(SILK AND
SURGICAL WIRE)
SUTURE TYPES/ COLOR RAW MATERIALS INTERACTION USAGE
SILK BRAIDED (Black) PROTEIN FIBRE SPUN BY SILKWORM VERY SLOWLY ABSORBED AND DISSAPEAR AFTER FEW YEARS Most body tissues for ligating and suturing
STEEL WIRE MONO OR MULTI- FILAMENT (Silver) AN ALLOY OF IRON (Stainless or Silver wire) NON- ABSORBABLE General and skin closure, tendon repaired, cranioplasty
13
MONOFILAMENT SUTURES
PLAIN GUT
PROLENE
POLYPROPYLENE
STEEL WIRE
CHROMIC GUT
SILK
14
BRAIDED/MULTIFILAMENTS SUTURES
CHROMIC GUT
SILK
CHROMIC GUT
SILK
VICRYL
NYLON
15

• TENSILE STRENGTH AND DIAMETER
• 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)
• SUTURE LENGTH
• 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

16
IDENTIFCATION OF SUTURE
SUTURE SIZE
BATCH NUMBER
SUTURE NAME
SUTURE LENGTH
NEEDLE SIZE SHAPE
PRODUCT NAME
17
SUTURES COLOUR CODING PACKAGES
SUTURE COLOUR CODE
PLAIN GUT YELLOW
CHROMIC GUT BROWN
SILK LIGHT BLUE
NYLON GREEN
PROLENE ROYAL BLUE
VICRYL PURPLE
ETHIBOND ORANGE
PDS GREY
STAINLESS STEEL SILVER
18
COLOUR CODING AND PACKAGES OF SUTURES

19
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

20
ASEPTIC SUTURE TRANSFER TECHNIQUE
SUTURE RETRIEVAL TECHNIQUE
FLIPPING TECHNIQUE
21
SURGICAL NEEDLES

• Made of a steel alloy with high carbon
• content (stainless steel)
• Varies in shape, size, point design and wire
• diameter

22
ANATOMY OF NEEDLE
23
BASIC PARTS OF SURGICAL NEEDLES

• THE EYE

ROLLED END ATRAUMATIC REGULAR EYE SPRING
EYE SPRING DOUBLE
24
BASIC PARTS OF SURGICAL NEEDLES

• THE BODY SHAPE

1/2 Circle
3/8 circle
1/4 Circle
J shape
compound
5/8 Circle
straight
½ curve
25
GENERAL USES OF NEEDLE ACCORDING TO ITS SHAPE
BODY SHAPE COMMON USAGE
Straight Flat or shallow depth of skin wound
Circle 3/8 Shallow depth of skin wound
Circle ½ and ½ curve General purposes, interior of any wound
Circle 5/8 Deepest, smallest maneuvering room wounds such as vaginal hysterectomy, hemorrhoidectomy
Circle 1/4 Same as 1/2 circle
J Curve Deep inaccessible wound or flat wound
26
(No Transcript)
27
BASIC PARTS OF SURGICAL NEEDLES

• THE POINT

Taper cut
Spatulated end
Cutting edge
Blunt Point
28
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
29
WORKING WITH SUTURES AND NEEDLES

• MOUNTING THE NEEDLE
• THREADING THE NEEDLE

30
WORKING WITH SUTURES AND NEEDLES

• PASSING THE NEEDLE HOLDER WITH SUTURE
• NEEDLES COUNTS

31
TYPES OF WOUND SUTURING

32
OTHER METHODS OF WOUND CLOSURE

• SURGICAL STAPLER
• SKIN STRIPS

SKIN GLUE
33
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

34
Comparison of tissue resorption according to
sutures
35
REMOVAL OF WOUND CLOSURE (SUTURE AND STAPLE)
36
THANK YOU