suture

• Before suturing


  • Ensure adequate exposure and lighting of the wound
• Nurse's position


  • Comfortable standing or sitting around the wound
• Wound preparation


  Wound must be prepared and draped
• Body hair


  • Should be shaved to prevent infection rates
• The skin surface adjacent to the wound can be cleaned with povidone - iodine or Hibitane solution
• Hand hygiene


  Hand washing and wear sterile gloves
• Face masks


  • Recommended, especially for any nurse with a bacterial upper respiratory infection
• Suture


  A stitch made to join together the open parts of a wound
• Types of suture stitch

  • Absorbable (temporary support)
  • Non-absorbable (permanent support)

  
• Polyglactin (Vicryl)


  • Absorption complete in just 42 days
  • Used in general soft tissue approximation and/or ligation
• Polydioxanone (PDS)


  • Wound support for approximately 42 days
  • Used for fascia closure, orthopedic surgery, anastomoses
• Non-absorbable sutures


  • Silk
  • Nylon
  • Polypropylene (Prolene)

  
• Silk


  • Used in wide variety of surgical procedures
• Nylon


  • Used most commonly for superficial closure of skin
• Suture size


  Smallest: 7/0, 6/0, 5/0, 4/0, 3/0, 2/0, 1/0, 0, 1, 2 Largest
• Types of suturing techniques

  • Simple interrupted
  • Continuous suture
  • Vertical mattress
  • Horizontal mattress
  • Sub-cuticular
  • Staples
• Staples


  • Used to close wound under high tension like scalp, trunk and extremities
• Duration of Suture Insertion
• The timing of removal of the sutures will vary
• Surgical Instruments for Suturing

  • Toothed Or Tissue Forceps
  • Dressing Forceps
  • Needle Holder
  • Iris scissors
  • Operating Scissors
  • Hemostats (clamping blood vessels, grasping)
  • Sharp Scissors
• Handling The Instruments


  • Inserting the thumb into one ring & the middle or ring finger into the other holds the needle holder
  • The index finger should be positioned onto the area of the hinge of the needle holder
  • The dissecting forceps should be held as shown
  • The suture scissors should be grasped in a similar fashion
• Injection Techniques for local Anesthesia (Lidocaine)

  • 25, 27, or 30-gauge needle
  • 5 or 10 cc syringe
  • Check for allergies
  • Insert the needle at the inner wound edge for clean wound, while for contaminated wound, insert needle into the skin of surrounding wound
  • Aspirate if the injection is deeper than the subcutaneous area or the area to be injected contains many large vessels
  • Inject agent into tissue SLOWLY
  • Wait 5-10 minutes
  • After anesthesia has taken effect, suturing may begin
• Procedure for Suturing


  • Ensure adequate exposure and lighting of the wound
  • Assume a comfortable standing or sitting position around the wound
  • Prepare and drape the wound
  • Shave body hair to prevent infection rates
  • Clean the skin surface adjacent to the wound with povidone-iodine or Hibitane solution
  • Perform hand washing and wear sterile gloves
  • Face masks are recommended, especially for any nurse with a bacterial upper respiratory infection
  • Avoid talking in proximity to the wound
  • Remove any foreign bodies, piece of glasses, bone fragments using forceps to prevent injury
  • Debridement (the process of cleaning an open wound by removal of foreign material and dead tissue) is importance in the management of the contaminated wound
  • Irrigate the wound with Sterile normal saline (NS) solution, Povidone-Iodine Solution, (Betadine)
  • Avoid hydrogen peroxide (H2O2)
  • Suture the wound, different techniques can be used based on type of wound
  • Keep all knots on one side of wound, do not position the knot directly over the wound edge
  • Sutures placed on the face should be approximately 2-3 mm from skin edges and 3-5 mm away from each other, for elsewhere on the body should be approximately 3-4 mm from skin edges and 5-10 mm away from each other
  • The needle enters the skin from the wound edge at 90 degrees
  • Cut the ends of the suture 6 mm from the knot
  • After sutures, clean the site of wound and cover with a sterile dressing
  • Discard the remained Suture, Do not use again
  • Remove gloves and perform hand washing

  
• Suture Removal Equipment


  • Forceps and scissors
  • Gauze
  • Wound cleansing agent, according to facility policy
  • Sterile gloves
  • Tape
• Suture Removal Procedure


  • Review the medical orders for suture removal
  • Gather the necessary supplies and bring to the bedside
  • Perform hand hygiene
  • Identify the patient, explain procedure
  • Close curtains around bed or close the door
  • Assist the patient to a comfortable position, use a bath blanket to cover any exposed area other than the incision, place a waterproof pad under the incision site
  • Put on Sterile gloves
  • Carefully and gently remove the soiled dressings, use small amounts of sterile normal saline (NS) to help loosen and remove if any part of the dressing sticks to the underlying skin
  • Clean the incision using the wound cleanser (Sterile saline solution, Povidone-Iodine, or Betadine) and gauze
  • Using the forceps, grasp the knot of the first suture and gently lift the knot up off the skin
  • Using the scissors, cut one side of the suture below the knot, grasp the knot with the forceps and pull the cut suture through the skin, avoid pulling the visible portion of the suture through the underlying tissue
  • Remove suture one by one to ensure the wound edges are healed
  • Cover wound by sterile gauze
  • Remove gloves and perform hand washing
• Do not suture wounds that are over 12 hrs old
• Check that the patient gets order for Tetanus Antitoxin Injection before he leaves the hospital
• Do not suture deep wound
• Before you suture any wound, make sure it is free of any foreign bodies