PRACTICAL SKILLS IN CLINICAL PRACTICE

DR.AVINASH BHONDWEPRESIDENT I.M.A. Pune (2008-09)

Special Skills

Minor Surgeries Stitches- Skin & Mucus Membranes Special Dressings Splints & Plasters I.V . Fluids & Injections ECG Spirometer Physiotherapy Refraction

Injections Ampoules Vials Prefilled Pen

Injection Sites

Injection Sites

Intravenous Injections

17 Jan 2010

I/V injections Salines

IV Presentations

Scalp Vein

IV SET

Syringe

Type of Needles

SUTURING

SKIN SUTURESMUCUS MEMBRANEDEEP WITH FACIA, FAT & SKINMUSCLESBLEEDING FROM VESSELS

SUTURINGThere are several shapes of surgical needles: Straight 1/4 circle 3/8 circle 1/2 circle. Subtypes of this needle shape include,

from larger to smaller size, CT, CT-1, CT-2 and CT-3.[3]

5/8 circle compound curve half curved (also known as ski) half curved at both ends of a straight segment

(also known as canoe)

SURGICAL NEEDLES

SUTURING Needles may also be classified by their point

geometry; examples include: taper (needle body is round and tapers smoothly to

a point) cutting (needle body is triangular and has a

sharpened cutting edge on the inside curve) reverse cutting (cutting edge on the outside) trocar point or tapercut (needle body is round and

tapered, but ends in a small triangular cutting point) blunt points for sewing friable tissues side cutting or spatula points (flat on top and

bottom with a cutting edge along the front to one side) for eye surgery

SURGICAL NEEDLES

Suture Material Types of sutures : Absorbable sutures such as plain,chromic, a

traumatic catgut. Non absorbable or non absorbent sutures.

Reading the Suture Label

Company

Needle

Size Order Code

NameAlso:LENGTHNEEDLE SYMBOLCOLORAbsorbable or Non

Suture Material ABSORBABLE SUTURES: CATGUT A tough thin cord made from the treated and

stretched intestines of certain animals, especially sheep. This type of suture are commonly used to suture the inner structure of the body

Walls of the organs Rectal sheath Muscles Subcutaneous tissue Peritoneum Intestinal anastomosis

Suture Material 1) Plain catgut : These sutures are completely digested &

absorbed by the tissue. Sizes of the absorbable catgut suture vary from 5/0 which is the finest to 2 which is the thickest.

Suture Material Chromic catgut : Chromic catgut an

absorbable sterile strand derived from the intestinal submucosa of sheep.

It is an absorbable suture The chromic catgut is of brown color & is

absorbed slowly

Suture Material Atraumatic catgut It is another type which is

used for ligating small blood vessels. Dexon (Polyglycolic acid) is also an absorbable

suture synthetically prepared. It is available in various sizes such as 3/0 to 2.

This suture is used as ties for small blood vessels & also for suturing peritoneum ,rectal sheath etc.

Non absorbable sutures

These types of sutures are not absorbed. These sutures are used for closing or

suturing outer surface of the body such as skin.

These sutures are cheaper, easy to handle easy to sterile ,have smooth surfaces & knot securely with the ends cut short.

Suture Material Silk suture : these suture are non absorbent. Their

sizes vary from 10/0 to 2 . These are used for skin closure after abdominal operation.

Linen suture : these sutures are also non absorbent .their sizes vary form 3/0 to 2 . These are used for skin closure in hernia operation.

Monofilament Nylon suture ( Ethilon) : These are non absorbable suture. Their sizes vary from 10/0 to 2. these sutures are used as tension sutures in hernia repair.

Suture Material e) Prolene –Ethifex merseline : These non

absorbent sutures are used for cardiovascular & plastic surgery.

f) Metal Clips : these non absorbent types of suture are of various types such as : Michael clips Trazies Van petz

VICRYL (polyelatine– 916) PROLENE (Polypropylene) POLYSTER (ethibond) POLYDIXONE SUTURE

SUTURES SIMPLE SUTURES

SIMPLE SUTURES

MATRESS SUTURES

SIMPLE CONTINUOUS SUTURES

Alternative Methods of Wound Closure STERI STRIPS

STAPLES SUTURING

Tissue adhesive Superglues that contain acrylates may be applied to superficial wounds to block pinpoint skin hemorrhages and to precisely coat wound edges. Because of their bacteriostatic effects and easy application, they have gained increasing popularity.

They have demonstrated either cosmetic equivalence or superiority to traditional sutures in various procedures, including sutureless closure of pediatric day surgeries, saphenous vein harvesting for coronary artery bypass, and blepharoplasty.

Wound Closure Using Super Glue

Minor Surgeries

ABSCESS DRAINAGE- I/D CYST EXCISION LIPOMA EXCISION CORN EXCISION FOREIGN BODY REMOVAL AUROPLASTY NAIL BED ABSCESS I/D – NAIL EXCISION

ABSCESS DRAINAGE

AUROPLASTY

MINOR SURGERIES

LIPOMA EXCISION CORN EXISION

SPECIAL DRESSINGS

ROLLER BANDAGE

ELASTOCREPPE BANDAGE

Applying a Cravat Bandageto the Head

Place middle of bandage over the dressing and wrap around the head.

Applying a Cravat Bandageto the Head

Cross the two ends snugly.

Bring ends back around and tie knot.

Applying a Roller Bandage

For ankle: Make two straight turns around instep. Make figure-eight turn across front of foot,

around ankle, and under arch.

Securing Bandages

Loop method Encircle body part with

the looped and free ends and tie ends together.

SPLINT & PLASTERS

Plasters

ECG

SPIROMETER

REFRACTION

PHYSIOTHERAPY Short Wave Diathermy (SWD) Effective in Inflammation of Shoulder Joint,

Elbow Joint , Cervical Spondylosis, Osteoarthritis, Ligament Sprains in Knee Joints, Low Back Ache, Heel Pain, Sinusitis

Ultrasonic therapy:Ultrasonic waves are useful for treatment of Inflammation of Elbow Joint (Tennis Elbow), Plantar Fascitis (Heel Pain), Shortening of Muscle or Ligament, Inflammation of tendons (Suprasspinatus tendnitis), Ligament Sprain (Lateral Ligament Sprain of Ankle), Unhealed Scars

PHYSIOTHERAPY

Cervical Traction Lumbar Traction

Interferential Therapy (IFT) Computerized Interferential therapy is most

advanced version; based on solid-state circuitry, extremely light weight, compact design and portable and user friendly systems.

Interferential therapy can relieve pain, reduce swelling, activate cell function and promote healing &restors function.

Choice for the treatment in Rheumatism, Arthritis, Muscle Strains, Sports Injuries, Neuralgia, Neuritis, Circulation Disorder and Incontinence

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