PERIOPERATIVE NURSING
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Transcript of PERIOPERATIVE NURSING
PERIOPERATIVE PERIOPERATIVE NURSINGNURSING
SUTUREBY MURSIDI H.A
WHAT IS SUTUREWHAT IS SUTURE ““a thread, wire, or other materials a thread, wire, or other materials
used in the operation of stitching used in the operation of stitching parts of the body together”parts of the body together”
““to suture is to unite by stitching to suture is to unite by stitching (sewing) until healing take place”(sewing) until healing take place”
Purposes – ligating bleeding vessels, Purposes – ligating bleeding vessels, suturing internal structures, wound suturing internal structures, wound closure and retraction purposesclosure and retraction purposes
Characteristic of Suture Materials
Physical characteristicPhysical characteristic Monofilament or MultifilamentMonofilament or Multifilament CapillarityCapillarity Predetermined diameter (caliber)Predetermined diameter (caliber) Good tensile strengthGood tensile strength Knot strengthKnot strength Maintained elasticityMaintained elasticity Memory capacityMemory capacity
Handling characteristicHandling characteristic Pliability (easily bends)Pliability (easily bends) Co-efficient of frictions (slip easily) – to prevent Co-efficient of frictions (slip easily) – to prevent
tissue drag, knot slippage and to facilitate knot tissue drag, knot slippage and to facilitate knot tyingtying
Tissue-reaction characteristicTissue-reaction characteristic Non-allergenicNon-allergenic Non-carcinogenicNon-carcinogenic Minimal tissue reactionsMinimal tissue reactions
Characteristic of Suture Materials
TYPES OF SUTURE MATERIALS ABSORBABLE SUTUREABSORBABLE SUTURE
““a sterile, flexible strand prepared from collagen a sterile, flexible strand prepared from collagen derived from healthy mammals or synthetic derived from healthy mammals or synthetic polymers”polymers”
Capable of being absorbed by living tissues Capable of being absorbed by living tissues through hydrolyzed or enzymatic processthrough hydrolyzed or enzymatic process
May be impregnated with coating, softening or May be impregnated with coating, softening or anti-microbial agentsanti-microbial agents
Varies in treatments, colour, sizes, packaging and Varies in treatments, colour, sizes, packaging and resistance to absorption according to purposesresistance to absorption according to purposes
Types of Absorbable suturesTypes of Absorbable sutures
COLLAGEN DERIVEDCOLLAGEN DERIVED Surgical GutSurgical Gut
SYNTHETIC DERIVEDSYNTHETIC DERIVED Coated VicrylCoated Vicryl MonocrylMonocryl PDSPDS
DERIVED FROM SILKWORM LARVADERIVED FROM SILKWORM LARVA Silk sutureSilk suture
NON-ABSORBABLE SUTURENON-ABSORBABLE SUTURE ““a strands of materials that effectively a strands of materials that effectively
resist enzymatic digestion in living tissue”resist enzymatic digestion in living tissue” May be uncoated or coated with substance May be uncoated or coated with substance
to reduce capillarity and frictionto reduce capillarity and friction Encapsulated by tissues around it during Encapsulated by tissues around it during
healinghealing Required removal of suture after wound Required removal of suture after wound
healinghealing
TYPES OF SUTURE TYPES OF SUTURE MATERIALSMATERIALS
SYNTHETIC DERIVED Ethilon (Nylon) Prolene Ethibond Monosof
SURGICAL WIRE Stainless steel wire
Types of Non-Absorbable sutures
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
CHROMIC
(brown) COLLAGEN DERIVED TREATED
WITH CHROMIUM
SALTS
ABSORBABLEWITHIN TWO
WEEKS
Fascia or peritoneumLarge vessels ties, muscle or mucosal
layers(blue)[dye]
SUTURE TYPES/COLOR
RAW MATERIALS INTERACTION USAGE
CoatedVICRYL
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
MONO-FILAMENT
(Clear)
PDS MONO-FILAMENT
(Clear)SYNTHETIC POLYMERS
UP TO THREE MONTHS
