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SKIN SUTURING GPS 380

Exhibits professional behaviour 1. 2. 3. 4. 5. 6. 7. 8. 9. Professional appearance (attire, behaviour, overall conduct) Identifies correct patient Introduces self to the patient Explains the procedure to the patient Obtains informed consent from patient Sterile gloves Suture material Chlorexidine/H2O solution into galley pot and kidney dish Xylotox cartridge and dental needle into kidney dish

Adds to sterile field using non-touch technique

Preparation 10. Washes hands 11. Dons sterile gloves Administers local anaesthetic 12. Snaps dental syringe open 13. Chooses correct anesthetic for wound (xylotox plain) 14. Places xylotox cartridge in dental syringe (rubber stopper facing plunger) 15. Attaches dental needle 16. Infiltrates area with anaesthetic 17. Recaps needle without holding cap* 18. Reserves syringe and needle should further anaesthetic be necessary Cleans & drapes wound (should be done in order listed) 19. Cleans wound aseptically with chlorexidine/H 2O (use dry cotton wool swab on manikin) 20. Drapes wound with sterile towel (creates sufficient sterile working area) 21. Prevents contamination of sterile towel or hands* Inserts sutures 22. Grasps needle 2/3 from tip of needle with needle holder (not fingers) 23. Places first suture to enhance good approximation (in middle of wound) 24. Penetrates dermis and epidermis 3-4 mm from wound edge 25. Drives needle in a curvilinear path through dermis and subcutaneous tissues 26. Pulls needle through wound with needle holder whilst supporting skin with forceps 27. Pulls suture filament through wound so that 3 cm tail remains on entry side 28. Holds filament with nondominant hand, allowing needle to rest on sterile drape (preventing contamination)* 29. Places needle holder parallel over laceration to begin first throw of simple knot 30. Wraps suture OVER needle holder three times (into the L) 31. Rotates needle holder 90 degrees, grasps 3 cm tail and pulls it to opposite side (knot needs to lie flat) 32. Repeats process to complete SECOND and THIRD THROW 33. After final throw, pulls knot to one side of laceration 34. Cuts suture with scissors, leaving tails of approximately 1 cm

After care 35. Cleans wound with chlorexidine/H2O 36. Dresses wound with clean dry dressing 37. Verifies tetanus immunization status (within last 5 years) 38. Safely discards sharps* Health education 39. Keep wound covered for 24-48 hours 40. Wound should be gently cleansed after 24 to 48 hours 41. Instructs patient to observe and report signs of infection (erythema/ warmth/ swelling/ drainage) 42. Gives written directions as to when and where sutures are to be removed