Suture and Needles Nursing Lecture
Sutures needles Nursing Lecture
Suture Characteristics Handling: How the Tissue reaction: The suture performs when reaction the suture its in used induces on the body Pliability Absorption Friction Allergic reaction Risk for infection
Physical: Inherent property of the suture Configuration Capillarity Diameter Tensile Strength Knot Strength Memory
Physical Characteristics • Configuration: one thread or multiple threads o Monofilament: Easily pliable. The cross sectional size of the suture. although other materials other than sutures can be used to stitch together edges. A nurse should be familiar with sutures as he or she is familiar with the other instruments. Most sutures lose tensile strength as it is absorbed or encapsulated o Steel is the strongest among the non absorbable. It’s the ability of the suture to absorb and carry fluid along the thread. ↑ Capillarity means increased risk of infection. measured in millimeters.Suture and Needles Nursing Lecture
1. • Diameter. The smaller the size the weaker the tensile strength • Tensile strength the amount of weight that can break a suture. but more prone to break: Usually for vascular surgery o Multifilament: Stronger but more prone to cause infection. Its appropriateness is dependent on the type of surgery and the surgeon’s preference. Sutures Suture is a generic term for materials used to sew together tissues or to hold it together in place. ↑ Tensile strength means it can withstand more force. • Capillarity.
. Long tensile strength means it can last longer with that specific strength. Certain characteristics of suture come into play in establishing which suture is appropriate. To ligate means to tie off or isolate a mass of tissue or blood vessel It promotes hemostasis and allows visibility in the surgical field. No true ideal suture exists. To suture means to stitch together edges of tissues. while silk is the weakest. This way appropriateness and evaluation on its effect on healing can be assessed.
• Nonabsorbable sutures are sutures the resist digestion by the body.Suture and Needles Nursing Lecture
Polyglycolic is the strongest among the absorbable. The put chromium on the suture so that it is not absorb quickly. o Capillary action pulls liquid along suture can lead to infection. • Usually used on fast healing tissues since its absorb quickly. o Chromatization delays absorption of the suture in living mammalian tissue. o Stomach o Colon o Bladder • Surgical gut o Surgical gut is obtained from the collagen of the submucosal layer of the small intestine of sheep or the intestinal serosa of cattle or hogs. Capacity of a suture to return to its former shape after being re-formed. while cutgut is the weakest. Memory. high memory yields less security. . They don’t degrade. either partially or completely. The force necessary to cause a given type of knot to slip. Knot strength. o
• TYPES OF SUTURE MATERIAL Absorbable Sutures • Absorbable sutures can be digested (by enzyme activity) or hydrolyzed (by reaction with in tissue fluids to breakdown) and assimilated by the tissues during the healing process. Nonabsorbable Sutures. Inherent ability to regain original from and length after having been stretched.
. o Vicryl can be used in the presence of infection. The Knot is the weakest part of the suture since there is no actual link between the two ends of the suture. • Used for tissues that are slow healing o Skin o Fascia o Tendons • Silk o From silk worm cocoon o Considered the best suture in terms of handling. Elasticity. Dexron and Polsorb. as when tied. • Collagen Sutures o From cattle tendons • Synthetic absorbable sutures o Vicryl.
has high tensile strength and cause minimal tissue reaction.Suture and Needles Nursing Lecture
o o o •
Not truly a nonabsorbable suture since it disappears after several years. because of this surgeons usually ties three knots. Polypropylene o Monofilament. Stainless Steel o Very high tensile strength o Hard to handle can cause injury to the surgeon and the patient. Nylon o Synthetic material with high tensile strength o But has poor knotting ability. PREFERRED SUTURE Nonabsorbable: Stainless steel Nonabsorbable Absorbable Absorbable Nonabsorbable: Long tensile strength Absorbable Absorbable Nonabsorbable Absorbable Absorbable Absorbable Nonabsorbable: Silk Nonadsorbable:Silk Absorbable Absorbable. May not be sutured. o Steel can rip and tear tissue if too tight.
Cotton o Made from twisted cotton fibers o Gains tensile strength when wet o Rarely used today. Can cause spitting in which the suture migrates up to the wounds exterior surface. Losses tensile strength in 1 year. Nonabsorbable / Staples Nonabsorbable Absorbale Absorbable: Vicryl Absorbable suture: Vicryl Absorbable
TYPE OF TISSUE Bone surgery Cardiovascular surgery Colon Drain sutures Fascia Gallbladder Gynecologic surgery Infected wounds Kidney Liver Mesentery Neurosurgery Ophthalmic surgery Oral cavity Peritoneum Respiratory tract Skin Small intestine Spleen Stomach Subcutaneous fat
• A disadvantage is that it does not keep deep tissue held together and cannot minimize bleeding tendencies.Suture and Needles Nursing Lecture
Tendon surgery Urinary tract surgery Vascular prostheses
Nonabsorbable: Stainless steel Absorbable Nonabsorbable
Sutures are removed when the wound no longer needs the support provided by the wound suture.Skin Staples • Alternative to suturing • Frequently used for large skin closure and anastomosis hollow organs.