Fascial closure, elderly or oncologic
patients
INDIVIDUAL CHARACTERISTIC OF SUTURE
(synthetic absorbable sutures)
SUTURE TYPES/COLOR
RAW MATERIALS INTERACTION USAGE
ETHILONNylon
MONO-FILAMENT
(Green)
POLYAMIDE POLYMER
NON-ABSORBABLE
REMAINS ENCAPSULATED
IN BODY TISSUES
Skin Closure, retention, plastic
surgery, ophthalmology and
micro surgery
PROLENEPoly-
Propylene
MONO-FILAMENT
(Blue)
POLYMER OF
PROPYLENE
Abdominal surgery,
General plastic and Cardio-
vascularsurgery
ETHIBONDPolyester
Fibre
BRAIDED(Green/White)
POLYSTERFIBRE WITH
POLYBUTILATE
INDIVIDUAL CHARACTERISTIC OF SUTURE
(synthetic non-absorbable sutures)
SUTURETYPES/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
STEELWIRE
MONO OR MULTI-
FILAMENT(Silver)
AN ALLOY OF IRON
(Stainless orSilver wire)
NON-ABSORBABLE
General and skin closure, tendon
repaired, cranioplasty
INDIVIDUAL CHARACTERISTIC OF SUTURE
(SILK AND SURGICAL WIRE)
MONOFILAMENT SUTURES
PROLENE
CHROMIC GUT
PLAIN GUT
STEEL WIRE
SILK
POLYPROPYLENE
BRAIDED/MULTIFILAMENTS SUTURES
NYLON VICRYL
SILK
SILK
CHROMIC GUT
CHROMIC GUT
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
IDENTIFCATION OF SUTUREIDENTIFCATION OF SUTURE
SUTURELENGTH
SUTURESIZE
SUTURENAME
NEEDLESIZE &SHAPE
BATCHNUMBER
PRODUCT NAME
SUTURES COLOUR CODING PACKAGESSUTURE COLOUR CODE
PLAIN GUT YELLOWCHROMIC GUT BROWNSILK LIGHT BLUENYLON GREENPROLENE ROYAL BLUEVICRYL PURPLEETHIBOND ORANGEPDS GREYSTAINLESS STEEL SILVER
COLOUR CODING AND PACKAGES OF SUTURES
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 TRANSFER OF SUTURE
ASEPTIC SUTURE TRANSFER TECHNIQUE
FLIPPING TECHNIQUESUTURE RETRIEVAL TECHNIQUE
SURGICAL NEEDLESSURGICAL 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 EYEROLLED END
ATRAUMATIC
REGULAR EYE
SPRING EYE
SPRING DOUBLE
THE BODY SHAPE 1/2 Circle 3/8 circle 1/4 Circle
5/8 Circle J shape compound
½ curve straight
BASIC PARTS OF SURGICAL NEEDLES
GENERAL USES OF NEEDLE ACCORDING TO IT’S SHAPE
BODY SHAPEBODY SHAPE COMMON USAGECOMMON USAGE
Straight Straight Flat or shallow depth of skin woundFlat or shallow depth of skin wound
Circle 3/8Circle 3/8 Shallow depth of skin woundShallow depth of skin wound
Circle ½ andCircle ½ and ½ curve½ curve
General purposes, interior of any General purposes, interior of any woundwound
Circle 5/8Circle 5/8 Deepest, smallest maneuvering room Deepest, smallest maneuvering room wounds such as vaginal hysterectomy, wounds such as vaginal hysterectomy, hemorrhoidectomyhemorrhoidectomy
Circle 1/4Circle 1/4 Same as 1/2 circleSame as 1/2 circle
J CurveJ Curve Deep inaccessible wound or flat woundDeep inaccessible wound or flat wound
THE POINT
BASIC PARTS OF SURGICAL NEEDLES
Blunt Point
Spatulated end
Taper cut
Cutting edge
COMMON USAGE OF ATRUMATIC NEEDLES
NEEDLE TYPESNEEDLE TYPES COMMON USECOMMON USETAPER POINT Soft tissue closure below skin surfaces, dura,
fascia, GI, muscle, nerve, pleura, vesselsBLUNT 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 MOUNTING THE NEEDLENEEDLE
THREADING THE THREADING THE NEEDLENEEDLE
PASSING THE PASSING THE NEEDLE HOLDER NEEDLE HOLDER WITH SUTUREWITH SUTURE
NEEDLES’ COUNTSNEEDLES’ COUNTS
WORKING WITH SUTURES AND NEEDLES
TYPES OF WOUND SUTURING
OTHER METHODS OF WOUND CLOSURE
SURGICAL STAPLERSURGICAL STAPLER
SKIN STRIPSSKIN STRIPS
& & SKIN GLUESKIN GLUE
TISSUE REACTION AFTER SUTURING
Suture act as a Suture act as a foreign substanceforeign substance
Begins when the Begins when the suture inflicts injury suture inflicts injury to the tissue during to the tissue during insertioninsertion
Increased factors Increased factors include include allergic, allergic, absorption period, absorption period, cell reactions and cell reactions and types of suturetypes of suture
Comparison of tissue resorption according to sutures
REMOVAL OF WOUND CLOSURE (SUTURE AND STAPLE)
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