. AREA Face Scalp Trunk Arm or Leg Foot TIME 3 -4 days 5 days 7 days 7 . • Fast closure and less pain. • Can also be used to reinforce staples and sutures. • Since it does not involve stitching. 4. Sutures are removed depending on where the wound is located and the overall nature of the wound.Surgical Adhesives • Act as glue to keep wounds close • Requires mixing first before use • Indicated to areas not subjected to movement and tensions. The area is cleansed first with an antiseptic. When the suture is removed too early it may lead to failure to heal and infection. Hydrogen Peroxide is used to dissolve crusting around the sutures.10 days 10 – 14 days
2. its time saving.Skin Tapes • This are used on wounds that have minimal tension and low risk for infection. If its removed too late it could cause scarring. • Main advantage is that it is not as scary looking as a stitch and does not require suture removal. • Staples are removed using as special extractor 3.
Body of the needle • The body is the largest part of the needle. • It is where the tip of the needle holder is placed. This results to a smaller diameter on the point in which the needle and suture are attached. A surgical needle can be categorized according to its three characteristics or parts ANATOMY OF A SURGICAL NEEDLE Eye Body Point The eye determines how The body or the shaft The point is the the needle is attached to refers to the part in piercing end of the the suture. • French or Spring needles also requires threading but does not involve inserting the suture thru the needle hole.Suture and Needles Nursing Lecture
Allows the suture to pass thru the tissue. Instead it is pulled against the eye to force the suture inside. which the needle is needle. This means that there is less trauma to the tissue as the needle passes thru. • Eyeless or swagged needles do not require threading since the needle and suture are as one piece. in form Eyed Round Regular cutting French or Spring Flat Taper Point Eyeless Triagular Penetrating Point (Swagged/Atraumatic) Curved Blunt Point Straight Protect-point Reverse cutting Spatula side cutting Lancet
Eye of the needle • Eyed needles requires the scrub nurse to thread the suture thru the eye or needle hole. The point held. It may be determines whether rounded or flat in the needle can diameter and it can penetrate a tissue be curved or straight efficiently. This is the reason why eyeless needles are called atraumatic or “absence of trauma”.
Plastic surgery. Cutting edge is in the OUTER curvature Retention sutures. Subcutaneous tissue
• Reverse Cutting
o o Point is triangular.
Point • The point is the penetrating end of the needle. The shape in form is classified by using the circle as a reference. Cutting edge is in the INNER curvature Skin closure. Skin closure. Fibrous tissue and ligaments
. ¼ needle body looks like ¼ of a circle. The shape in form depends on the thickness of tissue to make it easier for the surgeon to pierce the tissue.
Kinds of Needle point • Regular Cutting
o o Point is triangular. • Needle points are determined by the density of the tissue.Suture and Needles Nursing Lecture
Its shape in diameter whether round. flat or triangular corresponds to the point of the needle to allow continuity is structure so that it will smoothly pass thru tissues.
Gynecologic surgery since accidental puncture is common.
. intestine. uterine cervix. Soft. GI suture. kidney. friable tissue. and Fascia
• Blunt Point
o o o Round point with no cutting edge.Suture and Needles Nursing Lecture
• Taper Point
o o Pointed needle with no cutting edge Soft tissue closure. liver. muscle.
cuts layers from the side of the needle.Suture and Needles Nursing Lecture
• Spatula Side Cutting
o o Has two cutting edges on the side. Ophthalmic surgery.retinal repair.
• Cutting Taper Point
o o Reverse cutting needle with a taper body Used for microsugery of tough tissues like blood vessels.
• Hand Honed Reverse Cutting
o o Same as Reverse Cutting but sharper Used for cosmetic plastic surgery
o o Spatula needle with a cutting point Used for Ophthalmic microsurgery.
The needle holder should grasp the needle on the flattened surface to prevent it from breaking or bending.
. 3.Suture and Needles Nursing Lecture
HANDLING SUTURES AND NEEDLES 1. 9. This prevents it from pulling out during suturing. Never run the suture along your hand to remove the kinks. Use a needle holder to pull the needle out of the packet. A curved needle is threaded from within its curvature. 7. This could damage the suture. Allow about 4 inches allowance from the needle eye to prevent accidental pull outs. in which it retains the shape of the packet. Grasp the loose end of the suture and hold the packet with the other hand. Usually the suture will have package memory. To remove the kinks gently pull the free end and abduct the hand holding the other end to straighten it. Long sutures are hard to handle and can cause an infection if it touches a contaminated area. Short sutures make tying difficult. 10. 6. The needle holder is placed on the body about 1/8 inch down from the tip of the needle holder. The Scrub nurse opens the packet by following the marked edge of the wrapper 2. 8. 4. 5. If the needle is already attached to the suture.